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POD":"\"81714f1141c506a825d865c5d7f39023\"","How to Use and Understand 'Tags'":"\"0afcd08d793be438086687e66cf30147\"","How to add a PDF link":"\"eaa1312dbc522bd51e841ba097f2341f\"","How to add a new tiddler":"\"60d9ab91ce0d54b6dc811b69557c5ae8\"","How to add a picture":"\"b34dfdd9eb57f4a332c0509d741bf4f5\"","How to add colour":"\"1090bdc0b7e20f047797bfe3be74ca87\"","How to centre a title, phrase or image":"\"c0bdc5e521a2781d1d2a3e70c1244b27\"","How to edit and delete tiddlers":"\"4dd44728b8d7517e7b7ad55ad75f145a\"","How to embed a video":"\"444f444a3cb834cfd3491c90dc16eea7\"","How to help young people manage exam stress":"\"cea1346f21cfadd00094128b8ea5feef\"","How to login":"\"5c900e206fdeaa19d848bdbfca8e76a6\"","How to resize a picture":"\"b1404a95daa393ec51ae12d955739b0e\"","How we Get Wiki Guide Feedback":"\"0e0b67d348341e6f9d54944b0691b949\"","How will we know if our CWPs are seeing the correct cases?":"\"efa0d8385d11781cde8956560bec1c21\"","IPT-A":"\"927af7728de1975e04ff495acffa771b\"","Inclusion":"\"037c5449d5aa490a840b9af4dc30ffb2\"","Initial contact checklist":"\"7003ef859170046089e370fef6ac6746\"","Internet Safety Toolkit":"\"18a9cece503e211a3d4c2e8fc6fb4ff4\"","Intersectionality":"\"53cd23784407548ae8496c47d728b313\"","Intersectionality - Belonging to More Than One Group.png":"\"a696dee54d10455829a3ce90e604a734\"","Intervention for Anxiety: key practice points":"\"efb43b94dac5e1707221f8ecb6699745\"","Interventions":"\"8e98ad4d535703c83baefb6d635506c8\"","Interviewing Parents":"\"f639b3216849dac60baf5f174d1cf21d\"","Introduction to child mental health problems":"\"900368586566e52033aef04a145e12ad\"","Introduction to the CWP Programme in 2017":"\"58a01787b6a12ac8c7575636c3b1a8d3\"","Introduction to the CWP training":"\"55428f9c8c73c35c49e32cd5d4452a3b\"","Introduction to the theory of behaviour change":"\"2e92cd5784ca1b0e96cd3bd355a26640\"","Invitation for feedback":"\"20b88f6c67b90dbd36aa5359f6774490\"","Involving parents":"\"17f67731d299b6d5cc0e1993b56fd048\"","Jargon Buster":"\"14d9ae47bf92907f66c08d82c982aff6\"","Job Role":"\"86a9335a6a23fee741696227cc49772a\"","Join the Largest MDT Ad.png":"\"3008084c20159ddaf3f707c22a05472c\"","Jungle Analogy":"\"69262cdc422d7337bfd6cb31c7bdc224\"","Key Documents: CWP Programme":"\"30cdc8dfee64550c984e9feea69a9fe2\"","Larking about":"\"cb0632778fdde21202009d8e10e3d0b1\"","Leadership Training":"\"9752572558c7c66936571cc650e35481\"","Learning about the impact of behaviour on mood":"\"e851fde4306e035fbb20804ab8a86cd8\"","Learning about the problem":"\"54a9ab2c5ff9839f8cafc587f79e331c\"","Learning through practice":"\"657fa3a771432591fc66ee13c5de5b5d\"","Length of CWP Interventions: London Audit 2018":"\"ffe826b730fb3d2fd2a1fe3e3c4990d2\"","Literature emphasising the role of parents":"\"b02acff4cf781558c0409778db4952f0\"","Logical Consequences Guidelines":"\"a65c521c997d8442cb759f9a10ec92c6\"","Low Mood":"\"5cdc7d1908fe077c4666dabe0d1dabb2\"","Low Mood - Manual":"\"4f8bdc03d139a44f3b55d0931d038350\"","Low Mood - Sessions Overview":"\"9fa55bba45b51ef0a673711143802f51\"","Low Mood Manual- previous versions":"\"5b4826da2d8321e4c4703f9ed8b85aa1\"","Low Mood Manual: COVID-19 Adaptions":"\"ecaa83a0e903025b5ccef71af6c15718\"","Low Mood Practice Activities":"\"d9178feeb41cabcce805d4c0c594f57a\"","Low Mood Session Material":"\"314aaed44fb41085225607d87d58a384\"","Low Mood knowledge":"\"b6da620078ca7966c0ab7f2d5005bd07\"","Low Mood practice":"\"30bb532b4e79cf11ade55c8f200a419b\"","Low intensity interventions:evidence and NICE guidance":"\"7fd9f5bbbe2499df35cccce5bc49784d\"","Low mood: Handouts for CYP":"\"7d6550a8094a93d4f2fee515087c8773\"","Low mood: Handouts for parents":"\"212b40e220e781ade83205a9740c076a\"","MainMenu":"\"798b6b894d2784b6c9aebaa4d78bf308\"","Maintaining Boundaries":"\"0fe72df08ff56c2c73a54abc4c44ac23\"","Making commands 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health: in our own words":"\"52e972352804f7e19865e45bca8706f9\"","More":"\"f085a6ec4a2a4aec0d9d7e5a7d21c586\"","MoreContents":"\"09c5050bdf0b676d8680588ea561d46a\"","Motivational Interviewing":"\"f8e8709725924dffdf40856d115cf9f8\"","NSPCC 'brain builders'":"\"046074886ab4322f04a3832cc318bebc\"","Nadiya: Anxiety and Me":"\"5b46931f09c53346c2a80ccd31788023\"","National CWP Implementation Group (Basecamp)":"\"41e079df557a5a258bccacbd4bed3944\"","National CWP Outcomes Report 2019":"\"8d515e2599cd4aa0e499671047d330bd\"","National Guidance on the CWP Curriculum: key sections from the Headline Plan (December 2016)":"\"9e22ad386bbb4c5dc901ba11df46c302\"","Nine Components of Guided Self Help":"\"ee65ee76c49aeb11c4eef793d9cc8b02\"","Non-text Based Materials":"\"3d9735bc1d011bb3eb8b29b0487f1ff2\"","Notes on national analyzer":"\"abb1d7fb46e97ca9cf09412a55111129\"","Number of cases for CWPs during training":"\"48596654f839e987df78a358926cd93d\"","OIPM87BY4FN-culture.jpg":"\"eff6e5a0c7cae8dc364ffb8bf37b857e\"","ORS/CORS":"\"338dad27706d94715ceb692b702f3917\"","Outcome measures":"\"7024b5b149a53154dd22f7a1ab65e97b\"","Outcome monitoring":"\"c029ead47c0fedfe30cea628ca11f992\"","Outcomes":"\"ebb96058c62a7d4d0da1ab0e8b67e40c\"","Outcomes - technical bits":"\"b323bd7c6e1f5c886e7cc474e46b3901\"","Outcomes for Cohort 1 CWP":"\"1cfd5988807d14b2b9da58ca8e96db0d\"","Outcomes practice":"\"edfd569d0f14075186a9b4c9d36d7778\"","Outcomes research":"\"ada8c603842c9f68401ae6b857221229\"","Overcoming Adolescent Anxiety - Overview":"\"63eebb899f54ead5460b8c3cccceeb01\"","Overcoming anxiety and guided self help: Cathy Creswell":"\"ebf2c0229cab9d4ad9a4676bfbbe8475\"","POD":"\"8303232de42d344b011b47d2263613a2\"","Parent and Carer Guide to Mental Health":"\"9f2eb75ee790688844733f5f341c5ef3\"","Parent work: trying out new things":"\"65ebfc95864d595ad34a14bf742f05f9\"","Parenting Techniques and 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problems":"\"c456c8f8c0862c9711ae40e9b31df929\"","Progressive Muscle Relaxation":"\"656e1265ae6e8cf7fce921ba7980c253\"","Psychoeducation":"\"af2e2c83657c153bb1666c2ebc83b79e\"","Psychoeducation Core Knowledge":"\"e313103c39f34451c515b49de2a29944\"","Psychoeducation Materials for Schools":"\"214e2145d7d797aae20920ff243e48f3\"","Psychoeducation Resources":"\"37f5adef96b03a398b8e9423f69fb391\"","Psychoeducation Workshops":"\"f28180ca4b39e40badf072f9cf33eb0e\"","Psychoeducation: Videos":"\"ae9a8ff9fcfb3ac7b38e7e8092c4f9d7\"","QQQ.png":"\"c7d0a86fe98525ee37eb97475f6af63b\"","RCADS":"\"942a355c35d2cbb7ba73e6278fba044c\"","Reaching their Goals":"\"2075a0bd677449e62077832aaa41a85d\"","Reading Well: Books on Prescription List":"\"cdbbade843dd3b7b005b419ca2d58ad0\"","Recognising diversity":"\"f2135533da63c319a42ef11798b6d7ec\"","Red Riding Hood: Flight or Fight":"\"42d3e923993bcf0f3c9f08650746f65e\"","Relaxation techniques":"\"2b78da516374e8c23958cfeae7813035\"","Relaxing lion.jpg":"\"aa8ed4ba4d164dc4c1c4bcc884877b3b\"","Relevant Government Policy to CWP":"\"3c8c26e136504065b8deb58642d1cf68\"","Resources for partnerships":"\"44b94ae53feb255baf84f80c9f8466f8\"","Resources for specific partnerships":"\"4c63b0e6ccf6333b846f9c2015484d7e\"","Review":"\"d4493d83239e17deaf0ed9e903b485a2\"","Reviewing goals":"\"8dd65967ea8d56eb5ecab630963df4df\"","Reviewing life activities and interests":"\"2bce2e24b1995a6d61561d8d457071e0\"","Risk and Safety Assessment":"\"3c3ae999d7d5d925ff618a762dc141d3\"","Risk assessment and management":"\"3327c4c3445ab068ca2ddc9e4edadf8c\"","Role Plays":"\"922fe55a663ed7a6b0f5577a1d778766\"","Routines Around the Home.png":"\"504477d06c5ad91f11f22e606d5a61fa\"","SDQ":"\"8f1c2e80edc487deecd9f330e18b99f9\"","SMART Goals":"\"0468b4fa7e0b936f9da6ce62be990252\"","Safeguarding":"\"a7e043fdd5219875256457d3d7a143da\"","Safeguarding guidance: London Child Protection Procedures":"\"01b3e3ab8baba6ec0c480329878587fb\"","Safeguarding/ Risk Assessment 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Adolescent Anxiety":"\"646f2ac48b929b24087c4f26b2fb183f\"","Session 8 - Overcoming Child Anxiety":"\"05d3684c961f01a381ffe3c8b9b765c3\"","Session 8:  Overcoming Low Mood":"\"ab117c3868c9a5ffc46572a02b0a4572\"","Session 8: Overcoming Adolescent Anxiety":"\"2bac0ca3e26c846fda9346cbd5d4c089\"","Session Feedback Questionnaire":"\"a544dad1771de0cd91b0d52f3a69874c\"","Session Feedback Questionnaire (SFQ)":"\"f9081d8df08d08e60ed2d1751d2ba556\"","Session Overview for Behaviour Problems":"\"28d3a1f3e2e87b269a0ef1a16ac56d1e\"","Session Overview for Child Anxiety":"\"cbdf85a5c704354443822398d440839e\"","Session Overview for Overcoming Adolescent Anxiety":"\"c8c47a54bacc8f264d88e8214e4eebfe\"","Session Plans for Behaviour Problems":"\"fcac3c71f26e7172328b7ce19b7e21aa\"","Session Plans for Overcoming Adolescent Anxiety":"\"11a1cadfb1e78618430a857cee2d463d\"","Session Plans for Overcoming Low Mood":"\"eebb6d58bdd89bc5b90dbb745f06eb5d\"","Session Rating 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Contacts":"\"12fb325320ef97bd9af71d68b39365a6\"","Site Information:Outcomes Data collection":"\"aed707c0dd33e4746f050e777f9bbd74\"","Site information: Course related information":"\"8f75208e2f9d94936ec05cf7aaeebe7e\"","Site information: Supervision":"\"a2ddb810e36ea4f8d31f50222176f460\"","Site visits and support":"\"80f78e84344cfaecedc16c432a2d009e\"","SiteIcon":"\"2d3eb99c6e6a3b5aa9ac501abd716c20\"","Skills Workshop Days":"\"e241e02b2947b303d5283e418b38e78d\"","Sleep disturbance":"\"78655fdf99947fa8e4dd0caf7cf0c202\"","Social GGRRAAACCEEESSS.png":"\"d30dda51bdcd1c941b3eae88d18c211d\"","Social Graces Model V1.png":"\"2a41fc337aa47eb33d3076631f4f9559\"","Socratic technique":"\"6e1898a72a2e0aa75343473d3dc48a43\"","Spence Child Anxiety Scale":"\"de9491406612a9e18a319a1c74b8f9af\"","Spoon/Fork Theory to Explain Mental Health":"\"bf3cd400821187dbe7221ba68261767c\"","Staff Burnout":"\"4c87ee105c80dadcc627ecb90dfe8f28\"","Steering Groups":"\"29b5e59b4a4943a018d06e55b8e3bbfe\"","Steps model":"\"cca9585d0b4ee7f04a6cd1d1132077e4\"","Strengths and Limitations of Social Graces Model V1.png":"\"d48c0ca9a4931f2e63d3e956f285684e\"","Strengths and Limitations of Social Graces Model V5.jpg":"\"2295ef42e9f61e2a2dbafe45092a7f3e\"","Strengths and Limitations of Social Graces Model V6.png":"\"192813cbdec071e7b09e82be6e0c5bcf\"","Strengths and Limitations of Social Graces Model.png":"\"0e255a609d22b517624a9f35e2c4e3b5\"","Stress":"\"5a5d7db36c604967d2e825fa95c253be\"","Study Skills":"\"66b0787018d4648b9db10cbfa7a2365d\"","Summarising":"\"6d0e99369115b057234b189add514800\"","Supervising":"\"4607bd3aa0da4663cd14210c314fdf03\"","Supervising CWPs":"\"67a5cd0458150f1178ae14bb2ddb468a\"","SupervisingContents":"\"91657153396b2963254d2c21a4c167f2\"","Supervision and risk":"\"320203a3fa7425f592306060e1f979e6\"","Supervisor role in skills workshop":"\"56f3b0c2ecc12d76a8fc414bcb97b169\"","Supervisors Core Information":"\"838eb102febcaae2ca6267a75ba993de\"","Supervisors Q&A":"\"ce0010b08c0bb789c4a8bb5d3cec0493\"","Supervisors Resources":"\"e90c2227df33c7a5269a20d2a2005099\"","Supervisors Training":"\"7199be26c3184ba19bfdb71c9eaa07a6\"","Supporting children and young people with worries about COVID-19":"\"6e1692ac7b7566d196d8a64eb0d70bc5\"","Survey of the Mental Health of Children and Young People in England, 2017":"\"25820cd1989d28d0d88fa8d9ff01563d\"","TAMHS study findings":"\"19cb30dc832aa9aff2524b90948ef3fb\"","THRIVE Framework for system change":"\"c617e7b07cdc7ce9b6baa7bd20d16813\"","THRIVE framework.PNG":"\"ce6ff698123345bb114cf1155480e238\"","TableOfContents":"\"3ec59e62ab73626f1d117cc310680e3d\"","Talking about ethnicity dos and donts.png":"\"649f11b1dba5c6d154a2b17d3ac0e577\"","Talking about ethnicity... dos and donts.png":"\"0341bb868d51d2c0a1ca434b6df72584\"","Teaching":"\"432aec30b9d4078b13e38b88f3ba5c32\"","Teaching check-in":"\"345883baa0b9a50e18ae305b84a6bed1\"","Template CWP Job Plan":"\"f29a4e48e572d1c70fd44cdf6fecced8\"","The  Practitioner Role in guided self help":"\"14f2d60d976cf8be9dd67711aa702950\"","The 'Adolescent Brain'":"\"b21fa361cd9d1bb7e25b83b0cbddef43\"","The CAMHS System":"\"25a11d31299557e46d911d62348d5e80\"","The CWP BAME INCLUSION GROUP LOGO x 4.png":"\"d1175d9bd378a89b0e28080465e6e3dc\"","The CWP online guide":"\"729e4a3c31d2c03044768fe4fd34e04f\"","The CYP IAPT Programme":"\"283c228987d8c958e6004b379d2314cd\"","The Children's Wellbeing Practitioner BAME Inclusion Group":"\"48a3c7c9292fc56ed3d6cd71e9416202\"","The Cultural Iceberg.png":"\"d1e666a4bd5fdf80273116b00d2ee3e7\"","The Cycle of Change":"\"803cae830f95ef64fde1b0956d61efa2\"","The Dinosaur Programme":"\"cbb3cad7dff1fa09f6dfb73962d78dbe\"","The Hot Cross Bun Technique":"\"4f05d42c1229acce345d0d3b6bc32392\"","The Importance of Feedback":"\"ec107f16c2cb83988e1a94fb62371fb0\"","The Incredible Years programme":"\"3b08fd301b5eb9cd6b81c5173d77f0a6\"","The Polish Community - Bars, Barriers and Solutions to 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wellbeing":"\"474abb647092800faf90ac327138b6ea\"","The purpose of guided self help":"\"e65a88ebc32b7b815642b42194c4bde8\"","The tagging system":"\"57c40625e7dcac09783df0d45163d32d\"","Theory of Behavioural Change":"\"9e740d439b33454573d83556ca8ca958\"","Therapeutic Alliance":"\"adbe0049c38fa43c6d94ff8f1ad53230\"","Thrive Model.png":"\"ed5c9ea88168a5cfa710e39fc5f2a479\"","Tips for Completing Activity Log":"\"2e504dcacf37b41d8c8873785d6ed3fa\"","Tips for noticing low mood in young people":"\"bac5a42e1ec3e471d8da72192f728e5e\"","Tips for teaching staff for CWP programme":"\"df9551c3bf0ce3ac5c64a9588b80804d\"","Tower Hamlets Low Mood: Session 0":"\"519c237516a8eccfb971155bf33a6724\"","Tower Hamlets Low Mood: Session 1":"\"1e0929aab9f68f1c73357f0a64a45458\"","Tower Hamlets Low Mood: Session 2":"\"7771e03b6baf8b8f1852ca996b813a7d\"","Tower Hamlets Low Mood: Session 3":"\"166d95d397b63df4e994f39ec4cad9da\"","Tower Hamlets Low Mood: Session 4":"\"3ce6152e0d8b3737e8a73580ce9465e7\"","Tower 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key concepts":"\"286d3be2fc26a3802cd3ecdd891ab75e\"","Useful training sites for CWP practitioners":"\"4eb359e81082dd2fb1401dd4ea020908\"","User Guide":"\"0ab87031ca4c3f0c54319bf672fd5165\"","Using Feedback and Outcome Tools":"\"0639446900f734e5d52d771265ae6df5\"","Using GSH Resources Remotely":"\"4c6b44fc42cd7a52ae619e631044ff3a\"","Using Outcome Measures and Getting Client Feedback":"\"b2c5cf455d84e539c9f7c8c355b74ddf\"","Using POD to produce site reports":"\"e62f27376b49e89f6195bbb495044348\"","Using Zoom":"\"3d494c23c990e0474482d462cd5ea6cc\"","Using supervision when its not working":"\"9d8d5a4fb8fc15b69272001a2050c79c\"","Using the Search Bar":"\"9bd32797ab2bfd3a81402d359b2b7f46\"","Validating":"\"25e239a176ed1f08715efb00ec0c5f78\"","Vending Machine Metaphor":"\"5575516c0abcbb83dd1218538ccddea2\"","Video":"\"11b77f4c04a3546a9a968c647bc6599d\"","Video Equipment Guidance":"\"d05401f89d2aa879273bb38e6a303ea5\"","Video: The Turtle 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ADHD?":"\"e751df0880dbe591f98eb44184fc7cc7\"","What is Anxiety?":"\"2e4adcd6867a717a8039abc300a36b08\"","What is BAME?":"\"a2acbca8028a6174c03b034df761a54a\"","What is Cultural Identity?":"\"b16a9178ebc2b88e30c04934147ee209\"","What is Culture?":"\"a5e2492485f35278cb3a28ada8fe458b\"","What is Low mood?":"\"66a34bad43b4edbbc013784c949314d9\"","What is Psychoeducation?":"\"8844997c0c9f4edd2e240ba8d3406b93\"","What is Racism?":"\"e69b40e6daeac13a1e9e62b7d68ff19e\"","What is Third Culture?":"\"447369fd94002370a9fe777dafbf1ac7\"","What is a 'low intensity' intervention?":"\"e3cb5ec306d7911679cfccacf7116fbc\"","What is a Behaviour Problem?":"\"4b6adbb087b2e210990f795879f83b26\"","What is a CWP":"\"b73154add00e01f0e1fe0f80d303cdd3\"","What is a Session 0":"\"fa66e9d127a4e9ff8457740c002e9ade\"","What is an Action Learning Set?":"\"7ca7e3dfc910d549de236f777edefc64\"","What is fight or flight?":"\"00dd5f5ed05e6bbcabe37a3af7ce74b9\"","What is helpful for the 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UA-9237856-2

{
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",
            "type": "image/png"
        }
    }
}

Public CORE CONTENT for the CWP Programme

[img width=150 [SiteIcon]]<br/>Children Wellbeing Practitioner  

<div style="margin-bottom:2em;margin-top:2em;">
[img width=160 [$:/_AFC/grey-wordmark.svg]]
</div>

<$reveal type="nomatch" state=<<folded-state>> text="hide" tag="div" retain="yes" animate="yes">
<div class="tc-xememex-tiddler-info tc-subtitle">
Bag: <$view tiddler="$:/state/federatial/xememex/tiddlers/bag" index=<<currentTiddler>>>(none)</$view>
</div>
</$reveal>

\rules only filteredtranscludeinline transcludeinline macrodef macrocallinline

@font-face {
  font-family: "Effra";
  font-style: light;
  font-weight: 200;
  src: url('https://manuals.annafreud.org/fonts/$:/_fonts/Effra Light.woff') format("woff");
}

@font-face {
  font-family: "Effra";
  font-style: bold;
  font-weight: 600;
  src: url('https://manuals.annafreud.org/fonts/$:/_fonts/Effra Bold.woff') format("woff");
}

@font-face {
  font-family: "Verdana";
  font-style: normal;
  font-weight: 400;
  src: url('https://manuals.annafreud.org/fonts/$:/_fonts/Verdana.woff') format("woff");
}

html {
font-family: "Verdana";
}

.tc-top-menu,
.tc-site-title,
.tc-site-subtitle,
h1, h2, h3, h4, h5, h6 {
font-family: "Effra";
font-weight: 600;
text-align: left;
}

.tc-site-title {
font-weight: bold;
}

body .tc-titlebar h2 {
font-weight: 700;
}

\define image(title,width,height)
<$image source=<<__title__>> width=<<__width__>> height=<<__height__>>/>
\end

\define embed-video(code)
<$reveal state="$:/state/consent-banner/accepted" type="match" text="yes" tag="div">
<iframe width="560" height="315" src="https://www.youtube.com/embed/$code$" frameborder="0" allow="autoplay; encrypted-media" allowfullscreen></iframe>
</$reveal>
<$reveal state="$:/state/consent-banner/accepted" type="nomatch" text="yes" tag="div">
<iframe width="560" height="315" src="https://www.youtube-nocookie.com/embed/$code$" frameborder="0" allow="autoplay; encrypted-media" allowfullscreen></iframe>
</$reveal>
\end

<<embed-video KtCUr83XgyE>>

afc-white: #ffffff
afc-black: #222222
afc-green: #209377
afc-pale-green: #6cbeaf
afc-blue: #155dac
afc-purple: #925195
afc-orange: #eb7837
afc-brown: #786e65
afc-light-grey: #e2e2e2
afc-very-light-grey: #f2f2f2

afc-mid: rgba(232, 232, 232, 0.84)

menubar-background: <<colour afc-purple>>
menubar-foreground: <<colour afc-white>>

page-footer-background: <<colour afc-green>>
page-footer-foreground: <<colour afc-white>>

alert-background: <<color afc-white>>
alert-border: #b99e2f
alert-highlight: #881122
alert-muted-foreground: #b99e2f
background: #fff
blockquote-bar: <<colour muted-foreground>>
button-background:
button-foreground:
button-border:
code-background: #f7f7f9
code-border: #e1e1e8
code-foreground: #dd1144
dirty-indicator: #ff0000
download-background: #34c734
download-foreground: <<colour background>>
dragger-background: <<colour foreground>>
dragger-foreground: <<colour background>>
dropdown-background: <<colour background>>
dropdown-border: <<colour muted-foreground>>
dropdown-tab-background-selected: #fff
dropdown-tab-background: #ececec
dropzone-background: rgba(0,200,0,0.7)
external-link-background-hover: inherit
external-link-background-visited: inherit
external-link-background: inherit
external-link-foreground-hover: inherit
external-link-foreground-visited: #0000aa
external-link-foreground: #0000ee
foreground: <<color afc-black>>
message-background: #ecf2ff
message-border: #cfd6e6
message-foreground: #547599
modal-backdrop: <<colour foreground>>
modal-background: <<colour background>>
modal-border: #999999
modal-footer-background: #f5f5f5
modal-footer-border: #dddddd
modal-header-border: #eeeeee
muted-foreground: #bbb
notification-background: #ffffdd
notification-border: #999999
page-background: <<color afc-light-grey>>
pre-background: #f5f5f5
pre-border: #cccccc
primary: <<colour afc-purple>>
sidebar-button-foreground: <<colour foreground>>
sidebar-controls-foreground-hover: #000000
sidebar-controls-foreground: #aaaaaa
sidebar-foreground-shadow: rgba(255,255,255, 0.8)
sidebar-foreground: #acacac
sidebar-muted-foreground-hover: #444444
sidebar-muted-foreground: #c0c0c0
sidebar-tab-background-selected: #f4f4f4
sidebar-tab-background: #e0e0e0
sidebar-tab-border-selected: <<colour tab-border-selected>>
sidebar-tab-border: <<colour tab-border>>
sidebar-tab-divider: #e4e4e4
sidebar-tab-foreground-selected:
sidebar-tab-foreground: <<colour tab-foreground>>
sidebar-tiddler-link-foreground-hover: #444444
sidebar-tiddler-link-foreground: #999999
site-title-foreground: <<colour tiddler-title-foreground>>
static-alert-foreground: #aaaaaa
tab-background-selected: #ffffff
tab-background: #d8d8d8
tab-border-selected: #d8d8d8
tab-border: #cccccc
tab-divider: #d8d8d8
tab-foreground-selected: <<colour tab-foreground>>
tab-foreground: #666666
table-border: #dddddd
table-footer-background: #a8a8a8
table-header-background: #f0f0f0
tag-background: #ec6
tag-foreground: #ffffff
tiddler-background: <<colour background>>
tiddler-border: <<colour background>>
tiddler-controls-foreground-hover: #888888
tiddler-controls-foreground-selected: #444444
tiddler-controls-foreground: #cccccc
tiddler-editor-background: #f8f8f8
tiddler-editor-border-image: #ffffff
tiddler-editor-border: #cccccc
tiddler-editor-fields-even: #e0e8e0
tiddler-editor-fields-odd: #f0f4f0
tiddler-info-background: #f8f8f8
tiddler-info-border: #dddddd
tiddler-info-tab-background: #f8f8f8
tiddler-link-background: <<colour background>>
tiddler-link-foreground: <<colour primary>>
tiddler-subtitle-foreground: #c0c0c0
tiddler-title-foreground: #182955
toolbar-new-button:
toolbar-options-button:
toolbar-save-button:
toolbar-info-button:
toolbar-edit-button:
toolbar-close-button:
toolbar-delete-button:
toolbar-cancel-button:
toolbar-done-button:
untagged-background: #999999
very-muted-foreground: #888888

<$list filter="[<currentTiddler>!is[tiddler]]" variable="ignore"> 
<div class="tc-sidebuttons">
<a href="mailto:manuals@annafreud.org?subject=Feedback%20on%20the%20manuals" target="__blank">
{{$:/core/images/plugin-generic-language}} Give Feedback
</a>
</div>
</$list>

\rules only filteredtranscludeinline transcludeinline macrodef macrocallinline

.tc-sidebuttons {
position: fixed;
right: 0;
top: 50%;
width: 8em;
}


.tc-sidebuttons svg {
fill: <<colour background>>;
float: left;
width: 2em;
height: 2em;
margin-right: 4px;
}

.tc-sidebuttons a {
display: block;
background: <<colour afc-green>>;
padding: 4px;
border-top-left-radius: 8px;
border-bottom-left-radius: 8px;
font-weight: bold;
text-decoration: none;
color: <<colour background>>;
}

.tc-sidebuttons a:hover {
background: <<colour afc-pale-green>>;
}

<$action-setfield $tiddler="$:/state/showeditpreview" $value="yes"/>
<$action-setfield $tiddler="$:/state/editpreviewtype" $value="$:/core/ui/EditTemplate/body/preview/output"/>

/* ------------------------------------------
PURE CSS SPEECH BUBBLES
by Nicolas Gallagher
- http://nicolasgallagher.com/pure-css-speech-bubbles/

http://nicolasgallagher.com
http://twitter.com/necolas

Created: 02 March 2010
Version: 1.2 (03 March 2011)

Dual licensed under MIT and GNU GPLv2 Nicolas Gallagher
------------------------------------------ */

/* NOTE: Some declarations use longhand notation so that it can be clearly
explained what specific properties or values do and what their relationship
is to other properties or values in creating the effect */

/* ============================================================================================================================
== BUBBLE WITH AN ISOCELES TRIANGLE
** ============================================================================================================================ */

/* THE SPEECH BUBBLE
------------------------------------------------------------------------------------------------------------------------------- */

.bubbles-triangle-isosceles {
  position:relative;
  padding:15px;
  margin:1em 0 3em;
  color:#000;
  background:#f3961c; /* default background for browsers without gradient support */
  /* css3 */
  background:-webkit-gradient(linear, 0 0, 0 100%, from(#f9d835), to(#f3961c));
  background:-moz-linear-gradient(#f9d835, #f3961c);
  background:-o-linear-gradient(#f9d835, #f3961c);
  background:linear-gradient(#f9d835, #f3961c);
  -webkit-border-radius:10px;
  -moz-border-radius:10px;
  border-radius:10px;
}

/* Variant : for top positioned triangle
------------------------------------------ */

.bubbles-triangle-isosceles.bubbles-top {
  background:-webkit-gradient(linear, 0 0, 0 100%, from(#f3961c), to(#f9d835));
  background:-moz-linear-gradient(#f3961c, #f9d835);
  background:-o-linear-gradient(#f3961c, #f9d835);
  background:linear-gradient(#f3961c, #f9d835);
}

/* Variant : for left/right positioned triangle
------------------------------------------ */

.bubbles-triangle-isosceles.bubbles-left {
  margin-left:50px;
  background:#f3961c;
}

/* Variant : for right positioned triangle
------------------------------------------ */

.bubbles-triangle-isosceles.bubbles-right {
  margin-right:50px;
  background:#f3961c;
}

/* THE TRIANGLE
------------------------------------------------------------------------------------------------------------------------------- */

/* creates triangle */
.bubbles-triangle-isosceles:after {
  content:"";
  position:absolute;
  bottom:-15px; /* value = - border-top-width - border-bottom-width */
  left:50px; /* controls horizontal position */
  border-width:15px 15px 0; /* vary these values to change the angle of the vertex */
  border-style:solid;
  border-color:#f3961c transparent;
  /* reduce the damage in FF3.0 */
  display:block;
  width:0;
}

/* Variant : top
------------------------------------------ */

.bubbles-triangle-isosceles.bubbles-top:after {
  top:-15px; /* value = - border-top-width - border-bottom-width */
  right:50px; /* controls horizontal position */
  bottom:auto;
  left:auto;
  border-width:0 15px 15px; /* vary these values to change the angle of the vertex */
  border-color:#f3961c transparent;
}

/* Variant : left
------------------------------------------ */

.bubbles-triangle-isosceles.bubbles-left:after {
  top:16px; /* controls vertical position */
  left:-50px; /* value = - border-left-width - border-right-width */
  bottom:auto;
  border-width:10px 50px 10px 0;
  border-color:transparent #f3961c;
}

/* Variant : right
------------------------------------------ */

.bubbles-triangle-isosceles.bubbles-right:after {
  top:16px; /* controls vertical position */
  right:-50px; /* value = - border-left-width - border-right-width */
  bottom:auto;
  left:auto;
  border-width:10px 0 10px 50px;
  border-color:transparent #f3961c;
}


/* ============================================================================================================================
== BUBBLE WITH A RIGHT-ANGLED TRIANGLE
** ============================================================================================================================ */

/* THE SPEECH BUBBLE
------------------------------------------------------------------------------------------------------------------------------- */

.bubbles-triangle-right {
  position:relative;
  padding:15px;
  margin:1em 0 3em;
  color:#fff;
  background:#075698; /* default background for browsers without gradient support */
  /* css3 */
  background:-webkit-gradient(linear, 0 0, 0 100%, from(#2e88c4), to(#075698));
  background:-moz-linear-gradient(#2e88c4, #075698);
  background:-o-linear-gradient(#2e88c4, #075698);
  background:linear-gradient(#2e88c4, #075698);
  -webkit-border-radius:10px;
  -moz-border-radius:10px;
  border-radius:10px;
}

/* Variant : for top positioned triangle
------------------------------------------ */

.bubbles-triangle-right.bubbles-top {
  background:-webkit-gradient(linear, 0 0, 0 100%, from(#075698), to(#2e88c4));
  background:-moz-linear-gradient(#075698, #2e88c4);
  background:-o-linear-gradient(#075698, #2e88c4);
  background:linear-gradient(#075698, #2e88c4);
}

/* Variant : for left positioned triangle
------------------------------------------ */

.bubbles-triangle-right.bubbles-left {
  margin-left:40px;
  background:#075698;
}

/* Variant : for right positioned triangle
------------------------------------------ */

.bubbles-triangle-right.bubbles-right {
  margin-right:40px;
  background:#075698;
}

/* THE TRIANGLE
------------------------------------------------------------------------------------------------------------------------------- */

.bubbles-triangle-right:after {
  content:"";
  position:absolute;
  bottom:-20px; /* value = - border-top-width - border-bottom-width */
  left:50px; /* controls horizontal position */
  border-width:20px 0 0 20px; /* vary these values to change the angle of the vertex */
  border-style:solid;
  border-color:#075698 transparent;
  /* reduce the damage in FF3.0 */
  display:block;
  width:0;
}

/* Variant : top
------------------------------------------ */

.bubbles-triangle-right.bubbles-top:after {
  top:-20px; /* value = - border-top-width - border-bottom-width */
  right:50px; /* controls horizontal position */
  bottom:auto;
  left:auto;
  border-width:20px 20px 0 0; /* vary these values to change the angle of the vertex */
  border-color:transparent #075698;
}

/* Variant : left
------------------------------------------ */

.bubbles-triangle-right.bubbles-left:after {
  top:16px;
  left:-40px; /* value = - border-left-width - border-right-width */
  bottom:auto;
  border-width:15px 40px 0 0; /* vary these values to change the angle of the vertex */
  border-color:transparent #075698;
}

/* Variant : right
------------------------------------------ */

.bubbles-triangle-right.bubbles-right:after {
  top:16px;
  right:-40px; /* value = - border-left-width - border-right-width */
  bottom:auto;
  left:auto;
  border-width:15px 0 0 40px; /* vary these values to change the angle of the vertex */
  border-color:transparent #075698 ;
}


/* ============================================================================================================================
== BUBBLE WITH AN OBTUSE TRIANGLE
** ============================================================================================================================ */

/* THE SPEECH BUBBLE
------------------------------------------------------------------------------------------------------------------------------- */

.bubbles-triangle-obtuse {
  position:relative;
  padding:15px;
  margin:1em 0 3em;
  color:#fff;
  background:#c81e2b;
  /* css3 */
  background:-webkit-gradient(linear, 0 0, 0 100%, from(#f04349), to(#c81e2b));
  background:-moz-linear-gradient(#f04349, #c81e2b);
  background:-o-linear-gradient(#f04349, #c81e2b);
  background:linear-gradient(#f04349, #c81e2b);
  -webkit-border-radius:10px;
  -moz-border-radius:10px;
  border-radius:10px;
}

/* Variant : for top positioned triangle
------------------------------------------ */

.bubbles-triangle-obtuse.bubbles-top {
  background:-webkit-gradient(linear, 0 0, 0 100%, from(#c81e2b), to(#f04349));
  background:-moz-linear-gradient(#c81e2b, #f04349);
  background:-o-linear-gradient(#c81e2b, #f04349);
  background:linear-gradient(#c81e2b, #f04349);
}

/* Variant : for left positioned triangle
------------------------------------------ */

.bubbles-triangle-obtuse.bubbles-left {
  margin-left:50px;
  background:#c81e2b;
}

/* Variant : for right positioned triangle
------------------------------------------ */

.bubbles-triangle-obtuse.bubbles-right {
  margin-right:50px;
  background:#c81e2b;
}

/* THE TRIANGLE
------------------------------------------------------------------------------------------------------------------------------- */

/* creates the wider right-angled triangle */
.bubbles-triangle-obtuse:before {
  content:"";
  position:absolute;
  bottom:-20px; /* value = - border-top-width - border-bottom-width */
  left:60px; /* controls horizontal position */
  border:0;
  border-right-width:30px; /* vary this value to change the angle of the vertex */
  border-bottom-width:20px; /* vary this value to change the height of the triangle. must be equal to the corresponding value in :after */
  border-style:solid;
  border-color:transparent #c81e2b;
  /* reduce the damage in FF3.0 */
  display:block;
  width:0;
}

/* creates the narrower right-angled triangle */
.bubbles-triangle-obtuse:after {
  content:"";
  position:absolute;
  bottom:-20px; /* value = - border-top-width - border-bottom-width */
  left:80px; /* value = (:before's left) + (:before's border-right/left-width)  - (:after's border-right/left-width) */
  border:0;
  border-right-width:10px; /* vary this value to change the angle of the vertex */
  border-bottom-width:20px; /* vary this value to change the height of the triangle. must be equal to the corresponding value in :before */
  border-style:solid;
  border-color:transparent #fff;
  /* reduce the damage in FF3.0 */
  display:block;
  width:0;
}

/* Variant : top
------------------------------------------ */

.bubbles-triangle-obtuse.bubbles-top:before {
  top:-20px; /* value = - border-top-width - border-bottom-width */
  bottom:auto;
  left:auto;
  right:60px; /* controls horizontal position */
  border:0;
  border-left-width:30px; /* vary this value to change the width of the triangle */
  border-top-width:20px; /* vary this value to change the height of the triangle. must be equal to the corresponding value in :after */
  border-color:transparent #c81e2b;
}

.bubbles-triangle-obtuse.bubbles-top:after {
  top:-20px; /* value = - border-top-width - border-bottom-width */
  bottom:auto;
  left:auto;
  right:80px; /* value = (:before's right) + (:before's border-right/left-width)  - (:after's border-right/left-width) */
  border-width:0;
  border-left-width:10px; /* vary this value to change the width of the triangle */
  border-top-width:20px; /* vary this value to change the height of the triangle. must be equal to the corresponding value in :before */
  border-color:transparent #fff;
}

/* Variant : left
------------------------------------------ */

.bubbles-triangle-obtuse.bubbles-left:before {
  top:15px; /* controls vertical position */
  bottom:auto;
  left:-50px; /* value = - border-left-width - border-right-width */
  border:0;
  border-bottom-width:30px; /* vary this value to change the height of the triangle */
  border-left-width:50px; /* vary this value to change the width of the triangle. must be equal to the corresponding value in :after */
  border-color:#c81e2b transparent;
}

.bubbles-triangle-obtuse.bubbles-left:after {
  top:35px; /* value = (:before's top) + (:before's border-top/bottom-width)  - (:after's border-top/bottom-width) */
  bottom:auto;
  left:-50px; /* value = - border-left-width - border-right-width */
  border:0;
  border-bottom-width:10px; /* vary this value to change the height of the triangle */
  border-left-width:50px; /* vary this value to change the width of the triangle. must be equal to the corresponding value in :before */
  border-color:#fff transparent;
}

/* Variant : right
------------------------------------------ */

.bubbles-triangle-obtuse.bubbles-right:before {
  top:15px; /* controls vertical position */
  bottom:auto;
  left:auto;
  right:-50px; /* value = - border-left-width - border-right-width */
  border:0;
  border-bottom-width:30px; /* vary this value to change the height of the triangle */
  border-right-width:50px; /* vary this value to change the width of the triangle. must be equal to the corresponding value in :after */
  border-color:#c81e2b transparent;
}

.bubbles-triangle-obtuse.bubbles-right:after {
  top:35px; /* value = (:before's top) + (:before's border-top/bottom-width)  - (:after's border-top/bottom-width) */
  bottom:auto;
  right:-50px; /* value = - border-left-width - border-right-width */
  left:auto;
  border:0;
  border-bottom-width:10px; /* vary this value to change the height of the triangle */
  border-right-width:50px; /* vary this value to change the width of the triangle. must be equal to the corresponding value in :before */
  border-color:#fff transparent;
}


/* ============================================================================================================================
== BUBBLE WITH A BORDER AND TRIANGLE
** ============================================================================================================================ */

/* THE SPEECH BUBBLE
------------------------------------------------------------------------------------------------------------------------------- */

.bubbles-triangle-border {
  position:relative;
  padding:15px;
  margin:1em 0 3em;
  border:5px solid #5a8f00;
  color:#333;
  background:#fff;
  /* css3 */
  -webkit-border-radius:10px;
  -moz-border-radius:10px;
  border-radius:10px;
}

/* Variant : for left positioned triangle
------------------------------------------ */

.bubbles-triangle-border.bubbles-left {
  margin-left:30px;
}

/* Variant : for right positioned triangle
------------------------------------------ */

.bubbles-triangle-border.bubbles-right {
  margin-right:30px;
}

/* THE TRIANGLE
------------------------------------------------------------------------------------------------------------------------------- */

.bubbles-triangle-border:before {
  content:"";
  position:absolute;
  bottom:-20px; /* value = - border-top-width - border-bottom-width */
  left:40px; /* controls horizontal position */
  border-width:20px 20px 0;
  border-style:solid;
  border-color:#5a8f00 transparent;
  /* reduce the damage in FF3.0 */
  display:block;
  width:0;
}

/* creates the smaller  triangle */
.bubbles-triangle-border:after {
  content:"";
  position:absolute;
  bottom:-13px; /* value = - border-top-width - border-bottom-width */
  left:47px; /* value = (:before left) + (:before border-left) - (:after border-left) */
  border-width:13px 13px 0;
  border-style:solid;
  border-color:#fff transparent;
  /* reduce the damage in FF3.0 */
  display:block;
  width:0;
}

/* Variant : top
------------------------------------------ */

/* creates the larger triangle */
.bubbles-triangle-border.bubbles-top:before {
  top:-20px; /* value = - border-top-width - border-bottom-width */
  bottom:auto;
  left:auto;
  right:40px; /* controls horizontal position */
  border-width:0 20px 20px;
}

/* creates the smaller  triangle */
.bubbles-triangle-border.bubbles-top:after {
  top:-13px; /* value = - border-top-width - border-bottom-width */
  bottom:auto;
  left:auto;
  right:47px; /* value = (:before right) + (:before border-right) - (:after border-right) */
  border-width:0 13px 13px;
}

/* Variant : left
------------------------------------------ */

/* creates the larger triangle */
.bubbles-triangle-border.bubbles-left:before {
  top:10px; /* controls vertical position */
  bottom:auto;
  left:-30px; /* value = - border-left-width - border-right-width */
  border-width:15px 30px 15px 0;
  border-color:transparent #5a8f00;
}

/* creates the smaller  triangle */
.bubbles-triangle-border.bubbles-left:after {
  top:16px; /* value = (:before top) + (:before border-top) - (:after border-top) */
  bottom:auto;
  left:-21px; /* value = - border-left-width - border-right-width */
  border-width:9px 21px 9px 0;
  border-color:transparent #fff;
}

/* Variant : right
------------------------------------------ */

/* creates the larger triangle */
.bubbles-triangle-border.bubbles-right:before {
  top:10px; /* controls vertical position */
  bottom:auto;
  left:auto;
  right:-30px; /* value = - border-left-width - border-right-width */
  border-width:15px 0 15px 30px;
  border-color:transparent #5a8f00;
}

/* creates the smaller  triangle */
.bubbles-triangle-border.bubbles-right:after {
  top:16px; /* value = (:before top) + (:before border-top) - (:after border-top) */
  bottom:auto;
  left:auto;
  right:-21px; /* value = - border-left-width - border-right-width */
  border-width:9px 0 9px 21px;
  border-color:transparent #fff;
}


/* ============================================================================================================================
== SPEECH BUBBLE ICON
** ============================================================================================================================ */

.bubbles-example-commentheading {
  position:relative;
  padding:0;
  color:#b513af;
}

/* creates the rectangle */
.bubbles-example-commentheading:before {
  content:"";
  position:absolute;
  top:9px;
  left:-25px;
  width:15px;
  height:10px;
  background:#b513af;
  /* css3 */
  -webkit-border-radius:3px;
  -moz-border-radius:3px;
  border-radius:3px;
}

/* creates the triangle */
.bubbles-example-commentheading:after {
  content:"";
  position:absolute;
  top:15px;
  left:-19px;
  border:4px solid transparent;
  border-left-color:#b513af;
  /* reduce the damage in FF3.0 */
  display:block;
  width:0;
}


/* ============================================================================================================================
== BLOCKQUOTE WITH RIGHT-ANGLED TRIANGLE
** ============================================================================================================================ */

.bubbles-example-right {
  position:relative;
  padding:15px 30px;
  margin:0;
  color:#fff;
  background:#5a8f00; /* default background for browsers without gradient support */
  /* css3 */
  background:-webkit-gradient(linear, 0 0, 0 100%, from(#b8db29), to(#5a8f00));
  background:-moz-linear-gradient(#b8db29, #5a8f00);
  background:-o-linear-gradient(#b8db29, #5a8f00);
  background:linear-gradient(#b8db29, #5a8f00);
  -webkit-border-radius:10px;
  -moz-border-radius:10px;
  border-radius:10px;
}

/* display of quote author (alternatively use a class on the element following the blockquote) */
.example-right + p {margin:15px 0 2em 85px; font-style:italic;}

/* creates the triangle */
.bubbles-example-right:after {
  content:"";
  position:absolute;
  bottom:-50px;
  left:50px;
  border-width:0 20px 50px 0px;
  border-style:solid;
  border-color:transparent #5a8f00;
  /* reduce the damage in FF3.0 */
  display:block;
  width:0;
}


/* ============================================================================================================================
== BLOCKQUOTE WITH OBTUSE TRIANGLE
** ============================================================================================================================ */

.bubbles-example-obtuse {
  position:relative;
  padding:15px 30px;
  margin:0;
  color:#000;
  background:#f3961c; /* default background for browsers without gradient support */
  /* css3 */
  background:-webkit-gradient(linear, 0 0, 0 100%, from(#f9d835), to(#f3961c));
  background:-moz-linear-gradient(#f9d835, #f3961c);
  background:-o-linear-gradient(#f9d835, #f3961c);
  background:linear-gradient(#f9d835, #f3961c);
  /* Using longhand to avoid inconsistencies between Safari 4 and Chrome 4 */
  -webkit-border-top-left-radius:25px 50px;
  -webkit-border-top-right-radius:25px 50px;
  -webkit-border-bottom-right-radius:25px 50px;
  -webkit-border-bottom-left-radius:25px 50px;
  -moz-border-radius:25px / 50px;
  border-radius:25px / 50px;
}

/* display of quote author (alternatively use a class on the element following the blockquote) */
.example-obtuse + p {margin:10px 150px 2em 0; text-align:right; font-style:italic;}

/* creates the larger triangle */
.bubbles-example-obtuse:before {
  content:"";
  position:absolute;
  bottom:-30px;
  right:80px;
  border-width:0 0 30px 50px;
  border-style:solid;
  border-color:transparent #f3961c;
  /* reduce the damage in FF3.0 */
  display:block;
  width:0;
}

/* creates the smaller triangle */
.bubbles-example-obtuse:after {
  content:"";
  position:absolute;
  bottom:-30px;
  right:110px;
  border-width:0 0 30px 20px;
  border-style:solid;
  border-color:transparent #fff;
  /* reduce the damage in FF3.0 */
  display:block;
  width:0;
}


/* ============================================================================================================================
== TWITTER
** ============================================================================================================================ */

.bubbles-example-twitter {
  position:relative;
  padding:15px;
  margin:100px 0 0.5em;
  color:#333;
  background:#eee;
  /* css3 */
  -webkit-border-radius:10px;
  -moz-border-radius:10px;
  border-radius:10px;
}

.bubbles-example-twitter p {font-size:28px; line-height:1.25em;}

/* this isn't necessary, just saves me having to edit the HTML of the demo */
.bubbles-example-twitter:before {
  content:url(twitter-logo.gif);
  position:absolute;
  top:-60px;
  left:0;
  width:155px;
  height:36px;
  /* reduce the damage in FF3.0 */
  display:block;
}

/* creates the triangle */
.bubbles-example-twitter:after {
  content:"";
  position:absolute;
  top:-30px;
  left:50px;
  border:15px solid transparent;
  border-bottom-color:#eee;
  /* reduce the damage in FF3.0 */
  display:block;
  width:0;
}

/* display of quote author (alternatively use a class on the element following the blockquote) */
.bubbles-example-twitter + p {padding-left:15px; font:14px Arial, sans-serif;}


/* ============================================================================================================================
== NUMBER
** ============================================================================================================================ */

.bubbles-example-number {
  position:relative;
  width:200px;
  height:200px;
  margin:50px 0 200px;
  text-align:center;
  font:140px/200px Arial, sans-serif;
  color:#fff;
  background:#C91F2C;
}

/* creates the larger triangle */
.bubbles-example-number:before {
  content:"";
  position:absolute;
  bottom:-140px;
  right:0;
  border-width:0 0 140px 140px;
  border-style:solid;
  border-color:transparent #C91F2C;
}

/* creates the larger triangle */
.bubbles-example-number:after {
  content:"";
  position:absolute;
  bottom:-140px;
  right:85px;
  border-width:0 0 140px 55px;
  border-style:solid;
  border-color:transparent #fff;
}


/* ============================================================================================================================
== PINCHED SPEECH BUBBLE (more CSS3)
** ============================================================================================================================ */

.bubbles-pinched {
  position:relative;
  padding:15px;
  margin:50px 0 3em;
  text-align:center;
  color:#fff;
  background:#333;
  /* css3 */
  -webkit-border-radius:10px;
  -moz-border-radius:10px;
  border-radius:10px;
}

/* creates a rectangle of the colour wanted for the pointy bit */
.bubbles-pinched:before {
  content:"";
  position:absolute;
  top:-20px;
  left:50%;
  width:100px;
  height:20px;
  margin:0 0 0 -50px;
  background:#333;
}

/* creates a rounded rectangle to cover part of the rectangle generated above */
.bubbles-pinched:after {
  content:"";
  position:absolute;
  top:-20px;
  left:0;
  width:50%;
  height:20px;
  background:#fff;
  /* css3 */
  -webkit-border-bottom-right-radius:15px;
  -moz-border-radius-bottomright:15px;
  border-bottom-right-radius:15px;
}

/* creates the other rounded rectangle */
.bubbles-pinched > :first-child:before {
  content:"";
  position:absolute;
  top:-20px;
  right:0;
  width:50%;
  height:20px;
  background:#fff;
  /* css3 */
  -webkit-border-bottom-left-radius:15px;
  -moz-border-radius-bottomleft:15px;
  border-bottom-left-radius:15px;
}


/* ============================================================================================================================
== OVAL SPEECH BUBBLE (more CSS3)
** ============================================================================================================================ */

.bubbles-oval-speech {
  position:relative;
  width:270px;
  padding:50px 40px;
  margin:1em auto 50px;
  text-align:center;
  color:#fff;
  background:#5a8f00;
  /* css3 */
  background:-webkit-gradient(linear, 0 0, 0 100%, from(#b8db29), to(#5a8f00));
  background:-moz-linear-gradient(#b8db29, #5a8f00);
  background:-o-linear-gradient(#b8db29, #5a8f00);
  background:linear-gradient(#b8db29, #5a8f00);
  /*
  NOTES:
  -webkit-border-radius:220px 120px; // produces oval in safari 4 and chrome 4
  -webkit-border-radius:220px / 120px; // produces oval in chrome 4 (again!) but not supported in safari 4
  Not correct application of the current spec, therefore, using longhand to avoid future problems with webkit corrects this
  */
  -webkit-border-top-left-radius:220px 120px;
  -webkit-border-top-right-radius:220px 120px;
  -webkit-border-bottom-right-radius:220px 120px;
  -webkit-border-bottom-left-radius:220px 120px;
  -moz-border-radius:220px / 120px;
  border-radius:220px / 120px;
}

.bubbles-oval-speech p {font-size:1.25em;}

/* creates part of the curve */
.bubbles-oval-speech:before {
  content:"";
  position:absolute;
  z-index:-1;
  bottom:-30px;
  right:50%;
  height:30px;
  border-right:60px solid #5a8f00;
  background:#5a8f00; /* need this for webkit - bug in handling of border-radius */
  /* css3 */
  -webkit-border-bottom-right-radius:80px 50px;
  -moz-border-radius-bottomright:80px 50px;
  border-bottom-right-radius:80px 50px;
  /* using translate to avoid undesired appearance in CSS2.1-capabable but CSS3-incapable browsers */
  -webkit-transform:translate(0, -2px);
  -moz-transform:translate(0, -2px);
  -ms-transform:translate(0, -2px);
  -o-transform:translate(0, -2px);
  transform:translate(0, -2px);
}

/* creates part of the curved pointy bit */
.bubbles-oval-speech:after {
  content:"";
  position:absolute;
  z-index:-1;
  bottom:-30px;
  right:50%;
  width:60px;
  height:30px;
  background:#fff;
  /* css3 */
  -webkit-border-bottom-right-radius:40px 50px;
  -moz-border-radius-bottomright:40px 50px;
  border-bottom-right-radius:40px 50px;
  /* using translate to avoid undesired appearance in CSS2.1-capabable but CSS3-incapable browsers */
  -webkit-transform:translate(-30px, -2px);
  -moz-transform:translate(-30px, -2px);
  -ms-transform:translate(-30px, -2px);
  -o-transform:translate(-30px, -2px);
  transform:translate(-30px, -2px);
}


/* ============================================================================================================================
== OVAL THOUGHT BUBBLE (more CSS3)
** ============================================================================================================================ */

.bubbles-oval-thought {
  position:relative;
  width:270px;
  padding:50px 40px;
  margin:1em auto 80px;
  text-align:center;
  color:#fff;
  background:#075698;
  /* css3 */
  background:-webkit-gradient(linear, 0 0, 0 100%, from(#2e88c4), to(#075698));
  background:-moz-linear-gradient(#2e88c4, #075698);
  background:-o-linear-gradient(#2e88c4, #075698);
  background:linear-gradient(#2e88c4, #075698);
  /*
  NOTES:
  -webkit-border-radius:220px 120px; // produces oval in safari 4 and chrome 4
  -webkit-border-radius:220px / 120px; // produces oval in chrome 4 (again!) but not supported in safari 4
  Not correct application of the current spec, therefore, using longhand to avoid future problems with webkit corrects this
  */
  -webkit-border-top-left-radius:220px 120px;
  -webkit-border-top-right-radius:220px 120px;
  -webkit-border-bottom-right-radius:220px 120px;
  -webkit-border-bottom-left-radius:220px 120px;
  -moz-border-radius:220px / 120px;
  border-radius:220px / 120px;
}

.bubbles-oval-thought p {font-size:1.25em;}

/* creates the larger circle */
.bubbles-oval-thought:before {
  content:"";
  position:absolute;
  bottom:-20px;
  left:50px;
  width:30px;
  height:30px;
  background:#075698;
  /* css3 */
  -webkit-border-radius:30px;
  -moz-border-radius:30px;
  border-radius:30px;
}

/* creates the smaller circle */
.bubbles-oval-thought:after {
  content:"";
  position:absolute;
  bottom:-30px;
  left:30px;
  width:15px;
  height:15px;
  background:#075698;
  /* css3 */
  -webkit-border-radius:15px;
  -moz-border-radius:15px;
  border-radius:15px;
}

/* ============================================================================================================================
== OVAL SPEECH BUBBLE WITH QUOTATION MARKS (more CSS3)
** ============================================================================================================================ */

.bubbles-oval-quotes {
  position:relative;
  width:400px;
  height:350px;
  margin:2em auto 10px;
  color:#000;
  background:#ffed26;
  /* css3 */
  /*
  NOTES:
  -webkit-border-radius:Apx Bpx; // produces oval in safari 4 and chrome 4
  -webkit-border-radius:Apx / Bpx; // produces oval in chrome 4 (again!) but not supported in safari 4
  Not correct application of the current spec, therefore, using longhand to avoid future problems with webkit corrects this
  */
  -webkit-border-top-left-radius:400px 350px;
  -webkit-border-top-right-radius:400px 350px;
  -webkit-border-bottom-right-radius:400px 350px;
  -webkit-border-bottom-left-radius:400px 350px;
  -moz-border-radius:400px / 350px;
  border-radius:400px / 350px;
}

/* creates opening quotation mark */
.bubbles-oval-quotes:before {
  content:"\201C";
  position:absolute;
  z-index:1;
  top:20px;
  left:20px;
  font:80px/1 Georgia, serif;
  color:#ffed26;
}

/* creates closing quotation mark */
.bubbles-oval-quotes:after {
  content:"\201D";
  position:absolute;
  z-index:1;
  bottom:0;
  right:20px;
  font:80px/0.25 Georgia, serif;
  color:#ffed26;
}

.bubbles-oval-quotes p {
  width:250px;
  height:250px;
  padding:50px 0 0;
  margin:0 auto;
  text-align:center;
  font-size:35px;
}

/* creates smaller curve */
.bubbles-oval-quotes p:before {
  content:"";
  position:absolute;
  z-index:-1;
  bottom:-30px;
  right:55%;
  width:180px; /* wider than necessary to make it look a bit better in IE8 */
  height:60px;
  background:#fff; /* need this for webkit - bug in handling of border-radius */
  /* css3 */
  -webkit-border-bottom-right-radius:40px 50px;
  -moz-border-radius-bottomright:40px 50px;
  border-bottom-right-radius:40px 50px;
  /* using translate to avoid undesired appearance in CSS2.1-capabable but CSS3-incapable browsers */
  -webkit-transform:translate(-30px, -2px);
  -moz-transform:translate(-30px, -2px);
  -ms-transform:translate(-30px, -2px);
  -o-transform:translate(-30px, -2px);
  transform:translate(-30px, -2px);
}

/* creates larger curve */
.bubbles-oval-quotes p:after {
  content:"";
  position:absolute;
  z-index:-2;
  bottom:-30px;
  right:25%;
  height:80px;
  border-right:200px solid #ffed26;
  background:#ffed26; /* need this for webkit - bug in handling of border-radius */
  /* css3 */
  -webkit-border-bottom-right-radius:200px 100px;
  -moz-border-radius-bottomright:200px 100px;
  border-bottom-right-radius:200px 100px;
  /* using translate to avoid undesired appearance in CSS2.1-capabable but CSS3-incapable browsers */
  -webkit-transform:translate(0, -2px);
  -moz-transform:translate(0, -2px);
  -ms-transform:translate(0, -2px);
  -o-transform:translate(0, -2px);
  transform:translate(0, -2px);
  /* reduce the damage in FF3.0 */
  display:block;
  width:0;
}

.bubbles-oval-quotes + p {
  position:relative; /* part of the IE8 width compromise */
  width:150px;
  margin:0 0 2em;
  font-size:18px;
  font-weight:bold;
}


/* ============================================================================================================================
== RECTANGLE-BORDER STYLE WITH CURVE
** ============================================================================================================================ */

.bubbles-rectangle-speech-border {
  position:relative;
  padding:50px 15px;
  margin:1em 0 3em;
  border:10px solid #5a8f00;
  text-align:center;
  color:#333;
  background:#fff;
  /* css3 */
  -webkit-border-radius:20px;
  -moz-border-radius:20px;
  border-radius:20px;
}

/* creates larger curve */
.bubbles-rectangle-speech-border:before {
  content:"";
  position:absolute;
  z-index:10;
  bottom:-40px;
  left:50px;
  width:50px;
  height:30px;
  border-style:solid;
  border-width:0 10px 10px 0;
  border-color:#5a8f00;
  background:transparent;
  /* css3 */
  -webkit-border-bottom-right-radius:80px 50px;
  -moz-border-radius-bottomright:80px 50px;
  border-bottom-right-radius:80px 50px;
  /* reduce the damage in FF3.0 */
  display:block;
}

/* creates smaller curve */
.bubbles-rectangle-speech-border:after {
  content:"";
  position:absolute;
  z-index:10;
  bottom:-40px;
  left:50px;
  width:20px;
  height:30px;
  border-style:solid;
  border-width:0 10px 10px 0;
  border-color:#5a8f00;
  background:transparent;
  /* css3 */
  -webkit-border-bottom-right-radius:40px 50px;
  -moz-border-radius-bottomright:40px 50px;
  border-bottom-right-radius:40px 50px;
  /* reduce the damage in FF3.0 */
  display:block;
}

/* creates a small circle to produce a rounded point where the two curves meet */
.bubbles-rectangle-speech-border > :first-child:before {
  content:"";
  position:absolute;
  bottom:-40px;
  left:45px;
  width:10px;
  height:10px;
  background:#5a8f00;
  /* css3 */
  -webkit-border-radius:10px;
  -moz-border-radius:10px;
  border-radius:10px;
}

