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Child parent psychotherapy in the treatment of severe trauma in a 4-year-old child with co-occurring autism spectrum disorder
- Clare Lamb, Barry O'Sullivan
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S203
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- Article
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Aims
This poster describes Child Parent Psychotherapy (CPP) in the treatment of severe trauma in a 4-year-old child with co-occurring Autism Spectrum Disorder (ASD).
BackgroundThe London Infant and Family Team (LIFT) implements the New Orleans Intervention Model. It targets the mental health needs of under 5 year olds, providing evidence based assessments and interventions for infants, their parents and foster carers within the framework of the Family Court in England. The majority of children seen by LIFT have suffered severe trauma. LIFT delivers a range of interventions including CPP - a relational treatment for young children who have experienced trauma.
CPP seeks to intervene in a number of ways: provides developmental guidance, demonstrates that the child's behaviour has meaning and can be linked to past traumas, enables the child to have space to play and talk about what has happened, helps to name and contain emotions - supporting emotional regulation, and helps the dyad to understand each other. The dyadic relationship is key to the intervention - helping to establish safety for the child and strengthen the caregiver-child relationship, enabling the child to make sense of past experiences and learn new ways to express feelings. Exploration of trauma takes place through a combination of play and interpretations made by the clinician, who supports and holds in mind the experiences and history of both child and carer. There is evidence that CPP helps young traumatised children to become less anxious, more secure in their attachment relationships and more able to cue their needs. There is less evidence of the efficacy of CPP in the context of young children with a co-occurring diagnosis of ASD.
MethodThe poster describes the assessment of a 4-year-old child of normal intelligence with a two year history of severe neglect, and physical and emotional abuse, who presented significant behavioural and emotional disturbance. Tools used to assess the child's behaviour, trauma symptoms and ASD are outlined. The process of CPP with the child and foster carer dyad is described. Outcome measures and symptom resolution are reported.
ConclusionCo-occurrence of ASD did not prevent this child accessing trauma therapy. He engaged in symbolic play, made use of CPP interpretations, and achieved significant improvement in his symptoms. The differential diagnoses of trauma symptoms and ASD presenting in young children are discussed, alongside the importance of understanding and treating trauma in this context.
10 - A comprehensive CAMHS
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- By Clare Lamb, North Wales Adolescent Service, Ann York, St George's Hospital Medical School, London
- Edited by Greg Richardson, Ian Partridge, Jonathan Barrett
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- Book:
- Child and Adolescent Mental Health Services
- Published by:
- Royal College of Psychiatrists
- Published online:
- 25 February 2017, pp 85-95
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Summary
‘Good order is the foundation of all good things.’
Edmund Burke (1729–1797)Introduction
The jurisdictions of England, Ireland, Northern Ireland, Scotland and Wales have each produced CAMHS strategies that are at different stages of development and implementation. There are no significant differences in the prevalence and types of mental health problems experienced by children under the age of 15 years in England, Wales or Scotland. Hence, there is no justification for inequity of service provision. Ireland and Northern Ireland have a higher percentage of young people in their populations and require a higher number of whole time equivalent (WTE) clinicians in their teams. Child and adolescent mental health services must be equitable across the jurisdictions, and practitioners and policy-makers must share practice and learn from each other. The five jurisdictions all have services that are currently stretched. Recruitment and retention as well as the geography of an area are problematic in different places.
The Royal College of Psychiatrists has tried to guide the provision of specialist CAMHS at Tiers 2–4 by the NHS (Royal College of Psychiatrists, 2006). There is insufficient evidence to give detailed guidance on services for those with intellectual disability, substance misuse or forensic problems, or infant mental health services. However, services should be able to provide for these groups, and indeed the English NSF (Department of Health & Department for Education and Skills, 2004) and proxy targets for a comprehensive CAMHS had services for 16- and 17-year-olds and those with intellectual disability as core targets. The recommendations for staffing and remit for services are necessarily ballpark ones, based on rationalising the evidence. The guidance is meant to be living, evolving support for service development, open to local interpretation based on careful needs assessment and priorities. It should be used wisely, with care and authority, to shape local services to be the best possible for young people.
Specialist CAMHS
Tier 2 and 3 services are the core of specialist CAMHS and cannot be disaggregated if young people and families are to experience a seamless CAMHS, and they should have a single point of entry. Many current specialist CAMHS only see young people up to the age of 16 years.
The divide between child and adult mental health services: points for debate
- Clare Lamb, Margaret Murphy
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- Journal:
- The British Journal of Psychiatry / Volume 202 / Issue s54 / January 2013
- Published online by Cambridge University Press:
- 02 January 2018, pp. s41-s44
- Print publication:
- January 2013
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- Article
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This discussion paper outlines our personal views for debate on some of the complexities inherent in the crucial task of improving mental health services for young people in the UK.
10 - A comprehensive CAMHS
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- By Clare Lamb, MBBS, MRCPsych, FRCPsych, Consultant Child and Adolescent Psychiatrist, North Wales Adolescent Service, Ann York, MBBS, MRCPsych, Consultant Child and Adolescent Psychiatrist and Clinical Team Leader, Child and Family Consultation Centre, Richmond Royal, Surrey, and Honorary Senior Lecturer, St George's Hospital Medical School, London, South West London & St George's Mental Health NHS Trust
- Edited by Greg Richardson, Ian Partridge, Jonathan Barrett
-
- Book:
- Child and Adolescent Mental Health Services
- Published online:
- 02 January 2018
- Print publication:
- 01 February 2010, pp 85-95
-
- Chapter
- Export citation
-
Summary
‘Good order is the foundation of all good things.’
Edmund Burke (1729–1797)Introduction
The jurisdictions of England, Ireland, Northern Ireland, Scotland and Wales have each produced CAMHS strategies that are at different stages of development and implementation. There are no significant differences in the prevalence and types of mental health problems experienced by children under the age of 15 years in England, Wales or Scotland. Hence, there is no justification for inequity of service provision. Ireland and Northern Ireland have a higher percentage of young people in their populations and require a higher number of whole time equivalent (WTE) clinicians in their teams. Child and adolescent mental health services must be equitable across the jurisdictions, and practitioners and policy-makers must share practice and learn from each other. The five jurisdictions all have services that are currently stretched. Recruitment and retention as well as the geography of an area are problematic in different places.
The Royal College of Psychiatrists has tried to guide the provision of specialist CAMHS at Tiers 2–4 by the NHS (Royal College of Psychiatrists, 2006). There is insufficient evidence to give detailed guidance on services for those with intellectual disability, substance misuse or forensic problems, or infant mental health services. However, services should be able to provide for these groups, and indeed the English NSF (Department of Health & Department for Education and Skills, 2004) and proxy targets for a comprehensive CAMHS had services for 16- and 17-year-olds and those with intellectual disability as core targets. The recommendations for staffing and remit for services are necessarily ballpark ones, based on rationalising the evidence. The guidance is meant to be living, evolving support for service development, open to local interpretation based on careful needs assessment and priorities. It should be used wisely, with care and authority, to shape local services to be the best possible for young people.
Specialist CAMHS
Tier 2 and 3 services are the core of specialist CAMHS and cannot be disaggregated if young people and families are to experience a seamless CAMHS, and they should have a single point of entry. Many current specialist CAMHS only see young people up to the age of 16 years. Psychiatric disorders increase in frequency above this age and specialist CAMHS that end at the 16th birthday will require significant extra resources to extend services to the age of 18.