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Documents":"\"c931cf13e30c2149f5a38fe180783367\"","How to Conduct Assessments":"\"2242450d01b75d7951df260691f2bfc5\"","How to Give Feedback":"\"094111132f80ccbbea25084302067ce0\"","How to Print":"\"c7b9d05fa1246b9faa9690c0968bb7ce\"","How to Use POD":"\"904d0ce198cfa3be1ad6255551079883\"","How to Use and Understand 'Tags'":"\"faf077d4e80fb8df4db797192f71baec\"","How to help young people manage exam stress":"\"cea1346f21cfadd00094128b8ea5feef\"","How to login":"\"2b1a066b48f325aee4432d3733dac88c\"","IPT-A":"\"d7a1c453027cf10120d593c5f16cfaa6\"","Including Parents in the Assessment Process":"\"8a4d31270e009c8b9a9cd9b9876f54bf\"","Inclusion":"\"037c5449d5aa490a840b9af4dc30ffb2\"","Information for schools":"\"a435016ceb055593852799513120d5b8\"","Initial contact checklist":"\"7003ef859170046089e370fef6ac6746\"","Internet Safety Toolkit":"\"18a9cece503e211a3d4c2e8fc6fb4ff4\"","Intersectionality":"\"acccf4e3f17dc3b4674a4cbf0dfc56da\"","Intervention for Anxiety: key practice 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referral":"\"498a01099ed6bf737d25f2fdee566f1f\"","Measuring EMHP Outcomes in South West England":"\"fecab464cad4e43fb812541ff9387946\"","Measuring attachment: the Strange situation":"\"9f4d56ecde51f83efadfc38d567c886d\"","Measuring recovery and reliable recovery":"\"c17baa89a6e85a7bb3a6be010c8bb9ac\"","Measuring reliable change":"\"83ae01b62278051f234322927d548c82\"","Measuring wellbeing in schools (19)":"\"ca26e3d1fc0c59e53469264c8c691ffb\"","Meeting children and young people:how to: (5)":"\"2769241a2cec696298c6eec75cd3a922\"","Mental Health Toolkit for schools":"\"3a5db5be99c7dd83289d105a184715fb\"","Mental Health and Wellbeing":"\"a29eea2b5bcbccfebecd72c314d76b4e\"","Mental Health in schools trailblazers in London":"\"293a57556a53874ea4d83c7435b587f1\"","Mental health services dataset (MHSDS)":"\"54bd72d9bc8c29dcdac18f82fcd5aa7c\"","Mental health: in our own words":"\"91fb4306c2530cdc067621dd08ac429e\"","Mentalizing":"\"8ff1077cbd0e98f792d006eb8c6e41b5\"","Methods of 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managing trauma (51)":"\"4302cee6d13d677c3966ff188bb86d87\"","Recognising diversity":"\"980e3b50d79d77ee2b1317cccb566c1f\"","Recognising the variability between schools":"\"cf9e5b694d0fba2034eeea76590c093c\"","Recruitment":"\"88db3ef062a4ae38f3edf0d0526badad\"","Red Riding Hood: Flight or Fight":"\"42d3e923993bcf0f3c9f08650746f65e\"","Referral Pathways":"\"0ed1c93eac0bb80ffc31e5327dd2cfaa\"","Referring to CAMHS (72)":"\"18687eb19f07e1cb4673400b9fc64d2d\"","Reflections on learning on the course (19)":"\"03281325540642da6c4ab5c18a1f5b66\"","Relaxation techniques":"\"10a5d0defca716ee23f58ba2f7ad8f9e\"","Resources":"\"0c8280fd6d14e9835d19398944ef6c8e\"","Review":"\"cd9f4d7d9f8a4d0bb12020795a3ef960\"","Review 2":"\"8db107244ef7a8b519bc676cc37c1ad2\"","Reviewing competencies and measuring progress (38)":"\"b2fd5c1d4e26f74d571714a725304a47\"","Reviewing goals":"\"228b0e10e348954b96db371059d7db90\"","Reviewing life activities and interests":"\"2bce2e24b1995a6d61561d8d457071e0\"","Risk and Safety Assessment":"\"743e9db563533674f37a62eaf640c630\"","Role play discussion of parent involvement":"\"cc412b33f59e8e4244736eeab80ee211\"","Routines Around the Home.png":"\"504477d06c5ad91f11f22e606d5a61fa\"","Running a Coffee Morning for Parents: How To":"\"d0bbb25202f9f0ba64112d429d7b1fed\"","Running psychoeducation groups (43/44)":"\"aabe483a8db2ba4ccda87c83f1970d81\"","Runnning workshops: what is mental health?":"\"9925ab03cb380069fc349336d0c87bff\"","SAPERE: PHILOSOPHY FOR CHILDREN, COLLEGES AND COMMUNITIES:":"\"a6c41423db6e4d974d126971d4a90694\"","SDQ":"\"8f1c2e80edc487deecd9f330e18b99f9\"","SENCOs as teachers on the course":"\"7044ef516446a0540c0bb4c49af6d2c8\"","SMART Goals":"\"46b97204726bee1138bedbefe1dc86ea\"","SWAT analysis of Schools programme":"\"c4c5408b8e0c7ba0fd09fba56c35dfe0\"","Safeguarding":"\"a7e043fdd5219875256457d3d7a143da\"","Safeguarding guidance: London Child Protection