/* creates a white rectangle to cover part of the oval border*/
.bubbles-rectangle-speech-border > :first-child:after {
  content:"";
  position:absolute;
  bottom:-10px;
  left:76px;
  width:24px;
  height:15px;
  background:#fff;
}

/* ============================================================================================================================
== OVER SPEECH BUBBLE, EMPTY, WITH BORDER (more CSS3)
** ============================================================================================================================ */

.bubbles-oval-speech-border {
  position:relative;
  padding:70px 30px;
  margin:1em auto 60px;
  border:10px solid #f3961c;
  text-align:center;
  color:#333;
  background:#fff;
  /* css3 */
  /*
  NOTES:
  -webkit-border-radius:240px 140px; // produces oval in safari 4 and chrome 4
  -webkit-border-radius:240px / 140px; // produces oval in chrome 4 (again!) but not supported in safari 4
  Not correct application of the current spec, therefore, using longhand to avoid future problems with webkit corrects this
  */
  -webkit-border-top-left-radius:240px 140px;
  -webkit-border-top-right-radius:240px 140px;
  -webkit-border-bottom-right-radius:240px 140px;
  -webkit-border-bottom-left-radius:240px 140px;
  -moz-border-radius:240px / 140px;
  border-radius:240px / 140px;
}

/* creates larger curve */
.bubbles-oval-speech-border:before {
  content:"";
  position:absolute;
  z-index:2;
  bottom:-40px;
  right:50%;
  width:50px;
  height:30px;
  border-style:solid;
  border-width:0 10px 10px 0;
  border-color:#f3961c;
  margin-right:-10px;
  background:transparent;
  /* css3 */
  -webkit-border-bottom-right-radius:80px 50px;
  -moz-border-radius-bottomright:80px 50px;
  border-bottom-right-radius:80px 50px;
  /* reduce the damage in FF3.0 */
  display:block;
}

/* creates smaller curve */
.bubbles-oval-speech-border:after {
  content:"";
  position:absolute;
  z-index:2;
  bottom:-40px;
  right:50%;
  width:20px;
  height:31px;
  border-style:solid;
  border-width:0 10px 10px 0;
  border-color:#f3961c;
  margin-right:20px;
  background:transparent;
  /* css3 */
  -webkit-border-bottom-right-radius:40px 50px;
  -moz-border-radius-bottomright:40px 50px;
  border-bottom-right-radius:40px 50px;
  /* reduce the damage in FF3.0 */
  display:block;
}

/* creates a small circle to produce a rounded point where the two curves meet */
.bubbles-oval-speech-border > :first-child:before {
  content:"";
  position:absolute;
  z-index:1;
  bottom:-40px;
  right:50%;
  width:10px;
  height:10px;
  margin-right:45px;
  background:#f3961c;
  /* css3 */
  -webkit-border-radius:10px;
  -moz-border-radius:10px;
  border-radius:10px;
}

/* creates a white rectangle to cover part of the oval border*/
.bubbles-oval-speech-border > :first-child:after {
  content:"";
  position:absolute;
  z-index:1;
  bottom:-10px;
  right:50%;
  width:30px;
  height:15px;
  background:#fff;
}

/* ============================================================================================================================
== OVER THOUGHT BUBBLE, EMPTY, WITH BORDER (more CSS3)
** ============================================================================================================================ */

.bubbles-oval-thought-border {
  position:relative;
  padding:70px 30px;
  margin:1em auto 80px;
  border:10px solid #c81e2b;
  text-align:center;
  color:#333;
  background:#fff;
  /* css3 */
  /*
  NOTES:
  -webkit-border-radius:240px 140px; // produces oval in safari 4 and chrome 4
  -webkit-border-radius:240px / 140px; // produces oval in chrome 4 (again!) but not supported in safari 4
  Not correct application of the current spec, therefore, using longhand to avoid future problems with webkit corrects this
  */
  -webkit-border-top-left-radius:240px 140px;
  -webkit-border-top-right-radius:240px 140px;
  -webkit-border-bottom-right-radius:240px 140px;
  -webkit-border-bottom-left-radius:240px 140px;
  -moz-border-radius:240px / 140px;
  border-radius:240px / 140px;
}

/* creates the larger circle */
.bubbles-oval-thought-border:before {
  content:"";
  position:absolute;
  z-index:10;
  bottom:-40px;
  right:100px;
  width:50px;
  height:50px;
  border:10px solid #c81e2b;
  background:#fff;
  /* css3 */
  -webkit-border-radius:50px;
  -moz-border-radius:50px;
  border-radius:50px;
  /* reduce the damage in FF3.0 */
  display:block;
}

/* creates the smaller circle */
.bubbles-oval-thought-border:after {
  content:"";
  position:absolute;
  z-index:10;
  bottom:-60px;
  right:50px;
  width:25px;
  height:25px;
  border:10px solid #c81e2b;
  background:#fff;
  /* css3 */
  -webkit-border-radius:25px;
  -moz-border-radius:25px;
  border-radius:25px;
  /* reduce the damage in FF3.0 */
  display:block;
}

\rules only filteredtranscludeinline transcludeinline macrodef macrocallinline

.tc-ext-doc-link {
color: <<color primary>>;
fill: <<color primary>>;
font-size: 1.2em;
font-weight: bold;
font-family: Effra;
text-decoration: none;
border-radius: 4px;
padding: 0.3em;
margin: 0.3em -0.3em 0.3em -0.3em;
border: 2px solid transparent;
}

.tc-ext-doc-link svg {
vertical-align: middle;
height: 0.75em;
}

.tc-ext-doc-link img {
vertical-align: middle;
height: 1.3em;
}

.tc-ext-doc-link:hover {
color: <<color background>>;
fill: <<color background>>;
background: <<color primary>>;
border: 2px solid rgba(0,0,0,0.5);
}

\rules only filteredtranscludeinline transcludeinline macrodef macrocallinline

@media (min-width: {{$:/themes/tiddlywiki/vanilla/metrics/sidebarbreakpoint}}) {

<<if-sidebar """

	.tc-sidebar-scrollable {
		background: linear-gradient(to right,rgba(255,255,255,0) 0%,rgba(255,255,255,0.85) 42px,rgba(255,255,255,0.85) 100%);
	}

""">>

}

@media (max-width: {{$:/themes/tiddlywiki/vanilla/metrics/sidebarbreakpoint}}) {

<<if-sidebar """

	.tc-sidebar-scrollable {
		background: linear-gradient(to right,rgba(255,255,255,0.85) 0%,rgba(255,255,255,0.85) 100%);
	}

""">>

}

\rules only filteredtranscludeinline transcludeinline macrodef macrocallinline

html body.tc-body .tc-tiddler-frame.tc-tagged-HideEditButton .tc-btn-\%24\%3A\%2Fcore\%2Fui\%2FButtons\%2Fedit,
html body.tc-body .tc-tiddler-frame.tc-tagged-HideEditButton .tc-btn-\%24\%3A\%2Fcore\%2Fui\%2FButtons\%2Finfo,
html body.tc-body .tc-tiddler-frame.tc-tagged-HideEditButton .tc-btn-\%24\%3A\%2Fcore\%2Fui\%2FButtons\%2Fmore-tiddler-actions,
html body.tc-body .tc-tiddler-frame.tc-tagged-HideEditButton .tc-tags-wrapper,
html body.tc-body .tc-tiddler-frame.tc-tagged-HideEditButton .tc-tagged-by {
	display: none;
}

/* Make links bolder */

button.tc-tiddlylink, a.tc-tiddlylink {
    font-weight: bold;
}

\rules only filteredtranscludeinline transcludeinline macrodef macrocallinline

.tc-topbar-right {
	top: 0;
	right: 0;
}

.tc-topbar-left {
	display: inline-block;
	top: 0;
	left: 0;
	width: 100%;
}

nav.tc-top-menu p {
	margin: 0;
}

nav.tc-top-menu > ul {
	position: relative;
	list-style-type: none;
	margin: 0;
    padding: 0 0 0 42px;
	text-transform: uppercase;
	background: <<colour top-menu-background>>;
	<<box-shadow "1px 1px 5px rgba(0, 0, 0, 0.3)">>
}

nav.tc-top-menu > ul > li {
	display: inline-block;
	margin: 0;
	padding: 0;
}

nav.tc-top-menu > ul > li > a,
nav.tc-top-menu > ul > li > button {
	display: block;
	font-weight: 700;
	color: <<colour top-menu-foreground>>;
	fill: <<colour top-menu-foreground>>;
	text-decoration: none;
	padding: 0.5em;
	margin: 0;
	background: none;
	border: none;
    cursor: pointer;
    text-transform: inherit;
    border-radius: 0;
    text-decoration: none;
}

nav.tc-top-menu > ul > li > a.tc-selected,
nav.tc-top-menu > ul > li > button.tc-selected {
	background: <<colour top-menu-foreground>>;
	color: <<colour top-menu-background>>;
	fill: <<colour top-menu-background>>;
}

nav.tc-top-menu > ul > li svg {
	width: 1em;
	height: 1em;
	fill: <<colour top-menu-foreground>>;
}

nav.tc-top-menu > ul > li > a:hover,
nav.tc-top-menu > ul > li > button:hover {
	background: rgba(0,0,0,0.25);
    border-radius: 0;
    text-decoration: none;
}

nav.tc-top-menu .tc-drop-down {
	max-height: 70vh;
	overflow: auto;
}

nav.tc-top-menu .tc-drop-down a {
	text-decoration: none;
}

nav.tc-top-menu .tc-drop-down button {
	display: inline-block;
	width: auto;
}

nav.tc-top-menu .tc-drop-down ol {
	margin: 0;
}

<hr/>
<$button class="tc-btn-invisible">
<$set name="tags" filter="[<currentTiddler>]">
<$action-sendmessage $message="tm-new-tiddler" tags=<<tags>>/>
Create new tiddler tagged '<$text text=<<currentTiddler>>/>'
</$set>
</$button>

\rules only filteredtranscludeinline transcludeinline macrodef macrocallinline

.tc-tag-navigation-buttons {
	clear: both;
	display: flex;
	font-size: 1em;
	border: 1px solid #c1e1ea;
}

.tc-tag-navigation-button-previous,
.tc-tag-navigation-button-next {
	cursor: pointer;
	border: none;
	background: #c1e1ea;
	border-radius: 4px;
	padding: 5px; color: white;
}

.tc-tag-navigation-button-middle {
	flex: 1; font-size: 100%;

}

.tc-tag-navigation-body {
	padding: 0.5em;
	border-left: 1px solid #c1e1ea;
	border-right: 1px solid #c1e1ea;
}

.tc-tag-navigation-button-previous:hover {
  background-color:#94d2e3;
}

.tc-tag-navigation-button-next:hover {
  background-color:#94d2e3;
}

\define tag-navigation-buttons()
<div class="tc-tag-navigation-buttons">
<$list filter="[<__tag__>tagging[]allbefore<currentTiddler>limit[1]]" variable="ignore">
<$button class="tc-tag-navigation-button tc-tag-navigation-button-previous">
<$action-setfield $tiddler=<<state>> $value={{{ [<__tag__>tagging[]before<currentTiddler>] }}}/>
{{left}} previous

</$button>
</$list>
<$button class="tc-tag-navigation-button tc-tag-navigation-button-middle tc-btn-invisible">
<$action-navigate $to=<<__tag__>>/>
 (<$text text={{{ [<__tag__>tagging[]allbefore<currentTiddler>count[]add[1]] }}}/> of <$text text={{{ [<__tag__>tagging[]count[]] }}}/>)
</$button>

<$list filter="[<__tag__>tagging[]allafter<currentTiddler>limit[1]]" variable="ignore">
<$button class="tc-tag-navigation-button tc-tag-navigation-button-next">
<$action-setfield $tiddler=<<state>> $value={{{ [<__tag__>tagging[]after<currentTiddler>] }}}/>
next {{right}}
</$button>
</$list>
</div>
\end

\define tag-navigation(tag)
<div class="tc-tag-navigation">
<$set name="state" value=<<qualify "$:/state/tag-navigation">>>
<$set name="state" value={{{ [<state>addsuffix[/]addsuffix<__tag__>] }}}>
<$tiddler tiddler={{{ [<state>get[text]] ~[<__tag__>tagging[]first[]]  }}}>
<<tag-navigation-buttons>>
<div class="tc-tag-navigation-body">
<h1><$text text={{!!title}}/></h1>
<$transclude mode="block"/>
</div>
<<tag-navigation-buttons>>
</$tiddler>
</$set>
</$set>
</div>
\end

<textarea readonly="readonly" style="width:100%;height:10em;"><$text text={{!!text}}/></textarea>

<$button message="tm-login" class="tc-consent-button tc-btn-invisible">
Login
</$button>

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    <!-- Generator: Sketch 43.2 (39069) - http://www.bohemiancoding.com/sketch -->
    <title>afc-black-wordmark</title>
    <desc>Created with Sketch.</desc>
    <defs>
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    <g id="Page-1" stroke="none" stroke-width="1" fill="none" fill-rule="evenodd">
        <g id="Group-3">
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            <path d="M91.886,0.179 C89.621,-0.203 87.826,0.322 86.587,0.682 C85.194,1.086 83.7,1.792 82.07,2.514 C78.173,4.304 75.681,5.746 72.155,7.997 C62.946,13.873 55.474,21.723 50.173,30.924 C48.058,34.595 46.333,38.502 44.938,42.563 C44.105,44.985 43.361,47.449 42.8,49.987 C42.112,53.103 41.657,56.234 41.414,59.36 C40.292,73.75 43.834,88.052 51.735,100.434 C51.965,100.794 52.215,101.135 52.451,101.49 C56.267,101.137 60.072,100.378 63.809,99.179 C65.032,98.787 66.228,98.339 67.408,97.865 C66.092,96.255 64.829,94.591 63.69,92.806 C56.38,81.349 53.818,67.811 56.369,54.52 C56.397,54.376 56.417,54.23 56.446,54.085 C56.447,54.078 56.448,54.071 56.45,54.064 C56.518,53.724 56.574,53.385 56.649,53.046 C57.693,48.32 59.368,43.843 61.573,39.678 C61.621,39.587 61.662,39.49 61.711,39.399 C65.921,31.557 72.075,24.872 79.784,19.952 C82.596,18.157 85.557,16.636 88.628,15.407 C88.77,14.749 91.876,0.226 91.886,0.179" id="Fill-56" fill="#888" mask="url(#mask-4)"></path>
        </g>
    </g>
</svg>

cwp-white: #f7f7f8
cwp-black: #333
cwp-grey: #e8e8ec
cwp-active: #59b799
cwp-primary: #6b717e
cwp-zone-cwp: #59b799
cwp-zone-young-person: #fc8f68
cwp-zone-parent: #f4ee7f
cwp-zone-more: #aee5d8

cwp-mid: rgba(232, 232, 232, 0.84)

top-menu-background: <<colour cwp-primary>>
top-menu-foreground: <<colour cwp-white>>

page-footer-background: <<colour cwp-primary>>
page-footer-foreground: <<colour cwp-white>>

alert-background: <<color cwp-white>>
alert-border: #b99e2f
alert-highlight: #881122
alert-muted-foreground: #b99e2f
background: #ffffff
blockquote-bar: <<colour muted-foreground>>
button-background:
button-foreground:
button-border:
code-background: #f7f7f9
code-border: #e1e1e8
code-foreground: #dd1144
dirty-indicator: #ff0000
download-background: #34c734
download-foreground: <<colour background>>
dragger-background: <<colour foreground>>
dragger-foreground: <<colour background>>
dropdown-background: <<colour background>>
dropdown-border: <<colour muted-foreground>>
dropdown-tab-background-selected: #fff
dropdown-tab-background: #ececec
dropzone-background: rgba(0,200,0,0.7)
external-link-background-hover: inherit
external-link-background-visited: inherit
external-link-background: inherit
external-link-foreground-hover: inherit
external-link-foreground-visited: #0000aa
external-link-foreground: #0000ee
foreground: <<color cwp-black>>
message-background: #ecf2ff
message-border: #cfd6e6
message-foreground: #547599
modal-backdrop: <<colour foreground>>
modal-background: <<colour background>>
modal-border: #999999
modal-footer-background: #f5f5f5
modal-footer-border: #dddddd
modal-header-border: #eeeeee
muted-foreground: #bbb
notification-background: #ffffdd
notification-border: #999999
page-background: <<color cwp-grey>>
pre-background: #f5f5f5
pre-border: #cccccc
primary: <<colour cwp-active>>
sidebar-button-foreground: <<colour foreground>>
sidebar-controls-foreground-hover: #000000
sidebar-controls-foreground: #aaaaaa
sidebar-foreground-shadow: rgba(255,255,255, 0.8)
sidebar-foreground: #acacac
sidebar-muted-foreground-hover: #444444
sidebar-muted-foreground: #c0c0c0
sidebar-tab-background-selected: #f4f4f4
sidebar-tab-background: #e0e0e0
sidebar-tab-border-selected: <<colour tab-border-selected>>
sidebar-tab-border: <<colour tab-border>>
sidebar-tab-divider: #e4e4e4
sidebar-tab-foreground-selected:
sidebar-tab-foreground: <<colour tab-foreground>>
sidebar-tiddler-link-foreground-hover: #444444
sidebar-tiddler-link-foreground: #999999
site-title-foreground: <<colour tiddler-title-foreground>>
static-alert-foreground: #aaaaaa
tab-background-selected: #ffffff
tab-background: #d8d8d8
tab-border-selected: #d8d8d8
tab-border: #cccccc
tab-divider: #d8d8d8
tab-foreground-selected: <<colour tab-foreground>>
tab-foreground: #666666
table-border: #dddddd
table-footer-background: #a8a8a8
table-header-background: #f0f0f0
tag-background: #ec6
tag-foreground: #ffffff
tiddler-background: <<colour background>>
tiddler-border: <<colour background>>
tiddler-controls-foreground-hover: #888888
tiddler-controls-foreground-selected: #444444
tiddler-controls-foreground: #cccccc
tiddler-editor-background: #f8f8f8
tiddler-editor-border-image: #ffffff
tiddler-editor-border: #cccccc
tiddler-editor-fields-even: #e0e8e0
tiddler-editor-fields-odd: #f0f4f0
tiddler-info-background: #f8f8f8
tiddler-info-border: #dddddd
tiddler-info-tab-background: #f8f8f8
tiddler-link-background: <<colour background>>
tiddler-link-foreground: <<colour primary>>
tiddler-subtitle-foreground: #c0c0c0
tiddler-title-foreground: #182955
toolbar-new-button:
toolbar-options-button:
toolbar-save-button:
toolbar-info-button:
toolbar-edit-button:
toolbar-close-button:
toolbar-delete-button:
toolbar-cancel-button:
toolbar-done-button:
untagged-background: #999999
very-muted-foreground: #888888

\define if-fluid-fixed(text,hiddenSidebarText)
<$reveal state="$:/themes/tiddlywiki/vanilla/options/sidebarlayout" type="match" text="fluid-fixed">
$text$
<$reveal state="$:/state/sidebar" type="nomatch" text="yes" default="yes">
$hiddenSidebarText$
</$reveal>
</$reveal>
\end

\rules only filteredtranscludeinline transcludeinline macrodef macrocallinline macrocallblock

@media (min-width: {{$:/themes/tiddlywiki/vanilla/metrics/sidebarbreakpoint}}) {

	.tc-story-river {
		padding: 84px;
	}

	.tc-tiddler-frame {
		width: calc({{$:/themes/tiddlywiki/vanilla/metrics/tiddlerwidth}} - 84px);
	}

<<if-no-sidebar "

	.tc-story-river {
		width: calc(100% - {{$:/themes/tiddlywiki/vanilla/metrics/storyleft}});
	}

	.tc-tiddler-frame {
		width: 100%;
	}

">>

<<if-fluid-fixed text:"""

	body.tc-body .tc-tiddler-frame {
		width: 100%;
	}

""" hiddenSidebarText:"""

""">>

}

\define image-link-body(image,caption,width,height,color,background-color,icon)
<div class="tc-thumbnail-wrapper" style="width:$width$px;height:$height$px;">
<div class="tc-thumbnail-image">[img[$image$]]</div><div class="tc-thumbnail-icon" style="fill:$color$;color:$color$;">
$icon$
</div><div class="tc-thumbnail-caption">
$caption$
</div>
</div>
\end

\define image-link(link,image,caption,width,height,color,background-color,icon)
<$link to="""$link$"""><$macrocall $name="image-link-body" icon=<<__icon__>> color=<<__color__>> background-color=<<__background-color__>> image=<<__image__>> caption=<<__caption__>> width=<<__width__>> height=<<__height__>>/></$link>
\end

\define image-link-ext(link,image,caption,width,height,color,background-color,icon)
<a href="""$link$""" target="_blank" rel="noopener noreferrer"><$macrocall $name="image-link-body" icon=<<__icon__>> color=<<__color__>> background-color=<<__background-color__>> image=<<__image__>> caption=<<__caption__>> width=<<__width__>> height=<<__height__>>/></a>
\end

\define link-doc(caption,url,type:"docs")
<a href="""$url$""" class="tc-ext-doc-link" style="" target="_blank" rel="noopener noreferrer" title="Open in Google Docs">
{{$:/core/images/chevron-right}}<$image source={{{ [tag[$:/_GoogleDocsIcon]caption<__type__>] }}}/> $caption$
</a>
\end

\define link-pdf(caption,url,colour:"#55c6a7")
<a href="""$url$""" class="tc-btn-big-green" style="background-color:$colour$;" target="_blank" rel="noopener noreferrer">
{{$:/core/images/file}} $caption$
</a>
\end

\define embed-video(code)
<iframe width="560" height="315" src="https://www.youtube.com/embed/$code$" frameborder="0" allow="autoplay; encrypted-media" allowfullscreen></iframe>
\end

<div class="tc-table-of-contents">
<<toc-selective-expandable 'Finding OutContents'>>
</div>

<div class="tc-table-of-contents">
<<toc-selective-expandable 'HelpingContents'>>
</div>

<div class="tc-table-of-contents">
<<toc-selective-expandable 'HomeContents'>>
</div>

<div class="tc-table-of-contents">
<<toc-selective-expandable 'MoreContents'>>
</div>

<a href="../cwp-richmond/index.html">Richmond</a>
<a href="../cwp-tower-hamlets/index.html">Tower Hamlets</a>
<a href="../cwp-westminster-rbkc/index.html">Westminster and RBKC</a>

<<list-links "[tag[Partnerships/SitesContents]tag[Partnerships/SitesContents]]">>

<div class="tc-table-of-contents">
<<toc-selective-expandable 'Partnerships/SitesContents'>>
</div>

<div class="tc-table-of-contents">
<<toc-selective-expandable 'SupervisingContents'>>
</div>

reverse

modified

hide

show

hide

show

show

show

hide

show

show

hide

no

hide

hide

show

! Our use of cookies

We use necessary cookies to make our site work. We’d also like to set optional analytics to help us improve it. We won’t set optional cookies unless you enable them. Using this tool will set a cookie on your device to remember your preferences.

The AFNCCF provides this wiki platform for external teams who are responsible for the content, including cookies, that are added to their individual manuals. Guidance for teams on how to embed correctly has been added to the user guide.

For more detailed information about the cookies we use, see our <a href="https://www.annafreud.org/your-privacy/" class="tc-tiddlylink-external" target="_blank" rel="noopener noreferrer">Cookies page</a>.

---

!! Necessary cookies

Necessary cookies enable core functionality such as security, network management, and accessibility. You may disable these by changing your browser settings, but this may affect how the website functions.

---

!! Analytics cookies

We’d like to set non-essential cookies, such as Google Analytics, to help us to improve our website by collecting and reporting information on how you use it. The cookies collect information in a way that does not directly identify anyone. For more information on how these cookies work, please see our <a href="https://www.annafreud.org/your-privacy/" class="tc-tiddlylink-external" target="_blank" rel="noopener noreferrer">Cookies page</a>. If you are 16 or under, please ask a parent or carer for consent before accepting.

---

<$list filter={{$:/core/Filters/Drafts!!filter}} >
<div class="tc-menu-list-item">
<$link><$view field="title"/></$link>  <$list filter="[all[current]frombag{$:/plugins/federatial/xememex/config/recipe}]" variable="listItem"><span style="display:inline-block;background:#ff4;border:1px solid #cc0;color:black;padding:0 2px;border-radius:4px;font-size:0.8em;line-height:1.3;">local</span></$list>
</div>
</$list>

\define lingo-base() $:/language/ControlPanel/
\define config-title()
$:/config/PageControlButtons/Visibility/$(listItem)$
\end

<<lingo Basics/Version/Prompt>> <<version>>

<$set name="tv-config-toolbar-icons" value="yes">

<$set name="tv-config-toolbar-text" value="yes">

<$set name="tv-config-toolbar-class" value="">

<$list filter="[all[shadows+tiddlers]tag[$:/tags/PageControls]!has[draft.of]]" variable="listItem">

<div style="position:relative;" class={{{ [<listItem>encodeuricomponent[]addprefix[tc-btn-]] }}}>

<$checkbox tiddler=<<config-title>> field="text" checked="show" unchecked="hide" default="show"/> <$transclude tiddler=<<listItem>>/> <i class="tc-muted"><$transclude tiddler=<<listItem>> field="description"/></i>

</div>

</$list>

</$set>

</$set>

</$set>

<$transclude tiddler="$:/core" subtiddler="$:/core/ui/ViewTemplate/subtitle"/>

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

Open Pages

Recent Edits

$:/_AFC/Palette

\whitespace trim
\define print-button()
<$button tooltip="print" aria-label="print" class=<<tv-config-toolbar-class>>>
<$action-sendmessage $message="tm-open-window" template="$:/plugins/federatial/print/window" windowTitle={{$:/config/plugins/federatial/print/window-title}}/>
<$list filter="[<tv-config-toolbar-icons>prefix[yes]]">
{{$:/core/images/print-button}}
</$list>
<$list filter="[<tv-config-toolbar-text>prefix[yes]]">
<span class="tc-btn-text">
<$text text="print"/>
</span>
</$list>
</$button>
\end
<$list filter="[<currentTiddler>tagging[]role[heading]limit[1]]" variable="ignore" emptyMessage=<<print-button>>>
<$text text=""/>
</$list>

\rules only filteredtranscludeinline transcludeinline macrodef macrocallinline

.tc-export-controls {
	background: #dfddf9;
	margin: -1em -1em 0 -1em;
	padding: 1em;
	border-bottom: 2px solid black;
}

.tc-export-controls textarea {
	width: 100%;
}

.tc-export-header {
	margin-top: 1em;
	padding: 1em;
	border: 1px solid black;
}

@media print {

	.tc-unprintable {
		display: none;
	}

}

<$transclude tiddler="$:/plugins/federatial/print/template/inner" mode="block"/>

! <$view field="title"/>

{{!!text}}

\whitespace trim

<$set name="themeTitle" value={{$:/view}}>

<$set name="tempCurrentTiddler" value=<<currentTiddler>>>

<$set name="currentTiddler" value={{$:/language}}>

<$set name="languageTitle" value={{!!name}}>

<$set name="currentTiddler" value=<<tempCurrentTiddler>>>

<$importvariables filter="[[$:/core/ui/PageMacros]] [all[shadows+tiddlers]tag[$:/tags/Macro]!has[draft.of]]">

<div class="tc-unprintable tc-export-controls">

<$button message="tm-print" tooltip="Print this page">
Print
</$button>

</div>

<$transclude tiddler="$:/plugins/federatial/print/template" mode="block"/>

</$importvariables>

</$set>

</$set>

</$set>

</$set>

</$set>

!! This tiddler is present to disable the default login status pill that Xememex provides

{"tiddlers":{"$:/config/Comments/EnableFilter":{"title":"$:/config/Comments/EnableFilter","text":"[all[current]!is[system]]\n"},"$:/plugins/tiddlywiki/comments/above-story":{"title":"$:/plugins/tiddlywiki/comments/above-story","tags":"$:/tags/AboveStory","text":"<$reveal state=\"$:/config/Comments/EnableWikiComments\" type=\"match\" text=\"yes\" default=\"no\">\n\n<$tiddler tiddler=\"$:/SiteTitle\">\n\n<$transclude tiddler=\"$:/plugins/tiddlywiki/comments/comments-template\" mode=\"inline\"/>\n\n</$tiddler>\n\n</$reveal>\n"},"$:/plugins/tiddlywiki/comments/add-comment-button-actions":{"title":"$:/plugins/tiddlywiki/comments/add-comment-button-actions","text":"<$set name=\"username\" value={{$:/status/UserName}} emptyValue=\"(anonymous)\">\n<$set name=\"target\" filter=\"[<currentTiddler>]\">\n<$action-createtiddler $basetitle={{{ [[Comment by ']addsuffix<username>addsuffix[' on ']addsuffix<currentTiddler>addsuffix[']] }}} role=\"comment\" list=<<target>> text=\"\" edit-mode=\"yes\"/>\n</$set>\n</$set>\n"},"$:/plugins/tiddlywiki/comments/add-comment-button":{"title":"$:/plugins/tiddlywiki/comments/add-comment-button","text":"<$reveal state=\"$:/status/IsReadOnly\" type=\"match\" text=\"no\" default=\"no\" tag=\"div\" class=\"tc-comment-button\">\n<$button class=\"tc-btn-invisible\" actions={{$:/plugins/tiddlywiki/comments/add-comment-button-actions}}>\nadd comment {{$:/core/images/add-comment}}\n</$button>\n</$reveal>\n"},"$:/plugins/tiddlywiki/comments/comments-template":{"title":"$:/plugins/tiddlywiki/comments/comments-template","text":"<div class=\"tc-comments\">\n<ol class=\"tc-comment-list\">\n<$list filter=\"[all[tiddlers+shadows]role[comment]contains<currentTiddler>sort[created]!has[draft.of]]\">\n<li>\n<div class=\"tc-comment-entry\">\n<div class=\"tc-comment-entry-heading\">\n<$link>{{!!creator}} at <$view field=\"modified\" format=\"date\" template=\"0hh:0mm:0ss DDD DDth MMM YYYY\"/></$link>\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/CommentToolbarButton]!has[draft.of]]\" variable=\"listItem\">\n<$transclude tiddler=<<listItem>> mode=\"inline\"/>\n</$list>\n</div>\n<div class=\"tc-comment-entry-body\">\n<$reveal type=\"match\" state=\"!!edit-mode\" text=\"yes\">\n<$edit-text tiddler=<<currentTiddler>> tag=\"textarea\" focus=\"true\"/>\n</$reveal>\n<$reveal type=\"nomatch\" state=\"!!edit-mode\" text=\"yes\">\n<$transclude tiddler=<<currentTiddler>> mode=\"block\"/>\n<$transclude tiddler=\"$:/plugins/tiddlywiki/comments/add-comment-button\" mode=\"inline\"/>\n</$reveal>\n</div>\n</div>\n<$transclude tiddler=\"$:/plugins/tiddlywiki/comments/comments-template\" mode=\"inline\"/>\n</li>\n</$list>\n</ol>\n</div>\n"},"$:/plugins/tiddlywiki/comments/config":{"title":"$:/plugins/tiddlywiki/comments/config","text":"\\define select(description,filter)\n<$button>\n<$action-setfield $tiddler=\"$:/config/Comments/EnableFilter\" $value=<<__filter__>>/>\n$description$\n</$button>\n\\end\n\n! Wiki Comments\n\n<$checkbox tiddler=\"$:/config/Comments/EnableWikiComments\" field=\"text\" checked=\"yes\" unchecked=\"no\" default=\"no\"> <$link to=\"$:/config/Comments/EnableWikiComments\">Allow wiki-level comments as well as tiddler comments</$link> </$checkbox>\n\n! Tiddler Comments\n\nThis filter expression determines which tiddlers will have commenting enabled:\n\n<$edit-text tiddler=\"$:/config/Comments/EnableFilter\" tag=\"input\"/>\n\nOr you can choose a preselected filter:\n\n* <<select \"All tiddlers except system tiddlers\" \"[all[current]!is[system]]\">>\n* <<select \"Only tiddlers tagged 'commentable'\" \"[all[current]tag[commentable]]\">>\n* <<select \"Disable all commenting\" \"\">>\n"},"$:/plugins/tiddlywiki/comments/filter-all-comments":{"title":"$:/plugins/tiddlywiki/comments/filter-all-comments","tags":"$:/tags/Filter","filter":"[role[comment]!sort[modified]]","description":"All comments","text":""},"$:/plugins/tiddlywiki/comments/footer-view-template-segment":{"title":"$:/plugins/tiddlywiki/comments/footer-view-template-segment","tags":"$:/tags/ViewTemplate","list-after":"$:/core/ui/ViewTemplate/body","text":"<$list filter={{$:/config/Comments/EnableFilter}} variable=\"ignore\">\n<div class=\"tc-comments-segment\">\n<$transclude tiddler=\"$:/plugins/tiddlywiki/comments/add-comment-button\" mode=\"inline\"/>\n<$transclude tiddler=\"$:/plugins/tiddlywiki/comments/comments-template\" mode=\"inline\"/>\n</div>\n</$list>"},"$:/plugins/tiddlywiki/comments/header-view-template-segment":{"title":"$:/plugins/tiddlywiki/comments/header-view-template-segment","tags":"$:/tags/ViewTemplate","list-before":"$:/core/ui/ViewTemplate/body","text":"\\define display-original-comment()\n<$link><$text text=<<currentTiddler>>/></$link>\n\\end\n\n\\define find-original-comment(exclude)\n<$list filter=\"[<currentTiddler>role[comment]]\" emptyMessage=<<display-original-comment>> variable=\"ignore\">\n<$list filter=\"[list<currentTiddler>sort[title]] -[enlist<__exclude__>]\">\n<$set name=\"newExclude\" filter=\"[enlist<__exclude__>] [<currentTiddler>]\">\n<$macrocall $name=\"find-original-comment\" exclude=<<newExclude>>/>\n</$set>\n</$list>\n</$list>\n\\end\n\n<$list filter=\"[all[current]role[comment]]\" variable=\"ignore\">\n<div class=\"tc-is-comment-header\">\n<p>\nThis tiddler is a comment on\n<$list filter=\"[list<currentTiddler>sort[title]]\">\n<span class=\"tc-small-gap-right\"><<find-original-comment>></span>\n</$list>\n</p>\n<$list filter=\"[list<currentTiddler>role[comment]sort[title]limit[1]]\" variable=\"ignore\">\n<p>\nParent comments:\n</p>\n<ul>\n<$list filter=\"[list<currentTiddler>role[comment]sort[title]]\">\n<li>\n<$link to=<<currentTiddler>>><$text text=<<currentTiddler>>/></$link>\n</li>\n</$list>\n</ul>\n</$list>\n</div>\n</$list>\n"},"$:/plugins/tiddlywiki/comments/readme":{"title":"$:/plugins/tiddlywiki/comments/readme","text":"This plugin provides a simple means for adding threaded comments to tiddlers.\n\n* Click the \"add comment\" button to make a new comment, and then click the \"save\" button to save it\n* You can comment on a tiddler itself, or add a comment to an existing comment\n* The sidebar tab ''Comments'' lists a timeline of all comments\n* Comments are attributed to the username stored in the system tiddler [[$:/status/UserName]]\n* By default, comments are available on all non-system tiddlers. The ''config'' tab lets you customise which tiddlers can accept comments by specifying a filter extension\n* The buttons for adding and editing comments are only available if the system tiddler [[$:/status/IsReadOnly]] is not set to `yes`\n* Use the \"All comments\" option in the $:/AdvancedSearch ''Filter'' tab to see or export all comments\n\n!! Data Model\n\nThe data model employed by the comments plugin is very simple:\n\n* Comment tiddlers are identified by the `role` field being set to `comment`\n* The `list` field of comment tiddlers lists the tiddlers to which this comment applies\n** It is thus possible for a comment to be applied to multiple tiddlers at once\n** The links between comments can be preserved when renaming them by using the relink checkbox in the edit template\n* The `edit-mode` field of comment tiddlers is set to `yes` to display it in edit mode, or `no` to display it in view mode\n* The `saved-text` field is updated when switching to edit mode so that it can be restored if the user cancels\n\n"},"$:/plugins/tiddlywiki/comments/sidebar-segment":{"title":"$:/plugins/tiddlywiki/comments/sidebar-segment","tags":"$:/tags/SideBarSegment","list-after":"$:/core/ui/SideBarSegments/site-subtitle","text":"<$reveal state=\"$:/config/Comments/EnableWikiComments\" type=\"match\" text=\"yes\" default=\"no\">\n<$tiddler tiddler=\"$:/SiteTitle\">\n<$transclude tiddler=\"$:/plugins/tiddlywiki/comments/add-comment-button\" mode=\"inline\"/>\n</$tiddler>\n</$reveal>\n"},"$:/plugins/tiddlywiki/comments/sidebar":{"title":"$:/plugins/tiddlywiki/comments/sidebar","tags":"$:/tags/SideBar","caption":"Comments","text":"<div class=\"tc-timeline\">\n<$list filter=\"[all[tiddlers+shadows]role[comment]has[modified]!sort[modified]eachday[modified]]\">\n<div class=\"tc-menu-list-item\">\n<$view field=\"modified\" format=\"date\" template=\"DDth MMM YYYY\"/>\n<$list filter=\"[all[tiddlers+shadows]role[comment]sameday:modified{!!modified}!sort[modified]]\">\n<div class=\"tc-menu-list-subitem\">\n<$link>Comment by '<$view field=\"modifier\">(anonymous)</$view>'</$link> on\n<$list filter=\"[list<currentTiddler>sort[title]]\">\n<$link to=<<currentTiddler>>><$text text=<<currentTiddler>>/></$link>\n</$list>\n</div>\n</$list>\n</div>\n</$list>\n</div>\n"},"$:/plugins/tiddlywiki/comments/styles":{"title":"$:/plugins/tiddlywiki/comments/styles","tags":"[[$:/tags/Stylesheet]]","text":"\\rules only filteredtranscludeinline transcludeinline macrodef macrocallinline\n\n.tc-is-comment-header {\n\tpadding: 0.25em;\n\tborder: 2px solid #c1e1ea;\n\tborder-radius: 4px;\n\tbackground: #f1fcff;\n}\n\n.tc-comments-segment {\n\tborder-top: 2px solid #d7eef4;\n}\n\n.tc-comment-button button {\n\twidth: 100%;\n\ttext-align: right;\n}\n\n.tc-sidebar-scrollable .tc-comment-button button {\n\twidth: auto;\n\ttext-align: right;\n}\n\n.tc-comment-button button svg {\n\tfill: #26cb56;\n\theight: 2em;\n\twidth: 2em;\n}\n\n.tc-comments {\n}\n\n.tc-comment-list {\n\tlist-style: none;\n     padding-left: 0;\n}\n\n.tc-comment-list .tc-comments {\n\tpadding-left: 1em;\n}\n\n.tc-comment-entry {\n\tposition: relative;\n\tborder: 2px solid #c1e1ea;\n\tborder-radius: 4px;\n\tmargin: 0.5em 0 0 0;\n\tbackground: #f1fcff;\n}\n\n.tc-comment-entry-heading {\n\tfont-size: 0.7em;\n\tfont-weight: bold;\n\ttext-transform: uppercase;\n\tbackground: #d7eef4;\n\tcolor: #5B6D80;\n\tpadding: 0 0.5em;\n}\n\n.tc-comment-entry-body {\n\tfont-size: 0.8em;\n\tpadding: 0 0.5em;\n}\n\n.tc-comment-entry-body textarea {\n\tfont-size: 1.1em;\n\twidth: 100%\n}\n"},"$:/tags/CommentToolbarButton":{"title":"$:/tags/CommentToolbarButton","list":"[[$:/plugins/tiddlywiki/comments/toolbar-button-cancel]] [[$:/plugins/tiddlywiki/comments/toolbar-button-delete]] [[$:/plugins/tiddlywiki/comments/toolbar-button-save]] [[$:/plugins/tiddlywiki/comments/toolbar-button-edit]]"},"$:/plugins/tiddlywiki/comments/toolbar-button-cancel":{"title":"$:/plugins/tiddlywiki/comments/toolbar-button-cancel","tags":"$:/tags/CommentToolbarButton","text":"<$reveal state=\"$:/status/IsReadOnly\" type=\"match\" text=\"no\" default=\"no\" tag=\"span\">\n<$reveal type=\"match\" state=\"!!edit-mode\" text=\"yes\">\n<$button>\n<$action-setfield $tiddler=<<currentTiddler>> $field=\"edit-mode\" $value=\"no\"/>\n<$action-setfield $tiddler=<<currentTiddler>> $field=\"text\" $value={{!!saved-text}}/>\ncancel\n</$button>\n</$reveal>\n</$reveal>\n"},"$:/plugins/tiddlywiki/comments/toolbar-button-delete":{"title":"$:/plugins/tiddlywiki/comments/toolbar-button-delete","tags":"$:/tags/CommentToolbarButton","text":"<$reveal state=\"$:/status/IsReadOnly\" type=\"match\" text=\"no\" default=\"no\" tag=\"span\">\n<$reveal type=\"match\" state=\"!!edit-mode\" text=\"yes\">\n<$button>\n<$action-deletetiddler $tiddler=<<currentTiddler>>/>\ndelete\n</$button>\n</$reveal>\n</$reveal>\n"},"$:/plugins/tiddlywiki/comments/toolbar-button-edit":{"title":"$:/plugins/tiddlywiki/comments/toolbar-button-edit","tags":"$:/tags/CommentToolbarButton","text":"<$reveal state=\"$:/status/IsReadOnly\" type=\"match\" text=\"no\" default=\"no\" tag=\"span\">\n<$reveal type=\"nomatch\" state=\"!!edit-mode\" text=\"yes\">\n<$button>\n<$action-setfield $tiddler=<<currentTiddler>> $field=\"edit-mode\" $value=\"yes\"/>\n<$action-setfield $tiddler=<<currentTiddler>> $field=\"saved-text\" $value={{!!text}}/>\nedit\n</$button>\n</$reveal>\n</$reveal>\n"},"$:/plugins/tiddlywiki/comments/toolbar-button-save":{"title":"$:/plugins/tiddlywiki/comments/toolbar-button-save","tags":"$:/tags/CommentToolbarButton","text":"<$reveal state=\"$:/status/IsReadOnly\" type=\"match\" text=\"no\" default=\"no\" tag=\"span\">\n<$reveal type=\"match\" state=\"!!edit-mode\" text=\"yes\">\n<$button>\n<$action-setfield $tiddler=<<currentTiddler>> $field=\"edit-mode\" $value=\"no\"/>\nsave\n</$button>\n</$reveal>\n</$reveal>\n"}}}

<div class="tc-timeline">
<$list filter="[all[tiddlers+shadows]role[comment]has[modified]!sort[modified]eachday[modified]]">
<div class="tc-menu-list-item">
<$view field="modified" format="date" template="DDth MMM YYYY"/>
<$list filter="[all[tiddlers+shadows]role[comment]sameday:modified{!!modified}!sort[modified]]">
<div class="tc-menu-list-subitem">
<$link>Comment by '<$view field="modifier">(anonymous)</$view>'</$link> on
<$list filter="[list<currentTiddler>sort[title]]">
<$link to=<<currentTiddler>>><$text text=<<currentTiddler>>/></$link>
</$list>
</div>
</$list>
</div>
</$list>
</div>

{
    "tiddlers": {
        "$:/plugins/tiddlywiki/consent-banner/banner": {
            "title": "$:/plugins/tiddlywiki/consent-banner/banner",
            "tags": "$:/tags/PageTemplate",
            "text": "\\whitespace trim\n\n<$reveal state=\"$:/state/consent-banner/accepted\" type=\"match\" text=\"\" tag=\"div\">\n\n<div class=\"tc-consent-backdrop\">\n\n</div>\n\n<div class=\"tc-consent-banner tc-consent-banner-left\">\n\n<$transclude tiddler=\"$:/config/plugins/tiddlywiki/consent-banner/greeting-message\" mode=\"block\"/>\n\n<div class=\"tc-consent-buttons\">\n\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/ConsentBanner/Button]]\">\n\n<$transclude tiddler=<<currentTiddler>> mode=\"inline\"/>\n\n</$list>\n\n</div>\n\n</div>\n\n</$reveal>\n"
        },
        "$:/plugins/tiddlywiki/consent-banner/blocked-embed-message-wrapper": {
            "title": "$:/plugins/tiddlywiki/consent-banner/blocked-embed-message-wrapper",
            "text": "\\define styles()\nwidth:$(width)$;height:$(height)$;\n\\end\n\n<div class=\"tc-blocked-embedded-content\" style=<<styles>>>\n<div class=\"tc-blocked-embedded-content-inner\">\n<div class=\"tc-blocked-embedded-content-inner-inner\">\n<$transclude tiddler=\"$:/config/plugins/tiddlywiki/consent-banner/blocked-embed-message\" mode=\"inline\"/>\n</div>\n</div>\n</div>\n"
        },
        "$:/plugins/tiddlywiki/consent-banner/buttons/accept": {
            "title": "$:/plugins/tiddlywiki/consent-banner/buttons/accept",
            "tags": "$:/tags/ConsentBanner/Button",
            "text": "<$button message=\"tm-consent-accept\" class=\"tc-consent-button tc-consent-button-default tc-btn-invisible\" tooltip={{$:/config/plugins/tiddlywiki/consent-banner/buttons/accept/hint}}>\n{{$:/config/plugins/tiddlywiki/consent-banner/buttons/accept/caption}}\n</$button>\n"
        },
        "$:/plugins/tiddlywiki/consent-banner/buttons/decline": {
            "title": "$:/plugins/tiddlywiki/consent-banner/buttons/decline",
            "tags": "$:/tags/ConsentBanner/Button",
            "text": "<$button message=\"tm-consent-decline\" class=\"tc-consent-button tc-btn-invisible\" tooltip={{$:/config/plugins/tiddlywiki/consent-banner/buttons/decline/hint}}>\n{{$:/config/plugins/tiddlywiki/consent-banner/buttons/decline/caption}}\n</$button>\n"
        },
        "$:/config/DefaultColourMappings/consent-banner-backdrop-background": {
            "title": "$:/config/DefaultColourMappings/consent-banner-backdrop-background",
            "text": "rgba(0,0,0,0.2)"
        },
        "$:/config/DefaultColourMappings/consent-banner-background": {
            "title": "$:/config/DefaultColourMappings/consent-banner-background",
            "text": "#009677"
        },
        "$:/config/DefaultColourMappings/consent-banner-button-background": {
            "title": "$:/config/DefaultColourMappings/consent-banner-button-background",
            "text": "transparent"
        },
        "$:/config/DefaultColourMappings/consent-banner-button-border": {
            "title": "$:/config/DefaultColourMappings/consent-banner-button-border",
            "text": "#fff"
        },
        "$:/config/DefaultColourMappings/consent-banner-button-default-background": {
            "title": "$:/config/DefaultColourMappings/consent-banner-button-default-background",
            "text": "#fff"
        },
        "$:/config/DefaultColourMappings/consent-banner-button-default-foreground": {
            "title": "$:/config/DefaultColourMappings/consent-banner-button-default-foreground",
            "text": "#009677"
        },
        "$:/config/DefaultColourMappings/consent-banner-button-foreground": {
            "title": "$:/config/DefaultColourMappings/consent-banner-button-foreground",
            "text": "#fff"
        },
        "$:/config/DefaultColourMappings/consent-banner-button-hover-background": {
            "title": "$:/config/DefaultColourMappings/consent-banner-button-hover-background",
            "text": "#fff"
        },
        "$:/config/DefaultColourMappings/consent-banner-button-hover-border": {
            "title": "$:/config/DefaultColourMappings/consent-banner-button-hover-border",
            "text": "#fff"
        },
        "$:/config/DefaultColourMappings/consent-banner-button-hover-foreground": {
            "title": "$:/config/DefaultColourMappings/consent-banner-button-hover-foreground",
            "text": "#009577"
        },
        "$:/config/DefaultColourMappings/consent-banner-foreground": {
            "title": "$:/config/DefaultColourMappings/consent-banner-foreground",
            "text": "#fff"
        },
        "$:/config/DefaultColourMappings/consent-banner-hr-background": {
            "title": "$:/config/DefaultColourMappings/consent-banner-hr-background",
            "text": "rgba(255,255,255,.25)"
        },
        "$:/config/DefaultColourMappings/consent-banner-link-foreground": {
            "title": "$:/config/DefaultColourMappings/consent-banner-link-foreground",
            "text": "#fff"
        },
        "$:/config/plugins/tiddlywiki/consent-banner/block-embedded-content": {
            "title": "$:/config/plugins/tiddlywiki/consent-banner/block-embedded-content",
            "text": "yes"
        },
        "$:/config/plugins/tiddlywiki/consent-banner/blocked-embed-message": {
            "title": "$:/config/plugins/tiddlywiki/consent-banner/blocked-embed-message",
            "text": "Blocked embedded content from<br/><a href=<<url>> class=\"tc-tiddlylink-external\" target=\"_blank\" rel=\"noopener noreferrer\"><$text text=<<url>>/></a>\n\n<hr/>\n\n{{$:/plugins/tiddlywiki/consent-banner/buttons/accept}} cookies to unblock"
        },
        "$:/config/plugins/tiddlywiki/consent-banner/blocked-raw-message": {
            "title": "$:/config/plugins/tiddlywiki/consent-banner/blocked-raw-message",
            "text": "<div class=\"tc-blocked-embedded-content\" style=\"width:100%;\">\n\n<div class=\"tc-blocked-embedded-content-inner\">\n\n<div class=\"tc-blocked-embedded-content-inner-inner\">\n\nBlocked raw content\n\n<hr/>\n\n{{$:/plugins/tiddlywiki/consent-banner/buttons/accept}} cookies to unblock\n\n</div>\n\n</div>\n\n</div>\n"
        },
        "$:/config/plugins/tiddlywiki/consent-banner/buttons/accept/caption": {
            "title": "$:/config/plugins/tiddlywiki/consent-banner/buttons/accept/caption",
            "text": "Accept"
        },
        "$:/config/plugins/tiddlywiki/consent-banner/buttons/accept/hint": {
            "title": "$:/config/plugins/tiddlywiki/consent-banner/buttons/accept/hint",
            "text": "Accept cookies"
        },
        "$:/config/plugins/tiddlywiki/consent-banner/buttons/clear/caption": {
            "title": "$:/config/plugins/tiddlywiki/consent-banner/buttons/clear/caption",
            "text": "Clear"
        },
        "$:/config/plugins/tiddlywiki/consent-banner/buttons/clear/hint": {
            "title": "$:/config/plugins/tiddlywiki/consent-banner/buttons/clear/hint",
            "text": "Clear cookies"
        },
        "$:/config/plugins/tiddlywiki/consent-banner/buttons/decline/caption": {
            "title": "$:/config/plugins/tiddlywiki/consent-banner/buttons/decline/caption",
            "text": "Decline"
        },
        "$:/config/plugins/tiddlywiki/consent-banner/buttons/decline/hint": {
            "title": "$:/config/plugins/tiddlywiki/consent-banner/buttons/decline/hint",
            "text": "Decline cookies"
        },
        "$:/config/cookie-consent-required": {
            "title": "$:/config/cookie-consent-required",
            "text": "yes"
        },
        "$:/config/plugins/tiddlywiki/consent-banner/greeting-message": {
            "title": "$:/config/plugins/tiddlywiki/consent-banner/greeting-message",
            "text": "! Our use of cookies\n\nWe use necessary cookies to make our site work. We’d also like to set optional analytics to help us improve it. We won’t set optional cookies unless you enable them. Using this tool will set a cookie on your device to remember your preferences.\n\n---\n\n!! Necessary cookies\n\nNecessary cookies enable core functionality such as security, network management, and accessibility. You may disable these by changing your browser settings, but this may affect how the website functions.\n\n---\n\n!! Analytics cookies\n\nWe’d like to set non-essential cookies, such as Google Analytics, to help us to improve our website by collecting and reporting information on how you use it. The cookies collect information in a way that does not directly identify anyone.\n\n---\n"
        },
        "$:/plugins/tiddlywiki/consent-banner/tv-block-embedded-content": {
            "title": "$:/plugins/tiddlywiki/consent-banner/tv-block-embedded-content",
            "tags": "$:/tags/Macro",
            "text": "<$set name=\"tv-block-embedded-content\" value={{{ [{$:/config/cookie-consent-required}else[no]match[yes]then{$:/state/consent-banner/accepted}!match[yes]then[yes]] }}}/>\n"
        },
        "$:/plugins/tiddlywiki/consent-banner/config": {
            "title": "$:/plugins/tiddlywiki/consent-banner/config",
            "text": "! [[Greeting Message|$:/config/plugins/tiddlywiki/consent-banner/greeting-message]]\n\n<div style=\"\">\n\n<div style=\"display:inline-block;vertical-align:top;width:45%;\">\n\n<$edit-text tiddler=\"$:/config/plugins/tiddlywiki/consent-banner/greeting-message\" tag=\"textarea\" class=\"tc-edit-texteditor\"/>\n\n</div>\n\n<div style=\"display:inline-block;vertical-align:top;width:45%;margin:0.5em;border:1px solid black;padding:0.5em;\" class=\"tc-consent-banner\">\n\n<$transclude tiddler=\"$:/config/plugins/tiddlywiki/consent-banner/greeting-message\" mode=\"block\"/>\n\n</div>\n\n</div>\n\n! Buttons\n\n|[[Accept caption|$:/config/plugins/tiddlywiki/consent-banner/buttons/accept/caption]] |<$edit-text tiddler=\"$:/config/plugins/tiddlywiki/consent-banner/buttons/accept/caption\" tag=\"input\"/> |\n|[[Accept hint|$:/config/plugins/tiddlywiki/consent-banner/buttons/accept/hint]] |<$edit-text tiddler=\"$:/config/plugins/tiddlywiki/consent-banner/buttons/accept/hint\" tag=\"input\"/> |\n|[[Decline caption|$:/config/plugins/tiddlywiki/consent-banner/buttons/decline/caption]] |<$edit-text tiddler=\"$:/config/plugins/tiddlywiki/consent-banner/buttons/decline/caption\" tag=\"input\"/> |\n|[[Decline hint|$:/config/plugins/tiddlywiki/consent-banner/buttons/decline/hint]] |<$edit-text tiddler=\"$:/config/plugins/tiddlywiki/consent-banner/buttons/decline/hint\" tag=\"input\"/> |\n\n! [[Consent Accepted Status|$:/state/consent-banner/accepted]]\n\nCurrent status: {{$:/state/consent-banner/accepted}} (blank indicates that consent has not yet been granted or declined)\n\n<$button message=\"tm-consent-accept\" tooltip={{$:/config/plugins/tiddlywiki/consent-banner/buttons/accept/hint}}>\n{{$:/config/plugins/tiddlywiki/consent-banner/buttons/accept/caption}}\n</$button>\n\n<$button message=\"tm-consent-decline\" tooltip={{$:/config/plugins/tiddlywiki/consent-banner/buttons/decline/hint}}>\n{{$:/config/plugins/tiddlywiki/consent-banner/buttons/decline/caption}}\n</$button>\n\n<$button message=\"tm-consent-clear\" tooltip={{$:/config/plugins/tiddlywiki/consent-banner/buttons/clear/hint}}>\n{{$:/config/plugins/tiddlywiki/consent-banner/buttons/clear/caption}}\n</$button>\n\n! Embedded Content Blocking\n\n//Requires page reload//\n\n<$checkbox tiddler=\"$:/config/plugins/tiddlywiki/consent-banner/block-embedded-content\" field=\"text\" checked=\"yes\" unchecked=\"no\" default=\"no\"> Block all embedded content such as &lt;iframe>, &lt;embed> and &lt;object> unless consent has been granted</$checkbox>\n"
        },
        "$:/plugins/tiddlywiki/consent-banner/docs": {
            "title": "$:/plugins/tiddlywiki/consent-banner/docs",
            "text": "! Features\n\nIf the same wiki is opened in multiple tabs then once the warning has been accepted or declined in one tab then the other tabs will autonatically follow suit.\n\nConsent is automatically granted if the user logged in (ie the tiddler [[$:/status/IsLoggedIn]] is set to `yes`).\n\n! Consent Banner Palette Entries\n\nAdd these entries to your current colour palette to change the colours used by the consent banner:\n\n* ''consent-banner-backdrop-background'' - the colour of the backdrop behind the consent banner (defaults to {{$:/config/DefaultColourMappings/consent-banner-backdrop-background}})\n* ''consent-banner-background'' - the background colour of the consent banner (defaults to {{$:/config/DefaultColourMappings/consent-banner-background}})\n* ''consent-banner-button-background'' - the background colour of buttons within the consent banner (defaults to {{$:/config/DefaultColourMappings/consent-banner-button-background}})\n* ''consent-banner-button-border'' - the border colour of buttons within the consent banner (defaults to {{$:/config/DefaultColourMappings/consent-banner-button-border}})\n* ''consent-banner-button-default-background'' - the background colour for the default button within the consent banner (defaults to {{$:/config/DefaultColourMappings/consent-banner-button-default-background}})\n* ''consent-banner-button-default-foreground'' - the foreground colour for the default button within the consent banner (defaults to {{$:/config/DefaultColourMappings/consent-banner-button-default-foreground}})\n* ''consent-banner-button-foreground'' - the foreground colour of buttons within the consent banner (defaults to {{$:/config/DefaultColourMappings/consent-banner-button-foreground}})\n* ''consent-banner-button-hover-background'' - the background colour of hovered buttons within the consent banner (defaults to {{$:/config/DefaultColourMappings/consent-banner-button-hover-background}})\n* ''consent-banner-button-hover-border'' - the border colour of hovered buttons within the consent banner (defaults to {{$:/config/DefaultColourMappings/consent-banner-button-hover-border}})\n* ''consent-banner-button-hover-foreground'' - the foreground colour of hovered buttons within the consent banner (defaults to {{$:/config/DefaultColourMappings/consent-banner-button-hover-foreground}})\n* ''consent-banner-foreground'' - the foreground colour of the consent banner (defaults to {{$:/config/DefaultColourMappings/consent-banner-foreground}})\n* ''consent-banner-hr-background'' - the background colour of horizontal rules within the consent banner (defaults to {{$:/config/DefaultColourMappings/consent-banner-hr-background}})\n* ''consent-banner-link-foreground'' - the foreground colour of tiddler links within the consent banner (defaults to {{$:/config/DefaultColourMappings/consent-banner-link-foreground}})\n\n! Embedded Content Blocking\n\nUnless disabled via the config tab, content embedded via &lt;iframe>, &lt;embed> or &lt;object> is blocked until the user consents to accept cookies.\n\n!! Implementation Details\n\nEmbedded content is blocked if the variable `tv-block-embedded-content` is set to `yes`. It is set to the current consent status by a [[global macro|$:/plugins/tiddlywiki/consent-banner/tv-block-embedded-content]]:\n\n<$codeblock code={{$:/plugins/tiddlywiki/consent-banner/tv-block-embedded-content}}/>\n\n! ~YouTube macro\n\nA simple macro for embedding ~YouTube videos is provided to show how to adapt content according to whether consent has been granted. It works by checking the tiddler [[$:/state/consent-banner/accepted]] for the following values:\n\n* ''empty or missing'' - the user has yet to accept or decline to give their consent\n* `yes` - the user has granted consent\n* `no` - the user has declined consent\n\n! Customising banner buttons\n\nThe [[\"accept\"|$:/plugins/tiddlywiki/consent-banner/buttons/accept]] and [[\"decline\"|$:/plugins/tiddlywiki/consent-banner/buttons/decline]] buttons in the banner are individual tiddlers with the tag [[$:/tags/ConsentBanner/Button]], allowing them to be customised and extended.\n\nA common use case is to add a \"login\" button allowing users to login directly to bypass the banner. This could be implemented as a tiddler tagged [[$:/tags/ConsentBanner/Button]] with the following text:\n\n```\n<$button message=\"tm-login\" class=\"tc-consent-button tc-btn-invisible\">\nLogin\n</$button>\n```\n\n! Integration with other plugins\n\nThird party plugins that set cookies can configure themselves to defer setting cookies until the user grants consent. There are several parts to this mechanism:\n\n* The consent-banner plugin includes a shadow tiddler [[$:/config/cookie-consent-required]] with the text `yes`. The third-party plugin should inspect this tiddler at startup; if it is not set to \"yes\" then it can proceed to set tiddlers immediately\n* Otherwise, the third-party plugin should listen for changes to the tiddler [[$:/state/consent-banner/accepted]] and only start setting cookies when and if the value changes to \"yes\"\n\nThe [[Google Analytics plugin|https://github.com/Jermolene/TiddlyWiki5/tree/master/plugins/tiddlywiki/googleanalytics]] shows an example of how this mechanism can be implemented.\n"
        },
        "$:/core/modules/widgets/raw.js": {
            "title": "$:/core/modules/widgets/raw.js",
            "text": "/*\\\ntitle: $:/core/modules/widgets/raw.js\ntype: application/javascript\nmodule-type: widget\n\nAn override of the raw widget that blocks raw content until the user has consented to accept cookies\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\nvar Widget = require(\"$:/core/modules/widgets/widget.js\").widget;\n\nvar RawWidget = function(parseTreeNode,options) {\n\tthis.initialise(parseTreeNode,options);\n};\n\n/*\nInherit from the base widget class\n*/\nRawWidget.prototype = new Widget();\n\n/*\nRender this widget into the DOM\n*/\nRawWidget.prototype.render = function(parent,nextSibling) {\n\tthis.parentDomNode = parent;\n\tthis.execute();\n\tthis.blocked = this.getVariable(\"tv-block-embedded-content\",\"no\") === \"yes\";\n\tif(this.blocked) {\n\t\tthis.makeChildWidgets([{\n\t\t\ttype: \"transclude\",\n\t\t\tattributes: {\n\t\t\t\ttiddler: {type: \"string\", value: \"$:/config/plugins/tiddlywiki/consent-banner/blocked-raw-message\"}\n\t\t\t}\n\t\t}]);\n\t\t// Render child widgets\n\t\tthis.renderChildren(parent,null);\n\t} else {\n\t\tvar div = this.document.createElement(\"div\");\n\t\tdiv.innerHTML=this.parseTreeNode.html;\n\t\tparent.insertBefore(div,nextSibling);\n\t\tthis.domNodes.push(div);\n\t}\n};\n\n/*\nCompute the internal state of the widget\n*/\nRawWidget.prototype.execute = function() {\n};\n\n/*\nSelectively refreshes the widget if needed. Returns true if the widget or any of its children needed re-rendering\n*/\nRawWidget.prototype.refresh = function(changedTiddlers) {\n\tif(this.blocked) {\n\t\treturn this.refreshChildren(changedTiddlers);\n\t} else {\n\t\treturn false;\t\t\n\t}\n};\n\nexports.raw = RawWidget;\n\n})();\n",
            "type": "application/javascript",
            "module-type": "widget"
        },
        "$:/plugins/tiddlywiki/consent-banner/readme": {
            "title": "$:/plugins/tiddlywiki/consent-banner/readme",
            "text": "The ''consent-banner'' plugin helps make websites that are compliant with \"cookie legislation\" such as the [[EU General Data Protection Regulation|https://gdpr.eu/cookies/]].\nIt presents a banner inviting the user to accept or reject cookies, keeping track of their consent in local storage so that the banner can be hidden on subsequent visits.\n\nBy default, content embedded with &lt;iframe>, &lt;embed> and &lt;object> is blocked unless the user consents to accept cookies.\n\nConsent status is  available via a configuration tiddler so that it is possible to construct content that behaves differently depending upon whether consent has been granted. As an example, a macro is provided for embedding ~YouTube videos that automatically uses the youtube-nocookie.com variant of video URLs unless the user has accepted cookies.\n\nPlease note that using this plugin does not guarantee compliance with any particular legislation. You will need to understand the technical issues specific to your situation, and if necessary seek legal advice.\n"
        },
        "$:/plugins/tiddlywiki/consent-banner/startup.js": {
            "title": "$:/plugins/tiddlywiki/consent-banner/startup.js",
            "text": "/*\\\ntitle: $:/plugins/tiddlywiki/consent-banner/startup.js\ntype: application/javascript\nmodule-type: startup\n\nStartup initialisation\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n// Export name and synchronous status\nexports.name = \"consent-banner\";\nexports.platforms = [\"browser\"];\nexports.after = [\"startup\"];\nexports.before = [\"render\"];\nexports.synchronous = true;\n\nvar CHECK_CONSENT_INTERVAL = 1000, // Milliseconds between checking local storage\n\tIS_LOGGED_IN_TITLE = \"$:/status/IsLoggedIn\",\n\tCONSENT_KEY = \"COOKIE_CONSENT\", // Local storage keyname\n\tCONSENT_TITLE = \"$:/state/consent-banner/accepted\", // \"\": undeclared, \"yes\": accepted, \"no\": declined\n\tCONFIG_BLOCK_EMBEDDED_CONTENT_TITLE = \"$:/config/plugins/tiddlywiki/consent-banner/block-embedded-content\",\n\tEMBEDDED_MESSAGE_WRAPPER_TITLE = \"$:/plugins/tiddlywiki/consent-banner/blocked-embed-message-wrapper\";\n\nexports.startup = function() { \n\tvar consentState = \"\",\n\t\tsetConsentStatus = function(state) {\n\t\t\tif(consentState !== state) {\n\t\t\t\tconsentState = state;\n\t\t\t\t// Write to local storage\n\t\t\t\twindow.localStorage.setItem(CONSENT_KEY,state);\n\t\t\t\t// Write to a state tiddler\n\t\t\t\t$tw.wiki.addTiddler(new $tw.Tiddler({\n\t\t\t\t\ttitle: CONSENT_TITLE,\n\t\t\t\t\ttext: state\n\t\t\t\t}));\n\t\t\t}\n\t\t},\n\t\tcalculateConsentStatus = function() {\n\t\t\t// Consent is implied for logged in users, otherwise we check local storage\n\t\t\treturn ($tw.wiki.getTiddlerText(IS_LOGGED_IN_TITLE) === \"yes\" && \"yes\") || window.localStorage.getItem(CONSENT_KEY) || \"\";\n\t\t},\n\t\tcheckConsentStatus = function() {\n\t\t\tsetConsentStatus(calculateConsentStatus());\n\t\t\tif(consentState === \"\") {\n\t\t\t\tpollConsentStatus();\n\t\t\t}\n\t\t},\n\t\tpollConsentStatus = function() {\n\t\t\tsetTimeout(checkConsentStatus,CHECK_CONSENT_INTERVAL);\n\t\t};\n\t// Set the current consent status\n\tcheckConsentStatus();\n\t// Listen for consent messages\n\t$tw.rootWidget.addEventListener(\"tm-consent-accept\",function(event) {\n\t\tsetConsentStatus(\"yes\");\n\t});\n\t$tw.rootWidget.addEventListener(\"tm-consent-decline\",function(event) {\n\t\tsetConsentStatus(\"no\");\n\t});\n\t$tw.rootWidget.addEventListener(\"tm-consent-clear\",function(event) {\n\t\tsetConsentStatus(\"\");\n\t});\n\t// Add our element rendering hook\n\tif($tw.wiki.getTiddlerText(CONFIG_BLOCK_EMBEDDED_CONTENT_TITLE,\"no\") === \"yes\") {\n\t\t$tw.hooks.addHook(\"th-rendering-element\",function(parseTreeNodes,widget) {\n\t\t\tif(parseTreeNodes) {\n\t\t\t\treturn parseTreeNodes;\n\t\t\t}\n\t\t\tif([\"iframe\",\"object\",\"embed\"].indexOf(widget.tag) !== -1 && widget.getVariable(\"tv-block-embedded-content\",\"no\") === \"yes\") {\n\t\t\t\tvar url = widget.getAttribute(\"src\"),\n\t\t\t\t\taddUnitsIfMissing = function(str) {\n\t\t\t\t\t\tstr = \"\" + str;\n\t\t\t\t\t\treturn str + ((\"\" + parseInt(str,10)) === str ? \"px\" : \"\");\n\t\t\t\t\t},\n\t\t\t\t\twidth = addUnitsIfMissing(widget.getAttribute(\"width\",\"\")),\n\t\t\t\t\theight = addUnitsIfMissing(widget.getAttribute(\"height\",\"\"));\n\t\t\t\treturn [\n\t\t\t\t\t{\n\t\t\t\t\t\ttype: \"vars\",\n\t\t\t\t\t\tattributes: {\n\t\t\t\t\t\t\turl: {type: \"string\", value: url},\n\t\t\t\t\t\t\twidth: {type: \"string\", value: width},\n\t\t\t\t\t\t\theight: {type: \"string\", value: height}\n\t\t\t\t\t\t},\n\t\t\t\t\t\tchildren: [\n\t\t\t\t\t\t\t{\n\t\t\t\t\t\t\t\ttype: \"transclude\",\n\t\t\t\t\t\t\t\tattributes: {\n\t\t\t\t\t\t\t\t\ttiddler: {type: \"string\", value: EMBEDDED_MESSAGE_WRAPPER_TITLE},\n\t\t\t\t\t\t\t\t\tmode: {type: \"string\", value: \"inline\"}\n\t\t\t\t\t\t\t\t}\n\t\t\t\t\t\t\t}\n\t\t\t\t\t\t]\n\t\t\t\t\t}\n\t\t\t\t];\n\t\t\t}\n\t\t\treturn null;\n\t\t});\n\t}\n};\n\n})();\n",
            "type": "application/javascript",
            "module-type": "startup"
        },
        "$:/plugins/tiddlywiki/consent-banner/styles": {
            "title": "$:/plugins/tiddlywiki/consent-banner/styles",
            "tags": "$:/tags/Stylesheet",
            "text": ".tc-consent-backdrop {\n\tz-index: 1999;\n\tposition: fixed;\n\tleft: 0;\n\tright: 0;\n\ttop: 0;\n\tbottom: 0;\n\tbackground: <<colour consent-banner-backdrop-background>>;\n}\n\n.tc-consent-banner-left {\n\tz-index: 2000;\n\tposition: fixed;\n\tleft: 0;\n\ttop: 0;\n\tbottom: 0;\n\tmax-width: 500px;\n\toverflow-y: auto;\n}\n\n.tc-consent-banner {\n\tpadding: 1em;\n\tbackground: <<colour consent-banner-background>>;\n\tcolor: <<colour consent-banner-foreground>>;\n\tbox-shadow: 0 0 20px rgba(0,0,0,.2);\n}\n\n.tc-consent-banner a.tc-tiddlylink-external {\n\ttext-decoration: underline;\n\tcolor: <<colour consent-banner-link-foreground>>;\n\tbackground-color: inherit;\n}\n\n.tc-consent-banner a.tc-tiddlylink-external:visited {\n\tcolor: <<colour consent-banner-link-foreground>>;\n\tbackground-color: inherit;\n}\n\n.tc-consent-banner hr {\n\tclear: both;\n\tpadding: 0;\n\twidth: 100%;\n\toverflow: hidden;\n\ttext-align: left;\n\tborder: 0 none;\n\tmargin: 24px 0;\n\theight: 1px;\n\tmax-height: 1px;\n\tbackground: <<colour consent-banner-hr-background>>;\n}\n\n.tc-consent-buttons {\n\t\n}\n\n.tc-consent-banner .tc-consent-button {\n\tmargin-right: 1em;\n}\n\n.tc-consent-button {\n\tborder: 1px solid <<colour consent-banner-button-border>>;\n\tmargin-top: 1em;\n\tpadding: 0.75em 1.5em;\n\tcolor: <<colour consent-banner-button-foreground>>;\n\tbackground: <<colour consent-banner-button-background>>;\n\tfont-weight: bold;\n}\n\n.tc-consent-button:hover {\n\tcolor: <<colour consent-banner-button-hover-foreground>>;\n\tborder-color: <<colour consent-banner-button-hover-border>>;\n\tbackground: <<colour consent-banner-button-hover-background>>;\n\topacity: .6;\n}\n\n.tc-consent-button-default {\n\tcolor: <<colour consent-banner-button-default-foreground>>;\n\tbackground: <<colour consent-banner-button-default-background>>;\n}\n\n.tc-blocked-embedded-content {\n\tdisplay: inline-block;\n\toverflow: hidden;\n\tcolor: <<colour background>>;\n\tbackground: <<colour muted-foreground>>;\n\tborder: 1px solid <<colour foreground>>;\n\t<<box-shadow \"inset 0 0 8px rgba(0, 0, 0, 0.15)\">>\n}\n\n.tc-blocked-embedded-content-inner {\n  display: flex;\n  justify-content: center;\n  align-items: center;\n  width: 100%;\n  height: 100%;\n}\n\n.tc-blocked-embedded-content-inner-inner {\n\tdisplay: inline-block;\n\ttext-align: center;\n}\n\n.tc-blocked-embedded-content-inner-inner hr {\n    background: <<colour foreground>>;\n    height: 1px;\n    width: 80%;\n    border: none;\n}\n"
        },
        "$:/plugins/tiddlywiki/consent-banner/youtube": {
            "title": "$:/plugins/tiddlywiki/consent-banner/youtube",
            "tags": "$:/tags/Macro",
            "text": "\\define embed-video-with-consent(code)\n<$set name=\"tv-block-embedded-content\" value=\"no\">\n<$reveal state=\"$:/state/consent-banner/accepted\" type=\"match\" text=\"yes\" tag=\"div\">\n<iframe width=\"560\" height=\"315\" src=\"https://www.youtube.com/embed/$code$\" frameborder=\"0\" allow=\"autoplay; encrypted-media\" allowfullscreen></iframe>\n</$reveal>\n<$reveal state=\"$:/state/consent-banner/accepted\" type=\"nomatch\" text=\"yes\" tag=\"div\">\n<iframe width=\"560\" height=\"315\" src=\"https://www.youtube-nocookie.com/embed/$code$\" frameborder=\"0\" allow=\"autoplay; encrypted-media\" allowfullscreen></iframe>\n</$reveal>\n</$set>\n\\end\n\n! Macro source\n\n<$codeblock code={{$:/plugins/tiddlywiki/consent-banner/youtube}}/>\n\n! Example\n\n<<embed-video-with-consent KtCUr83XgyE>>\n"
        }
    }
}

