The aim of this exercise.

• To explore the experience of service barriers from different persectives
• To understand that service 'barriers' are primarily relational, involving difficulties between workers in different teams involved in the young person's network.
• To relate this to the Dis-integration grid

Three examples.

• Problem 1 YOS and CAMHS. Young person (16 years) on court order with history of severe and persistent offending around violence to property and stealing. YOS worker (PERSON A) manages to negotiate that part of order can be met by the family attending family therapy appointments at CAMHS. YOS worker needs to know whether family attend as part of report back to court. CAMHS accept the referral, see the therapy as appropriate but the allocated clinician (PERSON B) believes that she cannot offer appointments if this is seen as being 'accountable' to the YOS worker for their work. The CAMHS worker has had previous experience of such arrangements becoming a little inflexible and unhelpful for the therapy. Referral is being delayed because of inability to agree this.

• Problem 2. Social Care and Adult disability services. Social care team has been referred a young person who is at risk of family breakdown. The mother of the young person has a learning disability (uncertain severity) but social care team unaware that mother is receiving help from adult learning disability services. Social care worker (PERSON A) is trying to empower mother to hold more responsibility with her son (13 years). When Adult disability keyworker (PERSON B) finds out about the work of the social care team, the keyworker feels that she has not been consulted about social care involvement and consider that the disability team are the primary agency involved with the family. The keyworker in the disability team has strong views about the rights of adults with learning disabilities to be parents and has been explicitly critical to the social care team manager about the impact of their intervention on her client.

• Problem 3. Acute hospital team and CAMHS outreach Services. Young person has been admitted for a couple of nights following an overdose and presentation at the local A and E department A mental health assessment has been completed and the locum Hospital Paediatrician (responsible doctor) (PERSON A) considers that the young person can return home but with high levels of community supervision. He has referred to the Outreach Team and the worker in that team (PERSON B) does not agree about the level of risk and feels that the young person does not require such intensive follow-up. The discharge is being delayed because of inability to agree a discharge plan.

Instructions for exercise

1. Divide the all trainees into three groups - ideally one trainer will work with each of these three groups.

• One group takes one scenario for consideration
• 3 example scenarios are given above (but others could be devised - ideally BEFORE the training event.)

2. Subdivide each of these groups into three small groups, and allocate responsibilities for each of these three small groups:

• Character A
• Character B
• The Young person and/or Family.

• NB ONE person from each group should be willing to be an active observer, who would be willing to form a Fishbowl in front of the group - consider this before starting the next step.

3. For about five minutes, the small groups actively try to mentalize the state of mind of their allocated person.

• The assumption is that each PERSON in the scenario is experiencing a dilemma
• How can you best represent the dilemma that each character is experiencing - so that if they heard you describe it they'd feel "YES! they have got it!"

4. The 'active observers' who have been part of conversations about characters in the same problem scenario now have a reflecting Fishbowl discussion about what they have observed.

• Try to represent "your" character's wants and needs faithfully - even if you as a professional would have different ideas.
• The other members of the group observe this.

5. The group now discuss one small action for each character in the scenario.

• E.g. something that would be observable to someone who knew what to look out for.
• Something that might help
• Consider the role and experience of the family:
• Are different professionals using inter-professional conflict to help them engage with the family?
• Facilitating conversation between who?
• Recognising positions(Positioning Theory) that could be considered which would help address issues raised.

6. Come together as a large group (all trainees) to share experiences

• Recap the usefulness of the Dis-integration grid
• A systematic way of mentalizing the different characters involved.

Time allocation

20 mins, then 10 mins whole group relfection