Procedures":"\"b3fa131500d282ef017151ea4036c851\"","Safeguarding/ Risk Assessment for Remote Working":"\"c76b4be9176c313eb925f261bc19e955\"","Safeguarding: Being a safe practitioner":"\"e7eb43ec912581051b773c75999c81bb\"","Safety Planning":"\"e0801dd876f56cf0f45ed8bf30b12587\"","School Exclusion: What's it Like for Parents and Children":"\"c41701eb30ea1a5283baedcfd86481ec\"","Self Care":"\"1ff43ef2fd98818ee903e985b7c33993\"","Self Help Materials":"\"e3c535bca3761ca720d1c14ccbbe3047\"","Self Help Materials for Adolescent Anxiety":"\"31cf732474a14153ad31f17443dcc9ba\"","Self Help Materials for Low Mood":"\"3d4cce59c2359d5b21b488cf0e29c144\"","Self Help Materials: Apps":"\"586b49f570c088f9a0183a7c769f4320\"","Self Help Materials: Books":"\"de753082b378ead71b180b7b2a726dd7\"","Self Help Materials: Videos":"\"939013be6a6d7647af522226afd53b79\"","Self Help Materials: Websites":"\"4e463161344ecea28c1e2f2bacb9f138\"","Self Help materials: Online Counselling/Therapy":"\"8362820f9c6fc5a5f96333ff9bf91b2a\"","Self-care for practitioners":"\"60664f018f57bedb883618161a72e400\"","Separation anxiety in a toddler":"\"5d15273fd9bda8fae8f782cb558c67cb\"","Session 0 for Adolescents: General Assessment":"\"ad5dc91019046726e75b788e1913348a\"","Session 0 for Younger Children: General Assessment":"\"be0707e4964beddfcb268abf930aba31\"","Session 1 - Overcoming Child Anxiety":"\"c290007d91180687f2af60cc44f2bf3b\"","Session 1: Guided Self Help for Behaviour Problems":"\"16a7d5fbf17e26c9323cb23dc9d850de\"","Session 1: Manchester Parent Training":"\"57653f7c98dcce8fe32b533a2b8e69f6\"","Session 1: Overcoming Adolescent Anxiety":"\"ca63e24299d2a9c9368d2bab48a533a0\"","Session 1: Overcoming Low Mood":"\"d815ab73e179f3f8df3959ffea0952d6\"","Session 2 - Overcoming Child Anxiety":"\"3348d585d13fb9128b55576a4d14ad2f\"","Session 2: Guided Self Help for Behaviour Problems":"\"ef6a477ffb280cd447754e9ed86a0b4e\"","Session 2: Manchester Parent Training":"\"1c095f3bdabb89f63797d42ddabdf542\"","Session 2: Overcoming Adolescent Anxiety":"\"9b38b28bfa4540f06d603b27b249cd1b\"","Session 2: Overcoming Low Mood":"\"dd91ee3d0e09001a9d4c9fe5bd393cbe\"","Session 3 - Overcoming Child Anxiety":"\"0c874c689169c30e5b78ec06b4974fb0\"","Session 3: Guided Self Help for Behaviour Problems":"\"a4086646773e30e417b8b4c6b958ac93\"","Session 3: Manchester Parent Training":"\"0e2f422ff0a3021e97c1b3751e408c26\"","Session 3: Overcoming Adolescent Anxiety":"\"c5309f47f07451776cdc033efbaaad4a\"","Session 3: Overcoming Low Mood":"\"398715a6bd57e65a21ab484335a773c1\"","Session 4,5,6 - Overcoming Child Anxiety":"\"c12f58dd8b6abb03bd4ace45af3999c6\"","Session 4-6: Overcoming Adolescent Anxiety":"\"dd4e1c7f4fb7fe6df0b694fde975dbf7\"","Session 4: Guided Self Help for Behaviour Problems":"\"ddd4d0d059dadd43f491789b50f927db\"","Session 4: Manchester Parent Training":"\"aaf50d3b16186b8969078b739fd9158e\"","Session 4: Overcoming Low Mood":"\"76700023c25664b02e3cf7d80c95bd34\"","Session 5: Guided Self Help for Behaviour 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during the pandemic":"\"a4c40cd5c0b063a42e713fa9e58db821\"","SiteIcon":"\"9fa161025c05d5cc444273b7d09e2352\"","Sleep disturbance":"\"3ccd4e2e877899a8d97e15da364ca96f\"","Snags":"\"89ca04c8f8ff99050c523227f986ea29\"","Social GGRRAAACCEEESSS.png":"\"d30dda51bdcd1c941b3eae88d18c211d\"","Social learning theory":"\"40b479526111c0ee01af2fe03a2e6e4e\"","Social media: risks and benefits in a school setting (67/68)":"\"33af80295524c93686a8c0bc3d584a7e\"","Social skills groups for young people":"\"8e7b4d9f3b1f09bfcb30ce07e817b1f0\"","Socratic technique":"\"6e1898a72a2e0aa75343473d3dc48a43\"","Spence Child Anxiety Scale":"\"ce91dbb8a99b3f370ab1bca29131bfe1\"","Spoon/Fork Theory to Explain Mental Health":"\"0ab95a1dafedb158e655d9efca2519c7\"","Staffing":"\"f6f9d241f1cb98af5ac9a7351d54ad67\"","Study Skills":"\"66b0787018d4648b9db10cbfa7a2365d\"","Summarising":"\"e3e0210326a5ec56b5eeaa33eb3cd94a\"","Superkids: breaking away from 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[img width=150 [SiteIcon]]<br/>Education Mental Health Practitioner