{
    "tiddlers": {
        "$:/plugins/tiddlywiki/googleanalytics/googleanalytics.js": {
            "title": "$:/plugins/tiddlywiki/googleanalytics/googleanalytics.js",
            "text": "/*\\\ntitle: $:/plugins/tiddlywiki/googleanalytics/googleanalytics.js\ntype: application/javascript\nmodule-type: startup\n\nRuns Google Analytics with the account number in the tiddler `$:/GoogleAnalyticsAccount` and the domain name in `$:/GoogleAnalyticsDomain`\n\n\\*/\n(function(){\n\n/*jslint node: true, browser: true */\n/*global $tw: false */\n\"use strict\";\n\n// Export name and synchronous status\nexports.name = \"google-analytics\";\nexports.platforms = [\"browser\"];\nexports.synchronous = true;\n\nvar CONFIG_CONSENT_REQUIRED_TITLE = \"$:/config/cookie-consent-required\",\n\tCONSENT_TITLE = \"$:/state/consent-banner/accepted\"; // \"\": undeclared, \"yes\": accepted, \"no\": declined\n\nexports.startup = function() {\n\tvar hasInitialised = false,\n\t\tinitialiseGoogleAnalytics = function() {\n\t\t\tconsole.log(\"Initialising Google Analytics\");\n\t\t\thasInitialised = true;\n\t\t\tvar gaAccount = $tw.wiki.getTiddlerText(\"$:/GoogleAnalyticsAccount\",\"\").replace(/\\n/g,\"\"),\n\t\t\t\tgaDomain = $tw.wiki.getTiddlerText(\"$:/GoogleAnalyticsDomain\",\"auto\").replace(/\\n/g,\"\");\n\t\t\t// Using ga \"isogram\" function\n\t\t\t(function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){\n\t\t\t(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),\n\t\t\tm=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)\n\t\t\t})(window,document,'script','https://www.google-analytics.com/analytics.js','ga');\n\t\t\tga('create',gaAccount,gaDomain);\n\t\t\tga('send','pageview');\n\t\t};\n\t// Initialise now if consent isn't required\n\tif($tw.wiki.getTiddlerText(CONFIG_CONSENT_REQUIRED_TITLE) !== \"yes\") {\n\t\tinitialiseGoogleAnalytics();\n\t} else {\n\t\t// Or has been granted already\n\t\tif($tw.wiki.getTiddlerText(CONSENT_TITLE) === \"yes\") {\n\t\t\tinitialiseGoogleAnalytics();\n\t\t} else {\n\t\t\t// Or when our config tiddler changes\n\t\t\t$tw.wiki.addEventListener(\"change\",function(changes) {\n\t\t\t\tif(changes[CONSENT_TITLE]) {\n\t\t\t\t\tif(!hasInitialised && $tw.wiki.getTiddlerText(CONSENT_TITLE) === \"yes\") {\n\t\t\t\t\t\tinitialiseGoogleAnalytics();\n\t\t\t\t\t}\n\t\t\t\t}\n\t\t\t});\n\t\t}\n\t}\n};\n\n\n\n})();\n",
            "type": "application/javascript",
            "module-type": "startup"
        },
        "$:/plugins/tiddlywiki/googleanalytics/readme": {
            "title": "$:/plugins/tiddlywiki/googleanalytics/readme",
            "text": "This plugin enables you to use Google Analytics to track access to your online TiddlyWiki document. Based upon the [[official Google code|https://developers.google.com/analytics/devguides/collection/analyticsjs]].\n\nBy default, the user is not asked for permission before initialising Google Analytics. This plugin also optionally integrates with the \"Consent Banner\" plugin (also found in the official plugin library) so that Google Analytics is not initialised until the user grants explicit permission.\n\n[[Source code|https://github.com/Jermolene/TiddlyWiki5/blob/master/plugins/tiddlywiki/googleanalytics]]\n"
        },
        "$:/plugins/tiddlywiki/googleanalytics/settings": {
            "title": "$:/plugins/tiddlywiki/googleanalytics/settings",
            "text": "You have only two value to set, only first is mandatory:\n\n# ''[[Google Analytics Account|$:/GoogleAnalyticsAccount]]'': (mandatory) a code of the form `UA-XXXXXX-XX` where X are digits<br/><$edit-text tiddler=\"$:/GoogleAnalyticsAccount\" default=\"\" tag=\"input\"/>\n\n# ''[[Google Analytics Domain|$:/GoogleAnalyticsDomain]]'': (optional) the website URL where the TiddlyWiki file is published. Defaults to `auto` if not set.<br/><$edit-text tiddler=\"$:/GoogleAnalyticsDomain\" default=\"\" tag=\"input\"/>\n"
        },
        "$:/plugins/tiddlywiki/googleanalytics/usage": {
            "title": "$:/plugins/tiddlywiki/googleanalytics/usage",
            "text": "!! Create a Google Analytics account\n\nIf you don't already have an account:\n\n# Go to the Google Analytics website: http://www.google.com/analytics/\n# Click the ''Access Google Analytics'' button and follow instructions to set up your account\n# Enter the URL where the wiki is hosted\n# Note the Tracking ID for this domain of the form `UA-XXXXXX-XX`\n\n!! Install the plugin on your local copy of the TiddlyWiki\n\n# ''Backup your TiddlyWiki''. Just in case\n# Install the plugin via the plugin manager in control panel\n# Save the TiddlyWiki andrefresh the page to load the plugin\n# Go to [[$:/ControlPanel]] > Plugins tab and unfold the Google Analytics Plugin\n# Go to the //settings// tab and edit the parameters\n# Save the TiddlyWiki\n\n!! Upload the new version of your TiddlyWiki\n\n# Upload the saved TiddlyWiki to TiddlySpot, GitHub, GitLab or other web host\n# Return to your Google Analytics page to check that your site is being tracked\n"
        }
    }
}

{"tiddlers":{"$:/config/DefaultColourMappings/menubar-foreground":{"title":"$:/config/DefaultColourMappings/menubar-foreground","text":"#fff"},"$:/config/DefaultColourMappings/menubar-background":{"title":"$:/config/DefaultColourMappings/menubar-background","text":"#5778d8"},"$:/config/plugins/menubar/MenuItems/Visibility/$:/plugins/tiddlywiki/menubar/items/pagecontrols":{"title":"$:/config/plugins/menubar/MenuItems/Visibility/$:/plugins/tiddlywiki/menubar/items/pagecontrols","text":"hide"},"$:/config/plugins/menubar/MenuItems/Visibility/$:/plugins/tiddlywiki/menubar/items/server":{"title":"$:/config/plugins/menubar/MenuItems/Visibility/$:/plugins/tiddlywiki/menubar/items/server","text":"hide"},"$:/config/plugins/menubar/MenuItems/Visibility/$:/plugins/tiddlywiki/menubar/items/sidebar":{"title":"$:/config/plugins/menubar/MenuItems/Visibility/$:/plugins/tiddlywiki/menubar/items/sidebar","text":"hide"},"$:/config/plugins/menubar/TableOfContents/Tag":{"title":"$:/config/plugins/menubar/TableOfContents/Tag","text":"TableOfContents"},"$:/config/plugins/menubar/breakpoint":{"title":"$:/config/plugins/menubar/breakpoint","text":"620px"},"$:/plugins/tiddlywiki/menubar/config":{"title":"$:/plugins/tiddlywiki/menubar/config","tags":"$:/tags/ControlPanel/Toolbars","caption":"Menu Bar","text":"\\define config-base() $:/config/plugins/menubar/MenuItems/Visibility/\n\n! Menu Bar Configuration\n\n!! Menu Items\n\nSelect which menu items will be shown. You can also drag items to reorder them.\n\n<$set name=\"tv-config-toolbar-icons\" value=\"yes\">\n\n<$set name=\"tv-config-toolbar-text\" value=\"yes\">\n\n<$macrocall $name=\"list-tagged-draggable\" tag=\"$:/tags/MenuBar\" itemTemplate=\"$:/core/ui/ControlPanel/Toolbars/ItemTemplate\"/>\n\n</$set>\n\n</$set>\n\n!! Breakpoint Position\n\nThe breakpoint position between narrow and wide screens. Should include CSS units (eg. `400px`).\n\n<$edit-text tiddler=\"$:/config/plugins/menubar/breakpoint\" default=\"\" tag=\"input\"/>\n\n!! Contents Tag\n\nThe tag for the ~TableOfContents used in the Contents dropdown\n\n<$edit-text tiddler=\"$:/config/plugins/menubar/TableOfContents/Tag\" default=\"\" tag=\"input\"/>\n\n!! Menu Bar Colours\n\nTo change the colour of the menu bar, define the colours `menubar-foreground` and `menubar-background` in the currently selected palette\n"},"$:/plugins/tiddlywiki/menubar/items/contents":{"title":"$:/plugins/tiddlywiki/menubar/items/contents","caption":"Contents","description":"Table of Contents","is-dropdown":"yes","tags":"$:/tags/MenuBar","text":"<div class=\"tc-table-of-contents\">\n\n<$macrocall $name=\"toc-selective-expandable\" tag={{$:/config/plugins/menubar/TableOfContents/Tag}}/>\n\n</div>\n"},"$:/plugins/tiddlywiki/menubar/items/hamburger":{"title":"$:/plugins/tiddlywiki/menubar/items/hamburger","tags":"$:/tags/MenuBar","caption":"Hamburger","description":"Show the full menu bar on a narrow screen","custom-menu-content":"{{$:/plugins/tiddlywiki/menubar/items/hamburger}}","show-when":"narrow","text":"<$list filter=\"[[$:/state/popup/menubar/hamburger]get[text]else[no]match[no]]\">\n<$button set=\"$:/state/popup/menubar/hamburger\" setTo=\"yes\">\n{{$:/core/images/menu-button}}\n</$button>\n</$list>\n<$list filter=\"[[$:/state/popup/menubar/hamburger]get[text]else[no]match[yes]]\">\n<$button set=\"$:/state/popup/menubar/hamburger\" setTo=\"no\">\n{{$:/core/images/close-button}}\n</$button>\n</$list>\n"},"$:/plugins/tiddlywiki/menubar/items/pagecontrols":{"title":"$:/plugins/tiddlywiki/menubar/items/pagecontrols","tags":"$:/tags/MenuBar","description":"Page controls from the sidebar","caption":"Page controls","custom-menu-content":"<$transclude tiddler=\"$:/plugins/tiddlywiki/menubar/items/pagecontrols\" mode=\"inline\"/>","text":"\\whitespace trim\n\\define config-title()\n$:/config/PageControlButtons/Visibility/$(listItem)$\n\\end\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/PageControls]!has[draft.of]]\" variable=\"listItem\">\n<$set name=\"hidden\" value=<<config-title>>>\n<$list filter=\"[<hidden>!text[hide]]\" storyview=\"pop\" variable=\"ignore\">\n<$set name=\"tv-config-toolbar-class\" filter=\"[<tv-config-toolbar-class>] [<listItem>encodeuricomponent[]addprefix[tc-btn-]]\">\n<$transclude tiddler=<<listItem>> mode=\"inline\"/>\n</$set>\n</$list>\n</$set>\n</$list>\n"},"$:/plugins/tiddlywiki/menubar/items/search":{"title":"$:/plugins/tiddlywiki/menubar/items/search","custom-menu-content":"{{$:/plugins/tiddlywiki/menubar/items/search}}","description":"Search","caption":"Search","tags":"$:/tags/MenuBar","text":"\\define cancel-search-actions()\n<$set name=\"userInput\" value={{{ [<__storeTitle__>get[text]] }}}>\n<$list filter=\"[<__tiddler__>get[text]!match<userInput>]\" emptyMessage=\"\"\"<$action-deletetiddler $filter=\"[<__storeTitle__>] [<__tiddler__>] [<__selectionStateTitle__>]\"/>\"\"\">\n<$action-setfield $tiddler=<<__tiddler__>> text=<<userInput>>/><$action-setfield $tiddler=<<__refreshTitle__>> text=\"yes\"/>\n</$list>\n</$set>\n\\end\n\n\\define input-accept-actions() <$list filter=\"[{$:/config/Search/NavigateOnEnter/enable}match[yes]]\" emptyMessage=\"\"\"<$list filter=\"[<__tiddler__>get[text]!is[missing]] ~[<__tiddler__>get[text]is[shadow]]\"><$action-navigate $to={{{ [<__tiddler__>get[text]] }}}/></$list>\"\"\"><$action-navigate $to={{{ [<__tiddler__>get[text]] }}}/></$list>\n\n\\define input-accept-variant-actions() <$list filter=\"[{$:/config/Search/NavigateOnEnter/enable}match[yes]]\" emptyMessage=\"\"\"<$list filter=\"[<__tiddler__>get[text]!is[missing]] ~[<__tiddler__>get[text]is[shadow]]\"><$list filter=\"[<__tiddler__>get[text]minlength[1]]\"><$action-sendmessage $message=\"tm-edit-tiddler\" $param={{{  [<__tiddler__>get[text]] }}}/></$list></$list>\"\"\"><$list filter=\"[<__tiddler__>get[text]minlength[1]]\"><$action-sendmessage $message=\"tm-edit-tiddler\" $param={{{  [<__tiddler__>get[text]] }}}/></$list></$list>\n\n\\define set-next-input-tab(beforeafter:\"after\") <$macrocall $name=\"change-input-tab\" stateTitle=\"$:/state/tab/search-results/sidebar\" tag=\"$:/tags/SearchResults\" beforeafter=\"$beforeafter$\" defaultState={{$:/config/SearchResults/Default}} actions=\"\"\"<$action-setfield $tiddler=\"$:/state/search/currentTab\" text=<<nextTab>>/>\"\"\"/>\n\n\\whitespace trim\n<$vars searchTiddler=\"$:/temp/menubarsearch/input\" searchListState=<<qualify \"$:/state/search-list/selected-item\">>>\n<span style=\"margin: 0 0.5em;\">\n<$keyboard key=\"((input-tab-right))\" actions=<<set-next-input-tab>>>\n<$keyboard key=\"((input-tab-left))\" actions=<<set-next-input-tab \"before\">>>\n<form class=\"tc-form-inline\">\n<$macrocall $name=\"keyboard-driven-input\" tiddler=\"$:/temp/menubarsearch\" storeTitle=<<searchTiddler>> selectionStateTitle=<<searchListState>> \n\t\trefreshTitle=\"$:/temp/menubarsearch/refresh\" tag=\"input\" type=\"search\" focusPopup=\"$:/state/popup/menubar-search-dropdown\" \n\t\tclass=\"tc-popup-handle tc-menu-show-when-wide\" placeholder=\"Search...\" default=\"\" cancelPopups=\"yes\" \n\t\tinputAcceptActions=<<input-accept-actions>> inputAcceptVariantActions=<<input-accept-variant-actions>> inputCancelActions=<<cancel-search-actions>> \n\t\tfilterMinLength={{$:/config/Search/MinLength}} configTiddlerFilter=\"[[$:/state/search/currentTab]!is[missing]get[text]] ~[{$:/config/SearchResults/Default}]\" />\n</form>\n</$keyboard>\n</$keyboard>\n</span>\n<$reveal tag=\"div\" class=\"tc-block-dropdown-wrapper\" state=\"$:/state/popup/menubar-search-dropdown\" type=\"nomatch\" text=\"\" default=\"\">\n\n<div  class=\"tc-block-dropdown tc-search-drop-down\">\n\n<$list filter=\"[<searchTiddler>get[text]minlength[1]]\" emptyMessage=\"\"\"<div class=\"tc-search-results\">Type your search terms</div>\"\"\" variable=\"ignore\">\n\n<$list filter=\"[<searchTiddler>get[text]minlength{$:/config/Search/MinLength}limit[1]]\" emptyMessage=\"\"\"<div class=\"tc-search-results\">{{$:/language/Search/Search/TooShort}}</div>\"\"\" variable=\"listItem\">\n\n<$vars configTiddler={{{ [[$:/state/search/currentTab]!is[missing]get[text]] ~[{$:/config/SearchResults/Default}] }}} userInput={{{ [<searchTiddler>get[text]] }}}>\n\n{{$:/core/ui/SearchResults}}\n\n</$vars>\n\n</$list>\n\n</$list>\n\n</div>\n\n</$reveal>\n\n</$vars>\n"},"$:/plugins/tiddlywiki/menubar/items/server":{"title":"$:/plugins/tiddlywiki/menubar/items/server","tags":"$:/tags/MenuBar","description":"Server options","caption":"Server","custom-menu-content":"<$transclude tiddler=\"$:/plugins/tiddlywiki/menubar/items/server\" mode=\"inline\"/>","text":"<$list filter=\"[[$:/status/IsLoggedIn]get[text]else[no]match[yes]]\" variable=\"ignore\">\n<$transclude tiddler=\"$:/core/ui/Buttons/save-wiki\" mode=\"inline\"/>\n</$list>\n<$list filter=\"[[$:/status/IsLoggedIn]get[text]else[no]match[no]]\" variable=\"ignore\">\n<$button message=\"tm-login\">\nLogin\n</$button>\n</$list>\n"},"$:/plugins/tiddlywiki/menubar/items/sidebar":{"title":"$:/plugins/tiddlywiki/menubar/items/sidebar","caption":"Sidebar","description":"Sidebar","is-dropdown":"yes","tags":"$:/tags/MenuBar","text":"<$scrollable fallthrough=\"none\" class=\"tc-popup-keep tc-menubar-dropdown-sidebar\">\n\n<$transclude tiddler=\"$:/core/ui/SideBarSegments/tabs\" mode=\"inline\"/>\n\n</$scrollable>\n"},"$:/plugins/tiddlywiki/menubar/items/topleftbar":{"title":"$:/plugins/tiddlywiki/menubar/items/topleftbar","tags":"$:/tags/MenuBar","description":"Items from $:/tags/TopLeftBar","caption":"Legacy Top Left Bar","custom-menu-content":"<$transclude tiddler=\"$:/plugins/tiddlywiki/menubar/items/topleftbar\" mode=\"inline\"/>","text":"<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/TopLeftBar]!has[draft.of]]\" variable=\"listItem\" storyview=\"pop\">\n\n<$transclude tiddler=<<listItem>> mode=\"inline\"/>\n\n</$list>"},"$:/plugins/tiddlywiki/menubar/items/toprightbar":{"title":"$:/plugins/tiddlywiki/menubar/items/toprightbar","tags":"$:/tags/MenuBar","description":"Items from $:/tags/TopRightBar","caption":"Legacy Top Right Bar","custom-menu-content":"<$transclude tiddler=\"$:/plugins/tiddlywiki/menubar/items/toprightbar\" mode=\"inline\"/>","custom-menu-styles-wide":"float: right;","text":"<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/TopRightBar]!has[draft.of]reverse[]]\" variable=\"listItem\" storyview=\"pop\">\n\n<$transclude tiddler=<<listItem>> mode=\"inline\"/>\n\n</$list>"},"$:/plugins/tiddlywiki/menubar/menu":{"title":"$:/plugins/tiddlywiki/menubar/menu","tags":"$:/tags/PageTemplate","text":"\\define menubar-inner(size)\n<ul class=\"tc-menubar-list\">\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/MenuBar]!has[draft.of]] -[all[tiddlers+shadows]tag[$:/tags/TopLeftBar]limit[1]then[]else[$:/plugins/tiddlywiki/menubar/items/topleftbar]] -[all[tiddlers+shadows]tag[$:/tags/TopRightBar]limit[1]then[]else[$:/plugins/tiddlywiki/menubar/items/toprightbar]]\">\n<$list filter=\"[<currentTiddler>addprefix[$:/config/plugins/menubar/MenuItems/Visibility/]get[text]] ~show +[match[show]]\" variable=\"ignore\">\n<$list filter=\"[[$size$]match[wide]] ~[<currentTiddler>get[show-when]match[$size$]] ~[{$:/state/popup/menubar/hamburger}match[yes]]\" variable=\"ignore\">\n<li style={{!!custom-menu-styles-$size$}} class={{{ [<currentTiddler>get[show-when]addprefix[tc-menubar-]] tc-menubar-item +[join[ ]] }}}>\n<$list filter=\"[<currentTiddler>!is-dropdown[yes]]\" variable=\"listItem\" emptyMessage=\"\"\"\n\t<!-- Dropdown -->\n\t<$set name=\"dropdown-state\" value=<<qualify \"$:/state/popup/topmenu/dropdown/\">>>\n\t<$set name=\"dropdown-state\" value={{{ [<dropdown-state>addsuffix<currentTiddler>] }}}>\n\t<$button popup=<<dropdown-state>> selectedClass=\"tc-selected\">\n\t<$set name=\"tv-wikilinks\" value=\"no\">\n\t<$transclude field=\"caption\" mode=\"inline\"/>\n\t<$text text=\" \"/>\n\t<span class=\"tc-menubar-dropdown-arrow\">\n\t<$transclude tiddler=\"$:/core/images/down-arrow\" mode=\"inline\"/>\n\t</span>\n\t</$set>\n\t</$button>\n\t</$set>\n\t</$set>\n\"\"\">\n<$list filter=\"[<currentTiddler>has[custom-menu-content]]\" variable=\"listItem\" emptyMessage=\"\"\"\n\t<!-- Link -->\n\t<$link to={{!!target}}>\n\t<$set name=\"tv-wikilinks\" value=\"no\">\n\t<$transclude field=\"caption\" mode=\"inline\"/>\n\t</$set>\n\t</$link>\n\"\"\">\n<!-- Custom content -->\n<$transclude field=\"custom-menu-content\" mode=\"inline\"/>\n</$list>\n</$list>\n</li>\n</$list>\n</$list>\n</$list>\n</ul>\n\\end\n\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/MenuBar]!has[draft.of]] -[all[tiddlers+shadows]tag[$:/tags/TopLeftBar]limit[1]then[]else[$:/plugins/tiddlywiki/menubar/items/topleftbar]] -[all[tiddlers+shadows]tag[$:/tags/TopRightBar]limit[1]then[]else[$:/plugins/tiddlywiki/menubar/items/toprightbar]] +[limit[1]]\" variable=\"listItem\">\n<nav class=\"tc-menubar tc-adjust-top-of-scroll\">\n<div class=\"tc-menubar-narrow\">\n<<menubar-inner narrow>>\n</div>\n<div class=\"tc-menubar-wide\">\n<<menubar-inner wide>>\n</div>\n<div style=\"clear:both;\"/>\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/MenuBar]!has[draft.of]is-dropdown[yes]]\">\n<$list filter=\"[<currentTiddler>addprefix[$:/config/plugins/menubar/MenuItems/Visibility/]get[text]] ~show +[match[show]]\" variable=\"ignore\">\n<$set name=\"dropdown-state\" value=<<qualify \"$:/state/popup/topmenu/dropdown/\">>>\n<$set name=\"dropdown-state\" value={{{ [<dropdown-state>addsuffix<currentTiddler>] }}}>\n<$reveal type=\"popup\" state=<<dropdown-state>> position={{{ [<currentTiddler>get[dropdown-position]else[below]] }}} class={{{ [<currentTiddler>get[class]] }}} tag=\"div\">\n<div class=\"tc-drop-down\">\n<$transclude/>\n</div>\n</$reveal>\n</$set>\n</$set>\n</$list>\n</$list>\n</nav>\n</$list>\n"},"$:/core/ui/PageTemplate/topleftbar":{"title":"$:/core/ui/PageTemplate/topleftbar","text":"<!-- The menubar plugin overrides this tiddler to remove the core top left menu. The menu items that it would include are instead included in the menubar -->"},"$:/core/ui/PageTemplate/toprightbar":{"title":"$:/core/ui/PageTemplate/toprightbar","text":"<!-- The menubar plugin overrides this tiddler to remove the core top right menu. The menu items that it would include are instead included in the menubar -->"},"$:/plugins/tiddlywiki/menubar/readme":{"title":"$:/plugins/tiddlywiki/menubar/readme","text":"!! Introduction\n\nThis plugin provides a menu bar with the following features:\n\n* Menu items take the form of simple text links, dropdowns, or entirely custom content\n* Menu items can be individually enabled via the control panel\n* Responds to reduced screen width by abbreviating the menu items to a \"hamburger\" dropdown\n\n!! Menu Item Tiddlers\n\nMenu items are tagged <<tag $:/tags/MenuBar>>. The following fields are used by this plugin:\n\n|!Field Name |!Purpose |\n|title |Each menu item must have a unique title (not shown to the user) |\n|description |Description for use in listings |\n|tags |Must contain `$:/tags/MenuBar` |\n|caption |The text that is displayed for the menu item. Avoid links, using `~` to suppress CamelCase links if required |\n|target |For simple link menu items specifies a tiddler title as the target of the link |\n|is-dropdown |Set to `yes` to indicate a dropdown menu item |\n|dropdown-position |Optional position for the dropdown (can be ''left'', ''above'', ''aboveleft'', ''aboveright'', ''right'', ''belowleft'', ''belowright'' or ''below'') |\n|text |For dropdown menu items, specifies the body of the dropdown |\n|custom-menu-content |Optional wikitext to be displayed in place of the caption |\n|custom-menu-styles-wide |Optional string of styles to be applied to menu item when the menubar is wide |\n|custom-menu-styles-narrow |Optional string of styles to be applied to menu item when the menubar is narrow |\n\nCustom menu items should make sure that the clickable link or button is an immediate child, and not wrapped in another element.\n\nNote that menu items can be pushed to the right of the menu bar setting the ''custom-menu-styles'' field to `float: right;`.\n"},"$:/plugins/tiddlywiki/menubar/styles":{"title":"$:/plugins/tiddlywiki/menubar/styles","tags":"[[$:/tags/Stylesheet]]","text":"\\define breakpoint-plus-one()\n<$text text={{{ [{$:/config/plugins/menubar/breakpoint}removesuffix[px]add[1]addsuffix[px]] ~[{$:/config/plugins/menubar/breakpoint}] }}} />\n\\end\n\n\\define sidebarbreakpoint-minus-one()\n<$text text={{{ [{$:/themes/tiddlywiki/vanilla/metrics/sidebarbreakpoint}removesuffix[px]subtract[1]addsuffix[px]] ~[{$:/themes/tiddlywiki/vanilla/metrics/sidebarbreakpoint}] }}} />\n\\end\n\n\\define set-sidebar-scrollable-top-if-hamburger()\n<$list filter=\"[all[tiddlers+shadows]tag[$:/tags/MenuBar]] -[all[tiddlers+shadows]prefix[$:/config/plugins/menubar/MenuItems/Visibility/]regexp:text[hide]removeprefix[$:/config/plugins/menubar/MenuItems/Visibility/]] -[all[tiddlers+shadows]tag[$:/tags/TopLeftBar]limit[1]then[]else[$:/plugins/tiddlywiki/menubar/items/topleftbar]] -[all[tiddlers+shadows]tag[$:/tags/TopRightBar]limit[1]then[$:/plugins/tiddlywiki/menubar/items/toprightbar]] -$:/plugins/tiddlywiki/menubar/items/hamburger +[limit[1]]\">\n\n\t.tc-sidebar-scrollable {\n\t\tmargin-top: 2em;\n\t}\n\n</$list>\n\\end\n\n\\define set-sidebar-scrollable-top()\n<$list filter=\"[all[tiddlers+shadows]tag[$:/tags/MenuBar]] -[all[tiddlers+shadows]prefix[$:/config/plugins/menubar/MenuItems/Visibility/]regexp:text[hide]removeprefix[$:/config/plugins/menubar/MenuItems/Visibility/]] -[all[tiddlers+shadows]tag[$:/tags/TopLeftBar]limit[1]then[]else[$:/plugins/tiddlywiki/menubar/items/topleftbar]] -[all[tiddlers+shadows]tag[$:/tags/TopRightBar]limit[1]then[$:/plugins/tiddlywiki/menubar/items/toprightbar]] +[limit[1]]\">\n\n\t.tc-sidebar-scrollable {\n\t\tmargin-top: 2em;\n\t}\n\n</$list>\n<$reveal state=\"$:/state/popup/menubar/hamburger\" type=\"match\" text=\"yes\">\n\n\t<$set name=\"itemCount\" value={{{ [all[tiddlers+shadows]tag[$:/tags/MenuBar]] -[all[tiddlers+shadows]prefix[$:/config/plugins/menubar/MenuItems/Visibility/]regexp:text[hide]removeprefix[$:/config/plugins/menubar/MenuItems/Visibility/]] -[all[tiddlers+shadows]tag[$:/tags/TopLeftBar]limit[1]then[]else[$:/plugins/tiddlywiki/menubar/items/topleftbar]] -[all[tiddlers+shadows]tag[$:/tags/TopRightBar]limit[1]then[]else[$:/plugins/tiddlywiki/menubar/items/toprightbar]] +[count[]] }}}>\n\n\t\t.tc-sidebar-scrollable {\n\t\t\tmargin-top: calc(<<itemCount>> * 2em);\n\t\t}\n\n\t</$set>\n\n</$reveal>\n\\end\n\n\\rules only filteredtranscludeinline transcludeinline macrodef macrocallinline\n\nnav.tc-menubar {\n\tposition: fixed;\n\tz-index: 850;\n\tdisplay: inline-block;\n\ttop: 0;\n\tright: 0;\n\tleft: 0;\n}\n\nnav.tc-menubar ul.tc-menubar-list {\n\tposition: relative;\n\tlist-style-type: none;\n\tmargin: 0;\n\tpadding: 0 0 0 42px;\n\tbackground: <<colour background>>;\n\tbackground: <<colour menubar-background>>;\n\t<<box-shadow \"1px 1px 5px rgba(0, 0, 0, 0.3)\">>\n}\n\n@media (max-width: <<sidebarbreakpoint-minus-one>>) {\n\n\thtml nav.tc-menubar ul.tc-menubar-list {\n\t\tpadding: 0 0 0 8px;\n\t}\n\n}\n\nnav.tc-menubar li.tc-menubar-item {\n\tdisplay: inline-block;\n\tmargin: 0;\n\tpadding: 0;\n}\n\nnav.tc-menubar .tc-menubar-narrow li.tc-menubar-item {\n\tdisplay: block;\n}\n\nnav.tc-menubar li.tc-menubar-item > a,\nnav.tc-menubar li.tc-menubar-item > button {\n\tdisplay: inline-block;\n/*\ttext-transform: uppercase; 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<center>''Creating a safe context''</center>


''1.'' Always make sure that contacts are planned to specific times. Do not have vague commitments to call.

''2.'' Check that person has time available, whether they are likely to be interrupted and if so plan for interruptions.  

''3.'' Plan loss of signal and who will call who if this happens.
 

<center>''Stay on track''</center>

''4.'' Connect with agreed goals if you have them and how session may help with those goals

''5.'' Try to monitor changes over time using measures (by email) or simple feedback.

''6.'' Notice small changes or exceptions to negative expectations.
 

<center>''Being responsive''</center>

''7.'' Validate what things are like for the person.

''8.'' Try not to reassure without hearing about the problem fully

''9.'' Invite solutions from the person and problem solve

''10.'' Be clear when you will next be in contact

This is a short clip where a five/six year old child explains about anxiety. She uses adult words and is very articulate. The script is an adult script but this might be useful in psychoeducation. 

<html><iframe width="560" height="315" src="https://www.youtube.com/embed/MjJmemgWM6A" frameborder="0" allowfullscreen></iframe></html>

Please see below for some clips of children young people and their parents talking about ADHD. This is a really good resource for gaining a better understanding of the lived experience of children you people and their families. These could be really helpful when discussing ADHD with CYP and their families.

Here Ethan ages 8 discusses what it feels like for him to have ADHD:

<html><iframe width="560" height="315" src="https://www.youtube.com/embed/wmM5sm8wYQQ" frameborder="0" allowfullscreen></iframe></html>


Here is a clip from 'what about the kids?' in which CYP discuss ADHD:
<html><iframe width="560" height="315" src="https://www.youtube.com/embed/Wppcxbm-28c" frameborder="0" allowfullscreen></iframe></html>



This is Brad's Story: A 12 year-old with ADHD:

Here is a clip from 'what about the kids?' in which CYP discuss ADHD:
<html><iframe width="560" height="315" src="https://www.youtube.com/embed/z2hLa5kDRCA" frameborder="0" allowfullscreen></iframe></html>


This is Ally Hardesty story of what it feels like living with ADHD which she describes as her biggest insecurity & how it affects her on an everyday basis:

<html><iframe width="560" height="315" src="https://www.youtube.com/embed/p3y5JZDpKIM" frameborder="0" allowfullscreen></iframe></html>


There is a plethora of videos of lived experiences on what it feels like to live with ADHD on [[YouTube|https://www.youtube.com/results?search_query=what+it+feels+like+to+have+ADHD]] so please do explore.

[img[lightbulb.jpg]]

!!!This Guide: 
This online guide has been designed for use by Wellbeing Practitioners and their supervisors. It is not a website in the usual sense but has a range of materials that provide a set of materials and resources to support CWP practice. Please take a moment to check out how this online guide works in [[User Guide]] as it takes a little bit of getting used to. 

We recommend you use ''Google Chrome'' or ''Mozilla Firefox'' instead of Internet Explorer. 

Any problems, use [[Contact us]]

The guide is an open resource for any Child Wellbeing Practitioners both in training and those who have qualified. CWP supervisors may also find the information on this guide helpful.

!!!The Purpose of this guide
The purpose of this guide is to make information freely available to all. However, this material is designed to be used by practitioners who have been trained in methods of guided self help and who are working under supervision from an experienced mental health professional. These materials are not designed to be used unless these conditions are met.

This guide is being written during the autumn 2018 and throughout 2019 while the first group of CWP trainees are being trained. It is being constructed out of the generosity of the teaching staff to share their expertise while teaching on this programme.

The author or source material is indicated on each page. Permission for use of any copyrighted material is routinely sought and, if not obtained, such material is not used. Each page is reviewed by the editorial team and by the source author before being completed. Pages in the process of being written are indicated with a banner at the top of the page. We aim not to include material from other sources which we believe to be discriminatory, disrespectful or offensive. The aim is that material will be as accurate and as up to date as possible but we welcome feedback on any of the material in this guide.

Please send any feedback or questions about the guide to [ext[PGS Online Guides|mailto:PGSonlineguides@annafreud.org]] 

!!!The CWP Role

In line with the Government’s priority to increase access and availability of mental health and wellbeing support for children and young people, the CWP role is an exciting opportunity to deliver evidence-based early interventions for children and young people, working across healthcare sectors in England. Please go to the follow link to find out more https://www.annafreud.org/mental-health-professionals/cyp-mh-workforce-development-1/

*Varying types of BA 
#Activity schedule
**plan activities then do them and see the impact on your mood, used a lot and start of CBT 
#Lejuez 
**activity in line with values in different life areas, you then start to plan in concrete activities that fit with values. Support available through planning in contracts to help young people along the way. 
**more likely to engage as its brief (Brief BA or BATD) and tried to keep it simple 
#Matrell
** function analysis which can be complicated for therapist and client. RCT conducted in the USA found equally as good as CBT and IPT.

!!!!!Source: CWP Audit Report for London and the South East 2018. Main author:  Deepa Mavji

!!!''Introduction''

The CWP teams had to work out a referral acceptance and rejection criteria based on the training material and also on site specific needs. 
Each site was asked about their inclusion and exclusion criteria and a summary of the main inclusion and exclusion criteria from all site qualitative data are listed below.

!!!Inclusion criteria:

*Low mood, anxiety or challenging behaviour
*Willingness to engage
*Case not previously known to other psychological service
*Case redirected from CAMHS as not appropriate for their service
*Early signs of emotional well-being distress
*Elevated RCADS scores

!!!Exclusion criteria:

*Extreme risk (e.g. self-harm) or safeguarding concerns
*High case complexity (Eating disorder, Obsessive Compulsive Disorder, Post Traumatic Disorder, Psychosis, cases currently in court)
*Learning disability
*Complex family circumstances or social concerns
*Receiving an intervention in CAMHS or engaged with private therapy or additional support

However, all sites adapted the inclusion and exclusion criteria based on the needs of the community and service expectations.

!!!''Rates of acceptance of referred cases'' 
The total number of referrals to the CWP service across all 15 sites were 1,434. 78% (1,111) of referrals met referral criteria and were accepted for an assessment and/or intervention and 17% (243) did not meet referral criteria and the remaining 6% (80) were in progress.


The proportion of children and young people who did not access the CWP service were referred to:

* 62% referred to a Tier 3 service
* 21% were referred to their G.P
* 5% were referred to a third sector organisation
* 5% were unspecified
* 3% were referred to a Tier 2 service
* 3% were referred to another service
* 1% were referred to a Tier 4 service

!!!''Referral source'' 


Children and young people were most  referred from the following sources:

* 37% Education sector (mainly schools) 
* 24% CAMHS Tier 3
* 8% Self-referrals
* 7% Other 
* 7% GP Practice
* 5% Local Authority
* 4% CAMHS Tier 2
* 3% Voluntary 
* 2% CAMHS triage
* 1% A&E
* 1% NHS other
* 1% Family Intervention Services
* Less than 1% CAMHS Tier 1
* Less than 1% CAMHS Tier 4      

Source: Peter Fuggle and Joe Hickey

!!What is active listening?

Active listening could also be called 'explicit listening'. It is simply a set of behaviours on the part of the practitioner to communicate to the young person or parent that you are interested in what they are saying. It usually involves a number of brief statements by the listener to make this unambiguous to the client. The sort of phrases that might be used are:

* //That seems really important.//
* //I think I understood that, but could you tell me a bit more//.
* //That's really helpful.//
* //I can imagine that wasn't easy to tell me about.//
* //I want to make sure I don't forget that.//

!!The rationale for active listening:

*it conveys that what you are hearing is important. 
*it challenges an idea that the client may have about themselves that they are boring or worthless.
*it doesn't assume that the client is used to being listened to and that he/she will interpret more passive listening as interest by the practitioner. 
*it help the practitioner make sense of complicated material. 

!!Practice points:

''The important thing is that it doesn't become mechanical and just a formula.''

__Be attentive__

* Appropriate eye contact, posture and tone of voice
__Open questions__

* Ask questions that invite more than yes/no answers
__Summarise__

* Short statements to offering your understanding of what you are hearing
__Reflect__

* Repeating a word or phrase to encourage the speaker
__Clarify__

* Use prompts or questions to seek better understanding of points that are relevant but unclear 
__React__

* Giving feedback and showing your reactions sensitively

For more information on how to actively listen watch 
'[[6 Tips for Active Listening|https://www.youtube.com/watch?v=oWe_ogA5YCU]]' a really useful short video which may  further your understanding about active listening.


!!Links to other pages

Active listening is a key technique for [[Engagement]]
and should be used as part of range of techniques included in pages around  [[Guided Self Help]] 

*Handouts in colour etc. can be flexible in how you deliver it to young people 
*Want them to record their activities but don't want to set them up to fail - need practitioner to be passionate about the activity log otherwise it wont be completed. No critisims or punishment if they don't do it, praise if they have completed it in any way. If they don't bring it back they can complete it in session 2. 
*Don't refer to it as homework but as 'getting to know you' and do an example day within the session. 
*How is it going to be feasible and manageable for the young person 
*Importance box means important to the young person

!!!''Key points''
*Having done some daily monitoring, the next step is to encourage the young person to start to plan activities which they have selected as part of their preferred activities in terms of enjoyment and/or importance.
*Activity lists may be helpful in prompting ideas about the range of possible activities. 

A useful Anxiety Manual Developed by the Richmond wellbeing team:

Richmond Adolescent Anxiety Model

<<link-pdf "Richmond Adolscent Anxiety Practitioner Manual" "https://drive.google.com/open?id=1CwY4g-GWE6unIwWMNNp24px4ua2OGruD">>

For the core intervention manual taught on the CWP/EMHP course please see [[Adolescent Anxiety - Manual]]

<<list-links "[tag[Adolescent Anxiety]]">>

Source: Helen Barker and colleagues 

---

!!'''Getting to Grips with Anxiety'''
The approach to helping young people with anxiety is summarised in the manual called 'getting to grips with anxiety'.  This has been drafted by Helen Barker and colleagues and provides a step by step account of how to help a young person with anxiety. 
We are indebted to Helen Barker and her team for generously sharing their work on adolescent anxiety with us.

Please use the link below for the full manual:

<<link-doc "Getting to grips with anxiety" "https://drive.google.com/file/d/1wUrDMPAYZnq0c1WPOEopQjmGV8SCS3Ri/view?usp=sharing">>

@@font-size:12px;
<<< <<link-doc "The Previous version of Getting to grips with anxiety can be found here" "https://drive.google.com/file/d/1CFJ4RymiV2RIlE4qksaUYgGz1DQntLLp/view?usp=sharing">> 
@@

---

!!''Introduction''

*This framework is designed as a guide as what might be useful content to cover in a course of guided self-help (GSH) for anxiety with adolescents. 
*Services should feel free to try this out and adjust accordingly. 
*Services should experiment with materials and resources available to them and utilise websites such as ‘get self-help’ or ‘Mind-Ed’ and other [[self-help materials|Self Help Materials]] / books / literature. 
* We encourage services to develop their own booklets. 
*Although GSH is a mixture of shorter and longer sessions; the modality these sessions take place in (e.g. phone/Skype/face to face) will likely differ between services.

!! ''Sessions overview''

[[Session Overview for Overcoming Adolescent Anxiety]]

!!''Session Plans''

For a full list of session plans based on  'Getting to Grips with Anxiety' by Helen Barker and colleagues go  to:
[[Session Plans for Overcoming Adolescent Anxiety]]


!!''Related pages:''

Please also go to 
[[Working with Adolescents with Anxiety]] for general guidance on how to work with YP who are experiencing anxiety. 

!!Supplementary Manuals
 The Kings College London CYP-IAPT teaching team have also developed some excellent manuals ''to be used alongside the 'Getting to Grips with Anxiety' manual'', for more detailed guidance with the specified areas below.

!!!Injection, blood and injury fears supplement:

<<link-doc "Supplement: Injection, blood and injury fears" "https://drive.google.com/file/d/16SRtHJyJ0sXQWoF9pGUdRFBVt5ZW_JK7/view?usp=sharing">>

!!!Managing Panic supplement:

<<link-doc "Supplement: Managing Panic" "https://drive.google.com/file/d/1qt2Q_ZK1QV1ZKkUGdsWV5-G2WfxiJAiI/view?usp=sharing">>

!!!Managing Worry supplement:

<<link-doc "Supplement: Managing Worry" "https://drive.google.com/file/d/1DwsXWSq-cIj-TuXCrSCPs6tC9tqvtiQX/view?usp=sharing">>

!!!What to do when our thoughts get in the way supplement:

<<link-doc "Supplement: What to do when our thoughts get in the way" "https://drive.google.com/file/d/1sAtXtolQIYypSd7r8dEHoVYcjaXKw1TP/view?usp=sharing">>

@@
<<< <<link-doc "The Previous version of What to do when our thoughts get in the way can be found here" "https://drive.google.com/file/d/1Yzf2FE62B95fdgleePm88HA8GxMTdmjt/view?usp=sharing">> 
@@

Please see below for the adapted adolescent anxiety manual in response to the current circumstances caused by COVID-19. 

This manual was compiled and edited by the KCL CYP-IAPT team: Susanna Payne, Laura Bowyer, Sarah Carman and Helen Barker; and the UCL CYP-IAPT team: Vicki Curry

With information from: Caroline Stokes (KCL); Alice Kerr & Emma Warnock-Parkes, (Centre
for Anxiety Disorders and Trauma/KCL); Lisa Shostak (KCL); Ali Lambie, (Mindfulness
Hampshire); Jynna Yarrum and Alysia James, (University of Northampton).
Young people’s perspective from: Lila and Remy Moar

----

This manual suggests recommending study skills to families, below are some good examples of study skills.

Exam essentials: Studying for success

https://www.bbc.co.uk/bitesize/articles/zb7j382

Go The Distance: Study Skills

https://www.bbc.co.uk/learningenglish/gothedistance/studyskills

Nine nifty ways to study remotely

https://www.bbc.co.uk/bitesize/articles/z77svk7


These have all been taken from the 'support' section of [[BBC Bitesize|https://www.bbc.co.uk/bitesize/support]]

---

<<link-pdf "Adolescent anxiety manual: COVID-19 adaptations" "https://drive.google.com/file/d/1xg18Nv4yul_0taIaqa3HpG4nQSvW5Dp0/view?usp=sharing">>

The Improving Access to Psychological Therapies (IAPT) Manual and its resources have been produced to help the IAPT programme improve the delivery of, and access to, evidence-based psychological therapies within the NHS. The programme is designed  for adults and is distinct from the CYP-IAPT Programme which is for children and young people. 

The Manual can be downloaded from NHS England <<link-pdf "IAPT Manual" "https://www.england.nhs.uk/wp-content/uploads/2018/06/the-iapt-manual.pdf">> 

!!!What is the IAPT manual?
*IAPT Manual is a framework for services providing publicly accessible information bringing together guidance developed over the 10 years of IAPT. 
*Single source for all information on the IAPT programme (workforce, measures, therapies, outcomes, supervision, service improvement)
*Guide for commissioners, IAPT service managers and therapists working in IAPT

!!!Manual in practice 
Services can use the manual as a blueprint and as a benchmark for the local balance between access, recovery and wait times whilst maintaining standards. Bench marking exercises from the manual can help services understand when they aren't reaching the standard and how they can improve. 

!!! What are you doing since qualifying
* Funding in some boroughs for Band 5
* Some people doing doctorates
* Transferable skills for other positions
* Sustainability is still a discussion and trying to think about expanding workforce

!!! Advice for first session
* Know the materials
* Role play with colleagues
* Speak to supervisor
* Don't worry about covering everything. Most important thing is to engage and build good relationship with young person. 
* Go in with a crib sheet so you can glance at it throughout as a reminder
* Allowing them to feel heard is important part of session 1 

!!! What did you find most challenging?
* Not knowing what was coming next but hopefully cohort 2 will be more contained 
* Worrying about getting clients and taking on inappropriate clients - don't worry about this, clients will increase
* Course team are also speaking to new services and passing on learning from partnerships from last year. 
* Video submission: try to video a lot of clients and then you can pick from it. Also everyone finds it hard to watch yourself but you do get used to it. Persuading people to be filmed was also not a big challenge, most people agreed easily.
* Assignments: Have discussions with colleagues and ask for help.
* Using ipads work phones or camcorders to film was fine once learnt how to use it.
* Client and CWP tended to forget it was filming so didn't create huge anxiety
* If young person is anxious then you can use session 1 for young person to hold camera on CWP and then next session might feel more comfortable

!!! How to you make it collaborative and person-centred?
* Ask the client what they want to work on and make sure you take their lead 
* Set goals together and make sure that you check back on goals 
* Manualised interventions can mean it is a challenge. Sometimes you can balance the material in intervention and do general problems solving etc as well. make time for both and direct back to interventions/ have a structure and bring client back to it.
*Give client space to tell you what works and doesn't work. 
* Sharing ideas with clients so that you can learn together
* Set learning goals as these will make progress faster 

!!!!Source: Doreen S. Marshall and colleagues, [[SPRC|http://www.sprc.org/]]  and [[AFSP|https://afsp.org/]]

'After a Suicide' provides guidance, tools and resources on how to respond in the immediate aftermath of a suicide death of a student to prevent further trauma which may lead to further suicidal behaviour. This is referred to as 'postvention'.

This toolkit reflects consensus recommendations developed in consultation with national experts, including school-based administrators and staff, clinicians, researchers, and crisis response professionals. 

This resource was developed in America for administrators and staff in middle and high schools, but it can also be useful for parents and communities. As such, some of the materials may need adapting for work in British schools however is still a valuable resource for supporting schools around a students death from suicide.

<<link-pdf "After a Suicide" "https://drive.google.com/file/d/1v5r7yI5R1cd4XTAAl7KW_2Wx_r3QG5hf/view?usp=sharing">>



!!!!© 2018 Education Development Center and American Foundation for Suicide Prevention. All rights reserved. This publication may be copied, reproduced, and distributed provided the correct copyright procedure is followed. 

!!!!Source: Laura Bowyer and Peter Fuggle 

Much of the material in this page is consistent with ideas around relapse prevention. 


!!!''The principle of having a plan''
Different services will have different contexts that will influence how a plan is developed with a parent or young person. The exact format of the plan is less important than that the client leaves the contact with a clear sense of what is going to happen next and what the purpose will be for future contacts. 

The intention is to model the idea that help is purposeful, collaborative and explicit. The reason for being clear about the next contact is to make the process of help as predictable as possible. If the  appointment had gone well, the client, when asked by a friend what was happening, would be able to say in ordinary terms what was agreed and what would happen next. 

The plan should always include an action that the young person or parent is going to carry out, however modest. Help is not something that is done to a client but something that is carried out collaboratively together between the practitioner and the client but with a focus on the client maintaining a position of agency  (see [[The basic stance for guided self help]]).

!!!''Practical skills around having a plan''
Some young people will prefer to record the plan on their phone rather than have a piece of paper. The important thing is that something is written and both the client and practitioner have a copy. The plan should have some of the following:

#the purpose of what the helping process is all about. - e.g. the aim is to worry less, or go to school more or see friends etc
#the client will be invited to think about some specific goals and bring these to the first session (active stance)
#the expected way that the help will be offered - frequency of contact, type of contact, who will be included etc. 
#look at some self help materials before first session. 
#what to do if things get much worse. 
!!!''In the session'' 
This may be the final session with a young person or near the end of your intervention as a art of the work around relapse prevention 

*Leave adequate time to cover – it is an important part of any intervention 
*Be creative!
*Review the content of your sessions and discuss what YP has found most helpful
*Create a folder of resources the YP can keep and refer back to
*Think with them about the important people who will continue to support them (back up team)
*Discuss other resources available to them. 
*Many of the booklets will have worksheets for relapse prevention where common questions for the YP / parent to think about include:
!!!''Useful questions to ask''
*What are the key things learnt?
*What has been helpful?
*How have you done in relation to your goals?
*What do you still want to work on?
*Who is going to help you? 
*What do you need to help you?
*What could cause set-backs? 
*How would you overcome these?

Source: Deb ~McNally and the Manchester Collaborative 

* To improve parent-child interactions and the relationship in order to reduce the escalation of behavioural and emotional problems 
* To break any unhelpful patterns of interaction by establishing a positive, relationship between the parent and child
* To learn about children’s behaviour, including the triggers for challenging behaviour and what reinforces behaviour
* To increase parents’ confidence in interacting with their child 
* To consider the importance of special time and positive attention for the parent-child relationship
* To learn ideas for managing difficult behaviours
* Acknowledge how difficult being a parent is and to normalise the experience of needing help with parenting to remove self-blame

{{manc}}

Below is a list of alternative session material that a practitioner may want to use with a parent of children with behaviour problems:

<<list-links "[tag[Alternative Session Plans for Behaviour Problems]]">>

''Surfs up'' is an animation developed by Michelle Bainbridge (an Education Mental Health Practitioner) for children. This animation for children explains how anxiety can effect us during the COVID-19 pandemic, and how to ride the waves of anxiety during this time. Michelle feels this could be particularly helpful for children those who have parents and carers who are key workers.

<html><iframe width="560" height="315" src="https://www.youtube.com/embed/jfbKq49NKaE" frameborder="0" allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe></html>

''Time for Change'' is an animation created by Michelle Bainbridge about the transition of year 6 students into secondary school considering the uncertainty and changes due to the global pandemic. This animation was made in partnership with Barnet, Enfield and Haringey NHS trust, Enfield CAMHS, and a collection of year 6 students and their parents.


<iframe width="560" height="315" src="https://www.youtube.com/embed/wbmvWsWvdQU" frameborder="0" allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe>

[img[pink and orange.jpg]]
The intervention practitioners are trained in for Anxiety covers two ages groups as seen below.

* [[Adolescent Anxiety]]
* [[Child Anxiety]]

The core materials relating to this intervention can be found via the [[Helping]] page.

!!!Anxiety Overview

<<list-links "[tag[Anxiety Overview]]">> 

!!!!Source: Peter Fuggle and David Trickey 
Below is a general summary and introduction about anxiety drafted by Peter Fuggle, David Trickey  and colleagues at the Anna Freud National Centre for Children and Families for the Royal Foundation in 2017. 

!!!Anxiety in young children: a brief introduction 
''Anxiety as normal.'' Young children get worried about things. For young children, many get worried about the dark, they are nervous with strangers, they are not always sure that the world is a safe place. As small people, inexperienced in the ways of the world, and still learning how it all works, they are vulnerable; anxiety is in that sense an appropriate and proper response that prepares them to cope with possible hazards. For instance, when they are exposed to potentially unkind adults (strangers) they may practically-speaking be helpless alone, but knowing how to signal and ensure that they stay close to safe adults who can protect them has real survival value.  So, in a supermarket, if a young child stays close to his parent or carer out of a nervousness about getting lost, this is generally helpful in making sure that he/she stays safe. So small levels of anxiety have an adaptive function. This also applies to older children and young people although they commonly have other worries, often about whether they have friends, or how others feel towards them. The worries of older children are generally related to the developmental challenges of becoming a more autonomous person as they progress towards becoming young adults. Complete indifference to worry – either in younger children or adolescents – about these kinds of predictable challenges may be more a concern than typical levels of social apprehension. 
So some level of anxiety in children is adaptive and the absence of such anxiety is not entirely a good thing.  It is adaptive because it helps a parent to do the job of caring for their child by providing  signals to the parent about how their child is. Parents (however sensitive and well attuned to their children) need this feedback and most will quite naturally (without having to be purposefully or additionally alert) notice the signs of distress that their child sends out. This is good too. This is what makes the parenting process work – a good mix of  parental sensitivity to the mental state of the child, alongside the child’s capacity to communicate the coming and going of their distress and anxiety as they explore and discover the world.  Without such signals the parent would be at a loss as to what to do. So in a way the child’s capacity to communicate distress is helping the parent to do their job. This is fine in moderation but sometimes this ‘adaptive dance’ gets into trouble and this is what we shall turn to next. 
''When anxiety gets worse''. So some level of anxiety is both normal and adaptive for children and young people. Difficulties arise when such normal levels of anxiety become more severe, more persistent and begin to have an impact on the child’s capacity to engage in normal aspects of living. In young children, parents are nearly always the first to notice such developments but it is not always easy to identify in the early stages often because children will show this through their behaviour as much as by anything they may say. The most common indicator of an anxiety problem is the emergence of a pattern of responding to something that is generally referred to as ‘avoidant behaviour’; for instance,  when a child becomes resistant to particular places (e.g. buses), social situations (e.g. saying goodbye to a parent at the nursery), objects (e.g. spiders) or events (e.g. going to bed). Avoiding the feared situation is also usually accompanied by increased levels of distress or protest when the child is then encouraged or required by others to face these kind of situations.  Often this escalating level of distress results in changes of behaviour in the parents or adult caring for the child as they then understandably attend to trying to settle the child’s distress (e.g. crying or explicit silence and withdrawal) more than addressing the situation (or understanding and coping with the situation) that is triggering this. 
It is not always easy to know whether a child’s distress and anxiety around something is a temporary reaction to a particular event or whether it indicates a more enduring difficulty.  For example, the death of a grandparent may lead a child to seek the presence of a parent more than previously. This is a common response and on its own is not an indication of an anxiety problem. After a while this reaction is likely to diminish and a child will regain their previous ways of being and behaving. However for some children this reaction persists for several months and this may be a reason for some concern. Similarly a child may have an unhappy day at nursery and may be unenthusiastic about going to school the following day.  There may be complaints of feeling unwell etc, or escalating distress when the time to leave approaches. Again this is not uncommon but if such a pattern of avoidance of school persists for several weeks, then this is a cause for concern. When this does start to happen, typically the parent, too, becomes a little unsure as to what is the best thing to do.  Such problems may trigger a lot of thinking about why the problem started (e.g. “he has always been a bit of an anxious baby”, or “he was very close to his grandmother”, or “I hated nursery when I was a child.”.)  Sometimes, as part of the development of a pattern of avoidant behaviour, the parent starts to become less confident about encouraging their child to do the things that they may be avoiding opportunities for ‘experimenting’ and ‘having a go’ may, without anyone being particularly aware of this, reduce.  Anxiety becomes a significant problem when it starts to set up rather fixed ways of responding to the world, rather than allowing for adaptation, and experimentation.   
''How can we help children with anxiety problems?'' The vast majority of help for young children with anxiety problems is provided by parents. 75% of children with such problems do not receive any professional help.  Although, psychologists and others have described a lot of different types of anxiety problems that occur in young children (e.g. phobias, separation anxiety, social anxiety, etc), the effective principles of how to help a child with anxiety are essentially similar and are also consistent with parenting in general. So what can parents do to help?  
Validating feelings: Firstly children can easily feel both anxious about something and also that they are doing something wrong by being anxious. Their anxiety can quickly become muddled up with feeling that they are causing trouble (not wanting to do to go to school; not wanting to stay at grandma’s because of spiders) and, of course, in a sense they may be.  So, as with lots of parenting it is about helping a child really to feel that they are not being criticised for how they feel, that their feelings are ‘validated’ and not dismissed This helps a child to feel better and safe. In ordinary language this is about a child feeling loved and accepted when they are feeling vulnerable. As always, these things are easy to write about but are not always so straightforward in practice so, although this may sound a bit basic, it remains the cornerstone of how to be helpful to a child who has developed a pattern of being worried about things.  What does this look like in practice?  Doing as much listening as possible: some parents find the saying “listen to understand, not to respond!” helpful here.  As parents we easily fall into having an answer or some kind of response to everything our children throw at us.  Young children do not find it easy to say what is happening and showing acceptance, warmth and genuine curiosity will help the child to make sense of what it is that they are feeling, believing, anticipating or fearing. A little gentle humour may be reassuring to a child that things will be okay. 
''Supporting experimentation'': That first step is not the last one. The next step is the need to not get stuck in ‘validation’ but to enable a child to get back to a usual process of experimentation. This is tricky as it requires the parent not to be overly protective of the child and also for the child to be supported to try new things again. The fundamental process is called ’encouragement’ (there is no need to dress this up with science!) and usually both the parent and the child are a little apprehensive about it. However parents in general do this all the time, so it is not really a new thing.  What this means in practice is helping a child to practice small steps at a pace that is perhaps just a little bit faster than their fear would prefer, but not so fast that the parent isn’t confident that they can cope. There is no benefit in pushing a child into an experiment that is almost bound to fail, and upset them even more.  So, if a child is anxious about going to sleep on their own and wants a parent to get in bed with them while they go to sleep, then the plan would be to gradually encourage the child to tolerate increasing distance between himself and his parent.  There are many parent guides to helping with this process, of which one of the best is the guidance by Cathy Creswell – “”.  The most effective approaches manage to create some reassuring security for both parent and child by creating very clear and organised plans.  The important thing is that plans mean there are no surprises, and that progress can be gentle rather than forced.  Making progress measurable in ways that allow for the child (and the parent) to feel rewarded by their successes is important.
''What do I do if this doesn’t work or that I don’t really feel that I understand the problem?'' There are some types of anxiety problems that may need a slightly modified approach to this basic approach. For example children who have experienced trauma may have a specific form of anxiety which, if they continue to show persistent distress over time, needs some specialist help. These subtypes of anxiety are less significant in young children in that the overall approach remains more similar with younger children. For some children, despite the approaches outlined above, the anxiety problems continue and may become more severe.  When this happens it is important that additional professional help is sought so that the child’s pattern of relating to the world does not become too firmly established. What we know is that professional interventions for anxiety are no more likely to be helpful than parent-led interventions if the problems are quite new and ‘ordinary’ anxieties such as some of the things we have described above. However, professional interventions for significant problems are likely to be more effective if those problems have not been allowed to become entrenched for too long. This is a balancing act, but talking with other parents or professionals can often help a parent to decide when their own efforts might need extra support.

18th February 2017
 

This is a tag tiddler

<<list-links "[tag[Anxiety practice]]">>

<<list-links "[tag[Anxiety skills]]">>

!!!!!Source: Laura Bowyer	

!!Explaining what anxiety is
Anxiety is a natural human emotion and although it feels unpleasant, it cannot harm us physically 

*We all get anxious (but do acknowledge we don’t all get it to the same frequency and degree as the YP struggling with an anxiety problem)

*Anxiety becomes a problem when it gets overly distressing and has an impact on our day to day lives / gets in the way of things 

*Anxiety can be helpfully explained by the flight / fight explanation. You can use [[videos|Psychoeducation: Videos]] from [[YouTube|https://www.youtube.com/]]. 

*Various handouts from booklets are available to show the body and what happens in fight / flight. The key is to explain the sometimes ‘scary’ or ‘unpleasant’ symptoms young people get when anxious. 

*The ‘false car alarm’ metaphor is useful to explain that we often get ‘false alarms’ with our anxiety just like a car alarm going off when it’s too windy or someone walks too close – we only really want our car alarm to go off when someone is actually breaking in (i.e. when there is a real life threatening or serious situation). Guided self help (GSH) can teach us skills to help our alarm system to go off less frequently and help us learn to have less false alarms. 

*Anxiety in children is caused by a range of factors and we don’t really know what accounts for what. The key point is it is no-one’s fault. Things we think from research contribute: temperament/genes (~30%); life events; learning by example; learning from example; coping experiences.

!!Talking about anxiety with parents 

Parents are evolutionarily designed to protect their children – it’s almost like we have to resist these very primal urges which can be really difficult at times (to help normalise reassurance giving from parents)

Parents are expert at supporting their child when they are anxious and helping them feel ok. Sometimes, they are so expert that the child doesn't learn to do it themselves. As children get older they have to do more things by themselves – learn to be more independent.  So we need to think how we can teach him all those things that you’re really good at doing, so he can do them himself when you’re not there

! Breathe With Me

''What is it?''

An animated app designed to teach children and young people diaphragmatic breathing. This breathing technique is known to reduce anxiety and help users control anxious feelings.

''How does it work?''

This simple app works by asking users to select an animal: either a cat, dog or panda. Once selected, users are then shown instructions to prepare for the deep breathing technique. Users are told to sync their breath with the movement of the animation, which shows their chosen animal breathing in and out.

The animation includes pop-up instructions reminding users to breathe from the belly. It also keeps time and tells users when they’ve been breathing for two minutes and for five minutes.
Users also have the option to play or mute music during the animation, and can view the full instructions at anytime if they need reminding of the technique.

''How to access the app?''

Breathe with Me is available via the Breathe with Me website: https://breathewithme.co.uk.
Although it is possible to use the app through a web browser, we recommend downloading to the home screen of your device (tablet, smartphone, etc.) and using as a normal app. Installation instructions are available here.
Please note: Breathe with Me is not currently accessible via the Windows smartphone.

! Grow
''What is it?''

Grow is an app for managing your personal goals, aimed primarily at users aged 12-18 in the CAMHs system.

Users can set themselves goals, either on their own at home or in a session with a clinician, and then rate them (along with a reason for the rating), edit the goals, or delete the goals. Goals can be tracked graphically.

''How does it work?''

Users can currently register to use Grow via Facebook, as it needs a way to store the goals for a specific user. However, Grow stores no identifiable data on users, nor does it draw any data from Facebook. Users can input goals and track them over time by accessing the web-based tool.

''How to access the app?''

You can try out Grow here: https://polar-dawn-55555.herokuapp.com/login
!!! 
!!! Getting to Know You

''What is it?''
A fun and accessible questionnaire for children when first visiting CAMHS (Child and Adolescent Mental Health Services). Designed for tablets.
This questionnaire aims to reduce the anxieties of children (5 – 12 years old) coming to CAMHS for the first time. It offers an alternative questionnaire to the paper based one which is currently used and is not appropriately designed for children.
This questionnaire helps therapists get to know a young person better so that they can more quickly build a healthy and meaningful relationship.

''How does it work?''
The child chooses an avatar (lion, monkey or bear) then goes on to answer a series of interactive questions about themselves.

''How to access the app? ''
The app can be found here: https://welcome-in.herokuapp.com/

!!!''What is it like being helped?'' 
*Difference types of help 
**Practical, emotional etc. 
*Normalising and listening and offering reassurance which helps you feel understood and comforted 
*Unconditional support - how can you create this? 
**Characteristic of a long standing relationship which creates the feeling
**Explicit about what is going on- trust around why is this person helping me, what will happen if I can't change 
*Nice to be thought about without being asked and not being annoyed if you do ask for help
*Positive acceptance and validation 

!!!''Reflections of the helping process''. 
Difficult to ask for help as it may expose vulnerability. The importance of trust when this is the case. 
In ordinary life there is a balance between giving and receiving help- how do we balance this in daily life and also as a EMHP? 
*How can we draw on one's own experience of asking for help and receiving help to develop our work as a EMHP? 

How do we find it asking for help? 
*It varies but can make you feel vulnerable 
*Independence vs. dependence- do you lose control asking for help? 

!!!!!Source:Deb ~McNally and the Manchester Collaborative 

* The assessment is important in determining what support the parent may benefit from. If there is a group available to the parent, then the assessment should be used to consider the parent and child’s suitability for brief individual intervention vs group intervention. 
* If following the assessment, it is deemed that the parent and child would benefit from more intensive support, then the family can be stepped up. 
* The assessment should involve a brief clinical interview with the parent as per CYWP guidelines, with some additional questions (see below). This must include the use of routine outcome measures (ROMS) to ascertain the severity of child behavioural problems. 
 
''Brief Clinical Interview ''

During your assessment, it is recommended that the following information is gathered from parent, and child where appropriate: 

* Detailed description of the problem behaviours, preferably with a recent example i.e. “tell me about the last time they hit, what was happening? What was the trigger? How did you/ other respond?”
* Description of development of the problem. Specifically: 
**“When did the problem/ behaviour start?”
**	“What was going on around that time? (in your family, at home, with the child, for you?)”
**	“Can you think of any significant experiences that may have impacted on the problem behaviour?”
* Parents theory about the problem i.e. “why do you think he has started hitting?”, “what are your thoughts about why this behaviour has started?”
* Details of what strategies they have already tried to manage the behaviour/ how do they respond to the behaviour. (NB: if parent states that they use smacking as a means of discipline, this needs further exploration i.e. is it with force, does it leave a mark, parents beliefs about smacking).
* Their hopes for support, what would they like to change. Here setting SMART goals for the intervention will help keep the focus of intervention and track change over time. 

''*Should parents disclose concerns that raise safeguarding concerns, you must follow your service’s safeguarding procedure as appropriate. ''

''Routine Outcome Measures

''

* The use of routines outcome measures (ROMS) will be important when assessing the needs of parents with children presenting with some behavioural problems. ROMS are also important to evaluate the effectiveness of the intervention for the clinical problem; they are an evaluation tool that can track change over time. 
* It is recommended that this brief intervention is offered to those children where they score within the borderline – subclinical ranges on measures of behavioural difficulties, or where there are clinical problems but no evidence-based parenting group available at the time or in their area. 
* If children are scoring well within the clinical range on these measures and a group intervention is available in their area, then this would be the recommended treatment in line with NICE guidance.
* In addition to ROMS, it is advised that goal based outcomes (GBO) are used track and evaluate progress towards a parent’s goal throughout the intervention. GBOs use a simple scale from 0-10 to capture the change; the outcome is simply the amount of movement along the scale from the start to the end of the intervention. GBOs should be used at every session.
* Session trackers are used to evaluate how the intervention is progressing. They can be used as a collaborative tool to think about ‘how are we doing?’ and consider whether anything needs to change. Session trackers should be used at every session. 
* Additional ROMS (child measures – see below) should be used at time 1 (pre-treatment) and time 2 (post-treatment) at a minimum. 
* It is best practice to use patient/ client report measures; parent and child measures to assess clinical problems and as an evaluation tool. The recommended measures are: 
//''
Child measures - aim is to measure frequency/severity of behavioural concerns''//. 

* The Strengths and Difficulties Questionnaire (SDQ) - Brief behavioural screening questionnaire for 2-17 year olds
* RCADS – 47 Item questionnaire with 6 sub scales: Separation anxiety disorder, Social phobia, Generalized anxiety disorder, Panic disorder, Obsessive compulsive disorder, Major depressive disorder (MDD). Normed for children 7+
* The Eyberg - evaluates parental report of behavioural problems (paid)

//''Parent measures – aim to assess and monitor the presence of parental mental health, primarily depression and anxiety''//

* PHQ-9 – brief self-report screening tool for monitoring and measuring the severity of depression
* GAD-7 – brief self-reported screening tool for monitoring the severity of generalized anxiety disorder (GAD)
* Becks Depression Inventory – screening for depression (paid)
* Parent Stress Index (PSI) – identify parent-child problem areas. Measure of parental stress

''//Session Rating – aim to measure therapeutic relationship/ helpfulness of session//''

* Session Rating Scale (SRS) (Miller, Duncan and Johnson, 2002)
* Outcome Rating Scale (ORS) (Miller and Duncan, 2000)


{{manc}}

[img[books with open book and pen.jpg]]

The core materials relating to conducting an assessment can be found under the [[Helping]] section for this guide.

!!!''The approach of [[Guided Self Help]] may not be the right one for everyone''

As such an assessment session will be conducted before the intervention starts (either by the practitioner or a supervisor - depending on the service). 

!!!Session 0
This session may be called may different things by different services. You may hear it be referred to as a choice appointment or a ''Session 0'' these all mean the same thing. Within this guide it is most frequently referred to as a session 0 this is because it is a 'pre-intervention' session (i.e. it takes place before the intervention starts). Please see [[What is a Session 0]]

!!!Why conduct a Session 0? 
The main reason to conduct a session 0/ assessment session is to check if the approach of [[Guided Self Help]] is the most appropriate type of help for the young person/ family before they start the intervention. 

For more general additional information on conducting assessments please see below in the relevant subtopics:

!!!Overview of Assessments

<<list-links "[tag[Overview of Assessments]]">>

!!!Assessments with Parents

<<list-links "[tag[Assessments with Parents]]">>

!!!Additional Needs Assessment
This area of the guide is still being developed
<<list-links "[tag[Additional Needs Assessment]]">>

!!!Anxiety Assessment
<<list-links "[tag[Anxiety Assessment]]">>


!!!Related topics: 

[[Psychoeducation]]: During an assessment session you may want to include some information on the specific area of concern. 

!!!!!Source: Laura Bowyer

For more information about the Assessment that practitioners may be conducting please see [[Assessment]]

!!!First session
*Even if an assessment has already taken place, might be helpful to have a 'session 0' with CYP to work out what treatment route/goals 

!!!Aims
*Identify situations, emotions, bodily sensations, thoughts and behaviours 
*2 key things: how severe and how much is it impacting on the person.
**How frequently is it happening?
**Rate on a scale of 0-10 (10 being it is taking over my entire life)
*Use assessment to build engagement and alliance with YP (validation and normalising, highlighting strengths, praise)
!!!Multi-informant
*Use different people, measures, observation (in waiting room etc)

!!!''Key starting points''
*Prepare any assessment with a good agenda, setting expectations, and creating a ‘problem list’ so you know what to focus on in the assessment 
*Cover introductions / consent / confidentiality at the beginning 
*Use the assessment as a chance to build rapport and a therapeutic relationship with the YP or family 
*Consider time together and time apart with the YP alone for any assessment 
*Use multiple sources of information; e.g. from YP, observations, ROMS, parents, schools etc.
*Remember to use outcome measures for useful information and to flag up risk concerns 
*Always assess for risk and check low mood, even in cases of anxiety 
*Funnelling questions are important – start with open questions and get more specific as the assessment goes on
*Use the [[‘5 W’s’|https://en.wikipedia.org/wiki/Five_Ws]] as useful prompts to gather information; what, when, why, where, who 
*Consider the onset and development of the problem over time.
!!!''Obtain a detailed description of one example of the problem''  
*Once you have the information from the 5 W’s, focus on a typical, recent example to collect information about a specific situation. Specifically, what thoughts, emotions, physical sensations and behaviours did the YP / parent engage in? The below is a useful diagram to have in mind when in an assessment. Remember to ask about environment and also about the responses / behaviours of others e.g. do mum / dad reassure or enable the YP to avoid anxiety provoking situations?
*Using [[The Hot Cross Bun Technique]]
!!!''Taking a developmental perspective'' 
**We also need to think about developmental stage and what it normal e.g. children aged 2-4 find it more difficult to distinguish between fantasy and reality so anxiety might be related to fantasy, but this might be normal levels of anxiety for age group
!!!''What is the impact of this problem on everyday functioning? ''
**Normal' anxiety versus anxiety 'disorder' in CYP; Try to work out what is normal and when anxiety becomes a disorder
**To do this we need to think about how much distress/impact it has on YP in order to figure out what would be appropriate treatment (e.g. signpost or low intensity treatment) we need to assess the impact that it has on CYP e.g. is it keeping them up every night?
*Don’t forget to check in about coping and the YPs’ / families’ strengths
!!!''Setting realistic goals around improvement not cure ''
*Setting up realistic expectations
*Ask about the YP / Parent’s goals and try to ensure these are SMART (specific, measurable, achievable, realistic, time limited). It is unlikely in an assessment to get goals particularly SMART due to time constraints and the fact you might still need to make decisions about the intervention plan with your supervisor. Aim to get goals SMART in the initial GSH session. 
*Difficulties: 'I don't want to feel anxious' - anxiety is normal and helpful, we don't want to get rid of anxiety completely. How are you going to know if you have achieved a goal like this? Needs to be more measurable. 
*Ask - are there things that you would want to do that you can't do now e.g. to be able to go in lifts
*Summarising and using 0-10 scales 
*Prioritising goals might be useful as not all might be achievable in LI treatment 

!!!Self monitoring
*Monitoring thoughts, feelings and behaviours
*Using faces, rating scales (create your own e.g. inside out - what happens when anger takes over your control centre?) 
!!!Identifying negative thoughts
*Being a thought detective/using thought diaries etc
!!!Identifying behaviours 
*Identifying behaviours or what mum and dad do in these situations 
!!!Making sense of anxiety
*Common child behaviours: escape, safety behaviours, hypervigilant, reassurance-seeking
*Common child cognitions: catastrophising, over-generalisation, personalisation, perception of not being able to cope


!!!''Checking out about the session''
*Aim to leave at least 10 minutes at the end of any assessment to explain about what LI work is and to socialise the YP / family to the intervention and give them a chance to ask questions and obtain feedback on the session. 

!!!!@@Color:red; THIS PAGE IS CURRENTLY BEING WRITTEN AND IS AWAITING REVIEW@@ 

Source: Joe Hickey

The five W's are a good tool to use when exploring with the CYP or their parent/carer the main issue the CYP is facing. Please see below for some examples of questions MHPs may want to use when exploring the main issue the CYP is concerned about.

!!!''WHAT?''

* What is the main problem you want help with?
* What have you been doing more/less of since feeling…..
* What kinds of things have been bothering you?
* What helps?

!!!''WHERE?''

* Where do you feel……?
* Are there places where it’s not as bad?
* Where were you when you last noticed things getting difficult?
* Are there places that you avoid because of….?

!!!''WHEN ''

* When do you feel most…?
* When are things a bit better?
* Are there times of the day/the week that are better/worse?
* When did this first become a problem for you?

!!!''WHO?''

* Is there anyone who makes it better?
* Is there anyone who makes it worst even if they don’t mean to?
* How does mum/dad/sister help?
* Are there people you turn to when you’re…?

!!!''WHY?''

* What do you worry might happen?
* What’s the worst case fear for you?
* When you feel…does that mean something to you at the time?
* What the worst thing about ….?


!!Links with other pages:

for more information on how to conduct assessments please go to [[How to Conduct Assessments]]

Please go to [[Assessment]] for a list of relevant pages 

!!!!!Source: CWP Audit Report for London and the South East 2018. Main author:  Deepa Mavji

During 2017-18, a comprehensive audit was carried out on the first cohort of the CWP programme in London and the South East. This included information from 15 sites across London with approximately 1500 cases included in the audit. 

The full report can be found in a folder in googledocs using the link below.  

<<link-pdf "Full CWP Audit Report 2017-18" "https://drive.google.com/drive/u/1/folders/1HjAQ4SLc-esh1MIOBts4_OCTOZbZ38eE">>

Specific details from the audit are shown in different parts of the guide in order to link the information form the audit to the material in the guide. 

These pages are listed below. 

[[Access to CWP services: London Audit 2018]]

Source: Georgia Pavlopoulou, The National Autistic Society, Autism Education Trust 

For more information on what ASD is and videos please go to [[Autistic Spectrum Disorder (ASD)]]

!!Overview
Those with ASD are often still misunderstood, which can have emotional consequences for both the person with ASD and their family. For many young people with ASD anxiety infiltrates their daily life, which can have a big impact on their social life as well as their learning. 
As practitioners it is important that you understand the link between ASD and mental health problems, and the impact this can have on a CYP, their family and their education.


!!!Impact of social environment and welbeing
The ''‘problems of living’'' people on the autism spectrum have in navigating a social world that was not designed for their needs. The lack of opportunities, coupled with the social stigma of being seen as autistic can impact massively on a person with autism's mental well being.
Dr Damian Milton explains this in more detail along with defining autism, in the article 'So what exactly is autism?' Please see below for the full document:
<<link-pdf "'So what exactly is Autism?'" "http://www.aettraininghubs.org.uk/wp-content/uploads/2012/08/1_So-what-exactly-is-autism.pdf">>


!!Mental health
A vast amount of literature on autism would suggest that autistic people are in some way predisposed to mental health difficulties including anxiety and depression.


!!!Suicidal ideation
A small body of research is showing worryingly high rates of suicidality in people with autism. The risk factors for suicide in people with autism can be very different to those in the general population, and thus require tailored prevention strategies. For example, substantially more adults with Asperger's syndrome experienced suicidal ideation (66%) than were depressed (32%), indicating a different route to suicidality than in the general population. Suicidality in people with autism remains poorly understood, and under-researched and studies have failed to explore risk or protective factors. Please see below for an interview with Dr Sarah Cassidy about autism and suicide:

<<link-pdf "Interview with Dr Sarah Cassidy" "https://network.autism.org.uk/knowledge/insight-opinion/interview-dr-sarah-cassidy-autism-and-suicide">>

!!!The family

Levels of stress experienced by families of autistic children are widely reported as higher. A study by Galpin et al. (2018), sought to establish families' support needs from their own perspectives. Please see below for a link to the abstract of this study (Full study not freely available)

<<link-pdf "'''The dots just don't join up'''" "https://doi.org/10.1177/1362361316687989">>

People with supportive family and good social experiences and relationships generally have better mental and physical health than those who lack these networks. Please follow the link for research by Dr Georgia Pavlopoulou and Dr Dagmara Dimitriou on the role of and effect that siblings can have on people with autism: 

<<link-pdf "Research with siblings" 
"https://network.autism.org.uk/good-practice/evidence-base/strengths-based-approach-autism-research-siblings">>

An existential view of well-being, away from a deficit focus might help us understand further the needs of family members when they interact with healthcare and educational specialists. This is in line with siblings' stories who are often ahead of the game showing resilience, understanding and acceptance.  Research by Dr Georgia Pavlopoulou and Dr Dagmara Dimitriou on Sisters’ accounts of growing up with autistic siblings. Please see below for a link to the abstract of this study (Full study not freely available)

<<link-pdf "‘I don't live with autism; I live with my sister’" 
"https://www.sciencedirect.com/science/article/abs/pii/S0891422219300253?dgcid=author">>
 
!!Impact on learning
Please go to [[Autistic Spectrum Disorder (ASD)]] for more information on how learning is impacted by ASD 

!!!Well being and learning
The article below is by Dr Smith and looks at emotional well being and learning, before outlining some approaches used to improve emotional well being in young autistic people. 

''Key points:''

* For young people with autism their emotional state often captures the essence of the day. 
* A student who is confused, scared and anxious cannot focus on the teacher’s tasks or their own learning.
* They can’t often clearly articulate their emotional predicament, and may communicate their discomfort in different ways such as hitting out, screaming, avoiding situations, running away or closing down
 Please follow the link below for the full article:

<<link-pdf "Emotional wellbeing and Mental Health in Young People with ASD" 
"https://network.autism.org.uk/sites/default/files/ckfinder/files/Emotional%20wellbeing%20and%20Mental%20Health%20in%20Young%20People%20with%20ASD%20FINAL.pdf">> 


!!Practice Points: Helpful links
Please follow the link below to go to the National Autistic Society's You Need To know campaign highlighting the mental health commonalities for those with ASD and how services can better help those with ASD and poor mental health. This resource may be a good resource to share with teachers and parents: https://www.autism.org.uk/get-involved/campaign/successes/you-need-to-know.aspx


''Working with CYP:''
It is important to consider that social and emotional implications of having ASD and how this may effect your work with the CYP.

<a class="tc-float-right">[img width= 100 [brain.jpg]]</a>


Source: Georgia Pavlopoulou, The National Autistic Society, Autism Education Trust 

---
As practitioners it is important that you understand the impact that ASD can have on a persons mental health. For more information on Mental health in young people with ASD please go to:  [[Autism Spectrum Disorder (ASD) and Mental health]]

---

!!What is ASD?

ASD is a lifelong, developmental disability that affects how a person communicates with and relates to other people, and how they experience the world around them.
It is often diagnosed by a multi-disciplinary diagnostic team, often including a speech and language therapist, paediatrician, psychiatrist and/or psychologist.

There are approximately 700,000 autistic adults and children in the UK, however those with ASD are often still misunderstood, this can have emotional consequences for both the person with ASD and their family. 

'So what exactly is Autism?' is a document written by autistic academic Dr Damian Milton covering key areas, including: correct terminology, the triad of impairments, theories surrounding functioning, sensory overload, Mental health. Please see below for the full document:

<<link-pdf "'So what exactly is autism?'" "http://www.aettraininghubs.org.uk/wp-content/uploads/2012/08/1_So-what-exactly-is-autism.pdf">>

!!Gender differences
Originally it was thought that only males could have autism. Now however it is known that both males and females can have autism. Still, it is more likely for boys to be diagnosed over girls, with many girls who are diagnosed not getting a diagnosis until much later in life. 

This is because autism ''presents differently'' in males and females often boys might be overactive or appear to misbehave. Whereas girls more often seem anxious or depressed. Furthermore, women are more likely to 'camouflage' (any effort made to mask an autism feature/ behaviour). Camouflaging is emotionally, physically and mentally draining.

Please see below for the full article by by Francine Russco on 'camouflaging' and autism in women

<<link-pdf "'The costs of camouflaging autism'" "https://www.spectrumnews.org/features/deep-dive/costs-camouflaging-autism/">>

!!Learning:

It is estimated that 44% - 52% of autistic people may have a learning disability, although research concerning the exact numbers is varied depending on methods used. Around a third of people with a learning disability may also be autistic. (NAS, 2019). Please follow the link for more information on [[SEND|The SEND Framework]] 

!!!Sleep effecting learning

Autistic people struggle to fall asleep and stay asleep during the night at higher rate than their typically developing peers, ranging from 40% to 80% affecting memory, language, social skills, physical and mental health. For the full article please see Devnani, P. A., & Hegde, A. U. (2015) via the link provided: 

<<link-pdf "Autism and sleep disorders" "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4770638">>

!!!Interests and learning

Research carried out by Rebecca Wood (2019):

Intense or “special” interests with a tendency to focus in depth to the exclusion of other inputs, is associated with autism.

Despite some drawbacks and negative associations with unwanted repetition, this disposition is linked to a range of educational and longer-term benefits for autistic children. It may enhance curriculum access and learning, including their participation in classroom activities, independence and ability to gain intrinsic enjoyment from activities.

For the full article please visit:

<<link-pdf "Autism, intense interests and support in school" "https://www.tandfonline.com/eprint/9BS2x7p77frBWiHZ8fdd/full?target=10.1080%2F00131911.2019.1566213&">>

!!!Schools based interventions
For more information on schools based interventions for CYP with Autism please go to the link provided:

<<link-pdf "School-Based, Educational Interventions and Autism" "http://www.researchautism.net/autism-interventions/types/educational-interventions/school-based-interventions">>

!!!Working with families:
If you need to explain what autism is to a child, young person or parent, the following link provides reliable and authoritative sources of accessible information about ASD.  

Useful information on broaching the subject of ASD can be found [[here|https://www.autism.org.uk/about/what-is/broaching.aspx]]

!!!Working with CYP:
It is important to consider that social and emotional implications of having ASD and how this may effect your work with the CYP. Please go to [[Autism Spectrum Disorder (ASD) and Mental health]] for more information 

''The National Autistic Society'' has some really useful information/ videos on what ASD is and how it can feel to have ASD [[here|https://www.autism.org.uk/about.aspx]]


!!!Working in schools:
Children, teenagers and young people with autism need additional help and support with education. Some will need highly-specialised education, others will follow a more mainstream path. This section of The National Autistic Society website provides advice about school life such as getting extra help in school, dealing with school refusal and exclusion, bullying, and coping with exams. You may want to refer school leads or families to this [[resource|https://www.autism.org.uk/about/in-education.aspx]]


!!Videos

Please see below for a quick [[cartoon explaining ASD|https://www.youtube.com/watch?v=RbwRrVw-CRo]] in a simple but effect way. This video could be used to help those that you are working with such as parents, teachers, other students in the school and the CYP you are working with get a better understanding of ASD.



!!!Diagnosis
These films have been made by young people on the autism spectrum who wanted to share their experiences of receiving a diagnosis with other young people who may be going through the diagnostic process. They know that receiving a diagnosis of autism can be difficult and confusing at any age and for this reason wanted to offer some help and support to young people and their families. Please find the videos [[here|https://www.autismeducationtrust.org.uk/receiving-and-understanding-a-diagnosis/]]

!!!Sensory processing
The clip below has been produced from the National Autistic Society and was part of their 'Too much information' (TMI) campaign. This is a really helpful perspective on what it may feel like for a young person who has ASD:

*[[Make it Stop|https://www.youtube.com/watch?v=xHHwZJX67-M&t=1s]]

*[[TMI: virtual reality|https://www.youtube.com/watch?v=Lr4_dOorquQ]]

!!!Gender differences
An interesting video, from a group of women talking about the misconceptions and issues relating to [[women who have ASD|https://www.youtube.com/watch?v=NwEH9Ui4HV8]]


!!Links to other pages:

Information about special educational needs can be found  in [[The SEND Framework]]

The BAME Inclusion group was started by the wonderful Sarah Thompson and Shayo Bryan-Fenelon, and through conversations with Sarah, I became involved as an honorary contributor to this amazing cause. 
I was asked to write a reflection on the work we’ve been doing so far, and I should preface this reflection by saying I am no great speech writer, I am just a person who believes passionately in the cause that we are working towards; fair and equal access to low intensity CBT for all, which is meaningfully adapted to acknowledge and celebrate all cultures, and provide the best possible outcomes for the clients we work with.

I am a white middle class British male, with seemingly no obvious personal connection to the root of the BAME inclusion cause; white middle class British people are exactly who the manuals were written for.
For me however, it seemed that it should not be fair that the interventions we offer only cater to one specific and small section of the population, rather it should aim to improve outcomes for as much of the population as possible. 

Just as a quick background to me, I was born and raised in Kent to a middle class family, as the eldest of five. I was privately educated through most of primary school, before attending the local grammar school. I coasted through most of my secondary years, before failing my A-Levels. From there I went on to study childcare at levels 2 and 3 at a local college, and then completed my undergrad at a local university, whilst working as a nursery teacher.
I consider myself lucky that I have had some incredible people shape my thinking over my education, from that one fantastic Early Years teacher who taught me to question the status quo, to the psychology lecturer who talked about improving access to psychological therapies for all. They inspired me to become an agent of change, to stand up for equality and to challenge those who don’t. 

I have done my best to educate myself in the topic of systematic inequality, with the hope of learning from the mistakes of others before me. I have had to sit with feelings of discomfort and disgust, because I believe it is important to not “brush them under the carpet”, but to expose them and label them for what they were.   
It is easy to maintain the status quo unintentionally, by not standing up and by turning a blind eye, but nothing that was ever worth fighting for was easy.

I am incredibly lucky and excited to have been included in this inclusion group, and I urge as many people to become involved with this project, in any capacity that you feel able to! I believe we have a moral obligation and duty to make sure all are treated with the respect that they deserve.

It almost seems strange to me if people should question my involvement to an extent, as in my mind, of course I would! I may not experience the difficulties and hardships that others have to deal with on a daily basis, but that does not mean that I do not want to help! To change systems, and to bring about true equality that is considerate of the individual and their unique circumstances is my ultimate aim.

Please see the links below for incredibly useful articles regarding the coronavirus pandemic. these have all been taken from the 'support' section of [[BBC Bitesize|https://www.bbc.co.uk/bitesize/support]]

''Exam essentials: Studying for success''

https://www.bbc.co.uk/bitesize/articles/zb7j382

''Go The Distance: Study Skills''

https://www.bbc.co.uk/learningenglish/gothedistance/studyskills

''Nine nifty ways to study remotely''

https://www.bbc.co.uk/bitesize/articles/z77svk7

''Eight ways to support your anxious child during the coronavirus pandemic''

https://www.bbc.co.uk/bitesize/articles/z6ksy9q

''Six ways to cope with lockdown loss''
https://www.bbc.co.uk/bitesize/articles/z7xyvk7 - Ros Law writing for young people, 

''Six ways to help your child come to terms with lockdown loss''
https://www.bbc.co.uk/bitesize/articles/znxyvk7 - Sheila Redfern writing for parents and carers 

''Eight ways to support your anxious child during the coronavirus pandemic''

https://www.bbc.co.uk/bitesize/articles/z6ksy9q - Vicki Curry writing for parents and carers 

''Five ways to manage your wellbeing as a parent during lockdown''

https://www.bbc.co.uk/bitesize/articles/zrmhscw - Peter Fuggle and Yvonne Millar writing for parents and carers.

!!!Barriers to digital
*Fear of digital 
*Lack of funding
*Fear of change 
*Lack of evidence 

!!!Optimising the use of digital 
*By starting with the end in mind: 
**What's the problem?
**Who will it benefit?
**Where in the journey is the optimal place to use tech?
**Map interventions using behaviour change models
**Understand the context of the user to the appropriate tech
**Can you connect your local services into the  online tech offer?

!!!When using technology need to consider: 
*Tone of voice
*Addressing digital exclusion
*Sensory requirements
*Systems adoption
*Undermining stigma
*insight and trust/empathy

This translated version of the Parenting intervention has been generously shared with us by the Tower Hamlets CAMHS service. 
 


<<link-doc "Parent Behaviour Intervention in Bengali/Sylheti" "https://drive.google.com/drive/folders/1oSJ1x0kXQp9AWRhgDs_i7Csl07j6CD9j?usp=sharing">>

[img[blue pattern.jpg]]

!!''Behaviour problems in this guide''
All pages in this guide relate to behaviour problems for children under 11 years of age. The intervention for behaviour problems is parent led. Core materials relating to this intervention can be found via the [[Helping]] page.

!!!This area of the guide is divided into four key areas as listed below:

!!![[Behaviour Problems Overview]]

!!![[Behaviour Problems Practice]]

!!![[Behaviour Problems Session Material]]

!!![[Alternative Session Plans for Behaviour Problems]]

!!![[Behaviour Problems Research]]

!!!!!Source: Caroline Bengo, Matt Woolgar, Sara Dawson and Jelena Crnokrak 
---
!!'''Guided Self Help for Behaviour Problems''' 

The brief guided self help for behaviour problems follows the guidance in the guided self-help for behaviour problems manual. Written by Caroline Bengo and her team and generously shared with the other CYP-IAPT Training Collaboratives 

<<link-doc "Guided Self-Help for Common Behaviour Problems" "https://drive.google.com/file/d/1Bfh_KdCBjsBMnrJH_-o-dRbsjNMUV3OM/view?usp=sharing">>
 
@@font-size:12px;
<<< <<link-doc "The Previous version of Guided Self-Help for Common Behaviour Problems can be found here" "https://drive.google.com/file/d/1vBNYY-hZtqIKHZucyZmbxZmfjTvYYoRZ/view?usp=sharing">>
@@

ALL behaviour problems handouts: 

<<link-doc "Behaviour Manual ALL handouts word version" "https://drive.google.com/file/d/1DdoY9H4Hpvp6nlKIPRSBckbTYpMx5Ld7/view?usp=sharing">>

For translations of these materials please see page: [[Translation of Original Materials]]

__Sharing handouts with young people and parents during remote working__

For further adaptions made to the manual in light of COVID-19 and the changes to working please see page:
[[Behaviour problems manual: COVID-19 adaptions]]

The authors of the behaviour problems, low mood and adolescent anxiety manuals/handouts have given practitioners permission to create a Word version of the handouts for ease of sharing when remote working with young people and parents should you wish to do so.


PLEASE NOTE: The manuals/handouts are covered by Creative Commons copyright.  

Copyright: Available under License Creative Commons Attribution No Derivatives
See further: https://creativecommons.org/licenses/by-nd/3.0/

In addition, they are designed to fit with the evidence base for working with these interventions.  

For these reasons, the content of the manuals/handouts should not be amended by practitioners, but young people/parents/carers can fill them in as part of the intervention as they would a paper copy.

---


!!''Introduction''
Parenting programmes delivered in a structured manner over several weeks are the most widely researched psychological intervention in child and adolescent mental health. They are the single most effective intervention for the treatment of conduct problems in children.

!!''Sessions overview''
The brief guided self-help parenting intervention is divided into two broad areas that can be covered over seven (or more) sessions. These have been divided into parenting approaches that:

#To promote positive relationships, attachment and pro-social behaviour through sensitive responding
#To provide appropriate routines, boundaries and limit setting

For more information about the sessions please go to: [[Session Overview for Behaviour Problems]]

!!''Session Plans''
 For a list of the session plans: [[Session Plans for Behaviour Problems]]

!!Related pages:

[[What is a Behaviour Problem?]]

Below is a list of pages giving an overview of the approach for helping parents who have children with behaviour problems:

<<list-links "[tag[Behaviour Problems Overview]]">>

<<list-links "[tag[Behaviour Problems Practice]]">>

Below is a list of research relating to behaviour problems:

<<list-links "[tag[Behaviour Problems Research]]">>

Below is a list of the Materials that practitioners will use in their work with parents of children with behaviour problems.

<<list-links "[tag[Behaviour Problems Session Material]]">>

!!''Behaviour problems in this guide''
All pages in this guide relate to behaviour problems for children under 11 years of age can be found in [[Behaviour Problems]]. 

!!''Useful resources''
Dispatches programme on [[Challenging Children|https://www.youtube.com/watch?v=RlMAYaYRDJE]]


Description of [[behaviour problems in Hindi|https://www.youtube.com/watch?v=Wvii7HUY_GE]]


An interesting discussion of the [[nature of challenging behaviour|https://www.youtube.com/watch?v=zuoPZkFcLVs]]


NHS information on [[behaviour problems in young children|https://www.nhs.uk/conditions/pregnancy-and-baby/dealing-with-difficult-behaviour/]]

Royal College of Psychiatry [[guidance on behaviour problems|https://www.rcpsych.ac.uk/healthadvice/parentsandyoungpeople/parentscarers/behaviouralproblems.aspx]]

Please see below for the adapted behaviour problems manual in response to the current circumstances caused by COVID-19. This manual was Compiled and edited by the KCL CYP-IAPT team: Helen Barker, Zoe Maiden, Laura Bowyer, Sarah Carman, Victoria Pile, Susanna Payne; and the UCL CYP-IAPT team: Vicki Curry With information from: Caroline Stokes (KCL); Alice Kerr & Emma Warnock-Parkes, (Centre for Anxiety Disorders And Trauma/KCL); Lisa Shostak (KCL); Ali Lambie, (Mindfulness Hampshire); Jynna Yarrum and Alysia James, (University of Northampton). Young people’s perspective from: Lila and Remy Moar

---

<<link-pdf "Behaviour Problems manual: COVID-19 adaptations" "https://drive.google.com/file/d/1FYj3k_2JmBuclnMAkb_wWM4X8FWzLU-E/view?usp=sharing">>


ALL behaviour problems handouts: 

<<link-doc "Behaviour Manual ALL handouts word version" "https://drive.google.com/file/d/1DdoY9H4Hpvp6nlKIPRSBckbTYpMx5Ld7/view?usp=sharing">>

----

Sharing handouts with young people and parents during remote working

The authors of the behaviour problems, low mood and adolescent anxiety manuals/handouts have given practitioners permission to create a Word version of the handouts for ease of sharing when remote working with young people and parents should you wish to do so.

PLEASE NOTE: The manuals/handouts are covered by Creative Commons copyright.  

Copyright: Available under License Creative Commons Attribution No Derivatives
See further: https://creativecommons.org/licenses/by-nd/3.0/

In addition, they are designed to fit with the evidence base for working with these interventions.  

For these reasons, the content of the manuals/handouts should not be amended by practitioners, but young people/parents/carers can fill them in as part of the intervention as they would a paper copy.

!!!!Source:Laura Bowyer 
!!''Key points''
*Anxiety is maintained when someone avoids experiencing the anxiety by either escaping the situation in some way or avoiding it all together 
*Over time a reduction of anxiety becomes associated with avoidance 
*The YP never learns what will happen to their anxiety should they remain in that situation and don’t learn what might happen and how they might cope
*Main intervention (after psychoeducation) is to create a hierarchy and face a YP’s fears in a step by step fashion and wait for them to habituate to their anxiety (exposure)
*Exposure means facing fears until anxiety naturally reduces and subsides
*The YP should remain in the feared situation until their anxiety has come down by half 
*They should repeat each step of their hierarchy or ‘fear ladder’ until the anxiety has reduced 
*Exposure is best done in a graded manner, from the least difficult to the most difficult situation (use the fear thermometer for this)
*It needs to be repeated multiple times, until the anxious response is no longer elicited (or is weak)
*And it needs to be prolonged enough for the anxiety to reduce on each occasion
!!''Supporting children and parents to practice'' 
*You should be rating anxiety levels throughout the exposure 
*Encourage positive behaviours and coping with contingency management / use of rewards
*Practice new behaviours in session if possible to increase confidence in parent’s ability or the YP’s ability to do this for homework. You can role play with parents
*For the CWP, it requires a mixture of kindness and confidence. In general, starting slowly is best but not so slowly the CWP worker becomes avoidant of the problem too. 
*Reward effort, not just success 
!!''Supporting coping''
*Another behavioural intervention is to increase coping behaviours e.g. relaxation, but note these should only be done outside of planned exposure work. I.e. do not do relaxation when a YP is facing a fear on their ladder as this will prevent them habituating naturally to their anxiety and this also teaches them subtly that they need to do something to their anxiety to manage it. When outside of planned exposure, a YP can of course use coping strategies to help manage their anxiety. 

!!!''Source of this material''
The material in this section is drawn from the work of C.W. Lejuez,  Derek R. Hopko, Ron Acierno, Stacey B. Daughters, Terry L. Pagoto and the treatment manual for Brief Behavioral Activation Treatment for Depression (BATD): Revised Treatment Manual (BATD-R). This is an evidence based approach for adults with depression with indications of effectiveness with young people. 

<<link-pdf "BA Paper from Reading" "http://centaur.reading.ac.uk/64457/1/Pass%20Whitney%20Reynolds%202016%20Brief%20BA%20complexity%20Accepted%20manuscript.pdf">>
!!!''Introduction''
*The basic rationale of behavioural activation is quite simple. The assumption is that when a person experiences persistent low mood, it is very easy for positive life experiences (such as friendships and enjoyable activities) to become neglected and even avoided. 
*This absence of positive experience creates a vicious cycle of supporting the low mood. The approach of behavioural activation is to try to reverse this vicious cycle. 
*The application of this approach presents common difficulties for the practitioner as it is easy for the young person to experience this approach as critical of themselves or that it mimics negative patterns of interaction between the young person and their parents. 
!!!''Basic Rationale''
*Improvement in mood is more likely if each day includes some enjoyable or valued  activities that help a person feel valued and provides a sense of purpose.
*The approach invites the client to identify the areas of his/her life where either this used to happen or where it could be anticipated now and to consider how to reconnect with these. 
*The young person is then encouraged to identify and plan daily activities that help him/her to do things that they value and enjoy. 
*This is important because when a young person does positive and enjoyable experiences this is likely to improve how they feel and think about their life. 
*It is difficult to feel depressed and hopeless when regularly doing activities that are valuable and worthwhile and that bring a sense of pleasure and accomplishment. 
*In this way the approach focuses on changing behaviour as a way of improving mood. 
!!!''Motivation and cognitions'' 
*Many young people with low mood often feel tired and lack the motivation to do various activities; thinking that once they have more energy and think more positively, they will be able to do the activities they have ignored or have been unable to accomplish in the past. 
*The opposite approach is taken in this approach – behavior is changed first as a way to increase energy and motivation, as well as positive thinking and feelings. 
*The focus on behavior change, however, does not mean that  thoughts and feelings are ignored. Instead, we suggest that negative thoughts and feelings will change only after you change your behavior and are having more positive life experiences. 
*Healthy behavior is defined as behavior that is directed towards improving your quality of life, and is directed towards the attainment of the values you have in your life. In contrast with healthy behavior, unhealthy (depressed) behavior generally is not directly related to improvements in the quality of your life and does not move you closer to living according to your values.
!!!''Activity and low mood''
*It is possible to be active, yet still be depressed. This can happen if a person feels overwhelmed with activities that are unfulfilling or forced by others. For example, although you may be busy at work and home, these activities may be focused only on helping others. 
*Although it certainly is important to help others, it is never a good idea to focus so much on others that your own needs and feelings are completely neglected. 
*Focusing entirely on the needs of others may result in feelings of emptiness and dissatisfaction, followed by confusion and guilt for having such feelings. Thus, it is not only important to have many activities in life, but specifically to have activities that bring you some degree of pleasure and fulfilment.
!!!''Key steps in behavioural activation'' 
The method of behavioural activation has a number of common steps. 
#[[Diary keeping and daily monitoring of activity]] 
#[[Activity planning]]
#[[Reviewing life activities and interests]] 
#[[Learning about the impact of behaviour on mood]]
#[[Building a back up team]] 

!!!Learning objectives for the session
#Reflective- thinking about own practice in terms of safeguarding issues 
# Understand safeguarding responsibilities and roles 
#Understand how we assess and formulate risk in relation to children 
# Process around escalating and getting help
!!!CWP Core competencies covered by this session
*Use of outcome measures 
*Accountability and evidence-based principle of IAPT
!!!Slides for session
*These can be found via the following link:
!!!Main content of the session - where to find relevant pages in the wiki guide 
*[[Being a safe Practitioner]]
*[[Outcome monitoring]]
*[[Guided Self Help]]
<html><iframe width="560" height="315" src="https://www.youtube.com/embed/k96-DISPP88" frameborder="0" allowfullscreen></html>
!!!References for session
*London Safeguarding Guide 
*Cognitive-Behavioural Therapy for Child Anxiety Confers Long-Term Protection from Suicidality 
*Child Outcomes Research Consortium (CORC) for full list of measures 
*Is it time for clinicians to routinely track patient outcome? A meta-analysis 
*Effects of routine feedback to clinicians on mental health outcomes of youths: a randomised trial 
!!!Feedback from session - points to improve
*Thought Creswell lecture was going to be about book rather than research behind it 
*Hard to concentrate all day in lectures (not relevant today, but highlighted how the variety helped)
*Afternoons more interactive or practical sessions 
*Feedback or question box in sessions so people don't have to speak out in lectures 
*Demo different ways of giving feedback i.e. post-in notes 
*More visual presentations, suggestion of showing a session in the beginning and the end of treatment 
*Whole day on the same topic i.e. justifying what we are doing with evidence. Suggestion to break up the content 
*Lecture slides given further in advance 
!!!Feedback from session - positives from the day
*Three different lectures, kept people interested due to variety 
*Useful to know why we are doing what we are doing i.e. justification around ROMs and GPD-CBT
*Case vignettes during safeguarding to think in practice how its going to work 
*Video useful to look and see if something is working i.e. the parental anxiety effects 
*Lots of links to extra readings students can look at later 
!!!Specific issues 

!!! What are breathing techniques and why should I use them?
Although we all breathe every day, it can sometimes be helpful to actually focus on this exercise to reduce our experiences of [[Stress]] or [[Anxiety]]. This is because when we feel this ways, we tend to breathe faster and more shallow, which is related to the [[Fight or Flight]] response. 

However, breathing techniques don't only have to be used when we feel stressed, worried or anxious. It can greatly improve our mental well-being to practice these techniques regularly. An added benefit of this is that you will be well practiced at using them faster, and more able to call upon them when your emotions are heightened. 

{{inhale-exhale.jpg}}

!!! A simple to use breathing technique:
* Let your breath flow as deep down into your belly as is comfortable, without forcing it. 
* Try breathing in through your nose and out through your mouth. 
* Breathe in gently and regularly. Some people find it helpful to count steadily from one to five. You may not be able to reach five at first. 
* Then, without pausing or holding your breath, let it flow out gently, counting from one to five again, if you find this helpful. 
* Keep doing this for three to five minutes. 
(sourced from nhs.co.uk)

!!! Guided breathing techniques
It can also help to follow guided breathing exercises such as this one: https://breathewithme.co.uk 

*Mindful of the CBT model but focuses on the target of behaviour change (which can impact cognitions)  
*Evidence that BA is not inferior to CBT and behavioural components are just as effective as cognitive 
*Thinking about doing rather than thinking and thinking might be easier for young people 
*Hardly any evidence for BA and a gap in the research of adolescent depression
!!!~ROMs 
*Benefit clinically for an understanding of the young person from parent and clinician
*Added question specifically about suicide - good to pick up risk. If not on questionnaire then discuss at beginning of session. 
*BA ~ROMs (RCADS, ORS, SRS) 
*Same principles apply with other measures used e.g. SFQ and SRS, ORS or GBO
!!!Brief BA 
* 8 session treatment
* the start the BA is about understanding yourself and what you are doing with your time so its important to get this understanding soon so that behaviour change can happen 
*Clinical review one month after sessions to see how they have got on on their own 
*Structured parental involvement in sessions (marked with a P) and this is formalised with a contract in session 6 
*Values based activities are reinforcing 
*No evidence behind the order of things so flexible in terms of what an activity is introduced to young person 
*Arranged phone calls with parents if working in schools

The goal-based outcome (GBO) tool guidance notes (2019) written by Duncan Law can be downloaded here

<<link-doc "Goals and goal based outcomes" "https://goalsintherapycom.files.wordpress.com/2019/02/gbo-version-2.0-guide-final-1st-feb-2019.pdf">>

Please also see the website [[Goals in Therapy|https://goals-in-therapy.com/2018/12/07/guidance-notes-for-using-the-goal-based-outcome-gbo-tool/]] for more guidance on goals and the GBO

!!!!Source: Joe Hickey

For information on what a therapeutic alliance is please go [[here.|Therapeutic Alliance]]

!!How to build a therapeutic alliance?

*Fit the intervention to the CYP, don’t make them fit in with the intervention
*Explore previous experiences of helping relationships
*Build and maintain the necessary alliances within the child’s systems (Parents/carers, teachers, TAs, etc.)
* Constantly reflect on whether the relationship alliance is good – use your supervisors, use colleagues etc.
*Ordinary/casual way of chatting can be helpful to build relationship (just like any other conversation that the YP would have had)

__Establish the bond with CYP__

*Use reflecting statements and other [[Active Listening]] techniques (OARS) -Reflect back on how the client feels when they talk to other people, in regards to the young person talking to you. 
*Use collaborative language (we, us, let’s) creates a sense of being in this together
*Track and validate feelings

__Collaborate on goals and tasks__

*Work with CYP and parents/carers to achieve mutually agreed-upon treatment goals and tasks

__Provide a treatment rationale__

*Link tasks to wider aims and goals

__Consider readiness for change__

*Transtheoretical model of change and motivational interviewing techniques
*Work within the CYP’s developmental level

!!What factors promote or hinder?
Practitioner-parent/carer alliance associated with CYP outcomes just as strongly as practitioner-CYP alliance.
For CYP work, you are always creating multiple alliances and they can all influence outcomes. Some factors that effect a therapeutic alliance:

* Discrepancies between CYP and parents
* Low motivation
* Poor expectations about outcome
* Lack of credibility in the help offered
* Alliance ruptures
* Negative previous experiences of help
* Severity of the problem 
* Practitioner factors 
* Timing of the help offered 


!!How do you know if a therapeutic alliance is good?

* Ask for feedback at the end of each session
*Use your supervision and practice tutoring
* Use your colleagues
* Observe the CYP or parent/carer
* Observe yourself
* Ask the CYP or parent/carer

!!What is a rupture?

Impasse or breakdown in the therapeutic relationship due to a disagreement on goals, lack of collaboration or strained bond.

__Spotting a rupture__

* May be characterised by confrontation or withdrawal and will vary in intensity, duration, and frequency
* Misunderstanding of some kind, followed by a marker in speech or behaviour

__Repairing a rupture__

* Investigate, don’t ignore
* Take responsibility for your part in what happened
* Show openness to the CYP’s experience
* Rupture repairs are associated with better therapeutic outcomes 

!!Links with other pages
There are a number of pages around [[Engagement]] which are highly related to this topic. 

!!!!!Source: Roslyn Law
This is a core component of guided self help which has been drawn from Interpersonal Psychotherapy for Adolescents (IPT-A). 
The core idea is to support the young person or parent in identifying key people in their social group who in their view may be able to be helpful to their problems and difficulties. 

More to be written here.

<<list-links "[tag[COVID-19 Resources]]">>

On the 24/07/2018, a total of 1136 clients were registered on POD, of which 958 clients had outcomes data which met the inclusion criteria. 368 of these cases were current and 590 had completed intervention with a CWP. 

The reported results are based on this sample. 

!!Goals Outcomes

Data for GBOs was available for 430 clients at Time 1 and 385 clients at Time 2, creating a percentage completion for Time 2 data of 89.5%.
{{Audit Descriptive Scores_GBO .PNG}} 

{{Audit GBO's graph.PNG}}

The mean GBO score significantly increased from baseline (M= 2.58, SD= 1.79) to discharge (M=7.00, SD=2.35; t (384) =33.65, p<.001, g=2.10, 95% CI [1.88-2.31]).

{{Audit Reliable Change for GBO.PNG}}
On average, 77% of clients showed a reliable improvement in GBO scores between Time 1 and Time 2. Few clients (1%) showed reliable deterioration, and 22% showed no reliable change. 

Data for the RCADS was available for 385 clients at Time 1 and 287 clients at Time 2, therefore the percentage of completion at Time 2 was 74.5%. 

{{audit RCADS graph.JPG}}


{{Audit RCADS_table.PNG}}


The mean total anxiety and depression score significantly declined from baseline (M = 58.46, SD = 13.87) to discharge (M = 48.87, SD = 13.67; t(235) = 11.49, p < .001, g = 0.69, 95% CI [0.56-0.83]).		

Data for the SDQ was available for 227 clients at Time 1 and 155 clients at Time 2, creating a percentage completion for Time 2 data of 68.3%. 

{{Audit SDQ graph.PNG}}
>
{{Audit SDQ Means.PNG}}

Table 1 shows that the mean Total Difficulties score significantly declined from baseline (M = 14.94, SD = 6.27) to post treatment (M = 10.94, SD = 5.82; t(111) = 7.40, p < .001, g = 0.66, 95% CI [0.46-0.85]).	

The mean Total IMPACT score significantly declined from baseline (M = 3.28, SD = 2.49) to post treatment (M = 1.65, SD = 2.05; t(127) = 8.89, p < .001, g = 0.82, 95% CI [0.61-1.02]).