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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: #ffffff;
float: left;
width: 2em;
height: 2em;
margin-right: 4px;
}

.tc-sidebuttons a {
display: block;
background: #8C4799;
padding: 4px;
border-top-left-radius: 8px;
border-bottom-left-radius: 8px;
font-weight: bold;
text-decoration: none;
color: #ffffff;
}

.tc-sidebuttons a:hover {
background: #8C4799;
}

<$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;
}

<$list filter="[{$:/_AFC/SurveyBanner/URL}!is[blank]]" variable="ignore">
<a href={{$:/_AFC/SurveyBanner/URL}} target="_blank" class="tc-survey-banner">
<div class="tc-survey-banner-heading">
{{$:/core/images/plugin-generic-language}}
Help us improve
</div>
<div class="tc-survey-banner-body">
We are hoping to gather valuable feedback on your use and opinion of the Wiki Manuals. By sharing your thoughts and opinions, you will contribute directly to ongoing improvements. It will take no longer than 10 minutes of your time to complete.
</div>
</a>
</$list>

\rules only filteredtranscludeinline transcludeinline macrodef macrocallinline macrocallblock

.tc-survey-banner {
background: #aaa0cd;
color: #000;
fill: #000;
padding: 1em;
text-shadow: none;
border-radius: 8px;
line-height: 1.2;
text-decoration: none;
display: block;
margin-right: 1em;
}


.tc-survey-banner:hover {
background: #fff;
}

.tc-survey-banner-heading {
font-size: 2em;
font-weight:bold;
margin-bottom: 0.5em;
}

.tc-survey-banner-heading svg {
width: 1em;
height: 1em; 
vertical-align: text-bottom;
}

https://forms.office.com/e/xv6FJJrXXV

<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

\rules only filteredtranscludeinline transcludeinline macrodef macrocallinline

body.tc-body .tc-tiddler-body {
clear: none;
}

.tc-tagged-by {
font-size: 0.8em;
background: <<colour code-background>>;
padding: 1em;
margin: 0.5em;
border-radius: 8px;
border-top: 3px solid <<colour code-foreground>>;
}