!!''Module 1: Children & Young People’s Mental Health Settings: Context and Values''

Number of credits: 15 credits

!!!''Aims:''
To equip the CYP worker with the necessary knowledge, attitude and competence to operate effectively in an inclusive, values driven service. 

!!!''Content to include:'' 

#CYP services context & principles – local & national 
#Service role of the CYP PWP & overview of roles 
#Multi agency working & navigation (including context of service delivery)
#Legal/professional issues, (incl. legal framework, ethics, confidentiality, capacity/consent, safeguarding etc)
#Overview of CYP MH therapies & evidence base 
#Diversity and Culture, social inclusion 
#Caseload & clinical management, use of supervision, liaison & clinical decision-making. 
#Child, youth and family development and transitions 
#Working with families and systems 
#Service user involvement 
#CYP mental health policy 
#Collaborative practice/working and participation?? 
#Outcomes-informed practice. 

!!!''Teaching and Work Placement Time'' 
To include 12 days teaching (90 hours) plus Service-based learning (including service supervision & observation/shadowing) and private study.

!!!''Module assessment (For guidance only - each HEI may specify individual requirements).'' 

#Portfolio (signed off by service supervisor) 
#Multi choice examination 
#Presentation of service related problem based leaning task in groups with project reflective analysis. 
 

!!''Module 2: Assessment & Engagement'' 

Number of Credits: 15 

!!!''Aims:''
 
#To be able to assess and identify areas of difficulty (including risk) and establish main areas for change. 
#Establish and maintain a working therapeutic alliance & engage the child/young person/family to support them in self-management of recovery # Identify and differentiate between common mental health problems in CYP 
#Navigate & signpost to appropriate interventions 
#Use Routine Outcome measures and standardized assessment tools effectively 

!!!''Content to include:'' 

#Therapeutic relationship skills, ability to engage and communicate across the age range. Developmental stages and background, working with difference. 
#Cultural diversity awareness - cultural competence 
#Engagement of CYP & families. 
#Using creativity to engage children & young people 
#Interviewing & questioning skills 
#Risk assessment, safeguarding & management 
#Common mental health problems in CYP 
#How to use measures, goal-setting & goal based outcomes 
#Knowledge of support interventions & giving evidence based information 
#Pharmacology 

!!!''Teaching and Work Placement Time'' 
12 days teaching (90 hours), service based learning and (including service supervision), and private study. 

!!!''Module assessment (suggested)'' 
#Video assessment of client demonstrating engagement, assessment, information giving and shared decision making 
#1000 word reflective analysis. 
#2,000 word case report 
#Portfolio (signed off by service supervisor) 

!!''Module 3: Evidence based interventions for common mental health problems with children and young people (Theory and Skills)''

Number of credits:30

!!!''Aims: ''
#To acquire knowledge and skills in effective brief (low-intensity) interventions for children, young people and family systems based on the most up to date evidence. 
#To acquire knowledge of a range of interventions (including written and computerised interventions) and services available to CYP & families across CYP agencies 

!!!''Content to include:'' 
#Behaviour change: Theories and models 
#Critical evaluation of the evidence base 
#Functional analysis & formulation of presenting difficulties 
#Goal setting (continued) 
#Collaborative working 
#Guided self-help – content and suitability. Sign-posting: when & how 
#Problem solving 
#Pharmacology – awareness of medication that may be prescribed for CYP for common mental health problems 
#Health promotion 
#Behavioural activation –theoretical principles & application in practice
#Exposure – theoretical principles & application in practice. 
#Working with parents 
#Assisting with Parenting training for conduct problems – social learning theory & application in practice. 
#Therapeutic endings 
#Delivery of interventions for anxiety, depression, conduct and low level regulatory issues via a range of communication methods. 


!!!''Teaching and Work Placement Time'' 
22 days teaching, service based learning and private study 


!!!''Module Assessment (suggested)'' 
#Two video recordings demonstrating skills in planning and implementing a low-intensity treatment: one of behavioural activation for depression and one of either a parenting intervention or a behavioural treatment for anxiety. 
#A 1000 word reflective video analysis 
# 2,000 word case report 
#Service based learning portfolio (signed off by service supervisor 

!!Grad/Postgraduate Certificate in Brief Evidence Based Interventions with Children and Young People with common mental health problems 

Credits: 60 (PG) Level 7 

The course will consist of three modules:  

#Fundamental Skills: Children and Young People’s Mental Health Settings: Context and Values ([[CWP National Curriculum - Module 1]]) (15 credits) 

#Fundamental Skills: Assessment and Engagement ([[CWP National Curriculum - Module 2]]) (15 credits)

#Evidence based interventions (Theory and skills) ([[CWP National Curriculum - Module 3]]) (30 credits) 

Modules 1 and 2 will run in parallel

This national guidance was drafted in 2017 by the CWP national curriculum group.  

Notes from National CWP Implementation Group and discussion across collaboratives can be found at:


https://3.basecamp.com/3393815/projects/5736629

* Barnet
* Brent
* Bromley Y
* Camden
* Croydon
* Hammersmith and Fulham
* Haringey
* Hertfordshire
* Hillingdon
* Hounslow
* Islington
* Kingston
* Lambeth
* Lewisham
* Norfolk
* Suffolk
* Surrey
* Sutton
* Tower Hamlets
* Westminster

''CWP Service Satisfaction ''

''Experience of Service Questionnaire (ESQ)''

257 young people completed the self-rated ESQ on POD.  

Most items on the ESQ were rated ‘certainly true’, majority of young people reported they felt ‘treated well’ (99%), listened to’ (95%) and ‘had received good help’ (94%), with the ‘comfortable facilities’ item scoring the lowest (63%). 

{{ESQ Young person reported responses.PNG}}

170 parents completed the self-rated ESQ on POD.  

Most items on the ESQ were also rated ‘certainly true’, majority of parents reported they felt they ‘had received good help’ (98%), were ‘treated well’ (98%), ‘listened to’ (97%) and found it ‘easy to talk’ (97%), with ‘comfortable location’ (84%) and ‘convenient appointment’ items rated the lowest (84%).  

{{ESQ parent reported responses.PNG}}


''Session Feedback Questionnaire (SFQ) ''

The SFQ was completed a total of 2922 times on POD. 

96% (n=2812) of sessions were rated the top 25% of the satisfaction scale or above (>16). 

''Session Rating Scale (SRS)  ''

The SRS was completed a total of 345 times on POD. 

78% (n=269) of sessions were rated the top 25% of the satisfaction scale or above (>36).

This section of the wiki contains all of the core information that sites need to know. A list of pages within this section are listed.

<<list-links "[tag[Site Information]]">>

[img[redd-book.jpg]]

<<list-links "[!is[system]!is[image]sort[]]">>

Each partnership will be invited to develop their own CWP pathway with the expectation that the supervisor will have a key role in selecting cases, particularly at the beginning of the training. 

*Overall, the local care pathway is the responsibility of the local steering group, supervisors and local commissioners. The role of the HEI is to train the staff who will be implementing this pathway. 
*Selection of cases is likely to fall into one of two options: 
**Develop a selection criteria which includes some indication of severity but also includes some recognition of the family context and help seeking stance. 
**All new cases to a service are offered CWP in the first instance as first level of help. 
* A key issue is that local services need to identify the young people who ''will not'' be served by the new service of guided self help. What cases will not be suitable for guided self help? Important to recognise that CWP service cannot take all cases not accepted by CAMHS Tier 3.  
*Signposting may be an important part of the pathway.  

!!!!Source: Peter Fuggle 
!!''Introduction''
This guide is being continuously updated and developed. This means that some pages are not finished or are incomplete. This is because we believe that this should be an open system with on-going improvements in the material. Some pages will have a tag (see below) saying ''draft page''. This indicates that this is still in the process of being written. Most pages are complete for now but some are more explicitly in a state of development. 

The software used to support this on-line guide is called tiddlywiki.

It has similarities to other wiki software, such as Wikipedia. This has enormous flexibility so that material can be linked together in very creative ways.

This guide has hundreds of pages of information (including handouts, self-help materials, videos) about the EMHP programme.

These have been organised into key areas that can be found through the row of tabs at the top of the screen - contents bar:

[img[CWP site map.PNG]]

!!''Finding your way around''
!!!''Tags and links''
The software used to support this on-line guide is called tiddlywiki. It has similarities to other wiki software, most notably for Wikipedia. This has enormous flexibility so that material can be linked together in very creative ways. 
However, for some users, they experience the guide as being hard to find things and to know what is available in the guide. 

This page explains some of the thinking about how to address this. 

There are hundreds of pages in this CWP manual that are linked together by ''tags'' and ''links''. 

A ''tag'' joins together pages to do with a particular topic. So there is a tag for [[Guided Self Help]] that links together all the pages related this approach.This is a big topic so it has lots of pages connected together under this tag. Within this big topic, there are tags with a smaller number of pages. One way of thinking about a tag is that it is like a washing line (remember these) where all the clothes on the line are held together on the line. The line is a tag. 

It is better not to have a huge number of tags as the guide can become confusing with too much  connectedness that leaves people being unable to see the wood for the trees. 

One of the main design  tasks of the guide is to work out the key tags. These could be thought of as chapter headings if the guide was a book. 

A ''link'' makes a specific connection between individual pages. So that someone can more easily find pages related to the page that they are reading. Using the metaphor of the washing line, a link would connect two pieces of clothing, like a pair of socks!

<<list-links "[!is[system]!is[image]sort[]]">>

* Warning “tea is ready in 5 minutes so you will have to stop playing”
* Command given “time for tea”
* Wait for compliance – if the child complies, praise and no need to calm time
* If child doesn’t comply – give an if-then warning. “if you don’t come for tea, you will go to calm time”
* If child still doesn’t comply say “you didn’t come for tea, go to calm time”
* When calm time is over, there is an expectation that the child will still comply. Say “it’s time for tea”. 

__Hammersmith and Fulham__ 

Set up service initally sitting as part of the community CAMHS team and set up team in schools in the borough. 
CAMHS uses a version of the CAPA model. Community CAMHS and specialist CAMHS sit under single point of access so screened together. Quota of assessment of choice appointment. Took mainly from the C-CAMHS team not tier 3 for CWP. 

''Case 1''
Eric (not real name),  9 years, referred for anxiety with facial ticks, assessed through choice appointment. Good fit for Cathy Creswell parent anxiety model. CWPs joined joint meeting, offered 8 sessions of GSH for anxiety. Identified goals around worries in schools, scored highly on social anxiety. Parent was motivated who bought the book and read the chapters and was able to work with CWP to deliver intervention. Good case as the parent was motivated and the symptoms weren't severe, needed extra support around taking part in class activities and generalised worries. Incident of bullying which the school wasn't responding to. CWP was required to speak on the phone and attend meetings. Example of cases which seem straight forward but complications may come up which is managed in supervision. 

''Case 2'' 
Supervisor has reservation with this client but was convinced to try. Boy, 6, on paper seemed complex as he was referred for behaviour. Eldest of 3 with severe behaviour at home. Assessed by C-CAMHS and query for neurodevelopmental concerns. What was missing was lack of structure and boundaries to contain the behaviour. Needed to go back to basic intervention based on IY. Caveats for working with the case, the case was held by the family therapist. Goal around reducing aggressive behaviour at home. Parents in chaotic mindset at home but motivated for help. Family engaged well, attended all appointments, resistance about trying things out at home. Noticed a significant change in his behaviour with manageable reward charts and attending with play time. 

__Cambridge and Peterborough __

*Invited parents to sessions 1 and 2 with psycheducation 
*Found that out of all the models the behaviour group parents were more likely to drop out.
*Clear in assessment if you cancel 3 times its the end of intervention 
*New Tier 2 service in CAMHS which sat in Tier 3.
Referrals now being made as they would have otherwise been signposted to another service. 
*Most success with parent and adolescent anxiety 

''Case 1''
Jane, 15 years, counselling not successful. Needed to adjust criteria as they went through the programme. General worries but phobia of illness and silence. Never spent a night away from home. safety behaviour is chewing gem constantly. 
1- formulation 
2- thinknng traps, goals 
3- hierarchy, relaxtion
4- revisit hiearych and thinking trpas/problem solving
5- thought challenging 
6- revisit strategies for managing anxiety 

__Richmond__

*Setting learning goals is the most successful  which can be set independently but also GBO-HIT 

!!!Role play- parent wanting you to see child only 
*Negative example 
**Not listening, trying to convince parent= not collaborative 
**Came across as the benefit for the therapist not the client 
*Positive example 
**Reassured and showed empathy about whose problem it was but how parents could help 
**Find out what the concerns were 
**Improve- ideas from parents what there views are about how they could help 
**Improve- Highlight that the parent is the expert on the child
!!!Role play- use of language 
*Positive example 
**Element of psychoeducation i.e. explaining terminology 
**Establishing the clients understanding of words 
**Building a therapeutic reliance through asking about hobbies etc. 
!!!Discussion 
*How to transition hobby discussion into problem discussion i.e. how would a dancer feel before a show
*Ask the child their understanding about why they are in the session 
!!!Case examples 

!!!Inventory in context 
*Emotional development
*Also important to think about how in tune parent is to this
*Social development: Interest in what is going on out of home becomes more important (evolutionary design to help us move to adulthood)
!!!The challenges of adolescents
*Capacity to consider others does change in adolescents and focus moves away from family to peers 
*Make riskier decisions with peers (need to think about back up team containing peers and others)
**Connections in brain  mean that making decisions in adolescence is harder (an adult might be able to help adolescent to make decisions)
*Brain is becoming attuned to wider social contexts 
!!!Asking about peers and family
*Research show importance of presence of adults in adolescents making decisions (even without any actual input)
*Best predictor of depression in teenage years was not what happened in younger life (maltreatment) but what they are experiencing socially (bullying)
*Longer outcomes for mental health are more mediated by parental attachments

Guided self help (GSH) for child anxiety generally adopts the parent led approach developed by Cathy Creswell and colleagues at Reading University.

Much of the information provided in this guide is generously shared by her team.

For a list of Pages relating to child anxiety please see below

<<list-links "[tag[Child Anxiety]]">>

!!''Treatment manual for parent led approach to child anxiety''

----
''The most recent version'' of the Cathy Creswell's therapist guide 'Helping Your Child with Fears and Worries: A self-help guide for parents Treatment Manual for Therapists'. The therapist manual is free to download, just click the following link and click on the box labelled ‘Request copy from Reading author’ and following the instructions. 

[[Treatment Manual for Therapists|http://centaur.reading.ac.uk/87041/]]
----

''The Previous version of Cathy Creswell's therapist guide'' can be obtained from the Reading [[website|http://centaur.reading.ac.uk]]
*Search on the left hand panel - type in 'overcoming your child's fears and worries'
*Click on the relevant article
*Click on 'request a copy from Reading author
Or directly use the links below:
For the [[individual programme manual|http://centaur.reading.ac.uk/65537/]] 
For the [[group programme manual|http://centaur.reading.ac.uk/65533/]]  

!!''Session Overview:''
For an overview of the session plans based on Cathy Creswell's therapist guide can be found here: [[Session Overview for Child Anxiety]]


----

''__Sharing handouts with parents/carers during remote working___
''
For further adaptions made to the manual in light of ~COVID-19 and the changes to working please see page: 

[[Child anxiety manual: COVID-19 adaptations]]

Cathy Creswell and her team have produced a Word version of the handouts from her manual for ease of sharing and completing with parents when working remotely.

PLEASE NOTE: The handouts are covered by Creative Commons copyright.  

Copyright: Available under License Creative Commons Attribution No Derivatives
See further: https://creativecommons.org/licenses/by-nd/3.0/

In addition, they are designed to fit with the evidence base for working with these interventions.  

For these reasons, the content of the handouts should not be amended by practitioners, but parents/carers can fill them in as part of the intervention as they would a paper copy.

Please find the handouts here:

<<link-doc "Child anxiety manual- Handouts" "https://drive.google.com/file/d/1fIIRwuKi-4TMA-rTj-IKvuElTor46H3p/view?usp=sharing">>

----

@@color:red;THE CHAPTER SUMMARY'S AND TRANSLATED VERSIONS HAVE BEEN SHARED FROM THE OLD MANUAL/BOOK. IF UPDATED VERSIONS ARE SHARED WITH US WE WILL ENDEAVOUR TO UPLOAD THEM HERE.@@

These recordings are taken from Cathy Creswells first book 'Overcoming Anxiety' the second version of this book can be purchased from [[Amazon|https://www.amazon.co.uk/s?k=cathy+creswell+anxiety+children&ref=nb_sb_noss]]

<<link-doc "Creswell English Audio" "https://drive.google.com/open?id=1hiq_qeG-QA6nGwcO5Ywd6W9WJnH1mRIR">>

<<link-doc "Creswell Sylheti Audio" "https://drive.google.com/open?id=1VVMtenh0tmVbctmjGdVene-gxh-bKuD7">>

!!'''Overcoming your child's fears and worries' by Cathy Creswell and colleagues. ''

@@color:red;PLEASE NOTE – THERE HAVE BEEN SOME RECENT UPDATES IN CATHY’S MANUAL AND BOOK. THIS MEANS SOME OF THE MATERIAL SHARED ON THE WIKI MAY RELATE TO THE OLD BOOK. WE AIM TO CLEARLY INDICATE WHERE THIS IS THE CASE. IT IS OUR HOPE THAT THIS IS STILL HELPFUL BUT THIS IS A NOTE ACKNOWLEDGING THAT SOME MAY FIND THIS CONFUSING.@@

Follow the link to access the previous version of the [[Treatment manual|http://centaur.reading.ac.uk ]] for parent led approach to child anxiety by Cathy Creswell for the full interventions manual. 

----

''The most recent version'' of the Cathy Creswell's therapist guide 'Helping Your Child with Fears and Worries: A self-help guide for parents Treatment Manual for Therapists'. The therapist manual is free to download, just click the following link and click on the box labelled ‘Request copy from Reading author’ and following the instructions. 

[[Treatment Manual for Therapists|http://centaur.reading.ac.uk/87041/]]

The most recent version of this book is entitled 'Helping Your Child with Fears and Worries 2nd Edition: A self-help guide for parents'

----

This is an excellent self help guide written for parents based on extensive research and practice.The book includes a step by step guide to helping a parent provide effective support to their anxious child.

This book follows the parent led intervention for [[child anxiety treatment manual. |Child Anxiety - Manual]] As such parents will be encouraged to read this book as part of the intervention. 
This book can be easily purchased and we would encourage parents and practitioners to purchase a copy of this.

 We are indebted to Cathy Creswell and her team for generously sharing their work on child anxiety with the London and South East ~CYP-IAPT Collaborative.

@@color:red;THE CHAPTER SUMMARY'S AND TRANSLATED VERSIONS HAVE BEEN SHARED FROM THE OLD MANUAL/BOOK. IF UPDATED VERSIONS ARE SHARED WITH US WE WILL ENDEAVOUR TO UPLOAD THEM HERE.@@

For translated version of the Cathy Creswell book please go to [[Child Anxiety Book- Translated Versions]]

Chapter summaries are also available (with Cathy's permission) for practitioners to use as a quick reminder of core ideas.  

<<link-doc "Chapter Summary Part 1 "  "https://docs.google.com/document/d/1CdLmESbIUql6mGDIgitzBZ-hssC2ORHAVca0nHarF8k/edit?usp=sharing">>

 <<link-doc "Chapter Summary Part 2" "https://docs.google.com/document/d/1MicoU_0T5RYC4UX5pBX_m0t0R_tYVuGpwDFmFw4OVhw/edit?usp=sharing">>  

 <<link-doc "Chapter Summary Part 3 "  "https://docs.google.com/document/d/1vv7k0BnlZybNkPo3Y4AuzUrLcMh2XRVa4LKDDG_DA18/edit?usp=sharing">>

[img[boys running.jpg]]

!!!''Child and adolescent development''
Pages relating to the overall development of both children and young people. 

<<list-links "[tag[Child and adolescent development]]">> 



!!!Adolescent Development
Pages that specifically relate to the development during adolescence 
<<list-links "[tag[Adolescent Development]]">> 

!!!Child Development
Pages that specifically relate to the development during childhood.
<<list-links "[tag[Child Development]]">> 

Please see below for the adapted child anxiety manual in response to the current circumstances caused by COVID-19. This manual was originally developed by Cathy Creswell and colleagues and has been adapted by Vicki Curry and Lauren Hassan-Leslie.

---

Much of the session plans in the original manual (Halldorsson,
Elliot, Chessell, Willetts and Creswell, 2019) can be conducted as usual. However, there may need to be some flexibility and creativity on the part of the practitioner and the parent in the context of the ever-changing circumstances caused by Covid-19 to make this work. In this guide, we have highlighted some aspects of each session that might particularly benefit from slight modifications in response to the current context.

----

<<link-pdf "Child anxiety manual: COVID-19 adaptations" "https://drive.google.com/file/d/1yhxljkK5v24WhbqZVL62Np0chaFRtblI/view?usp=sharing">>


Cathy Creswell and her team have produced a Word version of the handouts from her manual for ease of sharing and completing with parents when working remotely.

PLEASE NOTE: The handouts are covered by Creative Commons copyright.  

Copyright: Available under License Creative Commons Attribution No Derivatives
See further: https://creativecommons.org/licenses/by-nd/3.0/

In addition, they are designed to fit with the evidence base for working with these interventions.  

For these reasons, the content of the handouts should not be amended by practitioners, but parents/carers can fill them in as part of the intervention as they would a paper copy.

Please find the handouts here:

<<link-doc "Child anxiety manual- Handouts" "https://drive.google.com/file/d/1fIIRwuKi-4TMA-rTj-IKvuElTor46H3p/view?usp=sharing">>

This material has kindly been shared by Vicki Curry and was originally developed by Islington CAHMS service.

---

Please find below two power point presentations containing the parenting workshops 'Building confidence and managing anxiety in your child' part 1 and 2.


<<link-pdf "Part 1: Child anxiety (parent workshop)" "https://drive.google.com/file/d/1HBQjTDuHg4twaUHDkAN8Ze4wSPbqF8BU/view?usp=sharing">>


<<link-pdf "Part 2: Child anxiety (parent workshop)" "https://drive.google.com/file/d/1s2RKqxpLBEabYKXOs1YddNmq2cn_hotJ/view?usp=sharing">>

!!!!!Source: Derek Bolton 
Common mental health problems can be classified by a system of medical diagnosis. 

!!''Diagnosis''
*Different services will use diagnostic criteria/language to different extents
*The most widely used system of diagnosis is the International Classification of Diseases (ICD) which is now in its tenth iteration so it is known as ICD-10.
*There is also a system known as DSM-5 which is  the American system of classification of medical disorders.  
*Many people recognise there is a problem with the language around diagnosis but the key factor is the loss of/abnormal functioning.
*Even if the idea of diagnosis is thrown out, you need to be able to think about recognisable patterns

!!''Recognisable patterns''
*Key thing to track is distress which is so severe that is interferes with functioning
*Distress can sometimes be 'ordinary problems of living'. Mental health professionals need to look at functioning. With adults this is easier (they can compare it to their norm e.g. how they were 6 months ago). Children however are on a developmental trajectory so it is harder to identify. 

!!''Other connected pages'' 

[[What are 'mild/moderate' mental health problems?]]

[[What is a 'low intensity' intervention?]]

!!!Creswell model 
*Assessment with the parent and the child then no contact with child after that. unlikely for CWP 
!!!Child focused work 
*Coping Cat considered to be a child-focused intervention for anxiety 
*Effective but requires more than 8 sessions 
*What is the value of parent led work? Cheaper, and delivered in a shorter time frame 
*Time and a place for both child-focused and parent-focused work
**Depends on the age of the child- younger age= focus on parents 
**Conclusion through formulation process 

[img[leaves.jpg]]

!!!''Child mental health problems''

This Programme does not cover all mental health problems. It focuses on the three most common mental health problems for children and young people. These are:

* [[Anxiety]] (0-18 years)
* [[Low Mood]] (11-18 years)
* [[Behaviour Problems]] (0-11 years)


Pages providing an overview of child mental health problems can be found below:

!!!Mental Health Problems Overview 

<<list-links "[tag[Mental Health Problems Overview]]">> 
 

!!!!!Source: Laura Bowyer
!!!''Key points''
*Anxiety is maintained because the child thinks something bad is going to happen and thinks they will be unable to cope. They then look out for evidence to support this.
*The aim in cognitive interventions is to develop more flexible thinking and increase coping. Helping the YP to develop realistic/helpful thoughts can result in reduced anxiety and a reduction in avoidance and/or safety behaviours.
*Main interventions include helping the YP or parent to question their own (their child’s) thoughts by helping them evaluate them. This also helps gives parents alternatives to reassurance. Generally, parents and the YP look to ask questions versus provide answers.
!!!''Thinking about thinking''
*Avoid persuasion and start from a position that the child or young person has a reason to think the way they do. Be curious about how that has come about rather than feel you have to change their thinking. The process of increasing flexibility rather than content is useful. 
*Padetsky once commented that the purpose of Cognitive Therapy was to move people from certainty to doubt, to enable people to be less sure that there predictions about the world will always be true. 
*For children, this can be about asking them to notice when people behave in a surprising way, doing things they didn't expect, such as when a sibling is kind to them etc. 
*From this starting point, key  techniques include: 
**acting like a judge in a court and putting the thought on trial; 
**thinking about what a friend / other person might think in the situation (alternative view point)
**considering how helpful / unhelpful the thought is
!!!''Walking on eggshells''
*However, this process is much more tricky in adolescence. Young people have an astute radar for sensing that their way of seeing the world is being discounted by an adult. They are in a process of individuation in which they are working out what they think in contrast to the adults around them. Cognitive techniques for young people can be experienced as hugely disrespectful to their own understanding of the world.   
!!!''Engaging in enquiry''  
*The aim is to increase the number of alternative thoughts available to the YP in that situation and for them to reflect on their coping and build this up
*For adolescents you could use thought records 
*There is no ‘right’ or ‘wrong’ thought to have, it’s just that some thoughts are less helpful than others to have. *The really important next step is then to ‘test out’ the thoughts 
*Testing out thoughts is another way of re-evaluating them and is done via behavioural experiments. This is when a YP faces a fear in order to test out a thought and then reflects back on their prediction (thought) after the exposure to see what they learnt (how true it was).
*You should be rating the strength of belief in a particular thought before and after a behavioural experiment
*Be mindful of safety behaviours and support the YP to drop these during experiments

<<list-links "[tag[Cohort 1 Lecture summaries]]">>

!!!!Source: Duncan Law

!!!Local Collaboration

The CWP and EMHP programmes are not just about training a new workforce, they are about system change to improve CYPMH services and systems.  This requires good collaboration with in the services the CWP/EMHP are employed and good collaboration between all stakeholders in the local CYPMH system including: commissioners, school and community leaders, CYP and their families, services providers across health, local authority and the voluntary sector. Your level area should already have a CYPMH forum to support these connections  - make sure the CWP and EMHP programmes are on the agenda and that all stakeholders understand what they can (and can't) offer and how this fits with existing services and other initiatives.

!!!Regional Collaboration

The development the new of CWPs and EMHPs workforce is groundbreaking and we can learn form others who are developing services. link in with other areas who may be at the same stage of implementation as you and try and link with those who may be a little further down there road.  The CWP and EMHP steering groups are a great place to hear about how others are progressing, group problems solving and networking

!!!National Collaboration

the London and South East CWP programme link with all the other regions of England who are implementing the CWP workforce programme.  Here learning can be shared at a national level and link back to NHSE and DfE to report on progress.  This is one of the areas where data from the CWP work is vital.

This page is great!

!!!!!Source: Laura Bowyer
!!!''1.	Young person doesn't attend''. 
*Phone or text young person to enquire how they are. 
*Arrange to ring again at a specific time in a few days’ time. 
*Remind of next appointment. 
*Send materials to young person if they agree.
!!!''2. Young person attends but is very disengaged, passive and monosyllabic.'' 
*Reduce demands in the session. *Validate young person's state of mind. 
*Avoid too much praise for coming. *Problem solve about ways of making the contacts more adaptive to young person's preferences.
!!!''3.	Young person says problem has gone away''.
*Young person describes rapid improvement in mood and doesn't see need to come for more sessions. *Practitioner positively validates improvement, 
*emphasises the cyclical nature of low mood
*encourages persistence with plan
*focuses on relapse prevention in psycho-educational material.
!!!''4.	Young person says parent would like to phone practitioner.''
 *Discuss how young person feels about this. 
*Problem solve best way of responding to parent's request and use shared decision making. *Consider how to avoid secrets and option of doing call in front of young person. 
*Agree explicit plan with young person about what practitioner will do.
!!!''5.	Young person is relatively active and low mood has not impacted on behaviour significantly.'' *What does the young person believe would be helpful in improving his/her mood? 
*Secondly, it may be helpful to review the basic formulation and also to consider a developmental formulation as a way of making sense of the current difficulties. 
*It may also be important to recognise the resilience and coping that the young person is demonstrating.
!!!''6.	Young person says the problem has changed part way through a course of GSH''. 
*Sometimes when clients present with multiple problems, the issue you initially are working on resolves and the YP wants to change focus. 
*Other times there can be various reasons for wanting to change focus e.g. avoidance of talking about / doing things which are difficult for the YP. 
*Consider ROMS and progress towards goals in such situations. 
*Is there a reason why things have ‘changed’? 
*Consider formulation and practitioner/YP/environmental factors. 
*What are the pros and cons of switching tact? 
*Always discuss in supervision. *Consider shared decision making. *It is often useful to consolidate what has been done and to cover relapse prevention rather than trying to cover something new in a few sessions. 
!!!''7.	Young person or parent is over inclusive in sessions'' 
*YP or parent wants to talk about other things and you end up not getting through planned material. *Using the principles of GSH is important and setting up the intervention at the beginning well will help here. 
*For example, the parent / YP should know what each week will entail at the beginning of the course of GSH. 
*Additionally, setting up a good agenda at the start of each session will help give you something to refer back to.
*Make a decision collaboratively with the family as to how best to use the rest of the time if conversations go off track. 
*Of course, there are times when a YP or parent has experienced something unexpected in their week and wishes to talk about this, and this might be important. 
*The process of shared decision making here is helpful. Listen and validate and then gently consider the choice and the pros and cons of how you can use the time in that particular session. 

Source: Peter Fuggle

''Purpose of the page'' This page will provide basic information on common mental health problems in children and young people.  

!!''Common Mental health Problems'' 

Major surveys of the mental health of children and young people in England were carried out in 1999, 2004, and 2017. For more information and the full link of this survey please go [[here.|Survey of the Mental Health of Children and Young People in England, 2017]]

From this survey disorders were grouped into four broad types as follows:

!!Emotional disorders:

Anxiety disorders (7.2%) (characterised by fear and worry)   
Depressive disorders (2.1%) (characterised by sadness, loss of interest and energy, and low self-esteem)
Mania and bipolar affective disorder. 

Overall one in twelve (8.1%) 5 to 19 year olds have an emotional disorder. 

*girls (10.0%) 
*boys (6.2%) 

Using a system of medical diagnosis, (see [[Ways of describing common mental health problems]]) there are different types of anxiety:

# Generalised anxiety disorder
# Social anxiety 
# Panic
# Specific phobias
# Post traumatic stress disorder
# Obsessional Compulsive disorder 

See [[Young People Talk About Anxiety]] for seeing from young people's point of you.

!!Behavioural disorders 
A group of disorders characterised by repetitive and persistent patterns of disruptive and violent behaviour in which the rights of others, and social norms or rules, are violated. 

Overall about one in twenty (4.6%) 5 to 19 year olds had a behavioural disorder.

*boys (5.8%) 
*girls (3.4%). 

!!Hyperactivity disorders 
Include disorders characterised by inattention, impulsivity, and hyperactivity. 

Overall about one in sixty (1.6%) 5 to 19 year olds had a hyperactivity disorder

*boys (2.6%) 
*girls (0.6%). 

An example of a child’ description of ADHD: [[A child describes ADHD]]

!!Other disorders 

Such as: autism spectrum disorders (ASD), eating disorders (ED), tic disorders (Tourettes), very low prevalence conditions (Psychosis) . One in fifty (2.1%) 5 to 19 year olds were identified with one or more of these other types of disorder: 

* 	1.2% with ASD, 
* 	0.4% with an eating disorder, 
* 	0.8% with tics or another less common disorder.

Please got to the page [[Autistic Spectrum Disorder (ASD)]] for helpful information and clips about what it can feel like to live with ASD.

!!''Practice points for EMHPs''

1. Useful to have an overall knowledge of the frequency of mental health problems in children and young people. 

2. There are different forms of language around mental health disorders/ problems 

''Diagnostic language: ''Disorder; illness; e.g. anxiety disorder; psychotic illness.  

''Practitioner Language:'' Problems and difficulties e.g. anxiety problem; behaviour difficulty

!!''Links to other pages''
Other pages which may be of interest to this topic. If you go to the page [[Child/Adolescent Mental Health Problems]] you will see a list of pages about child mental health problems. 

Source: Peter Fuggle

For more information on RCADS please go to: [[RCADS]]

!!How to use RCADS?
RCADS will be used by practitoners when working with young people often of a secondary school age for students being seen for low mood or anxiety. 
Following a full RCADS at Session 1, practitioners should complete the relevant subscale at each session. The full RCADS is then completed again in the final session.

In completing the RCADS, some young people like to do it quietly on their own whereas other may like active involvement form the EMHP. The stance is to ensure that the process is not seen as an exam and it is important to support the young person by using a number of supportive phrases such as 

*there are no correct answers. 
*always ask if you are not sure
*this is not a test and you cant get things wrong
*the idea is to help you think about what you really feel 

!!Using POD

The RCADS is best collected [[using POD|How to Use POD]] as this will provide immediate feedback to the young person and also can compare repeat measures with previous ratings. 

Personal identifiable information is not collected on POD. However in order for the RCADS to be scored information on Gender and Year group is required.

For more information on POD please go to: [[POD]]

!!Practice Points:

* At the beginning of the intervention, fill out whole RCADS
* For subsequent sessions, only track them on the subscale you have both agreed to focus on. 
*you cant solve everything, choose something that is important to that CYP, be specific!
* Helps you be clear of how you are going to be helpful.
* Use subscales to track specific issue that you agreed to address.

!!!Videos
[[How to use RCADS|https://vimeo.com/57925678]] with a CYP on CORC's (Child Outcome Research Consortium) website (Copyright of CORC) is a helpful example of how the RCADS may be used in practice.



!!Links to other pages:

For more information on how to complete questionnaires, practice points and video demonstrations on this topic please go to: [[Using Feedback and Outcome Tools]]
For more pages concerning the outcome measures used by practitioners please go to [[Outcomes]] for a list of relevant pages.

This page contains an overview and link to the paper developed by Pennant et al. 2015 (see full reference below), Computerised therapies for anxiety and depression in children and young people: a systematic review and meta-analysis.

---

This work aimed to systematically review the evidence for computerised anxiety and depression interventions in CYP aged 5-25 years old. computerised CBT (cCBT) had positive effects for symptoms of anxiety and depression.
For a link to this paper please see 

<<link-doc "Pennant et al. 2015" "https://drive.google.com/file/d/17XWygYzV1SwGbB-1MadQuHIPS1Oxl1oS/view?usp=sharing">>


---

Pennant, M. E., Loucas, C. E., Whittington, C., Creswell, C., Fonagy, P., Fuggle, P., … Kendall, T. (2015). Computerised therapies for anxiety and depression in children and young people: A systematic review and meta-analysis. Behaviour Research and Therapy, 67, 1–18. doi: 10.1016/j.brat.2015.01.009tre for Mental Health, Royal College of Psychiatrists, London, UK

!!!!!Source: Laura Bowyer
!!''Consent and video recording''
In any piece of work you do, ensuring you have explained confidentiality and obtained informed consent is vital. This is however, perhaps particularly true when you want to be recording sessions for the purposes of completing a training course.

The emphasis here is on informed consent: in order to make a decision about whether their information can be used a YP / parent will need to know:

*What it is you are recording
*Why you are recording 
*How you will be recording 
*What will you do with / how will you use the recording 
*How will it be stored and for how long 
*Any other questions they might have 
The vast majority of YP and parents will not object to being recorded if this is discussed in an open, straight forward and transparent way. 

Be honest about your role as a trainee but also confident in what this means; e.g. 

*you will often have two heads thinking about a case due to close supervision, 
*you are training so have access to the latest developments in things which might be helpful to the family, *you work as part of a team with expertise in helping young people with common mental health difficulties etc. 

It is useful to explain the purpose of recording is more about monitoring you as the practitioner and about ‘quality control’ – to make sure you are doing your job well and to help think about what other support a family or YP might need. 

Confidentiality is especially important when working with children and young people. 

*Never promise / agree to keep anything secret
*You will always try to tell the YP or parent first and have a discussion about things if you need to tell other people about something (‘break confidentiality). It is helpful to explain that the point of this is always about helping support them / ensuring they are safe 
*Use of shared decision making 
*Always set up that confidentiality is held within the team i.e. you work as part of a larger team with a supervisor etc. 
*Always encourage the YP to allow you to share concerns with parents to help develop safety plans if needed 
*Remember, both confidentially and consent are on-going processes and should be re-visited throughout your work with a YP or family. 
*You should consult your local Trust’s policies and service’s protocols for specific consent and confidentiality forms.
*Don’t forget to seek permission from YP/families to use their work for your assignments and to document this in the appropriate way within your services 

@@color:red;This page is being developed in light of recent changes to working due to the outbreak of COVID-19@@

[img[typewriter.jpg]]

For more information about the CWP Programme in London and the South East or about this guide, please contact the CWP Team at the Anna Freud National Centre for Children and Families (AFNCCF). Or visit the [[CYP-IAPT website|https://cypiapt.com/2019/03/13/educational-mental-health-practitioner-2019-update/]]

For feedback regarding this guide please contact [ext[PGS Online Guides|mailto:PGSonlineguides@annafreud.org]] 

[img[books-2158737_1920.jpg]]

This guide has hundreds of pages of information. It is organised into five key areas that can be found through the tabs at the top of the screen.

!!![[Home]]: 
Contains  information about this guide and [[User Guide]] it as well as an overview of the core aspects of CWP's work.

!!![[Helping]]:
Contains the ''core manuals'' and ''session plans'' and related resources for the core interventions CWP's are trained in.

!!![[Finding Out]]: 
Contains information and guidance pages relating to 10 key areas of CWP work. These pages provide the knowledge and skills important to CWP's and also has additional resources/ self help materials that may be useful to use in CWP work.

!!![[Supervising]]: 
Contains information on supporting and supervising CWP's.

!!![[More]]:
Which contains information on UCL [[Teaching]] and 
background to the [[Training]] of CWP's

!!''Converting concerns into goals'' 
The challenge is how to set and develop goals with parents and convert these concerns (things they want to get rid of) into positive goals.
As always, try to get specific as possible. Here are some examples.  
*Parental concern: Child won't go to sleep, one of the main trigger points in a household (next to getting ready for school and mealtimes). 
**Agreed goal: go to bed at a specific time, go to bed the first time asked 
*Parental concern: Not listening (gain more information- how do you know they're not listening?)
**Agreed goal: Child responds by demonstrating listening. 
*Parent concern: Not doing what they are told
**Agreed goal:  acknowledge that they have heard you, being able to say the word no
*Parental concern: Poor table manners
**Agreed goal: use a knife and fork, keep food on the plate, not speaking with food in their mouth 
*Parental concern:Hitting people
**Agreed goal  playing nicely, listen to people, using a strategy other than violence to stay calm, using words instead of hitting 
*Parental concern: Running away- **Agreed goal: stay close to mum or dad (an agreed distance) 
*Parental concern:Tantrums 
**Agreed goal: non-dangerous way to express emotion, express emotions in words or in another way 

This is a tag tiddler

<<list-links "[tag[Copyright]]">>

<<link-doc "Copyright guidance" "https://drive.google.com/file/d/1grrqewCGXHw8uV5SJOZtdvTS_GqfvFQP/view?usp=sharing">>

Source: Peter Fuggle, AFNCCF 

Please see below for a document that can be easily shared regarding copyright and the wiki manual.

<<link-doc "Copyright guidance" "https://drive.google.com/file/d/1grrqewCGXHw8uV5SJOZtdvTS_GqfvFQP/view?usp=sharing">>



!!!''1. Materials produced by University Teaching staff''

All pages in the Guide should indicate the source of the material shown on that page. 

The source of the majority of the pages are written by teaching staff at UCL or KCL.

This material has been uploaded on to the guide with permission from the staff member. 

The name of the staff member is shown at the top of the page with the initials of the organisation (where this is applicable).

This indicates that copyright for the use of this material has been granted. 

The generosity of all teaching staff in contributing to this  guide is hugely appreciated. 

!!!''2. Linking to materials freely available on the internet'' 

For materials freely available on the internet, linking to them to the wiki, has few if any copyright implications and will be very low risk. 

We avoid linking to website content which is in itself obviously infringing (that is, it has obviously been uploaded without the permission of the copyright owner). 

We avoid “deep linking” which obscures the ownership/ branding of the site we are linking to. For example, rather than link straight into a pdf, we link to a preliminary page which makes the context clearer.   

!!!''3. Reproducing material from the internet''

Reproducing the material itself either in full or substantial parts does pose a risk of breaching copyright. 

If any of the material is already licensed by a Creative Commons licence or equivalent we are then able to reproduce this and comply to the terms of the specific licence. This is  evident from the information on the website.  Usually a Creative Commons licence has the following: "When reusing third party copyright material it is always important to credit the source and the author(s)". 

In the absence of such licence terms, though, we try to obtain permission from the copyright owner unless we are able to rely upon one of the statutory exceptions to copyright. 

When we seek permission, we request the copyright owner to let us know the wording they would prefer us to use in our  acknowledgement. Typically that could be something like: “Copyright […...] All rights reserved. Reproduced here with permission” 

 !!!''4. Permission for others to use material in this guide''

This guide is freely available for use by others under a Creative Commons Licence 
(see [[Creative Commons licence]])

This states that the material in this guide can be used by others as long as the source of this material is acknowledged and that it is not used on a commercial basis. 

!!!''5. Your Privacy''

You can see the AFNCCF privacy policy [[here|https://www.annafreud.org/your-privacy/]].


!!!''Useful contact for advice'' 

Chris Holland|Copyright Support Officer|UCL Library Services|Gower Street| London WC1E 6BT
T: 020354 95729| 

!!!!!Source: Deb ~McNally and the Manchester Collaborative 

The brief guided self-help parenting intervention for behaviour problems is divided into two broad areas that can be covered over five (or more) sessions. These have been divided into parenting approaches that:

# promote the child’s development, child’s attachment and the parent-child relationship
# keep children safe in their exploration through limits and positive discipline  

In the first part of the intervention, parents will be supported to improve their communication with their child and to encourage appropriate child behaviour by increasing the social attention that they give to their child through spending special time together and giving praise. In the second part of the intervention, the parent will be encouraged to think about the importance of routine and boundaries for their child’s development and learning. Parents will be supported to use clear instructions, set limits with their children and withdraw attention from inappropriate behaviours.

Research suggests that a strong relationship between parent and child builds the foundations for a child’s development and the setting of effective limits and boundaries. Therefore, it is recommended that the intervention starts with sessions that focus on improving the strength of the parent-child relationship prior to moving on to setting limits and withdrawing attention. It is really important that the structure is followed, because parents may ask how to manage behaviour that will be covered in later sessions. It might be tempting to do behaviour management earlier, but it will confuse the parent. Furthermore, these strategies will not be effective unless the foundations (special time, attention and praise) are firmly in place. It may be helpful to remind the parents that we will be covering behaviour management in later sessions. 

Session topics are:

1) 	Learning about your child and their behaviour


2) 	Enhancing your relationship and supporting children’s communication


3)	Building self-esteem and improving behaviour through praise


4) 	Using routines and boundaries to set limits for your child

5) 	Reducing problematic behaviour through withdrawing attention

6) 	Supporting emotional regulation through calm time and dealing with non-adherence to commands in children over 5 years


This page provides a link to the paper manual for the Manchester approach to parent training. This framework was written by Deb ~McNally, Consultant Clinical Psychologist in Manchester and generously shared with other collaboratives in the CYP-IAPT National Programme.   

''__Brief Guided Self-Help Parenting Intervention'' 



<<link-pdf "Manchester Parent Training Manual" "https://docs.google.com/document/d/1YVAXcYyWF5_4wxM1BfUOoogXwpxro3sSwLLoRg4zP3Y/edit#heading=h.gjdgxs">>


{{manc}}

!!!''25 CORE CWP COMPETENCIES'' 
These are divided into two groups, knowledge and skills. 

<<link-pdf "CWP Competencies" "https://drive.google.com/open?id=0B1hDLHd8syMsSkVMOVJhV3o2YVE">>

Competency Framework for Direct Low Intensity Work with Parents, Children or Young People:

<<link-pdf "Direct Low Intensity Work Competencies" "https://drive.google.com/file/d/1DFzy7oEWH1hAkbHDOEp0R6nqu_N-a7aA/view?usp=sharing">>

!!!Marking Frameworks:

This framework is also useful for preparation of [[video assignments (assessment)|https://drive.google.com/open?id=0B1hDLHd8syMsNmVOVkVjbEJNOXM]] 

And for [[intervention videos|https://drive.google.com/open?id=0B1hDLHd8syMsOWdSSEtoNHhpT2M]] 

!!!Core Intervention Manuals
Below is a list of the core manuals used by EMHP's in their work with CYP and their families.  

!!!''[[Child Anxiety]]:''
Cathy Creswell therapist guide based on the [[book|Child Anxiety: Book]] by Cathy Creswell and colleagues: 'Overcoming your child's fears and worries' (book available on amazon). can be obtained by following the links below:

*For [[individual|http://centaur.reading.ac.uk/65537/]] programme manual 
*For [[group|http://centaur.reading.ac.uk/65533/]] programme manual

!!!''[[Adolescent Anxiety]]:''
The manual called 'getting to grips with anxiety' by Helen Barker and colleagues 

<<link-doc "Getting to grips with anxiety" "https://drive.google.com/file/d/1MhSkweHKlMx3gAHe8SyVqss4nSjzJhFd/view?usp=sharing">>

!!!''[[Low Mood]]:''
The manual used to guide practice is the 'Guided Self-Help for Low Mood'. 

<<link-doc "Guided Self-Help for Low Mood: Full Manual" "https://drive.google.com/file/d/1Ua1L-0BUmNMBTJi2AkYQhdlmnWpKwl0g/view?usp=sharing">>


!!!''[[Behaviour Problems]]:''

The brief guided self-help parenting intervention, the manual for this intervention can be found here:

<<link-doc "Guided self-help for behaviour problems" "https://drive.google.com/file/d/1vBNYY-hZtqIKHZucyZmbxZmfjTvYYoRZ/view?usp=sharing">>

!!!!Source: Peter Fuggle 

!!What are the core outcome measures and feedback tool?

Outcome measures are a systematic way for practitioners and clients to measure, track and monitor if the interventions being implemented are being helpful to the young person. They help facilitate feedback from young people and families that help practitioners understand how they are being helpful  - in this sense they are both outcome measures and feedback tools.

They are also helpful to initiate conversations about issues a CYP is having. For more information please go to [[Using Feedback and Outcome Tools]]

For the CWP & EMHP programmes it is proposed that a core set of measures are'' used to evaluate the benefit of the interventions''. These are all taken from the CYP-IAPT basic set of measures. Please find linked below:

<<link-pdf "Outcomes Framework for London and the South East" "https://drive.google.com/open?id=19dWlwSybIYhh8mLqGUMd62JHECbrkFF7rP-YjMD7xlU">>


The core measures used in the CWP & EMHP programmes can be divided into three domains:  

!!!''Goals - using the Goal-based outcomes (GBO) tool''
This is the same measure either used by a parent or a young person for all cases. 

* [[Goal-Based Outcomes (GBO)]] 
!!!''Symptom change''
The symptom change measure is different depending on whether the child is primary school age or secondary school age. 

For primary school aged children the symptom change measure is the SDQ:

*[[SDQ]] for Child Anxiety and Behavioural Difficulties cases 

For secondary school aged young people it is the RCADS: 

*[[RCADS]] for Low Mood and Adolescent Anxiety cases 

!!!''Satisfaction with the service''
For each case, it is essential to obtain information in all three of these domains. 


There are two ways of measuring satisfaction; one is a feedback form for the session and the other is a feedback form for the end of the intervention. 

*''Session Feedback''
 
*[[Session Feedback Questionnaire (SFQ)]] 

*''Service (intervention) feedback''

*[[Experience of Service Questionnaire (ESQ)]]

!!Additional outcome measures for work in schools
Following discussion with both teaching teams (October 2018), a number of measures will be considered that are additional measures for use in schools.  

*A combination of child's goals and teacher goals. 
*RMQ  - the Impact supplement of the SDQ.
*Outcome Rating Scale (ORS) and the Child Outcome Rating Scale (CORS)
*IMPACT subscale of the Teacher version of the SDQ. 
*The measure of 'Me and my school' 

An excellent website for information about these outcome measures for children and young people can be found on the [[CORC website|https://www.corc.uk.net/outcome-experience-measures/]] (Children Outcomes Research Consortium)




!!POD
For the EMHP programme in London we use [[POD]] to collect measures as this supports good quality feedback to the young person. (see [[The Importance of Feedback]])

<<link-pdf "Paper Outcome Measures" "https://drive.google.com/open?id=0B1hDLHd8syMsU1lwY1ZTWUVORFU">>


!!Links to other pages:
For information on how to use POD please go to [[How to Use POD]]

Please go to [[Outcomes]] for a list of pages for information about core outcome measures and other aspects of outcome measurement in the guide.

Please go to [[Using Feedback and Outcome Tools]] for more information on how to use outcome measures

The term parent will be used throughout, however, refers to the child's primary caregiver. This approach builds on the core components of parent training developed by Carolyn Webster-Stratton and colleagues over many years. Building on the foundation of developing capacity in parents/carers to enhance skills in: 

*Empathy
*Play 
*Attending
*Praise 
*Problem Solving 

Axel Scheffler has illustrated a digital book for primary school age children, free for anyone to read on screen or print out, about the coronavirus and the measures taken to control it. Published by Nosy Crow, and written by staff within the company, the book has had expert input: Professor Graham Medley of the London School of Hygiene & Tropical Medicine acted as a consultant, and the company also had advice from two head teachers and a child psychologist.

The book answers key questions in simple language appropriate for 5 to 9 year olds:

*What is the coronavirus?
*How do you catch the coronavirus?
*What happens if you catch the coronavirus?
*Why are people worried about catching the coronavirus?
*Is there a cure for the coronavirus?
*Why are some places we normally go to closed?
*What can I do to help?
*What’s going to happen next?


Please find the book on the following [[website|https://nosycrow.com/blog/released-today-free-information-book-explaining-coronavirus-children-illustrated-gruffalo-illustrator-axel-scheffler/]]

''Assessment of CWP Supervisor/Service Development Lead'' 

Supervisors/Service Development Leads will be assessed on a pass/fail basis following completion of the course, based on the following criteria:

* Attendance – Supervisors/Service Development Leads will need a minimum of 80% attendance 
* Submission of a video, for peer review and reflection, of a supervision session where outcomes measures are used as part of the supervision
* Presentation of a new workforce/service model for CWPs
* Discussion and action planning from a participation/co-production event
* Evidence of data collection on throughput and outcomes and submission of data to the CYP IAPT/CWP central team via POD or other (or another online system) and is available for export as part of the CWP audit


Supervisors will recieve an Attendence Certificate upon passing the course. 

<<link-pdf "Course Handbook UCL" "https://drive.google.com/open?id=1xZkdv-jVplLLX-bxtrp-N11lXgPEisXc">>

<html><a rel="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/"><img alt="Creative Commons Licence" style="border-width:0" src="https://i.creativecommons.org/l/by-nc-sa/4.0/88x31.png" /></a><br />This work is licensed under a <a rel="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License</a></html>

See a readable summary of the terms of this license [[here|https://creativecommons.org/licenses/by-nc-sa/4.0/]]

!!!! Explored and Explained by Kimberley Saddler, CWP at Whittington Health NHS Trust and Cassandra Neo, Educational Psychologist Trainee at UCL

Definition

Cultural Competency is defined as “the ability of systems to provide care to patients with diverse values, beliefs and behaviors, including tailoring delivery to meet patients’ social, cultural, and linguistic needs” (Betancourt et al., 2003). The value of this definition is that it doesn’t just focus on healthcare but takes other systems into account. From a child and family context, we know that effective care relies on the interrelations between multiple systems, including, education, social care and voluntary sector services.

 

A limit of the traditional cultural competency is approach is the tendency to focus on the development of technical skills. There is a temptation to reduce the approach to merely increasing skills such as, booking interpreters, collecting ethnicity data, and so on. Culture is often synonymised with ethnicity and race and therefore the cultural competency approach can lend itself to a series of do’s and don’ts depending on someone’s ethnic background. However, we know that culture is not a fixed state, but something that is fluid, and whilst there are many values, attitudes and lifestyles that are common within ethnocultural groups each individual may ascribe to those values to varying degrees. 

 

Kleinman & Benson (2006) highlight the inherent challenges of the cultural competency approach and provides some alternative approaches that address these challenges. One major element of this approach is using a process of enquiry to elucidate what the individual values, for example, asking about ethnic identity and whether this is important to them, rather than merely asking about what ethnic group the individual belongs to. Essentially, Kleinman & Benson (2006) place the value of interpersonal qualities over technical skills.

 

Kirmayer (2012) highlights some alternatives to the traditional cultural competency approach which includes:

 
 
1.     Cultural safety – the acknowledgement of how power imbalances can contribute to how safe a system is for the individual (which can include the emphasis on institutional racism)

2.     Cultural sensitivity – practitioner self-reflexivity in the therapeutic interaction

3.     Cultural humility – a willingness in being open to hear from others’ experiences

 

Kirmayer emphasises that a combination of approaches including cultural competency (technical skills) and the above alternatives can enhance how culturally responsive an organisation or system is rather than emphasising one approach in isolation.

 
 
 

Why is this important?

The below video by the BBC called “Mental Health and Being Black” includes the experiences of a few individuals in the UK and touches upon the issues described so far.

 

BBC MENTAL HEALTH & MENTAL HEALTH VIDEO HERE – 5mins long approx.

 

The experiences highlighted in the video touches upon the issues described so far. One young black man describes how he feels that he hasn’t been supported by the “white power structure” and refers to the criminal justice system and the impact on mental health as an example. One young lady spoke about her experience of identifying as a queer, mixed-race woman, the impact on her mental health and the importance of speaking about this in her work with young people. Another individual spoke about her experience of having a Dad being diagnosed with schizophrenia and that people within the black community in particular are not getting the help that they need. Another individual spoke about her experience as being a mental health practitioner. An important discussion occurs around stereotypes and how this can affect what young people may be labelled with and how this impacts the help that is or isn’t offered. 

 

Research

Research has found ethnic variations in access to CAMHS…

 

Ethnic variations in mental health services research, incl. my dissertation.

 

Expand the CAMHS cultural competency approach by Papadopoulous

Use the sections of the diagram – cultural awareness, cultural competence, cultural knowledge and cultural sensitivity​



<<link-doc "Rethinking Cultural Competence Article" "https://drive.google.com/file/d/19Otyaw9-BhN_5mzgl9Z3oUTkNprdCpD7/view?usp=sharing">>

<<link-doc "Anthropology in the Clinic: The Problem of Cultural Competency and How to Fix It - Kleinman & Benson Article" "https://drive.google.com/file/d/1jksPtH47piYmC1No8_PcVSmDizUKxFmk/view?usp=sharing">>

<<link-doc "Cultural Competence: A Literature Review and Conceptual Model for Mental Health Services - Hernandez et al. Article" "https://drive.google.com/file/d/1QaMSzHNl3YTk3C1CIk66ADE6gv8yL4oP/view?usp=sharing">>

<<link-doc "Cultural competence in mental health care: a review of model evaluations - Kamaldeep et al. Article" "https://drive.google.com/file/d/1xy5B9LUcy7qKFfTiXcldhRkAmL0Nh5dw/view?usp=sharing">>



Tackling Anxiety (exposure :

<iframe width="560" height="315" src="https://www.youtube.com/embed/7YV3NXtzM8U" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe>



Children's experience in retrospect:

<iframe width="560" height="315" src="https://www.youtube.com/embed/Ii9o8B_9sXo" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe>


We all have mental health:

<iframe width="560" height="315" src="https://www.youtube.com/embed/DxIDKZHW3-E" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe>



<iframe width="560" height="315" src="https://www.youtube.com/embed/bpdT_p4iFxo" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe>


About south Asian history:

<iframe width="560" height="315" src="https://www.youtube.com/embed/kGvp5Dqa5Mk" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe>


Young black men:

<iframe width="560" height="315" src="https://www.youtube.com/embed/6J-R50NJC3Q" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe>


Being Black and Mental Health:

<iframe width="560" height="315" src="https://www.youtube.com/embed/bIhZcsGqWIM" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe>



Articles:


https://www.independent.co.uk/voices/mental-health-bame-communities-stigma-nhs-culture-crisis-misunderstood-a7973666.html





!!!! The Children's Wellbeing Practitioner BAME Inclusion Group

https://www.linkedin.com/groups/8873855/

!!!!Source: Duncan Law
!!Key points
*Effective help includes enabling the client to develop a clear set of goals that they would like to achieve form the help being offered. 
*There is a large literature on goals-based outcomes. Goals are routinely measured on a scale of 0-10 with higher scores being more positive. 
*Usually a young person or parent will discuss and agree three main outcomes and will then rate how far they are along these goals at the beginning and where they want to get to by the end. 
*So a parent might have a goal of enabling their child to get to bed before 9.00 each night. At the beginning this happens quite rarely so she rates the problem as being a 2 at baseline. She would like to reach a 7-8 by the end of the intervention. 
*The aim is to not always to reach 10 by the end of the intervention but to begin to progress towards an improvement against a goal.  
*It is important that goals are agreed in a collaboration with the practitioner as it is important to establish goals that are measureable, that can be influenced by the intervention and that are realistic.  

!!Helping to shape goals
This section is adapted from Law, D. (2019) 'The goal-based outcome (GBO) tool: guidance notes' ~MindMonkey Associates: London 

*Goals should be agreed collaboratively between the practitioner, working with the young person or family and the person asking for help. 
*The first step is to identify potential goals and then shape these into agreed goals for the intervention
*At the point where you feel the young person/family have told you enough initial information it can be helpful to start to introduce goals by saying something along the lines of:
“That has been really useful to help me understand a little about what has brought you here today; next it might be helpful for us to think together about what your hopes for the future might be”
 
*What comes out of the following discussion can begin to be shaped into goals:
“So, from what you have told me so far, what would you say your main goals are from coming to this service? If we were to work together in a very helpful way, when we agree to stop meeting, what things would you hope to be different in the future from how things are now?”

*Once a goal has been agreed it is useful to write it down in a sentence that summarises it – ideally using the young person’s own language 
*Helpful goals tend to be future-focused, positively framed and realistic
*Helpful goals could focus on:
**Change goals – goals that focus on something someone wants to be different or change in their lives – most therapy goals are ‘change goals’
**Learning goals –  getting ideas that might help with the issues even if these might not lead to (immediate) change
**Exploration or understanding goals - these might be goals that focus on the young person wanting to understand themselves better, or to explore who they are. These may lead to change but this is not the primary focus of the work
*Make sure the goal is safe for the young person and others
*Set up to three goals 
*You can write the agreed goals on the GBO ‘goals record sheet’

The below power point was developed by Dr Hannah Baron and Dr Russell Hurn who originally created this material for the CYP-IAPT Therapy course as part of the 'core skills' module. It has kindly been shared by the creators as the majority of the material within these slides will be relevant to all helping practitioners. 

''This presentation does not replace any Trust/Service policy or guideline. Please consult your local information governance team and policies.''

<<link-doc "Core Skills: Remote Therapy with Children, Young People and Families" "https://drive.google.com/file/d/1A8mskAgvVNRmeZH97ULpIWE4ZmrdvGeR/view?usp=sharing">>

!!!!!Source: CWP Audit Report for London and the South East 2018. Main author:  Deepa Mavji

!!Demographics of referred service users
The demographic characteristics of children and young people who were referred to CWP services within the collaborative are described below, all completed data was included in data analysis. Data was collected from 15 sites, each site reported data on age, gender and ethnicity of children and young people referred in their locality up until 1st April 2018.

!!Age 

Children referred to the CWP programme had a mean age of 11.47 years (SD= 3.66) and the most frequent age of the sample was 15 years old (11%), followed by 14-years old (10%) and 16-years olds (9%). The least frequent age was 1, 2 and 3 years old (less than 1%), followed by 18 years old (1%).

{{Audit Age Distribution.PNG}}

!!Gender 
54% were females and 45.8% were males, less than 1% of the sample self-disclosed and less than 1% did not wish to disclose.

{{Audit Gender.PNG}}

!!Ethnicity  

In total 54% of service user's were White, 10% were Mixed, 7% were Asian, 7% were Black, 5% were recorded as Other and 18% were unknown.

{{Audit Ethnicity.PNG}}

!!Developing this guide
This guide has been developed through a generous collaboration in London between staff at UCL, KCL and the AFNCCF.  It is being constructed out of the generosity of the teaching staff who share their expertise while teaching on this programme. This guide is constantly being updated and revised with feedback from those in training.

The author or source material is indicated on each page. Permission for use of any copyrighted material is routinely sought and, if not obtained, such material is not used.  We do not seek permission for material freely available on the web but we aim to be transparent where this is the case.

Each page is reviewed by the editorial team and by the source author before being completed. Pages in the process of being written are indicated with a banner at the top of the page indicating that the page is still being completed. We aim not to include material from other sources which we believe to be discriminatory, disrespectful or offensive. The aim is that material will be as accurate and as up to date as possible but we welcome feedback on any of the material in this guide. 


Please send any feedback or questions about the guide to [ext[PGS Online Guides|mailto:PGSonlineguides@annafreud.org]] 


!!!Local Developments in CWP Practice

Partnerships have developed a lot of their own materials for the CWP programme. Please note this is not the core intervention materials taught on the CWP programme. Please see [[Helping]] for the core materials.

*The first is a recently updated version of the CWP [[Richmond adolescent anxiety manual|Additional Adolescent Anxiety Manual]]. 

*The second is material to help children with the [[Primary to Secondary Transitions]] which has been developed by the Islington service.  

!!!''Diary Keeping: a basic stance of curiosity and encouragement'' 
*It is not a surprising to discover that for many (not all) young people who are experiencing low mood, keeping some sort of record about what they do each day is quite a challenge. 
*It is important in this process not to focus on how well the young person does the task but on what you are both learning about how the young person spends their day. 
*Diary keeping is not a test or homework (in a school sense) but a way, for the young person,  of coming to see how their behaviour maintains their low mood. So the stance for  the practitioner needs to be one of encouragement and curiosity. 
!!!''Being sensitive to privacy''
Apart from just being able to comply with the task, a young person may not wish to reveal what they do much of the time. It is important to recognise aspects of privacy in this process so that activities such as substance use, romantic/sexual relationships may APPROPRIATELY not be shared with a practitioner in the early stage (or at all).
!!!''The basic approach: getting started''
*Following a discussion of the rationale for behavioural activation, the task is to develop a collaborative plan as to how a young person will record the main activities for a period of a week. 
*There are a number of simple diary sheets that can be used in this process.  In sharing this with a young person.
*It is helpful to go through the previous day (or two days) with them as a way of introducing the chart. This helps the young person get a sense of what is involved. Often the focus will be on sleep routines, (sleeping all day etc), staying in and using the web, time on facebook etc. 
*If attending school, it i good to get a sense of how best to record things that take place at school. 
*More creative ways of recording activity may be considered with the young person. Some like to make notes on their phone or to use a diary app on their phone. Often in the beginning the information gathered will be very partial. 

!!!''The basic approach: be really interested in whatever they can recall''
*The CRUCIAL behaviour for the practitioner is to be extremely interested in what the young person tells you and much less focused on what they haven't done. 
*If, at the next contact, they haven't completed the dairy at all, then it is an opportunity to fill the diary in with them using their recall. 
*Sometimes young people will find it hard to recall what has happened on what day. This may be avoidant of the question but may also be an indication of the impact of low mood. 
*An example of a diary sheet for behavioural activation is shown below. 

<html><iframe width="100%" height="400px" 
 src="https://docs.google.com/document/d/1bFvkaLO0mpsw3jjNqO6phFX3HLLukzRCCDSVl1Py_3s/pub?embedded=true"></iframe></html>

Related Pages

[[Tips for Completing Activity Log]]

Source:Peter Fuggle, AFNCCF 

!!Education Mental Health Practitioner

The EMHP is trained by completing a one year post graduate Diploma in EMHP.

The EMHP programme aims to build better links with educational settings and offer quicker and more accessible access to low intensity evidence-based interventions, for mild to moderate mental health difficulties as part of a stepped care model of service delivery. 


Like the CWPs the EMHPs are trained to offer brief, focused evidence- based interventions in a range of settings in the form of low intensity support and guided self-help to young people who demonstrate mild/moderate:

* Anxiety (primary and secondary school age)

* Low mood (adolescents)

* Common behavioural difficulties (working with parents for under 8s)

Please see: [[EMHP Role Specification (JD)]] for a more detailed description of the role of a EMHP

!!Children’s Wellbeing Practitioner

The CWP is trained by completing a one year post graduate Certificate in CWP. 

The CWPs are based in community settings (including schools) and aim to offer brief, focused evidence- based interventions in a range of settings in the form of low intensity support and guided self-help to young people who demonstrate mild/moderate:

* Anxiety (primary and secondary school age)

* Low mood (adolescents)

* Common behavioural difficulties (working with parents for under 8s)

!!Links to other pages
This page relates to the general plan around [[Training]] a new workforce to meet the mental health needs of children and young people and the [[policies|Policy context]] surrounding this.

@@color:red;This page is being developed in light of recent changes to working due to the outbreak of COVID-19@@

''Panic attacks''

*Recognise whether, or not, you are having panic attacks
*Understand panic using specific psychoeducation, what causes it and what keeps it going (use a specific panic formulation)
*Accept that panic cannot harm you
*Learn techniques to reduce panic; this should mainly involve questioning the misinterpretation of bodily sensations with cognitive techniques as above and then facing situations the YP avoids. 
*Also, relaxation, controlled breathing and distraction can help e.g. in an exam situation. 

''Worry'' 

*Hypothetical fear – a worry about something that may happen in the future, e.g. family member dying, house being broken into, failing exams and not getting into university. Intervention = try and let worry go (utilize distraction or re-focusing of attention e.g. 5, 4, 3, 2, 1) and / or utilize worry time (writing the thought down and letting it go until planned worry time).

''Current problems''

* a worry about a problem that YP is experiencing, e.g. not being able to focus on revision, friends arguing, being bullied at school.
*Intervention = [[Problem Solving]] 

<<list-links "[tag[Diversity]]">>

!!!! Resources contributed by Kimberley Saddler, CWP at Whittington Health NHS Trust

<<link-doc "CHILD Parts of my life that affect my wellbeing handout (formulation)" "https://drive.google.com/file/d/1N7UTdTqBukpKCl4s4WYn7G6ysBgc1_7T/view?usp=sharing">>

<<link-doc "Diversity Inclusive TELEPHONE TRIAGE FORM -Whittington Health NHS Trust - Islington" "https://drive.google.com/file/d/1T0AAsyXFVz8hRQaTTH6zYBtcTHgaRABf/view?usp=sharing">>


!!!! The Children's Wellbeing Practitioner BAME Inclusion Group

https://www.linkedin.com/groups/8873855/

<a class="tc-float-right">[img width= 100 [brain.jpg]]</a>

!!!!@@Color:red; THIS PAGE IS CURRENTLY BEING WRITTEN AND IS AWAITING COMPLETION@@ 
Source: Lili Ly and NHS Education for Scotland 

!!What is Diversity?
'''…the recognition and valuing of difference'''

About //equal respect// and valuing the things that make us unique as individuals, not treating everyone the //same //

__Areas of diversity include:__

* gender, including those who are transgender;
* race or ethnicity, including refugees, asylum seekers and gypsy or travelling people;
* religion or spiritual beliefs;
* sexual orientation – being lesbian, gay or bisexual;
* disabilities, including mental health problems;
* age
Please see below for a diagram of the 'social GRRAACCEESS' which depicts all the areas of social diversity that practitioners need to consider.
(originally developed by Burgman in 1999 which has been expanded over the years). 

Image taken from [[ The National Elf Service|https://www.nationalelfservice.net/treatment/psychotherapy/social-ggrraaacceeesss-self-reflection-for-family-therapists/]]

[img[Social GGRRAAACCEEESSS.png]]


!!Mental health provision

"Every person, whatever his or her background, should expect to receive a high
standard of care from mental health services. Delivery of high-quality mental health
services is to a large extent dependent upon staff understanding and putting into
practice some key issues."

Inequalities in people’s health, including their mental health, have been linked to:

* ''socio-economic status'' – living in poverty, for example, and/or living in a socio-economically disadvantaged community
* ''life circumstances'' – being homeless, in care or in prison.
* ''social identity'' – being a woman, being a man, coming from a black or minority ethnic community, being lesbian or gay, or being old or young;
* ''health status ''– being physically disabled. 

!!EMHP practice considerations:
Below highlights diversity areas which you will need to consider when working with CYP and their families in schools.

!!!Gender
*Suicide rates and differences between men and woman: Men are more likely to commit suicide.
*Domestic abuse statistics: 1.2 million woman have experienced domestic abuse

!!!Disability
*co-morbidity of learning disability and other disorders such as ASD 
*Pupils identified with [[SEND|The SEND Framework]] accounted for approx. half of all permanent exclusions (46.7%) and fixed period exclusions (44.9%)

!!!LGBT
*34% of young LGB people had made at least one suicide attempt in their lives, compared to 18% of heterosexual young people
*48% of Trans* young people had made at least one suicide attempt in their lives
*Two in five pupils who have been bullied for being LGBT (40 per cent) have skipped school because of this bullying 
*Half of bullied LGBT pupils (52 per cent) feel that homophobic, biphobic and transphobic bullying has had a negative effect on their plans for future education 

!!!Ethnicity
*Black and ethnic minority people are more likely to be: diagnosed with MH problems, and have poor outcomes from treatment and are more likely to disengage from MH services 
*Pupils of Gypsy/ Roma and Traveller of Irish Heritage ethnic groups had the highest rate of both permanent and fixed-period exclusions
*Black Caribbean pupils were permanently excluded at nearly 3 times the rate of White British pupils
*Across the broad ethnic groups, Black and Mixed ethnicity pupils had the highest rates of both temporary and permanent exclusions

!!!Culture
*Different cultures may have different ways of constructing ‘mental health’ difficulties
*Parenting styles may also differ across cultures

!!Practice points:

Please go to [[Diversity: Shaping Practice]] for a more comprehensive overview of how diversity may shape EMHP practice.

!!Further reading:

[[The School Report|https://www.stonewall.org.uk/sites/default/files/the_school_report_2017.pdf]] -The experiences of lesbian, gay, bi and trans young people in Britain’s schools (Stonewall, 2017) 

[[Race Disparity Audit|https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/686071/Revised_RDA_report_March_2018.pdf]] (Cabinet Office, 2018) see Education section of report (rest of report focuses on adults)

Children and young people with learning disabilities - [[understanding their mental health|file:///C:/Users/lyl/AppData/Local/Microsoft/Windows/INetCache/IE/A5AN11NI/children-and-young-people.pdf]] (Young Minds)


!!Links to other pages:

Please got to [[Diversity]] for a list of pages relating to this topic.

Source: BBC THREE

!!What is it?
BBC THREE produced a series of short clips based around the idea of 'things not to say to ..' In these videos people from specific minority populations give frank and honest insights into what it is like to come from the population group specified and discuss common stereotypes they often hear. 

!!Why is it important?
These videos provide a fun and interesting introduction to diversity and will get you thinking about how diversity may impact your work. They also provide insight into the social and emotional impact that stereotyping has on the lives of those in the videos.

The videos highlight stereotypes and the importance of not assuming a persons personal experience from a generalization of a stereotype. This will be important in your work as and EMHP whilst also keeping in mind that a persons diversity may impact their mental health or their ability to access support. Please got to [[Diversity: Shaping Practice]] for more information.

!!Practice points:
These videos break down barriers around issues which you may find uncomfortable to broach with the specific populations outlined. 

The purpose of these videos is not to produce rigid guidance to practitioners about 'what not to say' to the people you work with. 

You will not always get it right for the people you work with but these videos highlight the importance of remaining curious about the diversity of the people you work with, asking them how they feel it may impact your work together.


!!''PLEASE NOTE: ''

*'' Some of these videos do contain swear words'' 
* ''These videos are ADULTS talking about their experiences.''
*''Some viewers may find the subject matter of these videos emotionally provoking'' (this is something that as practitioners you will need to address and understand why you may find it uncomfortable). 

!!The videos
!!!Faith
[[Things Not To Say To Someone Who Wears A Burqa|https://www.youtube.com/watch?v=FUVWVBrPsTM]]


!!!Disability

[[Things Not To Say To Someone Who Stammers|https://www.youtube.com/watch?v=xlDi0bMNV6g]]


[[Things Not To Say To Someone With Dyslexia|https://www.youtube.com/watch?v=ObwAzZr87jg]]

[[Things Not To Say To People With Tourette's Syndrome|https://www.youtube.com/watch?v=2-YeQUrX5M4]]

[[Things Not To Say To An Autistic Person|https://www.youtube.com/watch?v=d69tTXOvRq4]]

!!Ethnicity 
[[Things not to say to eastern Europeans|https://www.youtube.com/watch?v=l9Qm8jzomkU]]

[[Not To Say To Young Black Men|https://www.youtube.com/watch?v=2XPmyr5HRLY]]

[[Things Not To Say To A Refugee|https://www.youtube.com/watch?v=Rg3eaUj7Ovk]]

!!Sexuality
[[Things Not To Say To Gay People|https://www.youtube.com/watch?v=ujxl5WZJHL4]]

[[Things Not To Say To A Trans Person|https://www.youtube.com/watch?v=pvBwWeG4Rpc]]

!!Mental Health

[[Things Not To Say To Someone With OCD|https://www.youtube.com/watch?v=RDQPfR84cYE]]

[[Things Not To Say To Someone Who's Been Sexually Assaulted|https://www.youtube.com/watch?v=ySgTgJOqlgE]]

!!Links to other pages:

Please go to [[Diversity]] for more pages relating to this topic

* need to have an understanding of the stereotypes someone is being exposed to use it to try to engage the young person.
* Don't ever assume someones experience.
* Practitioners/ research have a tendency to focus on the negative instead of the richness of different perspectives

!!!Getting it wrong!
You will not get it right for everyone, important to ''acknowledge'' this and ''remain curious'' about their experience. 

''“I think I might make an error and offend you here so can you tell me if I do.”''

Try to use the wrong doing to build a stronger [[‘therapeutic’ relationship|Therapeutic Alliance]] and to break down barriers of awkwardness.

!!!Prejudice
Being politically correct: we all have prejudice but be aware of this and leave it at the door. 

Important to acknowledge that you may feel more comfortable talking to some people/ on some subjects rather than others- need to be aware and mindful of this.

!!!Working in schools:
*Teachers may have specific views on gender inequalities: Language used by teachers about gender stereotypes
*develop ways to have conversations about the messages being given in schools around gender 
*Running workshop in schools about male suicide rates and toxic masculinity- getting the head to talk about issues. Working on multiple levels.- 

!!Tips from MIND
MIND is a mental health charity that provides advice and support to people experiencing a mental health problem as well as campaign to improve services, raise awareness and promote understanding. 
Please go to MIND's website for their [[Top Tips|https://www.mind.org.uk/workplace/influence-and-participation-toolkit/how/planning/diversity-and-difference/]] on how to work with the framework of embracing diversity.

!!Links to other pages:

Please go to the page [[Diversity]] for a list of related pages.

Dog Poo Analogy (adapted from Stott et al., 2010; Kendall, 2012): Several people hurrying out of their block of flats fail to notice some dog poop on the path outside and step right into it!  

 
The first person thinks, “Well, that’s just my luck. This just like my whole life. I can’t do anything right. There’s no use in even trying today. I am just going to go home and go back to bed.” How would you think he is feeling? If you guessed sad, depressed or something similar, you’d probably be right!  

But now, imagine a second person leaves for the day and steps into the same pile of poop. This time, the person looks down at her shoes and thinks, “Oh no! I'm already running late! If I go home and change my shoes, l’ll be late for my meeting and my boss will think I am disorganized! But if I go to work with this poop still on my shoes, my boss will surely smell it and think I have a hygiene problem! I could get fired! What am I going to do?” How would you think she is feeling? If you guessed anxious, worried, or something along these lines, you’d also probably be right!  

Imagine a third person hurrying out steps into the same pile of poop! This time, however, the person looks down at his shoes and thinks, “What kind of world am I living in? This neighborhood is going downhill fast because people just don’t have the decency or consideration to care about cleaning up after themselves! I am certain that I know the S.O.B. whose dog made this mess! I am going to sit on my porch and wait for him to come by and then let him have it!” How would you think this person is feeling? If you guessed angry, mad or something similar, you’d probably be right again! 

How is it that three different people, encountering the same situation (stepping in the poop), can have three very different emotional reactions to the situation? Is it really about the poop? Well, yes and no! (1) it is not events in life that upset us, but rather our thoughts about these events, and (2) specific emotions are connected to specific thoughts. 

<a class="tc-float-right">[img width= 300 [sunshine-2596172_960_720.jpg]]</a>

This is a photo of some nice sunshine.

We can now embed images

To the right hand side, this is a great asset!

Will help to break up paragraphs and any dense writing.1111111111111111111

The only issue seems to be the comment function bar- must ask jeremy about this. 


!! But if we keep writing it goes down

''Today'' we are __editing__ the CWP Guide.

!! Day of the week

* Monday 
* Tuesday
* Wednesday 

The way we think: Often when we feel anxious we will be thinking that something bad will happen. Our thoughts tend to focus on potential threats and how to escape them. This can sometimes be useful e.g. if your child is about to step onto a busy road, it is good to be focused on the potential danger and getting your child out of the way.

<<list-links "[tag[COVID-19 Resources]]">>

Source: Helen Barker and colleagues 

---

!!'''Getting to Grips with Anxiety'''
The approach to helping young people with anxiety is summarised in the manual called 'getting to grips with anxiety'.  This has been drafted by Helen Barker and colleagues and provides a step by step account of how to help a young person with anxiety. 
We are indebted to Helen Barker and her team for generously sharing their work on adolescent anxiety with us.

Please use the link below for the full manual:

<<link-doc "Getting to grips with anxiety" "https://drive.google.com/file/d/1wUrDMPAYZnq0c1WPOEopQjmGV8SCS3Ri/view?usp=sharing">>

@@font-size:12px;
<<< <<link-doc "The Previous version of Getting to grips with anxiety can be found here" "https://drive.google.com/file/d/1CFJ4RymiV2RIlE4qksaUYgGz1DQntLLp/view?usp=sharing">> 
@@

---

!!''Introduction''

*This framework is designed as a guide as what might be useful content to cover in a course of guided self-help (GSH) for anxiety with adolescents. 
*Services should feel free to try this out and adjust accordingly. 
*Services should experiment with materials and resources available to them and utilise websites such as ‘get self-help’ or ‘Mind-Ed’ and other [[self-help materials|Self Help Materials]] / books / literature. 
* We encourage services to develop their own booklets. 
*Although GSH is a mixture of shorter and longer sessions; the modality these sessions take place in (e.g. phone/Skype/face to face) will likely differ between services.

!! ''Sessions overview''

[[Session Overview for Overcoming Adolescent Anxiety]]

!!''Session Plans''

For a full list of session plans based on  'Getting to Grips with Anxiety' by Helen Barker and colleagues go  to:
[[Session Plans for Overcoming Adolescent Anxiety]]


!!''Related pages:''

Please also go to 
[[Working with Adolescents with Anxiety]] for general guidance on how to work with YP who are experiencing anxiety. 

!!Supplementary Manuals
 The Kings College London CYP-IAPT teaching team have also developed some excellent manuals ''to be used alongside the 'Getting to Grips with Anxiety' manual'', for more detailed guidance with the specified areas below.

!!!Injection, blood and injury fears supplement:

<<link-doc "Supplement: Injection, blood and injury fears" "https://drive.google.com/file/d/16SRtHJyJ0sXQWoF9pGUdRFBVt5ZW_JK7/view?usp=sharing">>

!!!Managing Panic supplement:

<<link-doc "Supplement: Managing Panic" "https://drive.google.com/file/d/1qt2Q_ZK1QV1ZKkUGdsWV5-G2WfxiJAiI/view?usp=sharing">>

!!!Managing Worry supplement:

<<link-doc "Supplement: Managing Worry" "https://drive.google.com/file/d/1DwsXWSq-cIj-TuXCrSCPs6tC9tqvtiQX/view?usp=sharing">>

!!!What to do when our thoughts get in the way supplement:

<<link-doc "Supplement: What to do when our thoughts get in the way" "https://drive.google.com/file/d/1sAtXtolQIYypSd7r8dEHoVYcjaXKw1TP/view?usp=sharing">>

@@
<<< <<link-doc "The Previous version of What to do when our thoughts get in the way can be found here" "https://drive.google.com/file/d/1Yzf2FE62B95fdgleePm88HA8GxMTdmjt/view?usp=sharing">> 
@@

!!!!!Source: Peter Fuggle
!!Engagement
''The basic stance for engagement - How can I help?''
*''Engagement'' includes a wide range of practitioner skills. These can be broken down into lots of important components. These are useful but there is a risk that the core stance can become a bit over-complicated in description and technicalities. 
*Engaging young people, children and their parents in a process of guided self help requires the practitioner to adopt a non-critical stance of warmth, genuineness and empathy combined with ''a wish to understand things from the child, young person or parents point of view''.   
*The intention is to be helpful to the family and not to start with what the family has to do to follow our systems and practices but to start in the same way that one may be addressed in a shop - 'how can we help?'. This basic stance is probably more important that being technically proficient in specific practices although these may help. 
*Engagement is a process that is obviously prominent in the initial contacts with the family but essentially requires that the practitioner remains attentive to the nature of the relationship that he/she has with the client. 
!!!''Specific techniques for supporting engagement'' 
There are a number of techniques have been shown to facilitate engagement in contacts with clients. These include:
#[[Active Listening]]
#[[Summarising]]
#[[Validating]] 
!!Links to other pages
This process is much more fully covered in a series of pages around the [[Therapeutic Alliance]]. 
Please find a list of pages which relate to the subject of engagement. 
<<list-links "[tag[Engagement]]">>

Please find a useful articule from the mix on [[exam stress|http://www.themix.org.uk/work-and-study/study-and-exam-tips/exams-and-the-pressure-to-do-well-23966.html]]. 
This may be an article you want to share with YP, parents/ carers or teaching staff.

! Question:

''How'' do we __upload__ a video?

<html><iframe width="560" height="315" src="https://www.youtube.com/embed/J3PNCBPqJ7o" frameborder="0" allowfullscreen></iframe></html>

What about images?

[img[brain.jpg]]


We have uploaded an image of some building block:


[img[sunshine.jpg]]

The beautiful sunshine!


<<link-doc "RCADS "  "https://drive.google.com/file/d/0B-tACu2wi4-4dEdqbk93SlNvTE0/view?usp=sharing">>


<<link-doc "CWP BAME inclusion group flyer" "https://drive.google.com/file/d/1OKiWCRxNMBDSgf8zHW3zV9WasUefGqnD/view?usp=sharing">>

<<link-doc "CWP BAME Inclusion Group Powerpoint Presentation" "https://drive.google.com/file/d/1OKiWCRxNMBDSgf8zHW3zV9WasUefGqnD/view?usp=sharing">>

!!!!!Source: Peter Fuggle 
!!Nine components of guided self help.
These are offered as a general steer about what is meant by guided self help. It should not be treated too rigidly. The intention is to provide a framework so that practitioners can apply this to their work with children, young people and parents. If you are not doing any of these activities, then it would be good to think this through with your supervisor. 

It may not be necessary to do all nine steps for each case. The practitioner should seek feedback at each stage. Outcome monitoring needs to take place throughout. 
#[[Engagement]] (getting to know each other) 
#[[Making sense of things]] (formulation)
#[[Deciding on what you want to change]] (setting goals)
#[[Learning about the problem]] (psycho-education) 
#[[Trying out new things]] (doing experiments)
#[[Problem Solving]] (things rarely go to plan) 
#[[Outcomes]] (Learning from new experiences) 
#[[Building a back up team]] (not doing it alone) 
#[[Agreeing a future plan]] (making a self management plan) 
Self management has many overlaps with guided self help. It could be considered that self management is supported by promoting various forms of self help. 

 <<link-pdf "Self-managment vs. self-help" "https://drive.google.com/open?id=0B1hDLHd8syMsSm9EeTdXRUc3ZlE">>

!!Linked pages
[[What is a 'low intensity' intervention?]]

<<link-pdf "Video Equipment Guidance" "https://drive.google.com/file/d/18Rty4K9EQr4yGxDvjPrMVBloSFqNb9Yq/view?usp=sharing ">>

*This is only a guidance, please check with local information governance leads 

! ''__This is a test__''


this will be an interesting journey 

what is the difference between diversity and inclusion?


https://lnkd.in/gP_ncJe

!!''Chapter 1:'' 

* What are fears and worries?
* What do we mean by fears and worries?

Worries fears and anxiety have 3 things in common:

The way we think: Often when we feel anxious we will be thinking that something bad will happen. Our thoughts tend to focus on potential threats and how to escape them. This can sometimes be useful e.g. if your child is about to step onto a busy road, it is good to be focussed on the potential danger and getting your child out of the way.

This is a tag tiddler

All pages in this guide are expected to be updated and improved but some pages are specifically unfinished. All such pages are listed below. 

<<list-links "[tag[Draft pages]]">>

This is a tag tiddler
<<list-links "[tag[EMHP]]">>

This is a tag tiddler

Eating disorders are complex disorders that can have many underlying causes which tend to manifest during adolescence. There are multiple types of eating disorders and it is crucial to recognise the symptoms early on. Eating disorders, while serious, are treatable, and it is very possible to make a full and sustained recovery.

[[Beat|https://www.beateatingdisorders.org.uk/tips]] the UK’s eating disorder charity has a very useful page outlining 'Tips for Spotting the First Signs of an Eating Disorder'. This website also has [[downloadable resources|https://www.beateatingdisorders.org.uk/types/downloadable-resources]] such as posters, leaflets and guides for friends and family.

[[Healthy London|https://www.healthylondon.org/resource/guidelines-for-referring-children-and-young-people-with-eating-disorders/]] has some really useful guidelines for primary care professionals about treating children and young people with eating disorders.

 

<<list-links "[tag[Education Resources]]">>

!!!!!Source: Peter Fuggle
!!Engagement
''The basic stance for engagement - How can I help?''
*''Engagement'' includes a wide range of practitioner skills. These can be broken down into lots of important components. These are useful but there is a risk that the core stance can become a bit over-complicated in description and technicalities. 
*Engaging young people, children and their parents in a process of guided self help requires the practitioner to adopt a non-critical stance of warmth, genuineness and empathy combined with ''a wish to understand things from the child, young person or parents point of view''.   
*The intention is to be helpful to the family and not to start with what the family has to do to follow our systems and practices but to start in the same way that one may be addressed in a shop - 'how can we help?'. This basic stance is probably more important that being technically proficient in specific practices although these may help. 
*Engagement is a process that is obviously prominent in the initial contacts with the family but essentially requires that the practitioner remains attentive to the nature of the relationship that he/she has with the client. 
!!!''Specific techniques for supporting engagement'' 
There are a number of techniques have been shown to facilitate engagement in contacts with clients. These include:
#[[Active Listening]]
#[[Summarising]]
#[[Validating]] 
!!Links to other pages
This process is much more fully covered in a series of pages around the [[Therapeutic Alliance]]. 
Please find a list of pages which relate to the subject of engagement. 
<<list-links "[tag[Engagement]]">>

Source: Joe Hickey and Peter Fuggle

!!Therapeutic alliance and engagement

For information on what a Therapeutic alliance is please go [[here.|Therapeutic Alliance]]

The strength of therapeutic alliances have a massive impact on the [[Engagement]] and [[Outcomes]] when working with CYP and their families. As such it is important to begin developing a positive relationship or alliance from the first meeting.


!!Low intensity and guided self help

''Your role:'' to provide materials that the client can then use to help themselves outside of the context of a therapeutic space

Most of your direct work with CYP will be low intensity face-to-face interventions or guided self-help (GSH).
Attention to therapeutic alliance is vital in brief and manualised work. 

*Think about their level of understanding/check in about what they make of completing the materials. 
*Important to let them engage as much as possible (they hold pen, read etc)
*Find ways in which you illustrate that we don't always know how we spend our time etc in a sensitive way during BA tasks etc (that are helping YP to see their life). It's an important first step in them becoming active and aware of their own situation. 

Ask yourself: How well are you and the young person aligned in terms of goals, tasks and bond?

!!Exploring through questionnaires
You should aim to use questionnaires when working with CYP as if done in the right way it can be a great way to start having conversations about the problems that the CYP is having. 

*You have to be clear about checking out self harm and risk in the first session. Please go to [[Risk and Safety Assessment]]
*To get detail, you have to ask lots of questions (which can seem like an interrogation). Measures (e.g. RCADS) can be used to compliment questions and efficiently get to a shared point. 
Please go to [[Using Feedback and Outcome Tools]] for more information on how measures such as the RCADS can be beneficial and how to use them correctly.

!!How to set up a first meeting

*Be clear about who is attending and why
*Set boundaries of confidentiality
*Introduce the outcome measures
*begin to [[build a therapeutic alliance|Building a Therapeutic Alliance]] with the CYP 
*Use [[Active Listening]]
*[[Risk and Safety Assessment]] (This will be done during the assesment session which may be conducted by you or by your supervisor depending on what you have agreed)

__Setting expectations__

*Prepare client for the short nature of relationship
*What are they finding difficult? create specific goals together that you can work on together 

__Physical environment__

*Check the room’s suitability and availability in advance
*Make sure there is a clock or watch
*Arrange the furniture to align with enacting collaboration (chairs next to each other rather than facing each other)

__Session materials__

*Have ready what you will need (paper, pens, worksheets, toys)

__School setting__

*Check the CYP’s teacher/tutor is aware they need to leave class
*Check where they will return to after your meeting - is there a space they can go afterwards to 'cool off' before returning to lessons?

__Time boundaries__

*Agree the length of meeting
*Consider the school timetable
*Arrive in good time and be reliable

!!What does this look like?

Please click on the box below to view a role play video of meeting a CYP for the first time. (You will need to log in to access this video).

<<link-pdf "Session 1: Low mood video"
 
"https://manuals.annafreud.org/emhp/private.html#Session%201%20Low%20Mood%20Video:%5B%5BSession%201%20Low%20Mood%20Video%5D%5D">> 


!!Links with other pages:

Please see [[Therapeutic Alliance]] for more information on  the importance of therapeutic alliances for EMHP's. 

Please go to [[Building a Therapeutic Alliance]] for guidance on how to build therapeutic alliances successfully.

Please go to [[Using Feedback and Outcome Tools]] for guidance on how using questionnaires/ outcome measures like RCADS can support the therapeutic alliance.

!!!!!Source: Vicki Curry and Kate Martin 
!!''Engagement & Shared decision making'' 
*The pages on [[Engagement]] are all interconnected and contribute to engaging CYP in a collaborative way.
*Practitioners should consider specific developmental factors as well as systemic factors which might affect the [[Therapeutic Alliance]]
*YP are often ‘sent’ or brought for treatment.
* motivational issues
*Developmental issues 
*Power imbalances
*Establishing meaningful goals 
*Confidentiality
*Maintaining change in different contexts

When building up a collaborative relationship consider the following:

*What helps you to feel at ease?
 *What might make you feel less comfortable?
*What encourages you to ‘open up’ to another person, and what puts you ‘on your guard’?
Therapist factors have been shown to have an influence on engagement: e.g. flexibility, honesty, respectfulness, trustworthiness, confidence, warmth, being interested in the client, and openness (Ackerman and Hilsenroth, 2003) as well as techniques such as:

**exploration, 
**reflection, 
**noting past success in therapy, 
**making accurate interpretations,
**facilitating the expression of affect
 **attending to the patient’s experience (Ackerman and Hilsenroth, 2003). 
Remember the importance of [[Socratic Questioning|Socratic technique]] (Fuggle et al, 2013) 

The Model of Behavioural Change (Prochaska, ~DiClemente & Norcross, 1992) is a useful framework to consider CYP / parent motivation and readiness to change.

!!''Shared decision making''
See also [[Shared Decision Making]] for further consideration of this.

*Shared decision making is a crucial part of working with CYP research has suggested there is often a gap between our/services’ intentions, CYPs experience and what happens in practice.
*Lack of involvement can lead young people to feel out of control, affect their willingness to seek help or agree with decisions that have been made, or drop out (Kate Martin’s slides, 2018). 
*Often our view of what is in a child's best interest overrides their choice. We need to challenge this.
*Need to bear in mind that the parent will often have a different viewpoint to child. 
*There may be a number of service and context factors which make it hard for professionals to feel confident in how to involve CYP in decisions e.g. complexity of disagreement within a team about a child, risk for multiple parties, lack of ‘thinking time’, pressure on services, staff feeling powerless as they are not the ‘decision makers’
*Interestingly however, CYP have shown us the following about shared decision making: 
**The process of deliberation is often more important than the outcome
**They learn and internalise decision-making processes
**Reduces resistance or passivity 
**Increases awareness and understanding of risk, boundaries and restrictions as well as possibilities
**Increases safety
!!''The process of shared decision making''
See section 'open talk' on the page [[Shared Decision Making]]  for practice points on this subject.

It is routine to ask children and young people about what they are good at. This is clearly an important part of the approach but the question can evoke a mixed set of responses which it is helpful to anticipate. 

For some children and families, they genuinely cant think of anything. This may be because they are thinking in very narrow terms such as what subjects at school a child is good at. The practitioner needs to encourage the family to think more widely.

Light prompts with a little humour may help this process.

//'I guess I was wondering about things like going on Facebook or knowing everything about Arsenal. It doesn't just have to be serious stuff. Some people are really good at helping others or looking after their younger brother....'//

Some children find these sorts of questions a bit tedious and perhaps a bit phoney - a bit like 'what they like about school?'. Sometimes doing it in a more circular way, can open things up a little. 

//'If I was to ask your grandma what you are good at, what do you think she might say?'//. 

This may prompt a little discussion between family members. 

Some children and families just never speak about what they are good at. Social modesty may make this question quite strange. This is fine but may be helped by being recognised. 

//'Maybe this is something that isn't talked about much in your family. Some families are really good at being quiet about their abilities and talents.'//

It is not necessary to get a big list of strengths. The important thing is that the practitioner has communicated an assumption that everyone is good at something and that he/she will keep an ear open for such things as they go along. 

Sequence for interactions in therapy: establishing trust.
!!!Communication 1: Teaching and learning content 
*Therapist conveys a model for understanding to try to help the CYP understand (and see if it fits for them)
*Looking at same experience but from a different, more compassionate angle 
!!!Communication 2: Mentalization
*Trying to work out what is going on between us (so that you trust that I understand you)
*Epistemic trust: A sense that therapist sees me and the version you see matches the version I am experiencing. This is a window of opportunity (they will now show interest in the next thing therapist says)
*When we are anxious or depressed we don't tend to look at people and think you trust them/ that they are going to help you. 
*This helps to re-establish the basics of social learning
!!!Commination 3: Re-emergence of social learning
*Back up team can reinforce opportunities for social learning 

!!!! Explored and Explained by Isaac Cook, EWP at SLaM

[img[Equality Wordcloud.png]]

(source: https://stateofwales.com/2018/04/equal-wales-why-equal-rights/)

<iframe width="560" height="315" src="https://www.youtube.com/embed/4K5fbQ1-zps" frameborder="0" allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe>

!!!! Equality Act, 2010 GOV UK
https://www.gov.uk/guidance/equality-act-2010-guidance#:~:text=The%20Equality%20Act%202010%20legally,strengthening%20protection%20in%20some%20situations.


!!!! The Children's Wellbeing Practitioner BAME Inclusion Group

https://www.linkedin.com/groups/8873855/

There area a very wide range of self help materials available. This page provides links to guidance on how to assess the quality of self help materials available to children, young people and their parents/carers. 

  <<link-pdf "Evaluating self help material" "https://drive.google.com/open?id=0B2_m9ZgGWI-jUDlvNnBBVFQ2d0E">>

In the adult IAPT programme, a guide was  produced that provided a method for assessing self help materials for clients. This can be found at the following address. 

<<link-pdf "Criteria for self help materials" "https://docs.google.com/document/d/1OTKNmfUn_TQ4wkxKGmc_t-4JgULubPsjCPNx3PiPjGU/edit"">>

The guide lists 20 criteria which could be used to assess the quality of self help materials. These are grouped into four main sections. The paper includes an evaluation tool to audit materials in a programme. 
#''Scope'' 
##targeted
##relevant
##clear
##readable
##complementary 
#''Evidence''
##accurate and reliable
##comprehensive
##balanced
##peer reviewed
##current
#''Engagement''
##empathic
##illustrated
##positive
##collaborative
##interactive
#''Implementation'' 
##goal focused
##action focused
##self monitored
##preventive
#''Transparent''
##transparent in terms of sources etc

!!!Low intensity psychological treatments with children and young people: evidence base (use anxiety disorder as an example) 
*Real need for tier 2 interventions targeting children who don't reach the threshold for CAMHS using evidence-based interventions 
*Many children are experiencing difficult problems but not receiving any help 
*Offering low intensity treatments supported by self help materials means that this may enable high intensity for the children with more severe problems  
!!!Discussion points 
*What is important to know about interventions- GPS-CBT
*Does it work? 
*Who does it work best for? 
*Do people like it?
** Some parents and therapists like this approach 
*Is it relevant or generalizable to our population? 
*Cost and resources associated with it? 
**More cost-effective than brief treatments 
*Who has been studies?
** Rural Australia, PCAMHS, ANDY. Studies not limited to people with formal diagnostic criteria 
*What is it better than? 
**Number of things that obtained similar results 
*Does it last over time? 
**Improving outcomes over time, looked at on an individual basis 
*Cultural differences- research populations haven't been diverse i.e. English second language 
!!!Anxiety in young people 
*Understood to have a particularly early onset 
*Cochrane review have shown interventions can be effective compared to waitlist controls, guidelines suggests CBT to be the optimal first-line treatment 
!!!Evidence-base 
*Used to outcome results of around 60%
*Interventions not fully delivered by the therapist e.g. accompanied by a book (given to parents), computerised CBT. 
!!!Computerised CBT (CCBT) for adolescents 
*Some evidence of effectiveness with adolescents, but no strong evidence for children with anxiety disorder. Also included a lot of therapist input or become outdated after the research to prove its evidence base. 
**Research has shown less emphases on adolescents with anxiety due to either using a bottom up approach (making child interventions less childish) or top up approach (editing adult interventions). The specific needs for adolescents and what is maintaining the anxiety is not being targeted. 
**BRAVE program for adolescents- Psychoeducation, relaxation, helpful thoughts, facing fears (begin in session 6), problem solving, self-praise then maintenance. 
**Does it work? Do young people like it? They liked the convenience of doing it online at any time of day, but felt they didn't take the information in without face-to-face therapist contact. Raised the issue of optional modules such as exam stress. 
**Did the parent sessions make a difference? 
!!!Computerised CBT (CCBT) children 
*Guided parent-led approaches using bibliotherapy to implement CBT techniques in day to day lives 
*Multiple pathways to the development of child anxiety 
*Parents of anxious children express fear and transfer information ("are you sure you're alright?") which make children feel scared about things, also promote less autonomy ("do you want me to do that for you?")
*Parents have a profound effect on the anxiety reactions of their children if they have high trait anxiety 
*Natural responses for children being anxious
*What are the implications?
**Effective to deliver interventions for child anxiety through parents because parents can learn skill which they can implement throughout the week instead of one hour therapy session. 
**Also gives parents alternative ways to respond to a child's anxiety 
*Does it work? 
**Found the general principle can work- parent only group much better than nothing and no different outcomes in the parent and child group (which has twice as many therapists) 
*Lead to the development of the CWP book 'Overcoming your child's fears and worries'
*What is the evidence? 
** 5 hour version better than nothing, shorter version less effective but hardly any difference in the long term 
**Doesn't matter who could deliver the treatment in the 5 hour version i.e. clinical psychologist, PHD student, Psychology graduate. This is due to the manualised and structured way of the intervention.  
*Do people like it?
**High level of parental satisfaction, happy to have as little treatment as possible as long as they felt like they were getting better 
*Is it better than anything else?
**Solution Focused Brief Therapy- flexible with parental involvement but primarily worked with children. Find the exceptions to problems can help you find solution to the problem. No difference in outcomes between Brief and Guided Parent Delivered CBT. Outcomes also similar to high intensity treatments. 
*Cost-effectiveness?
**GPD CBT telephone reduces travel costs, Brief travelled out to patients. Differences in admin costs, Brief needed much more extensive notes whereas GPD CBT did not as it was so structured. 
!!!Can we make GPD CBT more efficient?
*Group approaches- normalise experiences, reduces feelings of isolation and increases feelings of self-worth 
*Qualitative themes include Acceptability (clinicians don't get 'dragged' into individual problems), Accessibility (importance of how we sell the group in the beginning; limited to timings) and Treatment Outcomes and their Mechanisms (normalised behaviours; share ideas for problem solving). 
*Need to keep in mind different options for different families 
!!!Future Steps
*Putting GPD CBT online through a collaboration with a tech company and PPI groups- currently in the feasibility phase
*Getting young people more engaged in the intervention - use accompanying child app where the child can unlock games when they complete a challenge associated with the intervention
*Conducting research into cultural differences 
*Add parental tolerance strategies- extra sessions on patterns of emotional responses (Tolerating your child's negative emotions). Found to go down naturally with GPD CBT, addition on extra session made no difference
!!!Key points
*Don't worry about parent anxiety and it's effect on child anxiety outcomes 
*Good evidence low intensity interventions work in a cost-effective way but increasing resources
*Potential to work individually, in groups and online 
!!!Q&A
*Ending treatment
**Data shows gains after treatment, and those who have made gains do not use them 
**How do we capture the final outcomes using ROMs- booster session at 3 months (check progress, final data point, discuss step up if needed) 
*Follow-ups: will the young people still have the skills and tools if a significant life event happens.
**Qualitative work found that parents went back to the skills they learnt in therapy and worked through the problem 
*Adolescent population- not used but in book as people asked for it. Adolescents want to be more involved in their treatment and it's difficult to maintain the same approach. Not evaluated. 

Please find a useful articule from the mix on [[exam stress|http://www.themix.org.uk/work-and-study/study-and-exam-tips/exams-and-the-pressure-to-do-well-23966.html]]. 
This may be an article you want to share with YP, parents/ carers or teaching staff.

Every week you go to the same shop to buy your loaf of bread you cant wait to get it home- its always baked to perfection, it butters really nicely, its so tasty! 

One week, you get your bread home and find that it is covered in green mould! What do you do? Likely that you will take it back to the shop and complain!

What do you do all the times the bread is baked to perfection? Do you go in and tell them how wonderful it is? 

It is hard determining exclusionary criteria for the CWP Programme because all services are different. As such, referral criteria will often depend on the service context. 

Nevertheless, there are some problems, diagnoses, and symptoms that are definitely not appropriate for [[low intensity treatment]] within the CWP Programme. These include:  (1) Patients whose primary referral is for a psychotic disorder.  (2) Patients who experience distress associated with [[attenuated psychotic symptoms]]

In these cases, it should be obvious that a referral should be made to either a (a) Early Intervention Service or (b) [[tier-3 CAMHS]] with a psychosis pathway so that the client can receive multidisciplinary assessment and treatment. 

@@color:red;This page is being developed in light of recent changes to working due to the outbreak of COVID-19@@

Source: Peter Fuggle, AFNCCF

!!What is it?

The Experience of Service Questionnaire formerly known as Chi-ESQ was developed as a means of measuring service satisfaction in Child and Adolescent Mental Health services. The ESQ is the most widely used feedback measure in this programme and should be used as the default measure for obtaining systematic feedback from the child, young person or parent.

Details about the ESQ can be found on the [[CORC website|https://www.corc.uk.net/outcome-experience-measures/]] (Child Outcomes Research Consortium) and is summarised below:

*The ESQ allows a family’s experiences with the service to be understood alongside the child’s symptom reduction.

*The ESQ consists of 12 items and three free text sections looking at what the respondent liked about the service, what they felt needed improving, and any other comments.

!!How to use it?

This measure should be used ''near the end'' of an intervention with a young person or parent around session 6-8. There are three versions of this questionnaire:

* one for parents
* one for children aged 9-11
* one for young people aged 12-16.
 
The measure is loaded on [[POD]]

However for a paper copy of the questionnaire please see below:

<<link-pdf "Paper version of ESQ" "https://drive.google.com/drive/u/1/folders/1Hub2gtgS4x2rPeMomKGl8nKxEq-SYGSC">>

!!Links to other pages:
Please go to [[Outcomes]] for a list of relevant pages about outcomes overall.

Please go to [[Using Questionnaires]] for guidance and tips on how to use outcome measures in practice to enhance therapeutic alliance

Please go to [[POD]] for a list of all related pages.

!!!How do you feel when asked to do a role play?
*Bodily sensations: hot, butterflies in stomach, heavy breathing 
*Feelings: Anxious
*Thoughts: 'I will go red', 'I will say something wrong' 'People will judge me negatively' 'I will make a fool of myself' 
*Behaviours: Shifting in seat, trying not to be seen, avoiding eye contact 
**This shows that we all feel anxiety. But it is important to distinguish between normal anxiety and an anxiety disorder
!!!'Normal' anxiety versus anxiety 'disorder' in CYP
*Try to work out what is normal and when it becomes a disorder 
*To do this we need to think about how much distress/impact it has on YP
*We also need to think about developmental stage and what it normal e.g. children aged 2-4 find it more difficult to distinguish between fantasy and reality so anxiety might be related to fantasy, but this might be normal levels of anxiety for age group
*In order to figure out what would be appropriate treatment (e.g. signpost or LI treatment) we need to assess the impact that it has on CYP e.g. is it keeping them up every night?
!!!Cultural differences in anxiety
*Gender: Men tend to present less for anxiety
*Age: they aren't going to be able to come in and tell you they feel anxious. It might just be the behaviours that are clear (and they may struggle to identify thoughts)
*Socio-economic factors may affect what anxieties are about. It is important to objectively understand the viewpoints of the person and what these things are influenced by (we all come with our own values/beliefs etc, and it is important to put that aside to understand it from the client's perspective)
*Cultural influences e.g. 'stiff upper lip' - 'just get on with it'
*Important to understand the groups that they belong to, which affects labels they put on anxiety e.g. gang culture = anxiety is 'weakness'
*Cultural differences in who reports anxiety and the barriers to this (anxiety might hold a certain connotation in cultures where performance is highly valued). These people might present with other things e.g. within a medical model (physical complaints) because these are more acceptable in their culture
*Western conceptualisation of anxiety: important to think about the construct of anxiety that we hold and how you explain that to someone who doesn't 

There is a nice explanation of a fear thermometer on youtube. This video takes about 4 minutes and is a good overview of scaling anxiety but also could be shown to a child young person or parent. 

https://www.youtube.com/watch?v=ek8rbdC0vAY

[img[bookshelf.jpg]]


!!!!!Source: Peter Fuggle

!!!''Introduction to the Finding Out area''
This area of the guide is about providing knowledge and skills to support the work of CWP's. The purpose is to develop and expand the CWP's knowledge, skills, practice and understanding of the theory and research which sits behind CWP practice. 

!!!Wellbeing Practitioners
The pages within this section of the guide are designed to help practitioners gain a deeper understanding of the main topic areas covered in their training. For instance if practitioners wanted more information about Psychoeducation or additional self help materials and videos for their work with YP and families they can explore these topics using the links below or by searching for them.

!!!Supervisors
CWP supervisors may find these pages helpful in providing information about the low intensity guided self help approach that CWP's are trained to deliver. 

!!!Navigating 
More information about  how to do this can be found in [[User Guide]]

There are three main ways to find things in this section:

*__Search bar__- type a specific word you want to find some basic information about.

*__Library__- If you just want to see what there in this manual use the [[CWP library]] which lists all the pages in the guide, click on any page on interest. 

!!''Main Topics''
The pages in the Finding Out area are organised into topics, as listed below:

# [[Child/Adolescent Mental Health Problems]]- the nature of child and adolescent mental health problems.
# [[Child and Adolescent Development]] - aspects of child and adolescent development
#[[Working with Parents]] - supporting the key role of parents 
# [[Outcomes]]- monitoring and reporting outcomes
# [[Guided Self Help]]- information surrounding guided self help, Knowledge practice and skills
# [[Psychoeducation]]  - knowledge, information and resources for understanding mental health problems  
#[[Assessment]] - knowledge, information and resources to support practitioners in conducting assessment sessions
 
!!!Specific Mental Health Problems 

# [[Low Mood]] 
# [[Anxiety]] - for both children and adolescents
# [[Behaviour Problems]]

There is some evidence, particularly from low intensity work for anxiety,  that clients continue to improve following the conclusion of regular sessions. 

We suggest that doing a ''six weeks/three month telephone follow-up'' for all low intensity cases as part of routine care and as a way of evaluating outcome should be used for all conditions. 

Decide on what outcome measures to use at follow-up within sites, and try to stay consistent to this. 

!!''General format:''
*All manuals to have a Top bar 
*All manuals to have the same size side bar 
*All manuals to have the Anna Freud logo on the side bar
*All manuals to have the name of the manual on the side bar in same colour (black)

!!''Colours:''
*Colour on brand for links, top bars, titles, text colors (ie make the standard ‘blue’ a AF blue?)
*Different colors (as long as on brand) for top bars for different manuals
!!''Text:''
*All text to be in ‘New verdana’
*The spacing should reflect the size of the font- i.e. headings should have larger spacing around them/ underneath them and main text should have smaller spacing (By a fixed amount that is consistent across manuals)
!!''Headings:''

*All word in headings to begin with upper case except for joining words such as: a, and, of 

* ! (H1): don’t use as too big
* !! (H2): used for all Headings, and to be in bold black 
* !!! (H3): used for all subheading and to be in bold black
* !!!!! (H5): to be used for ‘Source:’ not bold (Should be at the top of the page)
!!''Linking:''
*Google doc buttons: need to be smaller, rounded edges – change colour when you hover over it?
* YouTube button- to be created small as well but different colour – link to style of youtube- to make it clear 
* Website links- to be hidden by:
 [[ 
word | website ]]

The CWP Programme aims to help children, young people and parents with four common mental health problems. These are: - 


!!''[[Child Anxiety]]:''
The main approach here is based on the work of Cathy Creswell and her team at Reading University. The specific sessions plans for this approach are shown in the [[Session Plans for Overcoming Child Anxiety]].

This is based on Cathy Creswell's ''Overcoming your child’s fears and worries'' [[book|Child Anxiety: Book]]. The terapist guide can be obtained by following the links below:

*For [[individual|http://centaur.reading.ac.uk/65537/]] programme manual 
*For [[group|http://centaur.reading.ac.uk/65533/]] programme manual

!!''[[Adolescent Anxiety]]:''

include sessions with young people using 


The main manual used to guide practice is the 'getting to grips with anxiety' by Helen Barker and colleagues:

<<link-pdf "Getting to grips with anxiety" "https://drive.google.com/file/d/1MhSkweHKlMx3gAHe8SyVqss4nSjzJhFd/view?usp=sharing">>

CWPs may also use additional materials such as Camden and Islington self-help booklets for Panic and Phobia and Stress and Worry and <<link-pdf "Moodjuice Anxiety" "http://www.moodjuice.scot.nhs.uk">>

Richmond have developed their own material: [[Richmond Adolescent Anxiety Model]] 

!!''[[Low Mood]]:''
The manual used to guide practice is the 'Guided Self-Help for Low Mood'. 

 <<link-pdf "Guided Self-Help for Low Mood: Full Manual" "https://drive.google.com/file/d/1Ua1L-0BUmNMBTJi2AkYQhdlmnWpKwl0g/view?usp=sharing">>  

CWPs may also use alternative materials however this needs to be discussed with supervisors. examples of this alternative material is the adapted low mood self-help booklets from Camden and Islington  :

  <<link-pdf "Low Mood Booklet" "https://drive.google.com/open?id=0B2_m9ZgGWI-jMDhZdEl2MkRpV1E">> <<link-pdf "Moodjuice Depression" "http://www.moodjuice.scot.nhs.uk">>

!!''[[Behaviour Problems]]:''

The Parenting training for behaviour approach has been developed and shared by the Manchester Collaborative. The manual for this intervention can be found here:

<<link-pdf "Manchester Behaviour Manual" 
"https://docs.google.com/document/d/1YVAXcYyWF5_4wxM1BfUOoogXwpxro3sSwLLoRg4zP3Y/edit#heading=h.gjdgxs">>
CWP may also use alternative handouts and resources which need to be discussed with their supervisor. some handouts form the Parenting intervention which have been developed and approved by our Parent Panel can be found on the page: [[Parenting Techniques and handouts]]
 

!!Additional material 
''Example videos of GSH Sessions'' and ''Chapter summaries for Incredible Years''can be found in the locked/private section linked below. 

Please note: you will need a password to access this section- please email mailto:PGSonlineguides@annafreud.org

<<link-pdf "Private Wiki" "https://manuals.annafreud.org/cwp/private.html">>

For the training year, sites are given funding to support the training of new staff and placement support

*Salary support (mid point band 4 Agenda for Change including any relevant High Cost Area supplements, plus 25% oncosts) for trainees will be paid by HEE via the below arrangements: 
**NHS Trusts: Existing Learning and Development Agreement. LDA payments go out quarterly throughout the financial year
**Non-NHS: HEE will put in place a Service Level Agreement to govern the arrangements and provide an invoicing schedule
*Placement support (£12000 per CWP) is paid to the university and sites will need to invoice the university quarterly for this. Please state clearly that the invoice is for ‘CWP Placement Support funding’ and the names of the CWPs whose placements are being supported.  

For partnerships allocated to KCL, invoices will need to be sent to: christine.woburn@kcl.ac.uk

For partnerships allocated to UCL/AFNCCF, invoices will need to be sent to: Finance@annafreud.org

!!!''What is Future in Mind?''
Future in Mind is a major government initiative to improve mental health services for children, young people and their parents. The Report was published in 2015 and made a series of proposals for the next 5-10 years. It was in response to increasing public concern about the mental health of children and young people and the lack of services to address this need. The CWP programme is a direct consequence of this initiative. Government documents are not everyone's idea of a relaxing read. In the key references listed below is a version of Future in Mind for children and young people and may be a good place to start if you are interested in learning more about this programme. 

!!!''Key references'' 
Short version of Future in Mind for children and young people
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/454495/Childrens_Mental_Health_EasyRead.pdf

Full version:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/414024/Childrens_Mental_Health.pdf

There has been a recent report by the Education Policy Institute in March 2017 highly critical of progress against Future in Mind objectives. The link to this report is https://drive.google.com/open?id=0B1hDLHd8syMsLUVRRFlPM2N2WEU

!!!''Key points about Future In Mind.''
*Most adult mental health problems usually start before age 18. There needs  to be a large investment in CAMHS to try to save future costs in adult services.
*Recognition that waiting lists are extremely high (sometimes up to a year) and thresholds are very high (often has to be immediate risk)
*There is some indication of increasing mental health problems such as an increase in eating disorders and this is leading to a reduction of available beds.
*Future in mind has set a target to train 1700 new staff (inc CWPs).
*This is the first time that CAMHS has invested in a graduate work force
*There will be a Green paper later in the year which follows on from Future in Mind. This is likely to consider an increased role for education in child mental health. Child mental health is a CHILD matter not a HEALTH matter. All schools have a fundamental role. This moves away from a Tier system and encourages the idea that there is a collective responsibility 
*The course will encourage you to work out how things work in your own area and how this policy is being taken forward locally. 

!!!!Source: Duncan Law

!!!What is GBO-HIT?

HIT is an acronym for the ''Helpful Ideas Tracker'' which can be monitored alongside the young person or parents individual goals.
 
The Goal-Based Outcome - Helpful Ideas Tracker ([[GBO-HIT|https://goals-in-therapy.com/2018/05/02/goal-based-outcomes-helpful-ideas-tracker-the-gbo-hit/]]) is a very simple way to track if clients feel they are getting the ideas they need to help them with the things they want to change.  It can be used to track if clients feel they are getting helpful ideas and can then be used to facilitate discussions about this.

!!!Why use GBO-HIT?
Setting goals with young people and families is always important and this is certainly the case in guided self-help. One of the key focuses of guided-self-help is to share ideas and information that might help people move towards the changes they want to make in the future. Because of this it is helpful to track the persons view as to whether they fell that are getting idea that they think might help.

!!!How to use this measure?
The tool has a suggested goal: ‘I feel i have learnt as much as i need, to manage what i came for help with’ and also has space for more client led ideas or ‘learning goals’ that can also be tracked and discussed.  The GBO-HIT can be used along side the original GBO tool to track other goals the client may have
For more information on using the GBO-HIT and to download free PDF copies of the tool please visit [[Goals in therapy|https://goals-in-therapy.com/]] which is a website dedicated to the use of goals, goal-oriented practice and goal-based outcomes (GBOs), across physical and psychological health settings.

!!!!!Source: Laura Bowyer 
!!!''Normalise''
*Normalise, normalise, normalise and validate! Use examples from your practice e.g. “many families have told me that ……” / “lots of YP say when they feel anxious or scared they get funny feelings in their body”.
*Ordinary/casual way of chatting can be helpful to build relationship (just like any other conversation that the YP would have had)
!!!Finding out about the problem
* You have to check out self harm and risk in first session. To get this detail, you have to ask lots of questions (which can seem like an interrogation). Use measures (e.g. RCADS) to help get to a shared point. See: [[Using Feedback and Outcome Tools]]
*Use [[The Hot Cross Bun Technique]] to gather information (ask about thoughts, feelings, behaviours and physical sensations) 

!!!''Collaborative stance''
*Positioning of chairs can show that you are both working on the difficulty together (not facing YP as if they are the difficulty)
*With parents especially take a non-blaming stance (parents can feel guilty, blamed and judged): Begin by being positive, and highlighting things the parents are doing well that it would be helpful for them to do more of.
*Be collaborative and check in with the YP / parent throughout e.g. “is it ok if I ask you some more questions about X and then I would like to move onto Y”. 
!!!''Active listening''
*Clarification- making sure you understand and you aren't making assumptions
*You have got to make some guesses (some may be right, some may be wrong) but you have to do this to effectively manage time.
*Encourage and make explicit statements to show you are listening / care (ensure these are authentic) e.g. “You have been really brave today telling me about your difficulties with speaking in class at school” / “you’re doing a really great job giving me lots of helpful information”. 
!!!''Summarise''
*Summarise, summarise, summarise and if in doubt, or stuck in an assessment, summarise! This enables you to check out you have correctly understood the YP / parent. It also allows you / the YP or parent a chance to clarify anything. It ensures the YP / parent has been understood. It gives you time to collect your thoughts and consider what further information you need to ask about.
!!!''Avoid jargon''
*Watch out for jargon and overly technical language 

!!!''Looking at self help materials'' 
*Think about their level of understanding/check in about feelings of completing the materials. 
*Important to let them engage as much as possible (they hold pen, read etc)
*Find ways in which you illustrate that we don't always know how we spend our time etc in a sensitive way during BA tasks etc. 
!!!''Planning something to try out (diary keeping)''
*Thought diary: One technique that helps the YP to find out that they are spending time doing things that make them feel bad. Scaffold idea: more we do things we value then more we feel better/good.
*Try it yourself - because you will ask YP to do this - will help you talk differently to them when suggesting that they do it 

!!!''Seek feedback''
*Ask explicitly throughout for feedback, any questions, concerns, doubts the YP / parent has 

<<list-links "[tag[General Resources]]">>

!!!!@@Color:red; THIS PAGE IS CURRENTLY BEING WRITTEN AND IS AWAITING REVIEW@@ 

Source: Joe Hickey Peter Fuggle

''Purpose of this page:'' is to provide a general understanding of assessments.

!!What is the aim of assessments?
The priority of the initial assessment is to gain a basic understanding of what the issues are that the CYP is facing and what they would like help with. Other aims of using assessments throughout the therapeutic process are as follows:

* Establish a [[therapeutic alliance|Therapeutic Alliance]]
* Work within developmental level
* Is the EMHP service and a Low Intensity intervention appropriate?
* Collaboratively identify the main area of difficulty and if several, prioritise.
* Gather general information about the main difficulty and maintaining factors and collaboratively understand these
* Explore strengths and resources of CYP 
* Get information on history of presenting problem and past experiences of help seeking
* Assess and monitor risk
* Provide relevant information and psychoeduation 

!!Why are assessments are important?
A key part of an EMHP will be to use assessments to help track a CYP progress which helps them and their parents/ careers see the level of progress they have made or lack of. This enables conversations establishing what is working/ is not and why not.

!!How to conduct an assessment?
Please go to [[How to Conduct Assessments]]

* Self-report questionnaire.[[|using questionnaires]]
* Direct observation
* Interview.

For information about conducting risk assessments please go to [[Risk and Safety Assessment]]

!!Involving parents:
Involving parents in your work can help engage the child and work towards goals of treatment

Parents can improve outcomes for the CYP by:

* Being positive about the treatment
* Active involvement in treatment
* Supporting the child (and themselves!) in becoming more autonomous
* Assess and address parental factors that contribute towards child’s anxiety
* Provide information about how the child is doing

!!Links with other pages:

For more information please go to [[Assessment]] for a list of relevant pages.

Please go to [[Building a Therapeutic Alliance]] and [[Therapeutic Alliance]] for more information on how the theraputic alliance my impact assessments you carry out with CYP and their families 

For more information on how to conduct a first meeting please go to [[Engagement and First Meetings]]

for more information on how to conduct assessments please go to [[How to Conduct Assessments]]

Source: Natasha Byrne

After each SSDL session, please complete the session feedback via POD

To do this in the first instance you will need to: 

* Add yourself as a client using the 'Add new Client' button
* you can ignore the 'Client log in details' section but you may want to add a bespoke username as an identifier (though this is optional)
* In the 'Client details' section please ensure you choose the group label 'Supervisor and Service Development Lead', as well as your site, and 'Status' should be 'Current'

Once you have done this and can see yourself in the Client list you then:

* Click the 'Select' button 
* Find 'SSDL session feedback' in the Staff measures list (it should be the only measure there)
* Click 'Start' and complete the feedback

You can see these steps in video here: https://youtu.be/4-qiRuBJNSI 
This was created for Cohort 2 SSDLs but is still relevant

Click the link below to access a series of training videos that show different ways that practitioners and young people might work together to set and review collaborative goals

These videos have been developed by Duncan Law, Wendy Geraghty and the Young Champions

<a href="https://drive.google.com/drive/folders/1Deh7uuhPsz5mX8BiLnCzKve7tq_8Kyk7">Click here to view Goal Based Outcome training videos</a>

!!!!!Source Peter Fuggle, Duncan Law, AFNCCF

---

The Goal-based outcomes (GBO) tool has been developed by ''Duncan Law'', who has produced most of the material and used in this page. His work is generously shared for use in this guide. 

----
!!What are GBOs?

Goal-Based Outcomes (GBOs) are to be completed at the beginning of each session to evaluate progress towards a goal. 