.tc-tagged-by ul {
margin: 0;
list-style: none;
padding-left: 0;
}

<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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            <path d="M123.607,76.632 C121.303,72.037 116.978,65.453 114.616,62.665 C114.607,62.655 114.599,62.646 114.591,62.637 C113.775,61.695 112.946,60.845 112.071,59.942 C109.061,56.838 105.822,53.998 102.345,51.588 C102.069,51.397 101.826,51.247 101.566,51.07 C90.871,43.795 77.968,39.847 64.736,39.643 C64.416,39.638 62.509,39.654 61.573,39.678 C59.368,43.843 57.693,48.32 56.649,53.046 C56.574,53.385 56.518,53.724 56.45,54.064 C56.448,54.071 56.447,54.078 56.446,54.085 C56.417,54.23 56.397,54.376 56.369,54.52 C71.051,52.674 88.203,58.332 97.369,65.961 C97.425,66.007 97.479,66.059 97.535,66.106 C98.935,67.279 100.289,68.52 101.577,69.849 C103.96,72.306 106.069,74.956 107.903,77.757 C107.938,77.81 107.967,77.867 108.001,77.92 C113.652,86.618 116.614,96.786 116.451,107.389 C116.401,110.7 116.042,113.984 115.385,117.201 L115.385,117.203 C115.385,117.204 115.395,117.215 115.4,117.221 C115.739,117.579 126.182,128.566 126.231,128.616 C126.356,128.496 127.246,127.69 127.711,126.457 C128.429,124.55 129.45,120.662 129.745,118.903 C129.929,117.708 130.071,116.627 130.187,115.589 C130.482,112.945 130.585,110.611 130.632,107.608 C130.801,96.685 128.366,86.125 123.607,76.632" id="Fill-52" fill="#888" mask="url(#mask-4)"></path>
            <path d="M115.384,117.204 C112.973,117.504 110.604,117.806 108.089,117.827 C102.554,117.872 97.018,117.028 91.741,115.36 C86.848,113.813 82.206,111.522 77.95,108.656 C74.818,110.235 71.547,111.59 68.143,112.683 C66.168,113.317 64.175,113.826 62.176,114.273 C78.329,129.021 101.385,135.615 123.671,130.025 C125.196,129.643 126.122,128.718 126.232,128.615 C126.182,128.565 115.739,117.579 115.4,117.221 C115.394,117.215 115.384,117.204 115.384,117.204" id="Fill-54" fill="#888" mask="url(#mask-4)"></path>
            <path d="M95.413,1.917 C94.412,0.954 93.102,0.391 91.885,0.179 C91.885,0.179 88.77,14.749 88.628,15.407 C90.211,17.329 91.783,19.198 93.18,21.361 C96.182,26.012 98.434,31.139 99.851,36.489 C101.109,41.239 101.645,46.158 101.566,51.07 C101.826,51.247 102.069,51.397 102.345,51.588 C105.822,53.998 109.061,56.838 112.071,59.942 C112.946,60.845 113.775,61.695 114.591,62.637 C118.634,40.921 111.907,17.777 95.413,1.917" id="Fill-55" fill="#888" mask="url(#mask-4)"></path>
            <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>
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</svg>

\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:"""

""">>

}

emhp-white: #f7f7f8
emhp-black: #333
emhp-grey: #e8ece8
emhp-active: #00957A
emhp-primary: #8C4799
emhp-mid: rgba(232, 232, 232, 0.84)
top-menu-background: <<colour emhp-primary>>
top-menu-foreground: <<colour emhp-white>>
page-footer-background: <<colour emhp-primary>>
page-footer-foreground: <<colour emhp-white>>
alert-background: <<color emhp-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 emhp-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 emhp-grey>>
pre-background: #f5f5f5
pre-border: #cccccc
primary: <<colour emhp-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 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)
<a href="""$url$""" class="tc-btn-big-green" style="background-color:#55c6a7;display: inline-block; padding: 8px; margin: 4px 8px 4px 8px; color: #fff; fill: #fff; border: none; font-size: 1.2em; line-height: 1.4em; text-decoration: none;" 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>

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

Assignments

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! 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.

Anna Freud  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.

---

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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.

---

\define renderContent()
{{{ $(exportFilter)$ ||$:/core/templates/static-tiddler}}}
\end
\import [[$:/core/ui/PageMacros]] [all[shadows+tiddlers]tag[$:/tags/Macro]!has[draft.of]]
<<renderContent>>

<$list filter={{$:/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"/>

iVBORw0KGgoAAAANSUhEUgAAAEAAAABACAYAAACqaXHeAAAAAXNSR0IArs4c6QAACApJREFUeAHdmQmIlkUYxzfNq0NTo8PIlDKPyi4qi0yhErWkEoROhSxTISOVosuorCwUtKKiEC3tUCTNbonW9UpJ7c4y274kxDQ30y631H7/z31lvmlm3mu1b33gt+/MM8/zzMz7zvltRUX5S3OaeAO8CRthOcyHU+CAllb07l7YBLsNqurS23ieBwecNKFHY2ALmB2P0osN/S+ku8MBI73pydcQddb1XGeVryd/LDRoaUrrJ8IucHU60m312CxBfzA0SOlEq1dC1MnQc1XA7tGG2Pt+NHp7oFP2y6gM2P5D2bnQYORqWloLdid9+QK2s2PsP6O8MZS9jKCFO8HXWVP/DXbXgOa4tkblzXI7PZzyshZ1xm60K6+pMRq0LZqibe8vcPlIp8NSCyhLOZ9W/Qm+xkd6LXZaHH2ic0Jk63qO8jn+n/oOVP4TuBps6qZgo20xJJoOX4DpZ6arKWsUCrC/yw6iwkVgNtKVvjNFw/rHxNMOUzZyKy1xdTjS6QA0MkNrQ+eHlzPE2ycuHYn6G0SddT3vyVjz9YG4qrMsFsO5gUbqZWhvzyrNcawB10uVrm/WwPXld3agcWrgV3BIzsqm4+97AZNyxs7trh8xfI3TvO+Zu4aKiqsCdXxYD/Ezh9A+7uu89FMzRy51bEPWd4vUgSl4SwwWltaTOndTwEMLVDOYDn+ATn2boQDaw7+EHZBEtAashc4OY9WhRfhbR9k+VbUkuo6kvhFQGSiTjy5Jn8BkuAzi1onQQtsf//0mPahpGqwAX+d1bd0QKHf5aYTMhD6gQ5Ut+jHF5SfdUNt4X+QHEfRTiBqxzEhHuui5PFAW2YSea/C/BcxL0h2BmHdR5pW852V98aWgvby7UUs7I20ndQ3OI11wfha+gevqAv1a93Q94qaPyydW1xqLl8D1pUIXHg1/Ndbll1VXSby7AzEnUFavoittAXwNXh0o+zxQ5ouXRK/trsoT+yH0XkmzDWrx0VwbDyE/bXE+0bBdCPp1V78LHAaHwzGgbawTNIe0ou3uIlgCOn2adwBts7lFv7NNgyRfY0HAbmRMS7QmnQ6jYB6o8UnqNG10hqgx/G4mnUua4D0LzEpC6XcDtpembIlGiBa69wMxXW1Zi320Fl1OOrM0xXM+uCqxdb9jpymiHcEui/LdKMsq2mVmQNIfU7/HVi9BUyuz6LweNT70fAc7HTklGro+2/ZFi3x/zsTdt+DZ9WrN0Y6VSeJ+xVFltXCjFT00BY60bLNmtSDrF+MdYHfazr+WpZLeOP0dE3wb5a45HZoyx+NTn3I7wbaA3Wk7PyxNpUdgvDEm6AbKz/AEDS2YXT0+WdQaBRri60DtsTtt5nWXSDz9no4Jpjd+EvjkeQrMys30xT6nDPo+Rj3fk95k5M06o7RGZqycg0VoldVR9pKYKA9QHlVqP2+J8U1T/JZVz1LyOoTZdZr5K0IVaEitiglwWyhAXdnNgRhTEvgnMennqeN1jz56CTofNPFVMCDGeY7P0dL3CsTRC84rhxKgAFGn7GdVoEy2w8EplWjtYFFeR9Kki0jbQBxNoVaQRybhHLXL9XyKch2AXGXSVYOO9iVyJjmfg/T3l1jHZ74LxBsc7+616EGJXqKvrVoI24DOJj4b6QdCibxAzuewnrIWJdbxmScD8d6Od3danIw2bqUfUuepL/w1+Pqkk+te0dV2K/iMR++1TJ7oG4inL9gxeaii5XH8LYCvjdIvBFOGkPHZa6c7KjLuFTDUnb11ZJjiqZU29LXS7AYa0rri+jojvY7E9iGrGbqfA37DKCvK4/z1BU+68teFKnmEFivdHNuVWLszugHqtOdrX6Qf63aveCLgOzfy+cJhtAFdJegikXa44lKULvzdBVEj7eeLe8y8f4dSot3H9rPzz3kj7PmVyLaP8jX4NZJvVIkUi+BjMBuurzUG/rN1oIsTjaCoQvupOno5AuguMh1se1d+AXZaw3yiNm8Dl690xY/7KokVUBswlPFKOBvSyFkYmy/TbsiPlOvcIGkJ4+AXsO1ceY1c+cSJVnyXv3T95ax/PfkMXPoPsL8Sko6IGTHxZ1F+N2yJsTPbshrbdpBEHsHI9DXTI6IAaoBZkCRdwEcLXT84BHyihm4HM6bWmMWwDLTTmGVx6XnY6zicVPSboi/m+IOMKANJT4Mkw8pwKyZr+bsKdALUwekHUKe1HTaF8+AkaAHHwAmQRSbidCdoWiWVXhgu9Bg/Y+tPRFEJu8sMTY/BkEW64uTrz0xXQI2KYZBmTvoqyKvXl54KR0JW6YCjrx2zQ0G1HT0Gaeeor7K0+k+o+4JQAxOWtcfOV/ec4kHAE2gres23DvAgbIZ9LWroCtACuQaqIa+E1jTdSxJLcyyHgg5LoSup722H9Nr7F8BHYNrpI9wDaVZ9zEvkQnJmTDM9rcQyRUaHFy1KmkMFMIMmSWtaaYhXgnaPvyDk9zPl40HDOa1ci4Mv9mRzG0wb2LTXMDsNuoFejvJC2562w19BX7MAOsFpu2wFOoX2gaSijmh6vAEaMYq1C0Ki6Xufx2Bcfb0AT/xYdWMsJsDYWEu3ge4pn4NeqI7VOvdrNOkqrBes3xH0HAAu0ZQuCxlEKzTMfUM1r77SE7s3+rKRo2nJK5C3sz5/+yVo6hxRNr03GtKT9DLwdSSP3nwJut2WtWhxfA/ydNjlW1UXU9trg5DOtPJhqAZXh9LqdhJnHrSBBien0uIxMBc2QJrO12CvEaUv3xaK8i9e8Ax/5Ku5fAAAAABJRU5ErkJggg==