GBOs are simply a way of deciding at the beginning of an intervention where you want to head for (see [[Setting Goals]]), and to track progress along the way, or at the end to see how far along your agreed track you have managed to get. They are also a powerful tool to facilitate shared decision making.
Items are rated on an 11-point scale from 0 (Goal not at all met) to 10 (Goal reached) and 5 is a mid-point between the two . 

!!!Using goals in therapeutic work

An excellent easy read guide to using the GBO available here

<<link-doc "Goals and goal based outcomes" "https://goalsintherapycom.files.wordpress.com/2019/02/gbo-version-2.0-guide-final-1st-feb-2019.pdf">> 

!!!Useful Websites

For more information about the GBO tool please visit the [[Goals in Therapy|https://goals-in-therapy.com/goals-and-goals-based-outcomes-gbos/]] website or the [[CORC|https://www.corc.uk.net/outcome-experience-measures/]] (Children Outcomes Research Consortium) website.
Researchers at CORC have calculated that the GBO has a proxy ''[[Reliable change|Measuring reliable change]]'' for goals is a change in score of ''2.45 points.''

 It is recommended that a parent or a child has between ''1-3  goals.''


!!!POD
The measure is loaded on [[POD]] and is easiest completed using this system. 

However a paper copy of the questionnaire can be found [[here|https://goalsintherapycom.files.wordpress.com/2018/03/gbo-version-2-march-2018-final.pdf]]: 

You may also want to complete [[GBO-HIT]] which asks specifically if the young person or parent/career feel the information they are getting will be helpful to them - even though they might not be feeling better or noticing much change yet.

!!Practice points

!!!Reaching their goals
Don't be too worried if the parent or young person does not reach their goals. Goals help them to get __motivated__ as it is very satisfying when they can see progress against goals even if they don't get as far as they would like.  

Some find it useful to have one or two large targets rather than a few small targets. The aim is always to tailor the technique to individual preferences. 

Please find a helpful video regarding [[Reviewing goals]]

!!!Videos

A series of [[videos|https://vimeo.com/album/5500156]] on the CORC website have been developed by the Children's Wellbeing Practitioner (CWP) Programme in conjunction with the Anna Freud National Centre for Children and Families and the London and South East CYP-IAPT Learning Collaborative. 

The videos show examples of ways that practitioners and young people might work together to set and review collaborative goals. These videos are intended to provide examples of good practice and areas that could be improved; with the intention that they will facilitate discussions around goal setting.


!!Links to other pages

Please see [[Goal-Oriented Practice]], [[Outcomes]] and [[POD]] for relevant pages.

!!!''Goal-oriented Practice''

<<list-links "[tag[Goal-Oriented Practice]]">> 

!!!!Source: Charlotte Hepburn and Peter Fuggle 

!!What is the shared bag and why use it?
The EMHP and CWP manuals are designed to be experienced as completely separate. However, behind the scenes, many pages of each manual are shared between the two. This is not obvious as shared and unshared pages look exactly the same. This is deliberate. 

Pages which contain information applying to both CWP and EMHP manuals go in the 'shared bag'.  Editing 'shared bag' pages should be done on the 'shared bag' manual and not in the individual CWP/EMHP manuals. This is so the information provided for EMHP's and CWP's relating to interventions  and core policies is the same.

!!Overview of editing the shared bag
Whenever editing a page, ''always check whether the page is a shared page or not''. This can be done by looking at the information tab which is at the top of every page. It can be found by clicking on the v shaped button at the top of the page and by going to 'info'. It is especially important to do this when editing pages listed below 'Pages in the shared bag' as these are pages that should remain in the shared bag and not be edited in individual manuals.

You can edit either type of page - shared or unshared but it is important to know which one you are doing. If you want to edit the shared bag so that it changes in both manuals then you need to make this edit in the 'emhp-cwp-shared' bag. If you want to make an edit that only changes the page in one manual, then you can do this by editing the page in the individual manual itself.  This is very clever technology but potentially very confusing if the person editing doesn't know which he/she is doing. 

!!Pages in the shared bag
Below is a list of the types of pages that should be in the 'shared bag'. ''These pages should not be edited in individual manuals.'' This list is still being developed: 

*'Helping' pages, such as sessions plans and handouts: this is the core interventions used by both CWP's and EMHP's and should be THE SAME

*Pages which have standards that apply to all manuals go in the shared bag such as copyright and consent policies

*Core pages about outcome measures used by both CWP's and EMHP's.
*Core pages about psychoeducation 

All pages regarding outcome measures will generally be on the shared bag over time. Best practice for individual mental health support teams may develop over time and such differences can be integrated into local versions of the manual. 


!!Editing the shared bag
To avoid confusion editing of the shared bag is currently been restricted to Charlotte Hepburn and Peter Fuggle.

*local manuals= CWP and EMHP manuals
*Shared bag= shared bag manual
!!!Local copies of shared bag pages
If a shared bag page is edited and saved in a local manual, a 'local copy' of this page is created. In other words the shared page has now been overwritten. The original shared page still exists in the shared bag but the local copy is the one that is shown in the local manual. If this 'local copy' is then deleted the original version of this page (created in the shared bag) will then be the version shown again. 

!!!Deleting a page 
Never delete a page in a manual if it is in a shared bag without checking there is a local copy of the page on the other manual. (check which bag the page is in by using the drop down arrow). If it is in the shared bag it will be deleted off the shared bag meaning it will most likely be deleted off both manuals unless a local copy of the page has been created in the other manual. 

!!!How to move a page into different bags? 
If you would like to move a page from a local manual into the shared bag so that it is shown in both manuals you need to:

#Drag a link of the desired page into the shared bag 
#Hover over the top menu bar and wait for it to turn green 
#drop the page
#you will be prompted with an import box, click import
#delete the original page from the local manual you copied it over from
#refresh your browser 
Please note if there is an image in the tiddler you will need to import this separately. 
once you have completed all these steps the page you wanted to be in the shared bag should appear in both manuals. Any editing of this page would then need to happen on the shared bag manual to insure local copies are not created which will 'overwrite' the shared version.

Source: Natasha Byrne and Duncan Law

Excerpt from CWP Operational Guidance for London and South East

View Operational Guidance here:  https://drive.google.com/file/d/1KXOkFEFMGyJ3h5EHPP6MKyl3T0Gs_cCM/view?usp=sharing

The below summarises the specific difficulties the role could be expected to address, those they should not and identifies those situations where discretion is required and a case by case decision made.

! ''Do ''
!! Common mental health difficulties that may respond to early intervention
* Low Mood / Mild to Moderately Severe Depression
* Panic Disorder
* Panic Disorder & Agoraphobia
* Generalised Anxiety Disorder / Worry
* Simple Phobia (but not blood, needle, vomit)
* Sleep problems
* Stress management
* Behavioural Difficulties

! ''May do''
!! Conditions which may respond to early intervention but require discretion
* Anger difficulties
* Low self-esteem
* Mild social anxiety disorder
* Some compulsive behaviours
* Mild health anxiety
* Assertiveness/interpersonal challenges (e.g., with peers)
* Self-harm is disclosed but is assessed as linked to low- mood but is not assessed as enduring and high risk in nature
* OCD

! ''Should not do''
!! Significant levels of need/complex conditions which are not suitable for brief early intervention
* Pain management
* PTSD
* Bipolar Disorder
* Psychosis
* Personality Disorders
* Eating Disorders
* Chronic depression/anxiety
* Established health anxiety
* Historical or current experiences of abuse or violence
* Complex interpersonal challenges
* Bereavement
* Active, enduring and significant self-harm
* Relationship problems

!!Selecting cases for CWP training 

We want CWPs to experience success and develop skills in a graded way.  Therefore, for the training year especially, we advise where possible that CWPs start with single problem cases. Such cases will allow CWPs to apply the principles of guided self-help in a straightforward way. 

!!CWPs will: 
# Help build up emotional wellbeing and resilience in young people and the system around them (e.g. schools / family) 
# Guide and support young people and the system around them (e.g. schools / family) to intervene and manage low-moderate severity common mental health and/or behavioural problems
#Signpost young people and their families to a range of physical, emotional, social, educational, and other well-being services / resources in their local areas

!!Young people and/or parents/families likely to benefit from CWP help will:

* Describe their problems in good detail with little prompting (e.g. be able to give a clear time of onset, or exacerbation of their own / their child’s difficulties and relate this where relevant to a particular life event, with little help).  
* Be able to differentiate feelings, thoughts, behaviours etc. without needing too much scaffolding. 
* Their difficulties are not so complex that it would require many sessions to complete an assessment or determine what the primary presenting difficulty is. 
* They have not gone through many other courses of treatment with no effect.
* The child / parent is able to define clear goals / things they would like to change.
* The child / parent is available and can be committed to weekly short-term support. 
* The child / parent has a good support network around. There are obvious protective factors.
* The child / parent likes the idea of a supported self-help intervention and are committed to doing self-work in between contact from the CWP.

This is not an exhaustive list, and of course clinical judgement and supervision will also play a role in deciding which cases CWPs can see. However, we recommend that young people, or parents, who present with the following difficulties, are unlikely to benefit from, or find a low-intensity treatment useful. 

!!CWP interventions are unlikely to be useful when the young person has:

* Multiple Problems (all of which are severe and impacting on the young person)
* Not fluent in English- CWP work/resources can be adapted
* Failure to respond to several previous psychological treatments / interventions
* Severely complicated environmental/interpersonal factors (e.g., poverty, housing problems, unemployment)
* Stressful interpersonal circumstances (e.g., parents are undergoing divorce, family homeless etc.)
* Severe depression/actively suicidal
* Alcohol/substance dependence
* High doses of anxiolytic medication
* Psychosis
* High degree of functional impairment
* Intellectual problems (e.g., low IQ, neurological impairment, language problems)
* Significant physical health problems
* Young person / parent has a different conceptualisation of the problem (e.g., sees it as a biological problem)
* Ongoing threat (e.g., still with a violent partner / family member, returning to school where trauma may recur/being deported to country where trauma may recur)
* Young person or parent has a strong preference for other forms of treatment (e.g., wants medication or psychoanalysis)
* Certain presenting problems which would not be usefully or appropriately addressed with the low intensity treatment options available; e.g. PTSD.

We would never suggest to exclude a person from work with a CWP based on fluency in English. We would encourage the CWP to work with an interpreter if their supervisor believed it would be useful.
 

This guidance is based on the fact most of the material is written in English and would require the parent to read the material to practice the interventions. 


!!Guide to the Selection of __Training__ Cases 

!!!Criteria for Training Case:
Axis 1 Disorder –i.e. straightforward depression/anxiety disorder as main presenting problem

Clear current and predictable difficulties

Access to thoughts and feelings

Definable problems and goals

Available for weekly short-term therapy

!!!Criteria for being unsuitable:
* Multiple Problems (this does not exclude clients who present with co-morbidity as training cases)
* Failure to respond to several previous CBT treatments
* Severely complicated environmental/interpersonal factors (although some services have adapted the CWP model to meet the needs of more socially deprived families)
* Severe depression/actively suicidal
* Alcohol/substance dependence
* High doses of anxiolytic medication
* Psychosis
* Functional impairment

This guidance is primarily written for the selection of TRAINING cases – i.e. cases the CWPs use when getting familiar with the materials / structure of sessions etc. Adding in any complexity whether its language, neurodevelopmental difficulties (ASD), or anything else (e.g. unstable living situation / multiple difficulties) will often make delivering interventions more tricky. We would always encourage CWPs to therefore select as straight forward a case as possible for the purpose of their training / writing assignments in order to enable them to become familiar with the models or treatment and materials before they are then adapted.

Of course as CWPs progress after training, they will experiment with adapting things in line with the needs of individual clients / particular populations. Again, we would never exclude someone on the basis of solely not being fluent in English, but we would highlight to the CWP the amount of adaption which would need to take place with the current materials in order to effectively carry out a low intensity intervention (e.g. very short sessions and lots of reading materials) with a YP and family who are not fluent in English; this needs discussing with the family as you say to ensure GSH is right for them, but also it may just not be ideal for a training case (i.e. the CWP is unlikely to be able to cover all the material in the session time required for a tape assignment and will typically need 1.5x or double the time when working with an interpreter / will likely need more than the 8 sessions stipulated etc).  


[[What is meant by 'mild/moderate' problems?]]

[[What is meant by a 'low intensity' intervention?]]

[img[ripped jeans and laptop.jpg]]

!!!''Guided Self Help''
Guided self help aims to increase coping and self management capacity within clearly agreed time frames and resources.

This means the practitioner is often in the role of a coach, supporting the young person to practice things and try new ideas to help cope better. 

The core principle of GSH interventions is that the expertise is seen to exist in the self help materials that are being shared with the client AND in the practitioners expertise in making this knowledge available to the young person or parent, their knowledge about common pitfalls and their creativity in overcoming these. This is ''guided'' self help in which the practitioner plays a very active role. Self help is not about letting the young person do it on their own. 

This area of the Finding out section is split into four sections as seen below:

[[Guided Self Help knowledge]]


[[Guided Self Help practice]]

[[Guided Self Help skills]] 

[[Self Help Materials]]

This is the general approach taken for the guided self help sessions - please note for full session plans see [[Helping]]. This is not 

!!!The GSH approach described:

* There will be four face to face contacts alternated with four telephone contacts.
* Times between contacts will be approximate with face to face contacts being approximately 2 weeks apart.
* Face to face contacts will generally be for 45 minutes.
* Phone contact between these face to face contacts will be for 15-30 minutes.
* Overall intervention is 8 contacts over 8 weeks with a one month follow up.
* The full package is therefore generally about 12 weeks.
* Contact time with practitioner is three hours of direct contact time and two hours of telephone contact.
* Referral received/ conducted- including completion of the Parent SDQ, Parent and/or young person RCADS. These scored up before first intervention session in which you may then want to complete it again depending on who conducted the initial assessment session.

!!!Moderating factors to this basic intervention plan
* Shared decision making assumes that some young people will take full package but some may choose other forms of help. For example, some may only want telephone contact etc.
* Low intensity interventions for low mood need to take account of the young person's wishes around the type of help
* Lengths of time between contacts during this self help approach can vary depending on the needs and wishes of the young person
* Types of contacts (phone, email or face to face) can be agreed with the young person.

Below are listed a number of key pages around knowledge of the guided self help approach.  

<<list-links "[tag[Guided Self Help knowledge]]">>

Below are listed a number of pages about GSH practice . This overlaps with GSH skills but includes all aspects of practice such as safety, reading materials etc. 
l<<list-links "[tag[Guided Self Help practice]]">>

Below are listed a number of key pages showing core skills for the guided self help approach. 
<<list-links "[tag[Guided Self Help skills]]">>

!!! Here you will find instructions on how to do things such as: 

<<list-links "[tag[How To]]">>




<<list-links "[tag[Understand]]">>

!!Videos showing you how to do the basics:
<<list-links "[tag[HowToVideo]]">>

Habituation principle – the more we face a scary situation over and over, the easier it becomes. This is because our anxiety (or fight and flight system) goes up but then plateaus and goes down if we stay in a scary situation. 
Explanations of habituation can be found on [[YouTube|https://www.youtube.com/]].

How to Train a Brain- Covers the habituation principle:

<html><iframe width="560" height="315" src="https://www.youtube.com/embed/qG2SwE_6uVM" frameborder="0" allowfullscreen></iframe></html>

[img[joshua-ness-225844-unsplash.jpg]]

!!!!!Source: Peter Fuggle and Charlotte Hepburn
!!!Wellbeing Practitioners
This area of the guide is to support CWP practice, to provide resources, session plans and manuals to help CWPs with what to do at their next session with a young person or a parent. 

!!!Supervisors
CWP supervisors may find this area of the guide useful in understanding the content of guided self help sessions CWP are trained to deliver.  

!!!Session 0/Assessment session

Please see [[What is a Session 0]] for more information about what a session 0 is and when a CWP may may need to do a session 0.

!!!Main pages for Guided self help sessions.
Please follow the link for a comprehensive list of ALL the [[core intervention manuals|Core Intervention Manuals]] used by CWP's.
Please note: The age ranges for these interventions are a guide. The appropriateness of any interventions for a child/ young person should be considered with supervisors prior to being delivered:

!!![[Child Anxiety]]: (5-11 years)

<<list-links "[tag[Child Anxiety]tag[Anxiety practice]]">>

!!![[Adolescent Anxiety]]: (12-17 years)


<<list-links "[tag[Adolescent Anxiety]tag[Anxiety practice]]">>


!!![[Low Mood]]: (12-17 years)

<<list-links "[tag[Low Mood practice]tag[Low Mood Session Material]]">>


!!![[Behaviour Problems|]]: (5-8 years)

<<list-links "[tag[Behaviour Problems Session Material]tag[Behaviour Problems Practice]]">>

[img[cave.jpg]]

This page provides the ''core'' material for practitioners work with adolescents who have anxiety. The approach to helping young people with anxiety follows the manual called 'getting to grips with anxiety'. This has been drafted by Helen Barker and colleagues and can be found below.

!!!Core Materials:

<<list-links "[tag[Adolescent Anxiety]tag[Anxiety practice]]">>

!!!Additional Materials:
For useful additional self help materials practitioners may want to share with young people and families please go to [[Self Help Materials]]

[img[blue pattern.jpg]]

The brief guided self help for behaviour problems follows the guidance in the guided self-help for behaviour problems manual. Written by Caroline Bengo and her team and generously shared with the other CYP-IAPT Training Collaboratives.

This page provides the ''core'' material for practitioners work with parents of children who have behaviour problems.The brief guided self-help parenting intervention for behaviour problems is divided into two broad areas that can be covered over seven (or more) sessions. These aim to:

#To promote positive relationships, attachment and pro-social behaviour through sensitive responding
#To provide appropriate routines, boundaries and limit setting



!!!Core Materials:
<<list-links "[tag[Behaviour Problems Session Material]tag[Behaviour Problems Practice]]">>

!!!Additional Materials:
For useful additional self help materials practitioners may want to share with young people and families please go to [[Self Help Materials]]

[img[pink and orange.jpg]]

This page provides the ''core'' material for practitioners work with children who have anxiety. Guided self help (GSH) for child anxiety generally adopts the ''parent led approach'' developed by Cathy Creswell and colleagues at Reading University.

To access the previous version of the [[Treatment manual|http://centaur.reading.ac.uk ]] for parent led approach to child anxiety by Cathy Creswell for the full interventions manual. 

!!!Core Materials:

<<list-links "[tag[Child Anxiety]tag[Anxiety practice]]">>

!!!Additional Materials:
For useful additional self help materials practitioners may want to share with children and families please go to [[Self Help Materials]]

[img[bubbles1.jpg]]

This page provides the ''core'' material for practitioners work with young people who have low mood. This approach has a similar overall framework to the approach to anxiety problems. The manual used to guide practice for working with YP with Low mood is the 'Guided Self-Help for Low Mood' developed by Tower Hamlets CWP Service and can be found below.

!!!Core Materials:
<<list-links "[tag[Low Mood Session Material]tag[Low Mood practice]]">>

!!!Additional Materials:
For useful additional self help materials practitioners may want to share with young people and families please go to [[Self Help Materials]]

These supplementary materials have been created and kindly shared by practioners from different CAMHS sites. These have been written by the course teams and are not always directly connected to the KCL/UCL manuals. However,  they might be helpful for your practice. We suggest that you discuss these with your supervisor, before using them, as to whether they will be beneficial and are appropriate for your site. 

@@color:red;This area is being developed in light of recent changes to working due to the outbreak of COVID-19@@

This section includes information about supporting children young people and family through contact via phone calls, texts, emailing and video calling.

---

''Adaptions to the guided self help manuals'' 

(developed in light of the COVID-19 pandemic)

*[[Child anxiety manual: COVID-19 adaptations]]
*[[Adolescent anxiety manual: COVID-19 adaptions]]
*[[Low Mood Manual: COVID-19 Adaptions]]
*[[Behaviour problems manual: COVID-19 adaptions]]

----

For a list of resources developed in light of COVID-19 please see:

!!!<center>''<<tag [[COVID-19 Resources]]>>''</center>

----

There is a wide range of guidance regarding working remotely, these resources have been collated by the Anna Freud Library. Please find these [[here|https://manuals.annafreud.org/remote-working/index.html#Home:Home]]. 

---

To aid practitioners in their vital work with Children Young People and Families we will be compiling a list of pages to guide practice. The following pages are planned, if your team have developed any useful resources for working remotely in light of the outbreak of COVID19, then please share these with us using the 'Give Feedback' tab on the right-hand side of the page. 

Pages to be developed in light of the COVID19 outbreak all these pages are tagged with <<tag [[Working Remotely]]>>

<<list-links "[tag[Working Remotely]]">>

----

There is separate information about online interventions, such as online CBT. For more information about this type of support please visit the pages regarding this in the finding out section.''To go into the 'Finding out' section''

[[Computerised Therapies for Anxiety and Depression]]

!!''@@color:DarkCyan ;<center>Welcome to the London Guide for Wellbeing Practitioners for Children and Young People </center>@@''

!!!<center>(often known as the CWP Programme)</center>

<center>This guide has been produced by the teaching staff at UCL and KCL along with additional material from services trained by them</center>

<center>''<<image-link "About" "lightbulb icon1.jpg" "About" "220">><<image-link "Contents" "books-icon.jpg" "Contents" "220">><<image-link "Interventions" "pad of paper icon1.jpg" "CWP Interventions" "220">><<image-link "User Guide" "countryside for icon (4).jpg" "User Guide" "220">><<image-link "Contact us" "typewriter icon1.jpg" "Contact us" "220">><<image-link "Key Documents: CWP Programme" "documents icon (1).jpg" "Key Documents" "220">><<image-link "Developing the Guide" "collab icon.jpg" "Developing the Guide" "220">>''</center>



!!<center>More about the CWP role</center>
<center>This is a brief animation which provides an introduction to the CWP programme and the role of CWP's</center>


<center><html><iframe width="860" height="415" src="https://www.youtube.com/embed/RPeVsTVmXA8" frameborder="0" allowfullscreen/></html></center>

You can have as many pages open as you like. And can see what you have open by looking at the 'open pages' tab located on the right hand side panel or by scrolling down and up the pages.

If you have a lot of pages open, they are stacked one above the other a bit like iPhone tabs! A fun way to think about this is the pages open like a ‘story river’.

This can be confusing but just like a iPhone any pages you open will remain open and the quickest way to navigate back to a page you were looking at is by using the 'open pages' tab on the panel on the right hand side.

!!!!Source: Laura Bowyer 
!!''How common are anxiety problems''
*Anxiety is one of the most prevalent disorders of childhood (5-10%) (c.f. Weems and Stickle, 2005; Davis, May and Whiting, 2011)
*Anxious children are at increased risk of having social and academic difficulties (e.g. Pine, 1997; Wood, 2006)
*Untreated disorders have a high impact on the child’s life, and lead to an increased risk of other disorders (c.f. Ehrenreich and Santucci, 2009)
*Anxious children are at increased risk of becoming anxious adults (Kim-Cohen et al, 2003)
**65% of children and young people  who present for treatment of anxiety meet diagnostic criteria for at least 2 anxiety disorders
**80% of children who present for treatment of anxiety will have one or more symptoms of a disorder they were not seeking treatment for

*SAD, Simple & Social Phobia, OCD, GAD, PTSD are as common in children as adults:
**~1-3% in any 12-month period
**~15% lifetime and before 18 years of age for kids

*Notable exception is Panic Disorder/Agoraphobia:
**<13 years – Base rate is close to 0
**13-18 years – Base rate is ~0.5%
*Anxiety Disorders (multiple) are as common in children under 8 years of age as older children
*If you ask teenagers when their problems with anxiety started - the most common answers is when I first started school.

''Key reading''

*Silverman, W.K. and Ollendick, T.H., 2005. Evidence-based assessment of anxiety and its disorders in children and adolescents. Journal of Clinical Child and Adolescent Psychology, 34(3), pp.380-411.
*Schniering, C.A., Hudson, J.L. and Rapee, R.M., 2000. Issues in the diagnosis and assessment of anxiety disorders in children and adolescents. Clinical Psychology Review, 20(4), pp.453-478.
*Davis, T.E., May, A. and Whiting, S.E., 2011. Evidence-based treatment of anxiety and phobia in children and adolescents: Current status and effects on the emotional response. Clinical Psychology Review, 31(4), pp.592-602.

!!!!!Source: Peter Fonagy and colleagues (What works for Whom (second edition)  
!!''How common are behaviour problems?''
*''Conduct problems are the most common mental health disorders in children and adolescents'' (National Institute for Health and Clinical Excellence, 2013).
*The reported prevalence of Oppositional Defiant Disorder (ODD) ranged between 2.6% and 15.6% in community samples, rising to 28–65% in clinical samples. (Boylan, Vaillancourt, Boyle, and Szatmari (2007)) 
*The more serious problems included under the diagnosis of Conduct Disorder (CD) have a prevalence of 1.8–16.0% for boys and 0.8–9.2% for girls (Loeber, Burke, Lahey, Winters, & Zera, 2000). 
*Those in more disadvantaged socioeconomic groups are three to four times as likely to have a diagnosis of CD as those in more advantaged social classes (National Institute for Health and Clinical Excellence, 2011). 
*Behaviour problems are the most common reason for referral to child mental health services in the U.K. 

!!!!!Source: Peter Fonagy and colleagues in What Works for Whom (second edition)
!!''Key points''
*Prevalence has been estimated for depressive disorders of 
**2-4% for children (<13 years) 
**4-8% for young people (13-18 years) (Costello, Erklani, and Angold: 2006). 
*Depressive disorders are equally prevalent in boys and girls until adolescence.
*In adolescence,  there are twice as many girls to boys. (Angold, Erkanli, Silberg, Eaves, & Costello, 2002; Birmaher et al., 2007).
*Ethnic minority status may increase risk for low mood in adolescents. (Smith and Silva (2011).
*Sexual minority status is also associated with increased risk of depression in young people (Marshal et al., 2011). 
*The increase in prevalence in adolescence may be associated with:
**increased emphasis on social status
** reductions in supervision and support from adults
**increasing conflict with parents
**lack of sleep
**an increase in risk-taking behaviours such as substance use (Brent & Maalouf, 2009).

Funding for the Supervisor/Service Development Lead role is determined by the number of CWPs that you will be supervising. The general rule of thumb is that one CWP receives one day of supervision per week. For example, if your service has a total of 3 CWPs, you will receive funding from Health Education England (HEE) to provide supervision across 3 days.

Although we are working towards a national target of 70,000 more young people seen by mental health services by 2020, we recognise this will be a gradual process. During year 1, CWPs will focus on developing the skills required to take on a fairly large caseload moving into year 2. From July-December we would expect CWP trainees to see up to 30 cases.

Google documents will either look like big green boxes like this: 

 <<link-pdf "Example Google Doc" "https://">>

or like this:

<<link-doc "Example Google Doc" "https://">>

The reason you may see both of these types of google documents is due to the Wiki being updated.

You do not need to be signed in to google to access these documents and simply need to click on them to open them in a separate internet tab.

!!!!@@Color:red; THIS PAGE IS CURRENTLY BEING WRITTEN AND IS AWAITING REVIEW@@ 

Source: Joe Hickey 

When conducting an initial session with a young person all make sure to check in about Risk (see [[Managing Risk]])

You will notice that this page provides practice points on the different aspects of assessment structure as outlined below:

[img[Assessment structure.png]] 

!!!Connection:
Please go to [[Building a Therapeutic Alliance]]

!!!Expectations:
clarify the boundaries and limitations of your role please go to [[Engagement and First Meetings]]

!!!Exploring the main problem:
* Always check on mood, whatever the main difficulty
* Describing a day (good, bad, typical)
* Gather detail by using [[Assessment: Key Questions to Ask]]
* Key triggering situations 
* Emotions
* Bodily sensations 
* Thoughts
* Behaviours related to the main problem 
* Maintenance cycle: What’s keeping the problem going?

!!!Identifying negative thoughts

* Diaries
* Questionnaires
* Notice in the session
* Thought bubbles
* Stories

!!!Identifying behaviours

* Recent example
* Diary recording by CYP or others
* ABC charts
* Observations in session
* Others’ descriptions

!!!Identifying emotions

(Note that accuracy of emotional recognition in self and others)

* Sorting game
* Feelings cards
* Feelings faces/characters
* Feelings scrapbooks/collages
* Drawing
* Books, cartoons, TV, films, puppets
* Creating stories/poems/songs
* Link them to physical feelings
* Act them out
* Ask other members of the system


!!!Strengths and resources:
explore with the CYP and their families the existing strengths and resources at the CYP disposal
key questions may include; 

* What and who have helped up to now?
* How come things aren’t worse?
* What resources are around the CYP and family?

!!!Planning
* Explain and give the rationale for LI or GSH 
* Be clear about expectations for the intervention
* please go to [[Goal-Orientated Practice]] for a list of useful pages outlining how to plan goals with a CYP and their families.

!!!Ending 
* Check in with doubts and concerns 
* How have they found it today?
* Praise for effort and information given 
* Inform clearly of next steps 

!!General practice points:

What if you get a lot of ‘don’t know’ answers?
How can you explore further without pushing the young person?

* ‘Typical day’ question – explore patterns of thoughts/feelings/behaviours 
* Seek parent/carer views too
* Remember multi-informant options 
* Take a pause and re-engage

!!Links with other pages:
Please go to [[Assessment]] for a list of pages relating to assessments 

for how to set up a first meeting with a CYP please go to [[Engagement and First Meetings]]

For how to build a good connection please go to [[Building a Therapeutic Alliance]]

You can give us Feedback on the Wiki by simply clicking on the tab 'Give Feedback' on the right hand side of the screen or email [ext[PGS Online Guides|mailto:PGSonlineguides@annafreud.org]] 

Any learning materials that are on a google documents can be printed easily by clicking on the 'print' logo in the right hand corner.

The pages in the guide can also be printed by right clicking on the page and choosing the print option 

''PLEASE NOTE:''
if you want to print a specific page straight from the Wiki it is best to close
 all other pages you have open first. 

POD (People's Outcome Database) is an ''outcomes monitoring system'' in a website where staff or clients can log in and ''complete measures using any web enabled device''. 

Scores are calculated instantly and you can view these online with a child, young person or parent within a session.

 On the EMHP programme POD is used due to the [[The Importance of Feedback]]

A link to the pdf POD manual is shown below, which gives a comprehensive overview of POD and how to use it.

<<link-pdf "POD Manual" "https://drive.google.com/open?id=0B-tACu2wi4-4MEVNbWUtZFllUFk">>
For more information on how to use POD please see PODs [[information page|https://pod-database.org/info/]]. Which provides comprehensive guidance on how to use pod accompanied by screen shots and videos.

Brief document outlining how to add a new patient and complete a measure for a patient please see the instruction document below:
<<link-pdf "Instruction Document" "https://docs.google.com/document/d/1EtAYqGjO7gyKnfgWwL1x3D5nkpLo-VGv3rYLxSJyoOE/edit?usp=sharing">>

!!!Instruction videos:

<html><iframe width="560" height="315" src="https://www.youtube.com/embed/OY6tuqbRD70" frameborder="0" allowfullscreen></iframe></html>

<html><iframe width="560" height="315" src="https://www.youtube.com/embed/OiJ0i1mAoZ4" frameborder="0" allowfullscreen></iframe></html>

Pages that cover aspects of a common theme can be tagged (think of a tag as a topic thread that gathers together any number of relevant pages - much as a chapter heading "gathers" a series of pieces of information). The tags show up as coloured bars on the page. Clicking on a tag reveals a drop-down menu of all the content that is tagged with this title:

[img[using tags.png]]

Using google documents we can upload PDF's to the manual through the @@color:MediumSeaGreen ;''big green buttons'' @@. 

*Upload any PDF to your google drive and this can be linked to the manual. 

*Once you have uploaded a PDF to your google drive click on the 3 vertical dots //'More options'// and select //'share'//.

*If you select //'get shareable link'// in the top right hand corner the PDF's link will be copied to your clip board (this means to copy and paste you don't have to click copy it has done this automatically for you). This will be something like:

https://drive.google.com/file/d/16k7xkIInqwTuBtlpo6iZJI3w5jJNFPZ6/view?usp=sharing

*Each PDF on google has its own unique number/letter identifier, which can be found between the d/ and /view in the url above. 

*Use the code for the @@color:MediumSeaGreen ;''big green button'' @@ by copy and pasting it from this page (click on edit mode to view the code).   

<<link-pdf "PDF Document Title" "https://drive.google.com/open?id=16k7xkIInqwTuBtlpo6iZJI3w5jJNFPZ6">>

*Edit the title of the green button where it says 'PDF Document Title' and insert your documents unique identifier between the = and the ">>.

* Click save (tick)

<html><iframe width="560" height="315" src="https://www.youtube.com/embed/2jzfArg3RlY" frameborder="0" allowfullscreen></html>

Use the the paper clip icon above the search engine to upload an image to the manual.

Import
Select Picture from Documents
Click Import
Rename the tiddler if you want (by clicking the pen icon and editing as normal
Add the picture by typing: //Open// double curly brackets name of picture //Close// double curly brackets  {{name of picture}} wherever you want it to include it. 

Example below (click on the edit/pencil button to view)

{{CWP- logo.PNG}}

NB: the words in between the brackets need to be EXACTLY the same as the tiddler containing the picture. Either copy and paste straight from the tiddler name at import or change to something really easy. 

To create coloured text, for example @@color:MediumSeaGreen ;big green button @@ use this code (click the pen icon to view).

*Type your chosen colour after color: and the word you want to be in colour after between the ; and closing at signs.

*You can choose any colour, a good list of HTML colours can be found here:
https://www.w3schools.com/colors/colors_names.asp

Click the pen icon to view and use the code below:

! <center>''Title''</center>

<html><iframe width="560" height="315" src="https://www.youtube.com/embed/KxGKCOEu3hk" frameborder="0" allowfullscreen></html>

If you want to upload a video you can do so from Youtube. Copy and paste the coding below and change the unique identifier (letter/number combination) after /embed/

Example:

<html><iframe width="560" height="315" src="https://www.youtube.com/embed/RPeVsTVmXA8" frameborder="0" allowfullscreen/></html>

This BBC guide to Exam Stress shown to have benefit for a 12 year old client: http://www.bbc.co.uk/guides/zsvcqhv

Hounslow have been using the model STEPS (Strategies to Tackle Exam Pressure and Stress) available through Edge Hill University: https://www.edgehill.ac.uk/news/2014/01/steps-strategies-tackle-exam-pressure-stress/

//Marianne to complete//

Ideally, we should resize an image prior to uploading it to the manual. This can be done in paint or any other Picture formatting app.

However, within the manual you can also control the size of the image, using the following code (open tiddler to view code): 

[img width=100 [ImageTitle.jpg]] — forces the image to be displayed at a width of 100 pixels

[img width=100% [ImageTitle.jpg]] — forces the image to be displayed at the full width of the tiddler

Edit the % to suit the size you want.

!!How do we get systematic feedback?

* Email student reps with feedback
* Tutor groups (people find this easier to speak)
** General questions for the reps to ask
* Survey 
** Menti meter - remotely
** MM to send questions to reps to feedback on before
** 6th March- introduce to practice tutor -  two week deadline
** Feeding back in the summer term!
* A few months into the cohort and then towards the end.  
 * Feeding back to tutor group - any changes and any thing that came up!
** You said we needed this, so we did this

!!General feedback

*People do use it
* pulling information off to make their own folder on it
** Session by session
* Folder and click on - linking to pages from different pages
* Heres the manual and heres the other various documents - could this all be together.

Your role as the CWP Supervisor/Service Development Lead will be to work with your service to ensure that robust assessment processes are in place for assessing the suitability of referrals into the service, to ensure that CWPs have a caseload which is appropriate for them and the skills they will have developed through training.^^^^

<<link-pdf "Background info on IPT-A" "https://childadolescentpsych.cumc.columbia.edu/articles/interpersonal-therapy-adolescents-ipta"">>

*Focusing on relationship difficulties that are at the forefront of difficulties for CYP
*Following links between depression and interpersonal context (repeat again and again) - where symptoms overlap with interpersonal world (being with people relaxed you/how did depression limit social activity etc)

This area contains pages to support improved practice with respect to inclusion. This area is being developing in partnership with the founders of the ''CWP BAME inclusion group''. Please note this area is still under development. It is the aim that with support from the CWP BAME inclusion group best practice concerning inclusion will be threaded throughout all areas of the wiki manuals in time.

The CWP BAME inclusion group provides a space for professionals to discuss, reflect and share ideas around how psychological services can become more inclusive for all. For more information concerning the CWP BAME inclusion group please see their flyer below:

<<link-doc "CWP BAME inclusion group flyer" "https://drive.google.com/file/d/1OKiWCRxNMBDSgf8zHW3zV9WasUefGqnD/view?usp=sharing">>

For some initial notes about diversity please see the following pages:

!!![[Diversity]]

@@color:red;This page is being developed in light of recent changes to working due to the outbreak of COVID-19@@

Pleaase find below an example of a ''CWP Telephone Triage Assessment''. This has been kindly shared with us by Islington Community CAMHS and could be helpful for both CWPs, EMHPs and supervisors of both of these practiitoners. 

<<link-doc "CWP Telephone Triage Assessment" "https://drive.google.com/file/d/18odcmmloYH4kyAVhBH_7kIWf-Wsbv8sN/view?usp=sharing">>

Information taken from Mentally [[Healthy Schools|https://www.mentallyhealthyschools.org.uk/about/]]

---

Mentally Healthy Schools is a free website for primary schools, offering school staff information, advice and practical resources to better understand and promote pupils’ mental health and wellbeing.

---

Download the Mentally Healthy Schools [[free toolkit on internet safety|https://www.mentallyhealthyschools.org.uk/resources/internet-safety-toolkit/?utm_source=AFLN&utm_medium=email&utm_campaign=internetsafety_2019&utm_term=AFLN&utm_content=toolkit]] , packed full of practical teaching resources for primary school staff, to help keep children safe online.

The toolkit includes lesson plans, videos, quizzes, animations, assembly plans and information and guidance. It covers topics such as cyberbullying, gaming, social media, website use and other online risks.

!!! What Happens If You Belong to More Than One [[Group|The Social Graces Model]]?


!!!! By Isaac Cook, EWP at SLaM



[img[Intersectionality - Belonging to More Than One Group.png]]


<<link-doc "Intersectionality and Systemic Therapy" "https://drive.google.com/file/d/1OPbpDfwNIuy5TPi1QMPuLFz--m0SS2-z/view?usp=sharing">>


!!!! The Children's Wellbeing Practitioner BAME Inclusion Group

https://www.linkedin.com/groups/8873855/

!!!!!Source: Laura Bowyer
!!!''Some starting points''
*Ensure the young person/ parent has learnt about some basic ideas about how anxiety work  [[Anxiety: Explaining anxiety to children and parents]]
*Get used to using a way of measuring the level of anxiety such as a fear thermometer or paper scale. [[Fear Thermometer]]
*Formulation – as well as the above focus on what might cause anxiety, have a focus on what maintains anxiety and keeps it going; anxious thinking, bodily changes, anxious behaviour.
 
!!!''The Anxiety equation''
*Anxiety equation = danger (likelihood x cost)							        	    coping (self or others) (Based loosely on Padesky, 1997). With anxiety; YP generally fear something bad will happen (high likelihood and cost)  and either avoid it, or use a range of ‘safety’ behaviours to keep ‘safe’ or prevent the bad thing from happening (low perceived ability to cope). 
!!!''Anxious behaviour can involve lots of people''
*Anxious behaviour - remember behaviour is not just what the young person does when anxious to feel better, but also what the parents / system around the child do. 

!!!''The key role of avoidance''
*Anxious behaviour also involves avoidance and things the young person does mentally in their head e.g. preparing a conversation over and over again before they approach their peers.
*The key messages are avoidance keeps fears going as the child never learns / finds out if bad things happens or not and they don’t get the opportunity to develop coping skills. Likewise, reassurance or other safety behaviours can prevent children from learning that they can cope independently.

!!!''The habituation principle''

*Habituation principle – the more we face a scary situation over and over, the easier it becomes. This is because our anxiety (or fight and flight system) goes up but then plateaus and goes down if we stay in a scary situation. 
*Explanations of habituation can be found on youtube. For example, https://www.youtube.com/watch?v=qG2SwE_6uVM
*The next time we face that same situation, our anxiety goes up (but not as much as before) and comes down quicker and so on, until we no longer feel anxious in that situation. Key message: Your anxiety may feel as though it will go on forever (unless you run away/ avoid the situation etc.), but it will in fact pass on its own.
*‘Habituation’ means getting used to a situation or experience.  

!!!''Doing things one step at a time''
*Hierarchies or ‘fear ladder’ – facing our fears step by step and not doing it all in one go. Breaking tasks down and facing our fears one step at a time without safety behaviours. 
!!!''Thinking traps''
*Anxious thoughts - In anxiety, the child thinks something bad is going to happen and thinks they will be unable to cope. They then look out for evidence to support this. 
*It is our interpretation of a situation or anticipation of what is going to happen that determines how we feel about it and how we behave.
*Young people can find themselves using a series of thinking traps: 
**Mind Reading 
**Catastrophising 
**Over Generalising
**Labelling
**Focusing on the negatives
**Predicting the Future
**What if statements

*The main point is the child thinks something bad is going to happen and thinks they will be unable to cope and then they look out for evidence to support this. 
*Aim in intervention is to develop more flexible thinking and increase coping. 
!!!''Notice persuasion''
It is very easy to fall into trying to persuade a child that something is not as bad as he/she thinks. This is understandable but often not helpful. Sometimes being a little paradoxical, seeing it worse that the child may enable more change to occur. 

[img[pad of paper.jpg]]

Core interventions can be found on the [[Helping]] pages. 

Practitioner interventions focus on the areas listed below:

''Please note:''  The age ranges for these interventions are a  guide.  The appropriateness of any interventions for a child/ young person should be considered with supervisors prior to being delivered:

* [[Helping: Behaviour Problems]] (5-8 years)- a brief (7 sessions) guided self-help parenting intervention.
* [[Helping: Adolescents Anxiety]] (12-17 years)- a brief (8 sessions) guided self-help adolescent intervention, which may or may not involve working with parents 
* [[Helping: Child Anxiety]] (5-11 years)- a brief (8 sessions) guided self-hep parenting intervention.
* [[Helping: Low Mood]] (12-17 years)- a brief (8 sessions) guided self-help adolescent intervention, which may or may not involve working with parents 

You may also find the page outlining the [[Core Intervention Manuals]] used by practitioners helpful.

*Assessment process 
**For practitioners interviewing parents will be used as the source of information in addition to standardised measures 
!!!Interviewing parents 
*Warn at the beginning about the time scale and say in advance that they might cut across them etc. 
*Parents will be worrying ensure to normalise behaviour 
*Start off safe in the information in family details 
*Be clear about the presenting problem- what does a 'wobbly' look like: specific questions are needed 
*ABC Chart- Trigger, Behaviour, Consequence 
*Developmental questions- anything usual happened in childhood to discuss with supervisors 
*Prepare for reaction to emotional questions- 'What are your worries and fears if things don't get better?' then validate these feelings 'That must be a really difficult thing to carry around' or normalise behaviours 'We hear a lot about parents having negative feelings towards their child' 

!!''Mental health and Wellbeing''
Mental health can be defined as a state of well-being where individuals are able to: 

*realise their own potential
*cope with normal stresses of life
*work productively and contribute to their community.  

Mental health involves psychological and emotional well-being. The WHO defines health as //‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’//.

 
Well-being has been described as the state of being comfortable, healthy or happy.  It involves a cognitive sense of satisfaction with life. More than happiness and satisfaction it includes developing as a person, being fulfilled, resilience and having an active role in the community.

 
Mental health problems can result in a loss of wellbeing. Such problems may arise from individual vulnerabilities, life experiences including trauma or abuse, isolation, discrimination and adverse family circumstances. 

A person’s state of equilibrium or balance can be affected by these challenges leading to a reduced capacity to cope with stress, changes in how they relate to others and negatively affect well-being. During these times people may seek professional support (e.g. counselling, therapy and or medication) when their normal support systems or coping strategies no longer meet their current needs.

!!''What are common mental health problems for children and young people?'' 
!!!''Medical Classification of Disorders''
The most common way of describing child mental health problems. The most detailed classification is the system of medical disorders which sets out criteria against which a person can be assessed. If a person meets this criteria, a 'diagnosis' is given.

 
*The main child mental health disorders are:
**Anxiety Disorders
**Depression/Low mood
**Self Injurious Behaviour (Self Harm)
**Conduct (behaviour) Disorders
**Attention Deficit Hyperactivity Disorder (ADHD)
**Eating Disorders
**Specific Developmental Disorders (Autism) 
**Tourette Syndrome
**Psychosis
**Substance Misuse
The use of a medical model for child mental health problems presents a number of well recognised problems (are they really an illness?) and also some people find the language confusing and unhelpful. See [[Child mental health and medical diagnosis]] for consideration of this. 

!!!''The Strength and Difficulties Questionnaire (SDQ)''  
This simpler approach considers child difficulties in terms of: 

*Emotional Problems
*Behavioural Problems
*Attentional Problems
*Developmental/learning Problems 
*Habit Problems (e.g. sleep, feeding, toileting) 
This is not a formal classification system but is consistent with the information provided by the Strength and Difficulties Questionnaire (SDQ) which is the most widely used screening questionnaire used in the UK. 

!!!!''Child Behaviour Checklist (CBCL)''
The CBCL is a broad questionnaire covering a wide range of child mental health problems which  divides mental health problems into two broad categories:

*Internalising Difficulties (anxiety, low mood etc)
*Externalising Difficulties (behaviour problems, aggression etc) 
!!''The EMHP Programme''
The EMHP Programme does not cover all mental health problems. It  focuses on the three most common mental health problems for children and young people. These are:

*Anxiety Problems (0-18 years)
*Low Mood (11-18 years)
*Behaviour Problems (0-11 years) 

These are summary notes from the first teaching session of CWP programme in 2017. 

!!!''Learning objectives for the session ''
#CYP-IAPT principles and the role of CWP including guided self-help /self-management
#What are child mental health problems - also cover case selection
!!!''CWP Core competencies covered by this session ''
These should be taken from the 25 core competency framework used for the CWP Knowledge and Skills  Questionnaire 

#Knowledge of CAMHS, multi-agency services and the CYP-IAPT programme

!!!''Main content of the session - where to find relevant pages in the wiki guide ''
#CYP-IAPT principles - go to page [[The CYP IAPT Programme]]
#The CAMHS system -[[The CAMHS System]]
#Future in Mind - [[Future in Mind]]
#Role of CWPs - [[The Role of CWPs]]
#How to track progress - [[Outcomes]]
#What are CYP mental health problems - [[What are common CYP mental health problems?]]
#Low mood, anxiety, behaviour - [[What is an anxiety problem for children and young people?]] - [[What is low mood?]]- 
#Overview of common treatments - [[What is the difference between guided self help and some traditional forms of therapy?]]
#Guided self-help /self-management - [[Introduction to guided self help]]
#Case selection - [[Guide to selecting cases]]

!!!''References for session''
<<link-pdf "Meltzer et al 1999" "https://drive.google.com/open?id=0B1hDLHd8syMsSUNoV0dDRTk2dEU">>

!!!Video
<html><iframe width="560" height="315" src="https://www.youtube.com/embed/DRS3uJzw94M" frameborder="0" allowfullscreen></html>

!!''Year Plan''
CWPs will receive university based teaching for 2-3 days a week during term 1, with 2-3 days for in service work. For term 2, CWPs will have 1 day a week for university based teaching with 4 days for in service work. During the final term, CWPs will be placed within their service full time. 

!!''Teaching''
Much of the teaching will take place jointly between UCL and KCL. Friday teaching slots will generally be taught separately between UCL and KCL. 
The [[CWP Partnerships]] will be spilt ibetween UCL and KCL for the friday teaching sessions. Details of the UCL friday teaching sessions can be found on [[UCL Teaching Days (Fridays)]]

!!''Supervision''
The CWPs will be supervised by an experienced specialist CWP supervisor/service development lead. Supervisors will provide support in selecting cases and reaching number of cases required for assignments

!!''Team Structure''
These new CWP teams do not have a uniform structure within each [[Partnerships]] and may be working in schools, CAMHS or in voluntary sector settings. It is helpful to be clear on [[The Role of CWPs]] and [[The CAMHS System]]

!!''Content of teaching''
Over the course, CWPs will be taught [[What are common mental health problems?]] and how to intervene using [[Guided Self Help]]. Below is an example of lecture: [[Introduction to the CWP Programme in 2017]]. Teaching will be centred around [[Core Competencies for CWP Practitioners]]. These competencies will be tracked throughout the year by recording learning outcomes for CWPs. CWPs will use models described under [[Self help materials]]

Source: Jeni Cross, Colorado University 

''Purpose of this page'' Provides a brief introduction to the theory of behaviour change

!!The Theory of Behaviour Change 

The theory of behavioural change is a very influential area of theory and research. It has wider applications than mental health as it is applied to problems such as healthy lifestyles, environmental care etc. 

[[10 minute TED talk|https://www.youtube.com/watch?v=l5d8GW6GdR0]] on behavioural change which is very watchable about some key principles of behavioural change.


Some very useful aspects of how to support making change.

# Making information in a form that makes sense to the client. 
# Ensuring that information is conveyed in a interpersonal way. 
# Modelling the behaviour that you want to encourage rather than focus on the behaviours that you are trying to reduce. 
# Attitudes tend to follow behaviour. So important to try to set behavioural expectations rather than focus on attitude change. 


!!Links with other pages

Ideas about behavioural change are important to consider in relation to [[Psychoeducation]].

There is a potential for this to become a bit mechanistic and behavioural. People just fill in a feedback form or get their phones out and put a score on POD. However, encouraging feedback as a reflective process and not a behaviour is very helpful. 

We need to develop a practice of inviting students to stop and reflect on what has been helpful about the session, what they have learnt etc. This is the primary task. If possible it would be great to review learning objectives as part of the feedback at the end of the session. Again, mirroring practice with guided self- help is a key aspect of this.

This could be prompted by some verbal discussion maybe included alongside inviting people to do ratings of the session on POD. We recommend that this part of the session should take about between 5-10 minutes. 

!!!Reasons to involve parents
*Important to put agency on parents - they will be doing the majority of this work at home (increase independency)
*Parents often have anxiety themselves, so it is important to consider how they manage their own anxiety - this will have an affect on what they are encouraging their child to do 
*Important to explore how they are maintaining problem etc - e.g. instinct to protect and encourage them to try things differently
*They are the ones who will be around long term to put techniques into practice. You are the coach and parents and children are running the marathon 
!!!Overcoming potential problems
*Parents seeing you as a support for them: Being up front about your role and managing expectations/ Normalising and sign posting them to support.
*Difference of opinions/goals on what their child should be doing (to the CYP and to the CWP): Speak about common and realistic goals from beginning, building strong alliance 
*Struggling to see there is a problem/what the problem is: Sensitivity, normalising 
*Confidentiality and privacy: negotiating this with parents and opening up discussions- setting up expectations of what intervention entails from beginning 
*Practicalities (time, resources): important to be clear up front about commitment required (how many sessions/if they have holidays etc/their concerns) *Experiences of services (particularly negative): Evidence base for it

[img[jumbled words.jpg]]

Here is a list of some words and acronyms and their meaning. Please tell us about any others you have come across!

AFC: Anna Freud Centre

EMHP: Education Mental Health Practitioner

CWP: Children Wellbeing practitioner 

CAI: Child Attachment Interview

CAMHS: Child and Adolescent Mental Health Services

CBT :Cognitive Behaviour Therapy

CBT-OBI: Cognitive Behaviour Therapy and other Outcomes-Based Interventions

CORC: CAMHS Outcomes Research Consortium

EBPU: Evidence Based Practice Unit

IAPT: Improving Access to Psychological Therapies

PRU: Pupil Referral Unit

Mentalization: the ability to perceive and to communicate one's own mental states and those of others - the ability to be 'mindful of minds.' 

Neuroscience: The scientific study of the brain, its structure and its functioning

Psychoanalysis: A therapeutic method for treating personality/behavioural disorders that brings the
unconscious fantasies and desires of the sufferer into their conscious mind.

SEN – special educational need

SEND – special educational need or disability

LD – learning difficulty or disability

LA – local authority

SSEN – statement of special education need

EHCP or EHC Plan – education, health and care plan

‘The Code’ – Special educational needs and disability 
code of practice: 0-25 years 

SEMH – Social, emotional and mental health difficulties

SENCO – special educational needs coordinator

''Job role''

It will be the responsibility of the service for recruiting an appropriate Supervisor/Service Development Lead. For some services this might be someone who already works within the service and knows it well - for others they may decide to recruit someone new. 

[[Supervisor role in skills workshop]]

 

//''Jungle analogy:'' You are lost in the middle of dense jungle. You can see only one path out which is well trodden – but this is the path you have just taken to get to where you are.  You don’t want to go this way!  It doesn’t lead you out.  You need to find a different way out. This means quite a lot of hard work – you have to clear a new path through the jungle and work really hard at clearing away branches and thick jungle.  This takes time and effort chopping away to create a new path. This is a bit like learning to think differently. Your old ways of thinking are very well known to you and easy to slip back into.  It takes a lot of hard work initially to develop a new way of thinking and battle with your old thoughts!  With some hard work, this path become more and more clear over time and easier to follow… but you need to keep trying (practice, practice, practice!).//

The CWP programme has various guidance and operational documents that state expectations of CWP sites and can help sites to shape their services. This page provides links and more information about these documents.

!!!The Memorandum of Understanding: 
This document outlines the terms and key tasks/responsibilities of all involved in the CWP programme (the Workforce Team, commissioners, sites and trainees). Sites sign in agreement with this document when they accept their funding offer.

<<link-doc "The Memorandum of Understanding" "https://drive.google.com/file/d/1gj9eGfJOScszpKYdvE9ypeSsH0kHwuiR/view?usp=sharing">>

!!!The CWP Operational guidance booklet: 
Provides an introduction and operational overview of the role of CWP. This can help sites to develop their local arrangements and procedures and provides recommendations as well as minimum standards/requirements.

<<link-doc "The CWP Operational guidance booklet" "https://drive.google.com/file/d/1auGJzGS6mAp9UAUoj6befpVHQ2q5Q1WM/view?usp=sharing">>

!!!The CWP site checklist: 
This checklist is sent to sites to complete 1-2 times in the training year. Information is collected to evidence the use of Placement Support funding and allows the Workforce Team to monitor the implementation of the CWP programme and feedback to HEE

<<link-doc "The CWP site checklist" "https://drive.google.com/file/d/15djvo7s5YbFs8I8hYIUR_NCm7cIoko35/view?usp=sharing">>

We like larking about. 

!!!!Source: Duncan Law 

!!!Leading change and transformation

Developing a service for new workforce to be effective requires ''good leadership'' and ''collaborative working'' across the system.

The Anna Freud Center and UCL provide training for Clinical and Operational leads who are involved in implementing change and transformation to improve the quality of the services they offer to CYP including CWP and EMHP workforce development and implementation of NHSE CYPMH policy

The Leadership Course is a one year programme for clinical leads & service managers committed to the delivery of high quality care for children and young people. 

This Postgraduate Certificate programme provides specialist post-qualification training for anyone in a leadership role implementing transformation & change in Children and Young People's Mental Health (CYPMH) and Wellbeing provision across Education, Voluntary Sectors, NHS or Social Care. 

The course is applicable to all aspects of CYPMH service improvement with particular focus on implementing policy around CYPMH including: Future in Mind, the Green Paper, Five Year Forward View & the Long Term Plan. It is relevant to leaders and service managers with responsibility for delivering  aspects of policy including CYP IAPT, Mental Health Support 

The programme aims to provide leaders with:
* the necessary background knowledge and understanding to implement change within their CYPMH services, 
* the practical tools to manage this change effectively and 
* a framework for reflective practice and evaluation of the implementation process
* critical knowledge of the theoretical, research and implementation literature that underpins such service change.

Next steps
If you are interested in this training, you can register your interest and find out more information [[CYP-IAPT Website|https://cypiapt.wordpress.com/postgraduate-cyp-iapt-training/]] and speak to your service manager about applying. 


Information
Find course brochures, videos from the open day, student testimonials and application information on our programme webpages:

[[CYP-IAPT Website|https://cypiapt.wordpress.com/postgraduate-cyp-iapt-training/]]

[[UCL Website|https://www.ucl.ac.uk/prospective-students/graduate/taught-degrees/children-young-people-mental-health-wellbeing-services-pg-cert]]

For further information and enquires please contact irina.nedelcu@annafreud.org or hannah.wright@annafreud.org 

!!!''Key practice points''
*Using a behavioural activation approach, it is very easy for the intervention to become focused on increasing activity. This is understandable but not always helpful. 
*The theory of behavioural activation is to enable a client to come to recognise the impact of behaviour on mood. This is important for the practitioner as it may enable curiosity to be shown when things have gone badly i.e. when behaviour has led to increased low mood and depression. 
*The emphasis on learning may enable the practitioner to become less strongly positioned as a somewhat critical parent  who is trying to get their young person out of bed. 
*So the overall approach is to use daily monitoring sheets simply to identify times when the young person had done things to improve mood but also  when the reverse happening. 
*Longer term is is likely that one of the benefits of this low intensity intervention is that it may facilitate the young person in beginning to learn about themselves and be able to make more conscious decisions as to what is likely to be helpful to them. 

!!''[[Psychoeducation]]'' 
*The purpose of psycho-education is to enable a child, young person or parent  to understand that, although their life is a unique one, some aspects of what they are experiencing are things that have occurred to others and that there may be some things that might be helpful to know about the experience of others with similar difficulties. 
*What is important is to check carefully that what is being shared is something that the family would like to know. In general, with psycho-education, a useful principle is that less is more.  
*Psycho-education works better when seen as part of an overall approach rather than a specific session in a sequence of sessions. 
*The whole approach of guided self help is to enable the client to take control of their own needs and information about these needs is aimed to support this process.  

Just like guided self help, the CWPs should be given opportunities and suggestions of things to practice or read up. References or self help materials might be useful here. 

This is a key aspect of mirroring guided self help. The key principle here (overstated) is that the CWPs won’t learn things because we teach them but they will learn things by practicing some things that we suggest to them.

For more theoretical or evidence related teaching this may be less straight forward and may just be about suggesting a very specific reference (or a web site) for them to read and discuss with a colleague. 

What is important is that students are encouraged to adopt an active sense of agency around their own learning, the link with guided self help is then made explicit and not implicitly assumed. 

''Intervention Length''

* Over 80% of cases were seen for between 6 and 10 appointments

* The most common number of sessions for each intervention was 8 

* The average number of appointments was 7

''Intervention Delivery''

* The most common format of session delivery was face to face (75%), followed by a combination of face to face and telephone (23%) and a small proportion was delivered by telephone (1%).

''Intervention Location ''

The location of sessions included the following: 

* Educational setting (41%)
* CAMHS premises (30%)
* Voluntary and charity sector (13%)
* Child or young person’s home (8%)
* Youth Centre (7%) 
* Community Centre (1%) 
* Primary care setting (<1%)

Source: Deb ~McNally and the Manchester Collaborative 

* Research has demonstrated the important role of parents in child development. It has been shown that mothers' frequent use of verbal scaffolding predicts superior problem solving and self-control in toddlers (Landry, Miller-Loncar, Smith, & Stewart, 2002)
* Environments that are ‘language-rich’ is a predictor of quicker language and vocabulary acquisition of vocabulary and grammar (Tamis-LeMonda, Shannon, Cabrera, & Lamb, 2004)
* Self-regulation and self-control are critically important for children’s development into adulthood. It has been found that a child’s ability to exert self-control and regulation correlates with the ease at which the child will make the transition to school (Rimm-Kaufman, Pianta, & Cox, 2000)
* Therefore, a key component of parenting interventions (early intervention) should be to support children’s development of self-regulatory skills 
* Mothers who praise their pre-schoolers for their good manners have children with better social skills (Garner 2006; Hastings, ~McShane, Parker & Ladha, 2007).
* 36-month olds who were most likely to tackle challenges and to persist at a task were the ones whose mothers had praised and encouraged their independence at 24 months (Kelley et al 2000).
* Praise that immediately follows a behaviour increases the chances of that behaviour occurring again (Alberto & Troutman, 2009; Kerr & Nelson, 2010). 

{{manc}}

Logical Consequences Guidelines

* Make sure you can live with the consequences
* Discuss in advance 
* Appropriate
* Immediate
* Straight forward
* Non-punitive
* Give warnings and choices
* Keep it brief – it is an opportunity to learn
* Use if…then messages E.g. If you put your coat on then we can go to the park now or we can stay inside. If you throw your food then I will take it away (take away for 5 mins and then return)
Examples: Natural

* Jump in a puddle – feet get wet
* Drop your ice cream – can’t eat it
* Don’t take turns – other child won’t want to play
Examples: Logical

* Don’t come off the computer – lose computer time later
* Don’t eat dinner – no dessert
* Don’t tidy room – privileges removed 

[img[bubbles1.jpg]]

This guide does not cover low mood in children it focuses on work with adolescents as this is what is taught on this programme. Information regarding the intervention for low mood can be found on the [[Helping]] pages.

There are two main areas within the learning pages for low mood which are:

[[Low Mood practice]] - guidance for working with young people who have low mood.

[[Low Mood knowledge]] - key information surrounding low mood.

----
!!'Guided Self-Help for Low Mood'
The manual used to guide practice for working with YP with Low mood is the 'Guided Self-Help for Low Mood'. This approach has a similar overall framework to the approach to anxiety problems. Please find the full manual linked below: //Manual developed by Tower Hamlets CWP Service: Information combined from C&I Depression and Low Mood GSH book, Depression Moodjuice Self-help Guide and Get self-help website//

 <<link-doc "Behavioural Activation
(BA) for Young People
with Low Mood: Guided Self-Help Manual" "https://drive.google.com/file/d/1PNZ5P71hlhORf4V83vipGqY3gG5WdVy6/view?usp=sharing">>  

---


__Sharing handouts with young people and parents during remote working__

For further adaptions made to the manual in light of COVID-19 and the changes to working please see page:

[[Low Mood Manual: COVID-19 Adaptions]]

The authors of the behaviour problems, low mood and adolescent anxiety manuals/handouts have given practitioners permission to create a Word version of the handouts for ease of sharing when remote working with young people and parents should you wish to do so.