Open Pages

Recent Edits

$:/_EMHP/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":{"$:/plugins/tiddlywiki/consent-banner/banner":{"title":"$:/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: $:/plugins/tiddlywiki/googleanalytics/googleanalytics.js\ntype: application/javascript\nmodule-type: startup\n\nRuns Google Analytics with the measurement ID in the tiddler `$:/GoogleAnalyticsMeasurementID`\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\", // \"yes\" or \"no\" (the default)\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 gaMeasurementID = $tw.wiki.getTiddlerText(\"$:/GoogleAnalyticsMeasurementID\",\"\").replace(/\\n/g,\"\");\n\t\t\tvar url =\"https://www.googletagmanager.com/gtag/js?id=\" + gaMeasurementID;\n\t\t\twindow.dataLayer = window.dataLayer || [];\n\t\t\twindow.gtag = function() { window.dataLayer?.push(arguments); };\n\t\t\twindow.gtag(\"js\",new Date());\n\t\t\twindow.gtag(\"config\",gaMeasurementID);\n\t\t\tconst scriptElement = window.document.createElement(\"script\");\n\t\t\tscriptElement.async = true;\n\t\t\tscriptElement.src = url;\n\t\t\twindow.document.head.appendChild(scriptElement);\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":"$:/plugins/tiddlywiki/googleanalytics/readme","text":"This plugin enables you to use Google Analytics to track access to your online TiddlyWiki document.\n\nBy default, the user is not asked for permission before initialising Google Analytics. This plugin also optionally integrates with the \"Consent Banner\" plugin (also found in the official plugin library) so that Google Analytics is not initialised until the user grants explicit permission.\n\n[[Source code|https://github.com/Jermolene/TiddlyWiki5/blob/master/plugins/tiddlywiki/googleanalytics]]\n"},"$:/plugins/tiddlywiki/googleanalytics/settings":{"title":"$:/plugins/tiddlywiki/googleanalytics/settings","text":"''[[Google Analytics Measurement ID|$:/GoogleAnalyticsMeasurementID]]'': (mandatory) a code of the form `G-XXXXXXXXXX` where X are digits or uppercase letters<br/><$edit-text tiddler=\"$:/GoogleAnalyticsMeasurementID\" default=\"\" tag=\"input\"/>\n\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 `G-XXXXXXXXXX`\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 Tiddlyhost, 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<$list filter=\"[<tv-config-static>!match[yes]]\" variable=\"ignore\">\n<$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</$list>\n"},"$:/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; */\n\tline-height: 1;\n\tfont-weight: 700;\n\tcolor: <<colour foreground>>;\n\tcolor: <<colour menubar-foreground>>;\n\tfill: <<colour foreground>>;\n\tfill: <<colour menubar-foreground>>;\n\ttext-decoration: none;\n\tpadding: 0.5em;\n\tmargin: 0;\n\tbackground: none;\n\tborder: none;\n\tcursor: pointer;\n\tborder-radius: 0;\n\ttext-decoration: none;\n}\n\nnav.tc-menubar li.tc-menubar-item > a.tc-selected,\nnav.tc-menubar li.tc-menubar-item > button.tc-selected {\n\tbackground: <<colour foreground>>;\n\tbackground: <<colour menubar-foreground>>;\n\tcolor: <<colour background>>;\n\tcolor: <<colour menubar-background>>;\n\tfill: <<colour background>>;\n\tfill: <<colour menubar-background>>;\n}\n\nnav.tc-menubar li.tc-menubar-item svg {\n\ttransition: none;\n\twidth: 1em;\n\theight: 1em;\n\tfill: <<colour foreground>>;\n\tfill: <<colour menubar-foreground>>;\n}\n\nnav.tc-menubar li.tc-menubar-item .tc-menubar-dropdown-arrow svg {\n\twidth: 0.5em;\n\theight: 0.5em;\n}\n\nnav.tc-menubar li.tc-menubar-item > a.tc-selected svg,\nnav.tc-menubar li.tc-menubar-item > button.tc-selected svg {\n\tfill: <<colour background>>;\n\tfill: <<colour menubar-background>>;\n}\n\nnav.tc-menubar li.tc-menubar-item > a:hover,\nnav.tc-menubar li.tc-menubar-item > button:hover svg,\nnav.tc-menubar li.tc-menubar-item > button:hover {\n\tbackground: <<colour foreground>>;\n\tbackground: <<colour menubar-foreground>>;\n\tcolor: <<colour background>>;\n\tcolor: <<colour menubar-background>>;\n\tfill: <<colour background>>;\n\tfill: <<colour menubar-background>>;\n\tborder-radius: 0;\n\ttext-decoration: none;\n}\n\nnav.tc-menubar li.tc-menubar-item > a:active,\nnav.tc-menubar li.tc-menubar-item > button:active svg,\nnav.tc-menubar li.tc-menubar-item > button:active {\n\tbackground: <<colour foreground>>;\n\tbackground: <<colour menubar-foreground>>;\n\tcolor: <<colour background>>;\n\tcolor: <<colour menubar-background>>;\n\tfill: <<colour background>>;\n\tfill: <<colour menubar-background>>;\n\tborder-radius: 0;\n\ttext-decoration: none;\n}\n\nnav.tc-menubar .tc-drop-down,\nnav.tc-menubar .tc-block-dropdown {\n\tmax-width: 70vw;\n\tmax-height: 70vh;\n\toverflow: auto;\n}\n\nnav.tc-menubar .tc-drop-down a {\n\ttext-decoration: none;\n}\n\nnav.tc-menubar .tc-drop-down .tc-table-of-contents button {\n\tdisplay: inline-block;\n\twidth: auto;\n}\n\nnav.tc-menubar .tc-drop-down ol {\n\tmargin: 0;\n}\n\nnav.tc-menubar .tc-drop-down .tc-menubar-dropdown-sidebar a,\nnav.tc-menubar .tc-drop-down .tc-menubar-dropdown-sidebar button {\n\tdisplay: inline;\n\twidth: auto;\n}\n\nnav.tc-menubar .tc-more-sidebar > .tc-tab-set > .tc-tab-buttons > button {\n\tdisplay: block;\n\twidth: 100%;\n}\n\n@media (max-width: {{$:/config/plugins/menubar/breakpoint}}) {\n\n\t.tc-menubar-wide {\n\t\tdisplay: none;\n\t}\n\n}\n\n@media (min-width: <<breakpoint-plus-one>>) {\n\n\tnav.tc-menubar li.tc-menubar-item.tc-menubar-narrow,\n\t.tc-menubar-narrow {\n\t\tdisplay: none;\n\t}\n\n}\n\n@media (max-width: <<sidebarbreakpoint-minus-one>>) {\n\n\t<<set-sidebar-scrollable-top-if-hamburger>>\n\n}\n\n@media (max-width: {{$:/config/plugins/menubar/breakpoint}}) {\n\n\t<<set-sidebar-scrollable-top>>\n\n}\n@media print {\n\n\tnav.tc-menubar {\n\t\tdisplay: none;\n\t}\n\n}\n"},"$:/tags/MenuBar":{"title":"$:/tags/MenuBar","list":"$:/plugins/tiddlywiki/menubar/items/hamburger $:/plugins/tiddlywiki/menubar/items/topleftbar $:/plugins/tiddlywiki/menubar/items/contents $:/plugins/tiddlywiki/menubar/items/search $:/plugins/tiddlywiki/menubar/items/pagecontrols $:/plugins/tiddlywiki/menubar/items/server $:/plugins/tiddlywiki/menubar/items/toprightbar"}}}

$:/themes/tiddlywiki/vanilla

960px

450px

fluid-fixed

tile motifemhp2.png

classic

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

<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 aged 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.

!!!@@color:red;THIS PAGE IS CURRENTLY BEING WRITTEN@@ 

What schools do now?
ASD experience in schools  

[img[lightbulb(1).jpg]]

!!!The EMHP 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 new Education Mental Health Practitioner (EMHP) role is an exciting opportunity to deliver evidence-based early interventions for children and young people, working across educational settings in England. (Taken from [[London and South East CYP-IAPT Learning Collaborative|https://cypiapt.com/2019/03/13/educational-mental-health-practitioner-2019-update/]] please follow the link for more information)

!!!This Guide:
The guide is an open resource for any Education Mental Health Practitioners both in training and those who have qualified. EMHP supervisors may also find the information on this guide helpful.