PLEASE NOTE: The manuals/handouts are covered by Creative Commons copyright.  

Copyright: Available under License Creative Commons Attribution No Derivatives
See further: https://creativecommons.org/licenses/by-nd/3.0/

In addition, they are designed to fit with the evidence base for working with these interventions.  

For these reasons, the content of the manuals/handouts should not be amended by practitioners, but young people/parents/carers can fill them in as part of the intervention as they would a paper copy.


---
!!!Session overview:

For a more detailed overview of the session plans please go to: [[Low Mood - Sessions Overview]]

!!!Session plans:

For session plans please go to: [[Session Plans for Overcoming Low Mood]]


!!!Session Handouts:


To access the handouts for low mood please go to:
[[Low mood: Handouts for CYP]]


The basic approach is to have sessions with the young person but these can be interspersed with contact with a parent. A guide for parents developed alongside the Low Mood manual can be found below.  You may want to call parents after the assessment (provided the young person consents to this) and then send parents this information. Parents are reporting finding it very helpful.

<<link-doc  "Parent Low Mood information" "https://drive.google.com/file/d/1uT6HP7yJLTq_qNl-u_Ym5ElXJJ8AGzus/view?usp=sharing">>


If you would like to share a specific handout with parents within this information you will find a list of the handouts for parents on the page: [[Low mood: Handouts for parents]]

For previous versions of the low mood manual please go to [[Low Mood Manual- previous versions]]

---

The full manual can be accessed through the link below: 

 <<link-doc "Guided Self-Help for Low Mood: Full Manual" "https://drive.google.com/file/d/12bn3n53aWhm5_21Za460fp_qOtPsWY_N/view?usp=sharing">>  

[[Session Plans for Overcoming Low Mood]]

---

!!Overview

*8 sessions with Adolescents - with parent involvement where appropriate and with consent. 

Parental involvement is recommended at assessment (session 0) and final session at least.  Face to face sessions are the norm for this intervention:  it is often a helpful part of the behavioural activation and in our experience young people often prefer them.  However, if young people prefer to have any of sessions 5-7 on the phone and it seems clinically appropriate to do this, that is fine

!!!''Assessment session''
An initial assessment session referred to in this guide as '''Session 0''' will take place before the intervention starts. This pre-intervention session (like a choice appointment) it is not counted as one of the intervention sessions. For more information please go to [[Session 0 for Adolescents: General Assessment]]

''Session 1:'' Goals setting, Psychoeducation and Formulation

*RCADS symptom tracker

*Goals

*Psychoeducation

*Formulation
''Session 2:'' Back-up Team and Behavioural activation

*Introduction to Behavioural Activation
*Introduce activity diary

''Session 3:'' BA The Next Steps; Values and Activity Planning

*RCADs symptom tracker & rate goals
*Review ROMs (RCADS DEP, GBO)
*Introducing values
* Translating values into activities
* Activity Planning

''Session 4:'' Review BA and The role of thoughts and unhelpful thinking styles

*Thinking Traps
* Challenging negative thinking
*Thought diary

''Session 5-7:'' BA Continued, alongside additional interventions, to be selected as appropriate

*Review homework 
*BA focuses on relationship between a balanced lifestyle and positive wellbeing 
*Monitoring the young persons week in terms of Achievement, Closeness and Enjoyment 
*Helping a young person start the journey towards building a new rewarding life that matters to them 

''Session 8:'' Relapse prevention and feedback to parents

 <<link-doc "Guided Self-Help for Low Mood: Full Manual" "https://drive.google.com/file/d/12bn3n53aWhm5_21Za460fp_qOtPsWY_N/view?usp=sharing">>  


 <<link-doc "Guided Self-Help for Low Mood: Full Manual WORD VERSION" "https://drive.google.com/file/d/1rZLRAEO4g3NTGGVPgCuAufg5nC2Tfn8k/view?usp=sharing">>  

Please see below for the adapted low mood manual in response to the current circumstances caused by COVID-19. This manual was compiled and edited by the KCL CYP-IAPT team: Helen Barker, Zoe Maiden, Laura Bowyer,
Sarah Carman, Victoria Pile, Susanna Payne; and the UCL CYP-IAPT team: Vicki Curry
With information from: Caroline Stokes (KCL); Alice Kerr & Emma Warnock-Parkes, (Centre
for Anxiety Disorders And Trauma/KCL); Lisa Shostak (KCL); Ali Lambie, (Mindfulness
Hampshire); Jynna Yarrum and Alysia James, (University of Northampton).
Young people’s perspective from: Lila and Remy Moar

---

<<link-pdf "Low mood manual: COVID-19 adaptations" "https://drive.google.com/file/d/12ZyyVDrLD4nvyDGZRL2qEm0HpvR0ijtT/view?usp=sharing">>

!!!!Source: Carolyn Edwards

Please find attached a set of practice activities you may find useful in relation to the LOW MOOD/ Behavioural activation intervention.  As before these are not marked or assessed as part of course requirements and are optional.  

If you are not involved in the activity, please be sure to get the feedback from trainees about how they found it and what they learned.  
For each activity you may wish to ask trainees to complete a ‘Practice Review Form’ to reflect on their learning from the task.


<<link-doc "Case Study: Fazian" "https://drive.google.com/file/d/1HVaGU-aFy06Z8n_JausFU_UzmJw-urDN/view?usp=sharing">>

<<link-doc "Clinical practice review form" "https://drive.google.com/file/d/17IILndc1tU_F5MIBbBgnMPGPd1VSnfjc/view?usp=sharing">>

<<link-doc "EMHP/CWP practice tasks for placement" "https://drive.google.com/file/d/1O8-WSGxb-iAdrL9RiHyumCSMU67n_Gxc/view?usp=sharing">>

<<link-doc "Article: Behavioural activation for depression" "https://drive.google.com/file/d/1kLp8H8BqOGoME0LX7ycm7s2-f9D1rP9q/view?usp=sharing">>

<<list-links "[tag[Low Mood Session Material]]">>

<<list-links "[tag[Low Mood knowledge]]">>

This is a tag tiddler 

<<list-links "[tag[Low Mood practice]]">>

!!''Notes for teaching session in 2017''
!!!''NICE mental health guidelines''
*10% or less relate directly to children: there is less evidence to look at, limited data need to draw on the adult literature 
*Reducing risk by combining treatments i.e. suicidal ideation 
*Clinical trials show 8% of people get worse after psychological therapies at the end of the treatment. But people might be shown to be on a 'recovery track' longitudinally and continue to get better in the future 
*Keep in mind supporting research in the long term 
!!!''Stepped Care'' 
When assessment time varies it create a waitlist. Goal is to reduce waitlist and facilitate better access to care. Low intensity intervention came out of this- where you can be clear about the nature of the intervention, with a clear time frame. 
Psychosocial intervention for low mood includes exercise which was found to be effective in adults 
*Not much evidence for the Stepped Care model in the beginning but evidence was increased over the last 10 years 
75% of adult disorders start in childhood, impact on education and in the long term employment if not treated. Early interventions have the potential to change a persons life course. 
*Able to see more people with IT interventions, evidence for groups is weaker than individual treatment but IAPT are considering this option to cope with the increasing patient load. 
!!!''Evidence of low intensity intervention'' 
*for guided self help and parenting training in depression (low mood) anxiety 
*Distinction between HI and LI will become clearer in the next 10 years e.g. digital interventions (David Clark, Kings) which reduced therapeutic hours from 12 to 4. More work in development but do not need to be delivered by high intensity therapists. Less training is needed but still as effective. 
*Different role in the Car model- it suggests to the therapists what they might be differently across a range of anxiety disorder 
*Clear evidence based  for digital interventions i.e. CCBT if there is facilitation by a low intensity worker. 
*Beating the Blues- commonly used adult intervention, evidence clear in outcomes and in the amount of facilitation. 
*Clear evidence if you are not facilitating things you are less likely to see benefit 
!!!''Process'' 
1. Least intrusive most effective intervention first - effective use of resource underpinned by increased access 
2. Build in a self-correcting mechanism - monitoring outcomes, if people aren't progressing as expected you have a way of monitoring that and then correcting that. If this is seen then it is possible to 'step up' 
!!!Assumption of LI intervention 
1. Efficiency - providing more structured, time limited, protocol driven = quicker, better with less intensive input, less time, less resource. This will break down if people 'go down the side of it' i.e. patients requesting their own treatments (Mindfulness). 
2. Equity of outcome - can be clinical or cost-effectiveness. Roughly equivalent outcomes in HI and LI interventions, less certainly about the long term outcomes (one year plus follow up). Ration of how much improvement in quality adjusted life years and how much is this is terms of cost, LI interventions more cost-effective. Required to think about both from a public health perspective. 
3. Acceptability - Interaction between acceptability with the young person and parents liking of books etc? Need examples which people can relate to. Rule of thumb with self-help materials is to make them accessible for everyone. 
!!!''Discussion'' 
*Harms associated with psychological interventions? 
**Create more dependence to the therapists, don't feel able to take skills into their lives, therapists putting their world view onto the client. 
**Do people get worse? Discover their issues are worse
*What is a standardised mean difference? Cohen invented a correction to the way we assess evidence- half a standard deviation (.5) is used to compare a treatment against a treatment or against a waitlist.
**Statistical problems (Book) 
*What was the number of contacts people had in the un-facilitated and lightly facilitated intervention? Answer is 1, Beating the Blues (in adults) found treatment as usual was best. 
*Thoughts on LI intervention- parents might think LI is not enough deal with this my presenting them with the available evidence. Parents might be relieved invention will be less demanding on time etc. Comparisons with other treatments within a school- can be tailored more to what people need. 
*What to say to parents? Low intensity interventions are recommended by NICE, they are just as effective as high intensity work and we believe they will work best for your situation. 
*NNT- numbers needed to treat is the lower the better (n=6). This means you would need to see 6 people to get one person better than the standard treatment. 
*QALYs for mental health compared to physical conditions compared very well- means we have good interventions which work as well as other interventions. 
*Difficulties of PWPs have been given people on the waitlist instead of being given people they can actually help 
*Specificity of interventions is beneficial
*How long is it before someone seeks treatments for social anxiety? 8-10 years 
*Effect is Johnansson study = control stayed as depressed at follow up as they were at baseline. Look at what the comparator is when you are looking at the results of research. 
 

Information has been drawn from a number of sources in the development of the handout material.  This includes Children’s Wellbeing Practitioner teaching, other CWP services and a range of websites.  In some cases material was found online that did not include references.  In most instances we have taken such material and adapted it to ensure it fits with our particular style of intervention.  Key acknowledgements are listed within the handouts. 

!!''All handouts:''
<<link-doc "All Handouts for Low Mood (CYP)" "https://docs.google.com/document/d/17TvWndurTgXkOjARPdrAujVXLb2NrEfIOU9qEWifMRg/edit?usp=sharing">>  

!!''Session 1:''
<<link-doc "Depression and Low Mood: Psychoeducation" " https://docs.google.com/document/d/1ruYpSKy13nxb13CFyreZAGn0w0BPba8BWlQn7PGIFlY/edit?usp=sharing">>
<<link-doc "Development Map of Low Mood" "https://docs.google.com/document/d/167VUIWaLoqrWbb1wOrcklO-N2CZNfjgcpsTDfiDdRyk/edit?usp=sharing">>
<<link-doc  "SMART Goal handout" "https://drive.google.com/open?id=1n-KiufWlI_3xIniCOtqv5iqNFe_ec-fDGYh_OumuvhE">>
<<link-doc "Paper version of GBO" "https://drive.google.com/drive/u/1/folders/1jaGGIN0Q_nI9eIFkJhx1TYBHxpOm0ojI">>
!!''Session 2''
 <<link-doc "The Back-up Team (CYP)" "https://docs.google.com/document/d/1WfmTz29skWDxADSQ3rN67MUPS88Jy8zu_6M1u59TmAY/edit?usp=sharing">>
<<link-doc "Behavioural Activation 1 (CYP)" "https://docs.google.com/document/d/1HLilN-S1H-6WnnbPAncz8Mn99QIbaQvzhRYiOuVDKfo/edit?usp=sharing">>  

!!''Session 3''
<<link-doc "Behavioural Activation 2 (CYP)" "https://docs.google.com/document/d/1uQ6Ik8hd3PADOcBQWSvmOfhyh_Zs3Gw97O_TxJqZk1A/edit?usp=sharing">>  

!!''Session 4''
<<link-doc "Negative Automatic Thoughts factsheet" "https://docs.google.com/document/d/1eYo3wxU0HAfd0lXt75Ba79logY4yhgz-G-jCIwtOxqA/edit?usp=sharing">>
<<link-doc "Thinking Traps" "https://docs.google.com/document/d/1uKIB6vs687FCuoYUwK52yQIdqQHm1pky0wTkLl1tFpw/edit?usp=sharing">>
<<link-doc "Challenge Negative Thinking " "https://docs.google.com/document/d/1svoln2f7jaKhLfYbexOHr7pBZzT6QPr4p8ELbW91JBw/edit?usp=sharing">>
<<link-doc "Thought Diary" "https://docs.google.com/document/d/1R2QZM747m9-WIoWYR5x1ld5etxd-R2LlVSJdNBHtliE/edit?usp=sharing">>
<<link-doc "Think Positive" "https://docs.google.com/document/d/1Z2CjcHutfYM6snQQksRzVdDj6WyCmPqywdJj1ZW_5d0/edit?usp=sharing">>

!!''Sessions 5- 7''
<<link-doc "Negative thought experiment" "https://docs.google.com/document/d/1vPOTb7xeh4k2FTTwjplK71Q9GGnHuZv0VAbT_KAGaec/edit?usp=sharing">>
<<link-doc "Putting Thoughts on Trial" "https://docs.google.com/document/d/1p-AOMr7B3IHg3UlBIFNHakdMXQKU4pvVSfyo0AHIBDY/edit?usp=sharing">>
<<link-doc "Internal Bully" "https://docs.google.com/document/d/1clKxDvH1eA1jWD0PsJcEsMhHlkEUsn_AftF5yHtm-LU/edit?usp=sharing">>
<<link-doc "Thought Acceptance" "https://docs.google.com/document/d/1AMTUadcRo5Hkt1Dk31DPAL3llWwdcZnyVhWP4N_w_Ys/edit?usp=sharing">>
<<link-doc "Recongnising your Qualities and Achievements" "https://docs.google.com/document/d/19-de69p_-IEDp9z-jh97sCnqpeSe-QcCZyEIGzknMRo/edit?usp=sharing">>
<<link-doc "Problem Solving (CYP)" "https://docs.google.com/document/d/1nskm3W7zSTv0G02SG6sSvUKGiU5a1Q9aZz9zFeNgEh4/edit?usp=sharing">>
<<link-doc "Sleep Hygiene" "https://docs.google.com/document/d/1uIpcRdEdXF_s7V3t7-4MVP6a0r0OcmuTpIQhcyNnMpI/edit?usp=sharing">>
<<link-doc "Worry Time" "https://docs.google.com/document/d/1lUqQz069CCbvpqnpnWrwKQH3_wn3XzD3WZZAg84DjgI/edit?usp=sharing">>
<<link-doc "Is Worry Helping Me?" "https://docs.google.com/document/d/1DHnwmlVvM6ISrUxtDzvvkRYM4qB2erzOZGrV4GiX82s/edit?usp=sharing">>
<<link-doc "Distraction" "https://docs.google.com/document/d/1Lq3vimhaIvmQdRcXzYe3ks3kb4Nf0wsskw4esQIzYIw/edit?usp=sharing">>

!!''Session 8''
<<link-doc "Relapse Prevention" "https://docs.google.com/document/d/1YyWU6cCJRu1iJi5NyuFepkfEFZj-PfkuulVx6OGKjt0/edit?usp=sharing">>
<<link-doc "Staying Well Plan" "https://docs.google.com/document/d/1skOzUa9z8f5W24-SeJ1SdN6qoobnKCgPMQm4Lm3fw2k/edit?usp=sharing">>

Information has been drawn from a number of sources in the development of the handout material.  This includes Children’s Wellbeing Practitioner teaching, other CWP services and a range of websites.  In some cases material was found online that did not include references.  In most instances we have taken such material and adapted it to ensure it fits with our particular style of intervention.  Key acknowledgements are listed within the handouts. 

<<link-doc  "SMART Goal handout" "https://drive.google.com/open?id=1n-KiufWlI_3xIniCOtqv5iqNFe_ec-fDGYh_OumuvhE">>
<<link-doc "Paper version of GBO" "https://drive.google.com/drive/u/1/folders/1jaGGIN0Q_nI9eIFkJhx1TYBHxpOm0ojI">>
 <<link-doc "Parent Guide: Low Mood" "https://docs.google.com/document/d/16zR1iGKv98BpWnI02GoHz1cYygXo7h76iOX6Ly7veX8/edit?usp=sharing">>
 <<link-doc "The Back-up Team (Parent)" "https://docs.google.com/document/d/1TI14Qtulb9PDRByBJRNLj_uR1ECMiwqp4aJF-_93x2k/edit?usp=sharing">>
 <<link-doc "Behavioural Activation 1 (Parent)" "https://docs.google.com/document/d/1Aaw4fG4r9Or5JzpPJzZJ3TCXM7GxYu83v-xdAo6RdoA/edit?usp=sharing">>
 <<link-doc "Behavioural Activation 2 (Parent)" "https://docs.google.com/document/d/1LdKZTZXUbIbCIjFk8yohIcGVJl1OMNKUWKHAGWxvX5A/edit?usp=sharing">>
 <<link-doc "Problem Solving (Parent)" "https://docs.google.com/document/d/1WMrr84N53ALcHTbIi1-BrJX0VD-7krTg8VaWA96gAPs/edit?usp=sharing">>
 <<link-doc "Day-night reversal problems (Parent)" "https://docs.google.com/document/d/1pdQcH6ocGg5y1HXPfq5jXqV6Cp9bkRICq8JIXBz1q5g/edit?usp=sharing">>
 <<link-doc "Useful Resources for Parents" "https://docs.google.com/document/d/10E95J--DU_-y95wNeXt1e323BAp-zRNiBeysADKcLfA/edit?usp=sharing">> 

<div class="tc-table-of-contents">
<<toc-selective-expandable 'TableOfContents'>>
</div>

@@color:red;This page is being developed in light of recent changes to working due to the outbreak of COVID-19@@

# Avoid unnecessary commands– reduce the number of commands given 
# One command at a time – demonstrate by giving a long list of commands “go and brush your teeth, when you’ve done that put your PJs on, then come downstairs and get a drink and make sure you say goodnight to dad”. 
# Keep commands brief
#Commands should be simple, clear and direct. Why? This will increase the likelihood of compliance.
#Avoid vague commands – demonstrate by saying “Behave”, “stop it”, “careful”, “you need pull your socks up”. Ask the parent did they know what you were referring to? Would the child understand what you want them to do?

# Use positive /do commands
# Avoid question commands– demonstrate by saying “How many times do I have to tell you?” or “would you mind tidying up?”. This gives children a choice and a chance to say “no”. 

# Avoid power struggles
# Offer choices - “When.... Then” and alternatives – this will increase compliance by giving them a sense of control. Get parents to generate examples applicable for their children e.g. “do you want to put your blue socks or your red socks on?”
# Age appropriate commands
# Give warnings and reminders
# Time to comply - Wait for response (5 seconds rule)
# Be polite and use eye contact 
# Use distractions and redirections 
# Ensure appropriate consequence – follow through by either praising “well done for listening” or consequence “you didn’t put your toys away, so you can’t you’re your treat” 

(Forehand & ~McMahon, 1981)

!!Making praise effective 

''Sincere and specific-'' Focus on behaviours that have been difficult for your child to demonstrate, and so it’s a big achievement when they show improvements in their behaviour. Encouraging eye contact before praising can be a nice way to show your child how much their efforts mean to you. 

''Given immediately'' the closer the praise is given to the behaviour, the more likely the child will link this positive experience to the behaviour

''Focus on behaviours and traits that they have power to change'': such as effort, perseverance, kindness, and patience, rather than outcome or talent

''Avoid comparing your child to others'': Avoid putting down yourself or another child in order to make your child feel good about themselves

''Don’t muddle the praise with criticism or teaching'' (e.g. ‘thank you for picking up your toys… finally’, ‘it’s great you tidied the bathroom, now if you’d just done this as soon as I’d asked then we could have avoided all that drama and gone to the park today’)” all the child will remember is the criticism


''Avoid waiting for perfection to praise/completed tasks'' – praise steps in the right direction if a child who  has had difficulties with physical aggression takes themselves away from a peer when angry and yells on their own instead, even though this is not the most desirable response, it is safer than hitting and this should be acknowledged. Praise during the task (don’t wait until the end)

''Make your rewards actually rewarding'': think about what your child likes (for example, if your child does not enjoy hugs, do not use this as a reward) and gain their feedback when developing rewards

''Ignore negative responses'': If the child talks back or shows minor misbehaviour after being praised, then ignore this and walk away – you’ve just shown you child that positive behaviour gains your attention better than misbehaviour, don’t then give them a bigger pay off (in terms of your attention) for misbehaving

''Rewards vs bribes'': Rewards are given after the behaviour is shown, bribes are given beforehand – only give a reward after the behaviour has been shown

!!Key points
Part of offering low intensity help to a child, young person or parent is to develop a shared understanding of the nature of the problem. This involves 
*sharing information about what the problem is like for people in general
*what we know about how such problems arise 
*how it has come about in this particular case. In CBT this is usually described as a formulation. 
*As part of the method the aim is to develop a shared understanding of the problem - i.e. how does the parent, child or young person make sense of what they are experiencing. How has it come about? 
*Making sense of the problem is seen as a component of effective help. 
*There are techniques for helping a parent or young person from making sense of their problem and these are described in a number of different pages linked to this page. 
*[[Making sense of problems using the hot cross bun]]

<<list-links "[tag[Managing Risk]]">>

!!!!Source: Barnet, Enfield and Haringey NHS Trust
---
This information is intended as a GUIDE of key areas to explore in a telephone conversation with a young people presenting with high/immediate risk concerns. However it is important to understand/follow your local protocols regarding risk. NOTE: You will not be expected to manage risk alone - please ask a senior clinician to join or support you.

---

!!!__FACTORS TO CONSIDER EXPLORING DURING TELEPHONE CONVERSATION__

__''Consent/confidentiality''__

__''Details about the young person and engagement''__

*Contact details (of YP and parent) in case you get cut off
*Other information: (e.g.) age/ school/ known to CAMHS/ clinician 
*Engagement and building rapport

__''Assessment of what's going on and current level of risk''__

*current situation/ concerns/ what trigger increased distress?
*Young person's thoughts, feelings, behaviours, urges, plans
*Situational context: who are they with / where are they/ what are they doing?
*who else is aware of these concerns?
*Does the young person currently feel safe? What needs to happen in order to feel safe?  
*Additional risk indicators: tone of voice (flat/fast paced), openness to disclose

__''Protective factors''__

*Info about the YP's: Likes/ interests/ hobbies/ plans for the weekend
*Friends/ families/ other support?

__''Immediate support''__

*Offer some initial guidance about how to access immediate support
*Clinician to contact support services/ family member
**If immediate risk- clinician might call ambulance or advice adult to take YP to A&E 
**If not immediate but high risk (13 years +)- contact SAFE
**If not immediate but high risk (under 13)- speak to senior duty CAMHS clinician/ ACCCESS clinician

__''Initial safety plan/ coping strategies (to share with young person over the phone and in a safety plan, while waiting to be seen)''__

*Grounding tecniques (e.g. 5 senses- what can you see/ hear/ feel/ touch/ taste, deep breathing to count of 4, 'square breathing', having a drink of water)
*Elicit positive and coping thoughts ('what would you say to a friend in this situation?')
*Distraction (getting the YP to focus on something else)
*Refer to self-regulation and coping sheet for further ideas

!!!__TASKS FOLLOWING THE TELEPHONE CALL__

__''Letter/ Documentation''__

*Document on telephone conversation on RIO (or service equivalent recording system)
*Summarise the initial safely plan with young person to the GP/ referrer, copy to parent/ guardian and young person (copy on RIO)
__''Debrief with a colleague that day''__

*It is important no to feel alone when managing risk.

__''Self-care''__

*What might support your self-care? (e.g. taking a break, going for a walk, talking with a colleague, not taking more phone calls that day, planning somthing for after work?).

__''Bring case to next team meeting''__

* Opportunity for reflection, to review outcomes and learning points and so the risk is held by the whole team.

!! 1) Managing role as team leader/supervisor 

!!!Challenges of the role/ relationship to CWP  
*Providing all support for CWPs i.e. manager, knowledge about the model, supervisor, service development
*Challenge of being a manager i.e. what to do if people don't do tasks as this is different to previous supervisor only role 
*Containment sacrificed when doing line manager and clinical supervisor- difference between being a clinical supervisor and line manager (difference in the relationship) 
* Feeling responsible for CWPs, especially when team is sat in a different area i.e. school team working in CAMHS
*CWPs pushing boundaries over things like study leave, arriving on time, participating in role plays 
*Relationship with cohort 1 and cohort 2 CWPs especially when there is a difference between cohorts 
*Assumption that people should be able to supervise, CPD and training on how to supervise and have access to supervision of supervision 
*Supervisor not wanting to criticise CWP within supervision even if something needed to improve, need to have discussion about how CWP would like to receive feedback. Naming that supervisor is an opportunity to learn. 
*CWPs not theraputically trained, so way they speak to clients can be conversational which can lead to messages which are not helpful to the client. Need to highlight this in the right way in supervision. 
*Restrictions by CAMHS managers and role within the service after a current time i.e. role after qualification 

!! 2) Applying the model 
*Moving away from the medical terminology in a CWP approach, think about it as a presenting problem rather than a diagnosis. This is needed to link the problem to the manual. 
*Separation Anxiety/Phobia when being taught general anxiety, same principles. Can we use phobia material from Moodjuice rather than Creswell model? Stick within the model of GSH. 
*Self-esteem? Look at RCADS and see what the measure is indicating i.e. low mood or an anxiety intervention. Formulation to see what is behind the self-esteem. 

! Question:

''How'' do we __upload__ a video?

<html><iframe width="560" height="315" src="https://www.youtube.com/embed/J3PNCBPqJ7o" frameborder="0" allowfullscreen></iframe></html>

What about images?

[img[brain.jpg]]


We have uploaded an image of some building block:


[img[sunshine.jpg]]

The beautiful sunshine!


<<link-doc "RCADS "  "https://drive.google.com/file/d/0B-tACu2wi4-4dEdqbk93SlNvTE0/view?usp=sharing">>


<<link-doc "CWP BAME inclusion group flyer" "https://drive.google.com/file/d/1OKiWCRxNMBDSgf8zHW3zV9WasUefGqnD/view?usp=sharing">>

<<link-doc "CWP BAME Inclusion Group Powerpoint Presentation" "https://drive.google.com/file/d/1OKiWCRxNMBDSgf8zHW3zV9WasUefGqnD/view?usp=sharing">>

!!!!!Source: Joanne Woodford, Catherine Gallop, Jonathan Parker, Dr Fin Williams & Kate Sandel

!!Wellbeing Practitioner: Data Handbook  

The following handbook has been compiled to assist with data collection relevant to the Wellbeing  Practitioner-Children and Young People (WP‐CYP) role for the South West Collaborative (Exeter University).  The handbook has been designed to support with the collection of both sessions clinical outcomes as well as tracking data. It provides an excellent resource and information about outcome measurement. For CWPs working in other areas of the country, please do not assume that you use exactly the same data management systems as there will be modified systems for different parts of the country. 

The handbook has been developed by the University of Exeter on behalf of the South West CYP-IAPT Collaborative, and also informed by the National WP-CYP Research and Evaluation Group. We are very grateful for the Exeter Group to share this excellent information about outcomes measurement in the CWP programme. 

Instructions to using all clinical outcome measurements listed has been informed by the Child Outcomes Research  Consortium (CORC) [[website|http://www.corc.uk.net/]]  

<<link-pdf "Data Handbook " "https://drive.google.com/file/d/1wd9Yqtm_ExNSdwliZKvpg4FY36Zn79FQ/view?usp=sharing">>

Here is a youtube clip showing the standard strange situation procedure. 

https://www.youtube.com/watch?v=QTsewNrHUHU

!!!!!!Source:Julian Childs and colleagues  (AFNCCF)  

!!!''Calculating recovery and reliable recovery''

''Recovery'' 
This uses the reliable change methodology (see [[Measuring reliable change]]).

 ''Recovery'' is shown if a young person moves from above a threshold or cut off to below a cut off. The size of change may be less than required for reliable  change. 

''Reliable recovery'' is shown if both recovery and reliable change criteria are met: 

#the young person scores above a threshold at Time 1 and below threshold at Time 2.  
#the young person shows improvement in scores greater than the reliable change criterion are considered to be ‘reliably improved’, 

For more information on calculating recovery please see the [[CORC website|https://www.corc.uk.net/information-hub/learning-from-corcs-analysis-of-data-from-child-mental-health-services-2011-2015/]]

!!!!!!Source:Julian Childs and colleagues  (AFNCCF)  

We are indebted to the Child Outcomes Research Consortium (CORC) for the information provided on this page. The CORC website can be found [[here|https://www.corc.uk.net/]]

!!!''Calculating reliable change''

''Reliable Change'' 
This calculates whether change in scores was greater than could likely be solely attributed to measurement error.

This involves calculating a reliable change criterion score. This is the amount of change that needs to occur between Time 1 and Time 2 for change to be more than chance variation due to  measurement error. This score will be different for each measure that is used. 

''Reliable improvement'' is shown if the young person shows improvement in scores greater than the reliable change criterion. 

''Reliable deterioration'' is shown if the young person shows reduction in scores greater than the reliable change criterion.

''No reliable change'' is shown if the young person does not show a change in score greater than the reliable change criterion in either direction. 



!!!''How it is calculated''

This formula calculates a size of difference between Time 1 and Time 2 for a particular sample of cases. For example, for goals measures, this is routinely recognised as being a difference of 2.45 on a ten point self report scale.  This is called the reliable change criterion. For different measures and for different samples, the reliable will be change criterion will be different.   
 
CORC provide a excell spreadsheet that includes the formula for calculating the reliable change criteria. This can be downloaded [[here|https://www.corc.uk.net/media/1495/corc-outcomes-spreadsheet_v1_mar17.xlsx]]. 

To calculate the criterion, you will need to be able to calculate the Cronbach's Alpha coefficient and the standard deviaiton for the sample at Time 1 as these need to be entered into the spreadsheet formula that is provided. 

The Healthy London Partnership has an excellent website with resources for schools. 

The toolkit has been developed in partnership with the Greater London Authority. Supporting children with their emotional wellbeing and mental health is a growing priority for health services and for education settings. We encourage leaders and staff, health care professionals and commissioners to use the toolkit for a wide range of information and guidance on how to promote emotional wellbeing and mental health within schools. 

https://www.healthylondon.org/resource/schools-mental-health-toolkit/

https://www.healthylondon.org/wp-content/uploads/2018/11/Mental-Health-Support-in-Schools-Mapping-Exercise-Report.pdf


https://www.healthylondon.org/wp-content/uploads/2018/11/Amplified-and-HLP-School-Insights-Report-2018.pdf

! Mental health and Wellbeing

 
Mental health can be defined as a state of well-being where individuals are able to: 

* realise their own potential
*cope with normal stresses of life
*work productively and contribute to their community.  

Mental health involves psychological and emotional well-being. The WHO defines health as //‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’//.

 
Well-being has been described as the state of being comfortable, healthy or happy.  It involves a cognitive sense of satisfaction with life. More than happiness and satisfaction it includes developing as a person, being fulfilled, resilience and having an active role in the community.

 
Mental health problems can result in a loss of wellbeing. Such problems may arise from individual vulnerabilities, life experiences including trauma or abuse, isolation, discrimination and adverse family circumstances. 

A person’s state of equilibrium or balance can be affected by these challenges leading to a reduced capacity to cope with stress, changes in how they relate to others and negatively affect well-being. During these times people may seek professional support (e.g. counselling, therapy and or medication) when their normal support systems or coping strategies no longer meet their current needs.

For children and young people, seen in mental health services, guidance on the data required by the MHSDS  can be found below. 

* [[How to enter data?|https://digital.nhs.uk/data-and-information/data-collections-and-data-sets/data-sets/mental-health-services-data-set]]
*[[Intermediate data set|https://digital.nhs.uk/data-and-information/data-collections-and-data-sets/data-sets/mental-health-services-data-set/how-do-i-submit-data-to-the-mental-health-services-data-set]]
* [[Specification and guidance|https://digital.nhs.uk/data-and-information/data-collections-and-data-sets/data-sets/mental-health-services-data-set/mental-health-services-data-set-specifications-and-guidance]]
*Medical record systems: These can be found by searching for 'free patient care software' on google

Articles from [[The Mix|https://www.themix.org.uk/get-support]]:

* [[Will I always have anxiety?|http://www.themix.org.uk/mental-health/anxiety-ocd-and-phobias/will-i-always-have-anxiety-6127.html]] 

* [[Exams and the pressure to do well|http://www.themix.org.uk/work-and-study/study-and-exam-tips/exams-and-the-pressure-to-do-well-23966.html]]

Our Young Champions really liked this video discussing mental health. 

Although the people in the video are older, you will see a lot of their difficulties started in adolescents. 

This video shows discusses experiences of different mental health problems with people from a variety of ethic backgrounds. Our Young Champions thought it was important the video discussed self-harm as they said young people know about it its a topic that needs addressing not ignoring. 

<html><iframe width="560" height="315" src="https://www.youtube.com/embed/watch?v=_y97VF5UJcc&list=PL3wHgZdQix8eugFvj7XiDPw1OHgLjFCO1" frameborder="0" allowfullscreen></html>

!!!This section of the guide provides additional information that may be of interest to both supervisors/teaching staff and trainee practitioners.

<<list-links "[tag[MoreContents]]">>

!!!!Source: Joe Hickey

!!What is motivational interviewing (MI)?

A style and method for having conversations about change, with young people, family members or staff (Miller & Rollnick, 1995).

*Motivation is a spectrum, rarely 0% or 100%
*All behaviour is motivated
*Young people have motivators to make a change, and to stay the same
*Ambivalence and mixed feelings about change is therefore the norm
*The approach encourages the practitioner to acknowledge ambivalence, rather than ignoring or denying it.
*Motivation varies over time
*Motivation is interpersonal and Influenced by system around the child
*The aim of MI is to create conversations around change.
*It is a directive approach but facilitative in style.
*Strategies to use across different stages of change which can be tracked using the transtheoretical model of behaviour change.

!! Practice points

__ Express empathy__ 

* Change is hard!
* Use [[Active Listening]]

__ Develop discrepancy__  

*Gently encourage awareness of the  consequences of no change 
*Highlight differences between current behaviour and goals

__ Support self-efficacy__ 

*CYP has resources to effect change
*Young person should present the arguments for change
__Roll with resistance:__ 

* Avoid argument and move topic when needed 
*Acknowledge disagreement openly
* Curiosity, not persuasion
* Resistance is valuable information


!!Applying motivational techniques to the cycle of change (TTM)

See [[The Cycle of Change]]

__Precontemplation__

Aim to highlight discrepancies between current and desired situations.

__Contemplation__

Explore ambivalence and mixed feelings.
Work through potential obstacles to change.

__Preparation__

Plan targets for realistic change, setting SMART goals.
Develop and use the young person’s network to support change.

__Action__

Support and review progress against goals. 

__Maintenance__

!!Video examples of MI

There are a number of useful examples of MI on Youtube. An example can be seen of using MI principles in an interview with a young person [[here|https://www.youtube.com/watch?v=ivPlhCD0pFY]]

!!Links with other pages

There are a number of pages around [[Engagement]] which are highly related to this topic.

This is a very helpful five minute animation from the NSPCC which sets out a series of key ideas about child development and the negative impact of stress and abuse on the developing brain. 


<html><iframe width="560" height="315" src="https://www.youtube.com/embed/hMyDFYSkZSU" frameborder="0" allowfullscreen></html>

!!!!Source: [[BBC iPlayer|https://www.bbc.co.uk/]]
This video entitled [[Nadiya: Anxiety and Me|https://www.bbc.co.uk/iplayer/episode/m00053fy/nadiya-anxiety-and-me]] is on BBC iplayer (as of 20/05/2019). Nadiya (best known as the winner of The Great British Bake Off, 2015) suffers from extreme anxiety and debilitating panic attacks, which she’s had since childhood. However, she’s never had a proper diagnosis. 

She speaks bravely and honestly about what it’s like to live with anxiety and panic attacks.
Raw, open and honest, this documentary provides an extremely good, very balanced and helpful perspective on the on anxiety disorders, shining a light and starting a debate about on an increasingly pressing issue. 

In this one-off documentary for BBC One, Nadiya sets out to find the cause of her anxiety, exploring the most effective, available treatments, whilst undergoing a course of cognitive behaviour therapy, in the hope of managing her anxiety. 

Meeting fellow sufferers Nadiya talks to Laura Bartley about her experiences of treating her anxiety with medication, visits a school in Brighton to see how they are tackling anxiety in their students, and goes online to meet Barry ~McDonagh, who offers support and therapy to an online community of around 250,000. At Kings College London, Nadiya hopes groundbreaking research into the role of genetics and environment on anxiety disorders can give her the answers she needs. 

PLEASE NOTE: This is an hour long documentary and is currently only available on BBC iPlayer. (Registration is free) once this documentary is removed off of BBC iPlayer a secondary source will aim to be found.

This is a web site set up by the Midlands Collaborative for the CWP national programme and enables communication between the collaboratives. 

https://3.basecamp.com/3393815/reports/progress

-------
This report was prepared with the support of all seven universities and partnership organisations involved in this national programme who have generously shared their data in order to obtain a national overview.This has been a collaborative effort and would not have been possible without those who contributed their time, effort and data. Please see the report for a full list of those who have contributed.

-------

Please find linked below the national report concerning the outcomes of CWP's thus far across the country. The purpose of this report is to update commissioners about the outcomes of the CWP's work nationally. 

<<link-pdf "CWP National Outcomes Report 2019" "https://drive.google.com/file/d/1FIciZj9O1l5ny-PLFhs-CPWxfsV_hLeS/view?usp=sharing">>

!!!''Purpose''
This paper sets out the headline plan, agreements in principle and process for the establishment of the new CYP PWP role. This role is being developed and delivered by Higher Education Institutes (HEIs) as part of the CYP IAPT programme in conjunction with CYP MH experts and will be funded by Health Education England (HEE). 

!!!''Five Year Forward View''
The Children and Young People’s Improving Access to Psychological Therapies programme (CYP IAPT) is a service transformation programme delivered by Health Education England in partnership with NHS England that aims to improve CYP mental health services in England. CYP IAPT does not create standalone services, but works to transform existing services providing mental health care to children and young people. “Implementing the Five Year Forward View for Mental Health” (NHS England, July 2016) sets out the need for significant expansion in access to high-quality mental health care for children and young people and delivering increased access to mental health services will require a significant expansion in the workforce. 

!!!''More therapists''
By 2020, at least 1,700 more therapists will be needed to meet the expected demand. In order to meet this demand the HEE are commissioning training for a new post that draws on the experience of the highly successful adult IAPT PWP programme, to create a new cohort of psychological practitioners capable of delivering high-quality, evidence-based interventions for mild to moderate difficulties in a way that can be efficiently brought to scale. We propose to make more effective use of the large cohorts of very able graduates in psychology and a range of other disciplines to deliver and support, under supervision, brief, outcome-focused evidence-based interventions for children and young people experiencing mental health difficulties. The PWP programme will allow us to attract graduates into CYP MH services, creating routes and a skills base that can be applied to further training in a variety of registered professional roles with children. 

!!!''Part of CYP-IAPT''
The programme will benefit from being integrated into existing CYP mental health services and the CYP IAPT programme, which brings a valuable organisational infrastructure for sustainable models of teaching, supervision and clinical governance. 

!!!''Key Principles''
* Representatives on the steering group should include HEE, representatives of all participating CYP IAPT Learning Collaboratives (per HEI for LaSE) providing training and independent clinical advisors. 
* HEE expects the final curriculum to also be agreed by the CYP IAPT overarching curriculum group established by NHS England
* PWP Supervision training should commence in February/March 2017
* PWP trainee courses should commence in April 2017 and run over 12 months

!!!''Evaluation of the CWP Programme''
* Alongside the education commissions HEE will commission an evaluation of the programme (TBC). This will need to be based on the use and application of the 6 HEE quality indicators.  Collaboratives will be required to report to HEE on stakeholder engagement, including all feedback received from HEIs, providers and students to support necessary consultation work running in parallel with the set up phase

!!!''Starting arrangements for the CWP Programme''
* In order to establish demand HEE will initially fund 30 trainees per collaborative. A second cohort may be commissioned in FY 2017/18 upon review of the programme and early evaluation
* Salary support will be set at a maximum of mid-point band 4, funded by HEE for the year of training (this will include the relevant LW where applicable). Trainees are expected to be employed at band 5 once qualified
* HEE will ensure the CYP IAPT National Accreditation Council (NAC), led by HEE, will take forward discussions around necessary accreditation processes and align the programme with an existing national accrediting organisation. 
* HEE will require assurance from the collaboratives on the suitability/ability of services to host and support trainees over the training year - this will be agreed and overseen by the steering group to provide assurance to HEE and other stakeholders that services are satisfactorily equipped to ensure trainees and risks around attrition, trainee isolation and supervision are mitigated.

!!!''Sustainability'' 
Plans from each collaborative delivering the training will be required. These will need to start to put in place arrangements for the funding of these courses to be picked up upon the cessation of central funding. Key to these plans will be a focus on ensuring trainees are able to be employed once the training year is complete. Plans will be signed off and monitored by the steering group

!!!''Supporting services''
*Collaboratives will be required to continually monitor services in their ability to support trainees and any issues will need to be flagged to HEE. HEE will reserve the right to withdraw funding for individuals part way through the course if issues are identified with particular providers/services that do not comply with the HEE Quality Framework, this would not be done without full discussion and negotiation with the collaborative. 
*HEE will pump prime the system to enable the successful establishment of the role. This will be locally determined but will need to be agreed by HEE. This may cover things such as a practice educator role to maintain close collaboration between services and HEIs, training for service leads and commissioners and in service work to support transformation to accommodate trainees
*It is anticipated that the programme will be funded for three years but as with all training programmes this will be subject to annual review - further funding will, to some extent, be dependent upon the outcome of the evaluation and will be agreed by the steering group, HEE Executive and the Department of Health
*This role is expected to  contribute to the 1700 new CYP MH therapists as set out in the 5YF implementation plan and provide another route in to becoming a CYP MH workforce
*Collaboratives will be expected to monitor first destination data and ideally plans will be put in place to monitor their progression after the year of training, this may be done in conjunction with the evaluation but collaboratives will retain a significant role in this. 

!!!!!Source: Peter Fuggle 
!!Nine components of guided self help.
These are offered as a general steer about what is meant by guided self help. It should not be treated too rigidly. The intention is to provide a framework so that practitioners can apply this to their work with children, young people and parents. If you are not doing any of these activities, then it would be good to think this through with your supervisor. 

It may not be necessary to do all nine steps for each case. The practitioner should seek feedback at each stage. Outcome monitoring needs to take place throughout. 
#[[Engagement]] (getting to know each other) 
#[[Making sense of things]] (formulation)
#[[Deciding on what you want to change]] (setting goals)
#[[Learning about the problem]] (psycho-education) 
#[[Trying out new things]] (doing experiments)
#[[Problem Solving]] (things rarely go to plan) 
#[[Outcomes]] (Learning from new experiences) 
#[[Building a back up team]] (not doing it alone) 
#[[Agreeing a future plan]] (making a self management plan) 
Self management has many overlaps with guided self help. It could be considered that self management is supported by promoting various forms of self help. 

 <<link-pdf "Self-managment vs. self-help" "https://drive.google.com/open?id=0B1hDLHd8syMsSm9EeTdXRUc3ZlE">>

!!Linked pages
[[What is a 'low intensity' intervention?]]

''[[Therapy comics|https://www.therapycomics.com/]]'' provides high-quality, illustrated materials for evidence-based interventions.  
This allows a universal resource to be available for therapists to use with anyone who struggles with typical text-based materials. 

The materials on this site have been designed for Psychological Wellbeing Practitioners, High Intensity Therapists and CBT therapists working in IAPT services in England.

Please explore the [[website|https://www.therapycomics.com/]] for a plethora of non-text based materials, see below for comics on the following subjects:  

<<link-pdf "Panic" "https://docs.wixstatic.com/ugd/133724_43705f61879745be89ea5eacf2290dc8.pdf">>

<<link-pdf "Sleep" "https://docs.wixstatic.com/ugd/133724_6942228618894d6bb067b537732e0448.pdf">>

<<link-pdf "Progressive Relaxation" "https://docs.wixstatic.com/ugd/133724_187827f942b4475bb55796b9f1a92a0e.pdf">>

Notes on meeting between Peter Fuggle and Matt Constantinou 

3rd Jan 2019

!!!''Case identification''   

Importance of having a clear identifier system for the dataset. 

Three levels of identifier. 

''Level 1. Master Analyzer ID''

Agreed that it would benefit form having a system where a National Analyzer ID is assigned to the case upon entry to the data set. 

These would have divided by region with tow initials at the beginning for the region followed by a code number. 

Aim would be to allocate 10,000 cases to each region. 
Matt to test capacity of system to support this size of dataset. 

Example of Master ID 

*SE000001

*SE000002

*SW000001

''Level 2. Project unique identifier'' 

Each service will have a patient ID system. Services using POD will generate a patient ID.  This is called a Project unique identifier

''Level 3'. Site identifier''

This will be a site name and will be a string variable. 
String (name)


!!!''Adding data: some tips''  

''1. New data must be pasted in as 'values'.'' 

Numeric values will aligned right in the column. 

Strings values will be aligned left in the column to allow for identification of errors of variables being entered as strings rather than numeric. 


''2. Missing values''
 
Key to ensure that white space in a cell is not automatically assumed to be an empty space. Guidance is in the notes of the analyser about this.  


''3. Date variables'' 
Pasting columns of data as values leads to dates being converted and need to convert them back. Notes in the analyzer about this. 

''4. Making the report''  

To make the executive report, the word document and the excell spreadsheet just need to be in the same folder in order for the report to select data form the spreadsheet. 

We agreed that:

# that the report would not include any comparison variables of data between regions. 
#that the data selected would be in a box format in order to avoid disruption of the report. 

* Over the first year of training,  c CWPs will be expected to complete a low intensity intervention for ''30 cases''
* This can include group work/one off workshops or coffee mornings 
* ''10 cases'' must have been a course of GSH across a range of presenting problems (i.e. depression/anxiety/common behavioural problems)

Information on this page was taken from [[CORC|https://www.corc.uk.net/]]. these measures were developed by Scott D Miller 

---

The Outcome Rating Scale (ORS) and Child Outcome Rating Scale (CORS) are measures that can be used to monitor children’s, young people and their families or carers feedback on progress.

The ORS is a simple, four-item session-by-session measure designed to assess areas of life functioning known to change as a result of therapeutic intervention. These include: symptom distress, interpersonal well-being, social role, and overall well-being. The ORS translates these four dimensions of functioning into four visual analogue scales which are l0cm lines, with instructions to place a mark on each line with low estimate to the left and high to the right. The ORS is designed to be accessible to a child with a 13-year-old’s reading level, making it feasible for adolescents and adults.

The CORS was developed for children age 6–12. It has the same format as the ORS but with more child friendly language and smiley and frowny faces to facilitate the child’s understanding when completing the scales (Duncan et al., 2003).

For children 5 or under there is also the Young Child Outcome Rating Scale (YCORS), which has no psychometric properties, but can be a useful way of engaging young children regarding their assessment of how they are doing.


Users may also obtain the measures in English and languages other than English at [[www.scottdmiller.com|https://scott-d-miller-ph-d.myshopify.com/collections/performance-metrics]]

This is a tag tiddler. 

<<list-links "[tag[Outcome measures]]">>

!!!Why is outcome monitoring important?
*Outcome monitoring improves the effectiveness of mental health interventions 
*Potential to improve the long-term trajectory of young people e.g. less suicidality if they respond to CBT in their youth
!!!Evidence-based practice and science 
*One of the principles of IAPT 
*Mental health measures are a simple tool which are effective in improving mental health treatments to improve lives and save lives. 
*Psychometric properties includes the concepts of reliability and validity
*What is reliability? Consistency in scores between weeks if not receiving information 
!!!Measurement in health services 
*Routine in more physical practice i.e. temperature but not so common in mental health 
*Self-report measures help us track and measure changes in mental health
*Using the measure at a number of time points i.e. beginning, middle and end of treatment is a routine outcome measurement (ROMs). 
*RCADS used to measure depressive symptoms 
*Depression is a complex construct within the psychological literature
!!!Key Points 
*If someone is scoring high on measures, it doesn't necessarily indicate a diagnosis
*Symptoms may be high, which suggests the young person isn't coping well and we would like to see those symptoms to come down before the end of treatment 
*Diagnosis not important, does the measure capture what is important to track the effectiveness of my intervention as a practitioner 
*Research suggests ROMs keep 'off track' cases 'on track' 
!!!Pros
*What are the benefits of outcome oriented work? Baseline to work from; Avoids subjectivity; Helps to keep us honest; Differences in perspectives from parents and young people
!!!Cons
*What are the negatives of outcome oriented work? Scoring doesn't reflex what they are saying; Using judgement when there is discrepancies; Under-reporting over over-reporting for acceptability


!!!Goals
*Goal Based Outcome Measure- are you measuring the right thing? If your goal is the top of the hierarchy for a short term intervention it will seem impossible to the young person. 
*Make sure your goal is achievable, measureable and properly graded. Useful to know if the intervention hasn't worked with this case to be able to build on long term goals for this young person. 
!!!What measures to use?
*Core health outcomes are used at the beginning and the end of intervention
*RCADS primary measure - has both parent and child measurement but the child report should be a preference 
*Using the RCADS on POD, you will get a raw score on POD, you can then take the raw score and compare it to the child's age and gender to discover if the score is in the high or low range 
*Idea is that high score will be seen at the beginning of the intervention which will decrease to low by the end of the intervention 
*RCADS as T-score used as part on initial assessments. Subtests listed around the bottom and we can see which subscales score higher than others. 
*Graphs easy to feedback to clients using POD
*Experience of service questionnaire- CHI-ESQ  
!!!ROM Research 
*Emphasis on regular outcome monitoring in the clinician version of Cathy Creswell's book 
*Lambert Meta-analysis- 2,500 participants in merged study. Interesting as this approach of using outcome monitoring are useful for cases that are 'off track'. When clinicians know there hasn't been a change, research highlights this is the most important thing
*If this is the case, check in with the young person to see if there is anything you can be doing differently 
*ROM feedback improves outcomes for children and adolescents 

[img[laptop typing.jpg]]

At its core, ''Outcomes'' focus on how both the client and the practitioner monitor whether new ideas and ways of behaving are helping the problem. This can be done in a wide variety of ways, not least by asking the parent or young person as part of routine check-ins and general informal conversation. However there are also ways of trying to measure this in a more systematic way. 

As well as measuring outcomes for the child, young person or parent, outcomes can also be used to evaluate how well a service is working by summarising outcomes over a particular time period. They can also be used to evaluate the effectiveness of the CWP national programme. An example of a report based on national outcomes can be found in [[National CWP Outcomes Report 2019]] For national reporting three key measures are used namely the RCADS, SDQ and Goals. These are sometimes called core measures that will be covered in training but additional measures may be used by some services according to their local protocols. 


For the EMHP/CWP programme it is proposed that a [[core set of measures|Core Outcome Measures & Feedback Tools]] are used to evaluate the benefit of the interventions for the clients. These are all taken from the CYP-IAPT basic set of measures. 

<<link-pdf "Outcomes Framework for London and the South East" "https://drive.google.com/open?id=19dWlwSybIYhh8mLqGUMd62JHECbrkFF7rP-YjMD7xlU">>

Pages about outcomes have been organised into sections on outcomes practice; outcomes measures; technical bits and outcome studies. These are listed out below. 

[[Outcomes practice]]

[[Outcome measures]]

[[Outcomes - technical bits]]

[[Outcomes research]]

This is a tag tiddler which lists out pages which are more to do with the technical aspects of outcomes work. 

<<list-links "[tag[Outcomes - technical bits]]">>

<<link-pdf "Cohort 1 Outcomes Presentation" "https://drive.google.com/open?id=10oQeu7ZdKZQDZErvrYjwF6T2HBXkP5XX">>

<<link-pdf "Cohort 1 Outcomes Report" "https://drive.google.com/open?id=125hUtp51D_x1GaQn1w7bFvxXQY_fsWht">>

!!Key Findings 
__What proportion of cases are included in the sample? __

The percentage for completion of time 2 data was: 

* 90% for GBOs
* 68% for SDQ 
* 75% for RCADS
__
What is the severity of the group? __

SDQ

At Time 1, 79% out of 112 cases were in the clinical range on any subscale. Post treatment this was reduced to 50%. 

RCADS

At Time 1, 67% out of 236 cases were in the clinical range on any subscale. Post treatment this was reduced to 38%.

__Does the data indicate CWP is effective?__

SDQ

* Almost half (44%) recovered
* Large effect size of 0.82 
* 38% of cases showed reliable improvement in IMPACT


RCADS

*50% of clients recovered 
*Medium effect size 0.69
*33% showed reliable improvement on Total Anxiety & Depression

GOALS 

*Highly significant increase with an effect size of 2.10.
*77% of cases achieved reliable improvement

__How did clients experience CWP?__

Session Feedback

96% of sessions were rated in the top 25% of the satisfaction scale for SFQ  (16 or above) and 78% for the SRS (36 or above). 

ESQ 

Young person:
Treated well (99%), Comfortable Facilities (63%)

Parent:
Good help (98%), Convenient Appointment (84%)

<<list-links "[tag[Outcomes practice]]">>

This  page lists pages related to outcomes evaluation relevant to the EMHS programme. 

<<list-links "[tag[Outcomes research]]">>

!!''Introduction''
*This framework is designed as a guide as what might be useful content to cover in a course of guided self help (GSH) for anxiety with adolescents. 
*Services should feel free to try this out and adjust accordingly. 
*Material to support these sessions is available in the form of an adapted adult PWP guided self-help booklet on anxiety. 
*Services should experiment with materials and resources available to them and utilise websites such as ‘get self-help’ or ‘mind ed’ and other self-help books / literature. We encourage services to develop their own booklets. 
*Although GSH is a mixture of shorter and longer sessions; the modality these sessions take place in (e.g. phone/Skype/face to face) will likely differ between services.
!!''Types of sessions''
*Longer sessions are 45 mins in length and are more likely to be face to face.
*Shorter sessions / check-ins are between 15-30 mins in length and are more likely to be over the phone. 
*We have suggested 8 sessions to be able to cover the material. There is still the option of doing a follow-up after this at around a month’s time, which we think will be important. 
*After the assessment, the YP is given the relevant material to read / look at in advance of session 1. 
!!!''General Plan of sessions'' 
**8 sessions with adolescents, with parent involvement in session 1 and 4  
**4 face to face sessions (30-45mins)
**4 telephone contacts (15mins)
**Appropriate guided self help material will be dependent on the main problem 
!!!!''Session 1''
*listening and validating, introduction to guided self help (GSH), assessing risk, completion of baseline outcome measures (RCADS), feedback to parents 
*EMHPs will have training on GSH principles, confidentiality and risk, introducing ROMs
*Understanding anxiety and how it impact young people 
*Decide on which GSH booklet to use based on formulation (using supervision)
!!!!''Session 2''
*Psychoeducation, formulation, recommend self-help material, monitoring task
*Fight/flight, normalisation, coping vs. safety behaviours  
*Maintenance cycle and what is keeping things going (using hot cross bun models in GSH booklets)
*Coping behaviours i.e. calm breathing/relaxation (if it fits with the presentation)
*Use booklets to facilitate psychoeducation conversation 
!!!!''Sessions 3-7''
*Work guided by formulation. The focus could be exposure, worry management, and or panic management. 
*Feedback to parent session 3 or 4. 
*Dependent on what the young person wants to focus on 
!!!!''Session 8''
*Review, relapse prevention and feedback to parents 

<<link-pdf "An overview of the framework" "https://drive.google.com/open?id=0B-tACu2wi4-4SG0zRmZ0ZGVzWTg">>

<html><iframe width="560" height="315" src="https://www.youtube.com/embed/k96-DISPP88" frameborder="0" allowfullscreen></html>

POD is the online outcome monitoring system used on the CWP programme. Staff or clients can log in and complete measures using any web enabled device. 

After completing a measure, scores are calculated instantly and you can view these online with a child, young person or parent within a session.

On the CWP programme POD is used due to [[The importance of feedback]]

POD can be accessed through the following link: https://pod-database.org/db3/login/

The POD manual can be found here: 

<<link-pdf "POD Manual" "https://pod-database.org/info/">>

This [[guide|https://www.mentalhealth.org.uk/publications/make-it-count-guide-for-parents-and-carers]] from The Mental Health Foundation is for parents and carers to help children understand, protect and sustain their mental health. It contains lots of useful links and resources that you may wish to share with parents carers. 

''Treatment Principles'' 
You should have already learnt a variety of things about the child, their family environment and previous parenting work from the assessment. 
!!!Order of skills introduced to parents 
#Positive reinforcement (play and rewards) for limit setting - need basis of positive behaviours to try to help things so when the limit setting happens its different from the positive relationship you have established 
**Can either present the 'Attention Table;' in the table or through talked through examples
**Parent Trap also known as Attentional Trap
#Praise and Rewards for appropriate behaviours which are associated with the goals of the parents 
**Gets parents to notice the good things again 
**Different types of rewards (social/tangible) and praise- specific praise helps your child know what behaviour you are happy about 
**Special choices can be rewarding and effective for an independent oppositional child
**Be genuine about your praise and ensure it fits your personality and family environment 
**Consistent when you notice the positive behaviour but don't be consistent when using rewards and praise 
**Pitfalls of reward charts- used for too long or used for too many behaviours
#Being Specific 
**Clarify the concerns, understand what is going on in the moment (ABC chart), need to be so clear what the behaviour is even if you aren't in the room you know exactly what it is. Then what would be the alternative so what behaviour they would like to see and the steps involved to achieve this (Praise Points
#Ignoring 
**Highlight to parents that ignoring is difficult and to expect behaviour to get worse before it gets better. If you are consistent with the response the behaviour should go away. Become comfortable with the behaviours at home first before ignoring in public. 
**What are the good behaviours to ignore? Shouting and crying as misbehaviour, throwing things
#Time-Out 
**Don't discuss time out after it has happened or force the child to apologise for the behaviour that resulted in a time out 
**Child needs to calm down before coming out of time out otherwise it won't be effective 
**Introduced last as often its not needed anymore
Skills 
!!!Attending 
*Really important to develop a relationship through play 
*It is important to teach parents key things to avoid during play to keep it child-centred, use examples so they understand why questioning isn't useful 
*Interest and empathy needs to be genuine i.e. turn phone off and keep the attention fully on the child 
*Highlight 'If it feels awkward, you're probably doing it right' as any new activity is expected to feel strange in the beginning 
*Suggested to use 10 minutes a day, rather than continuous throughout the day
*From roll play- attending can be boring for parents which is another reason for the short timeframe. Important to remember for the child it isn't a boring experience
*Name processes the child is going through to help them problem solve, this is true even if the child doesn't want to play or is bored or playing
!!!Instructions and Commands 
*Way we give instructions have a massive effect on how effective they are

#Positive reinforcement (play and rewards) for limit setting - need basis of positive behaviours to try to help things so when the limit setting happens its different from the positive relationship you have established 
**Can either present the 'Attention Table;' in the table or through talked through examples
**Parent Trap also known as Attentional Trap
#Praise and Rewards for appropriate behaviours which are associated with the goals of the parents 
**Gets parents to notice the good things again 
**Different types of rewards (social/tangible) and praise- specific praise helps your child know what behaviour you are happy about 
**Special choices can be rewarding and effective for an independent oppositional child
**Be genuine about your praise and ensure it fits your personality and family environment 
**Consistent when you notice the positive behaviour but don't be consistent when using rewards and praise 
**Pitfalls of reward charts- used for too long or used for too many behaviours
#Being Specific 
**Clarify the concerns, understand what is going on in the moment (ABC chart), need to be so clear what the behaviour is even if you aren't in the room you know exactly what it is. Then what would be the alternative so what behaviour they would like to see and the steps involved to achieve this (Praise Points)
#Ignoring 
**Highlight to parents that ignoring is difficult and to expect behaviour to get worse before it gets better. If you are consistent with the response the behaviour should go away. Become comfortable with the behaviours at home first before ignoring in public. 
**What are the good behaviours to ignore? Shouting and crying as misbehaviour, throwing things
#Time Out 
**Don't discuss time out after it has happened or force the child to apologise for the behaviour that resulted in a time out 
**Child needs to calm down before coming out of time out otherwise it won't be effective 
**Introduced last as often its not needed anymore

!!!!These handouts are not the core handouts which are taught as part of the Manchester model.

!!!@@color(purple):Handouts:@@
<<link-pdf "All handouts" "https://drive.google.com/open?id=1ingyS79eCdTIY4-yZd71zHKlmpCt_Qip">>

All handouts have been reviewed by and changed in line with our Parents Panel. 

This is a tag tiddler

<<list-links "[tag[Parents]]">>

!!!''Participation''

<<list-links "[tag[Participation]]">> 

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