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 EMHP 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]] 

To find out more about the wiki manuals and how they are being used across the Anna Freud Centre please refer to the animation below:

<iframe width="560" height="315" src="https://www.youtube-nocookie.com/embed/ah90xbtH0Do" frameborder="0" allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe>

*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: 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 EMHP 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. 

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

There is a plethora of additional outcome measures which can be found on the [[CORC website|https://www.corc.uk.net/]]

Additional there are many outcomes listed on the Miami School of Nursing and Health Studies website in there [[Measures Library|https://elcentro.sonhs.miami.edu/research/measures-library/child-adolescent-construct/index.html]]. Please note some of the measures listed are free to download although others may only be available to purchase. Some to the scales listed for free download are:

[[Children's Emotional Management Scales (CEMS)-Parent Report|https://elcentro.sonhs.miami.edu/research/measures-library/cems/index.html]]

[[Sexual Minority Adolescent Stress Inventory (SMASI)|https://elcentro.sonhs.miami.edu/research/measures-library/smasi/index.html]]

[[The Brief COPE|https://elcentro.sonhs.miami.edu/research/measures-library/brief-cope/index.html]]

<<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. 

!!Supplement 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/1lo1i82kvpvOkBo3vae4Cp5SfC5-TXENX/view?usp=sharing">>

!!!Managing Panic supplement:

<<link-doc "Supplement: Managing Panic" "https://drive.google.com/file/d/1WiMJb7d_alt10kAXjynrtPraihqVcbGj/view?usp=sharing">>

!!!Managing Worry supplement:

<<link-doc "Supplement: Managing Worry" "https://drive.google.com/file/d/1TctSV_1LM4SldrMqj7O8OrOS1Gte2kWr/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">>

*Formulation underpins everything- working with these thoughts and behaviours 
*Look out for avoidance or 'safety behaviours' 
!!!Psychoeducation 
*Fight or Flight 
*How their thoughts connect to behaviours and feelings (help people think about these links using pictures) 
*Anxiety is normal, and that it can't hurt you (overwhelming physical sensations like heart beating so it causes worry for young people and parents) 
!!!Fight or flight role play 
*Alarm system to keep safe (either run away from something or fight it) 
*Why would we still need this response in life now? Useful in a life threatening attack 
*Don't worry about remembering the complicated terms i.e. chemicals adrenaline and cortisol 
*Become expert with physiology of the human body- confident to know the reasons for the feelings in the body 
*Feedback
**Useful to hear how to adapt to someone younger i.e. dinosaurs
**Useful to hear how to validate from own personal experiences/examples 
!!!Rating scale of anxiety 
*Be clear what 0 means, can use a traffic light system for young children 
*Important to do a rating scale for a thing they are not scared of in the beginning (creates a concrete anchor, or baseline for reference) 
*10/10 is a life threatening situation which creates a maximum anxiety to compare with the anxiety issue they are seeing you for 
!!!Parent involvement 
*Modelling- gain knowledge about anxiety to change thoughts and behaviours 
*Motivation for children to take part 
*Remember strategies for children when they are in a anxious situation 
*No clear evidence of effect 
!!!Other Points 
*Needle phobia different from other anxiety disorders 
*Blood pressure rises when you are anxious which makes it unlikely you will faint (as your blood pressure lowers when you faint) 
!!!Graded exposure 
*Go back to the steps if young person claims they did exposure homework but it didn't work 
*Swimming pool example 
*Dogs Trust help out with exposure exercises 
!!!Barriers and how to overcome: 
*Distraction/reassurance= encourage to stop in exposure 
*Too distressed= need to come down in the hierarchy 
*Can't rate anxiety= using colours or symbols 
*Role of therapists= feel confident in the model 
*Refusing= go back a step, incentives, readdress goals 
*Parents= explain the rational, psychoeducation, evidence based
*Video discussion
** Using the word 'Vomit' - good to test out if its not anxiety provoking, careful not to avoid the word, using the word can be good modelling showing the young person that its a safe word to say 
**Able to advise young people and families on where to access resources needed for exposure tasks 
*If something happens in between the exposure tasks- depends on how the young person reacts
!!!Safety behaviour 
*Reinforces the idea there is something to be scared about so we would aim to reduce
*Use steps for reducing safety behaviours on hierarchy chart i.e. things they are avoiding, things they are doing to keep themselves safe, things other people are doing to keep you safe  
*EMHP to read up on different coping strategies before suggesting the young people 
!!!Rewards 
*Ideas for adolescents- later bed time, more like on the play station, go somewhere with their friends, negotiate a point system and goal 
!!!Working with thoughts and feelings 
*What are the thoughts? How do the thoughts make you feel? 
*Thinking traps that we fall into 
*Idea of testing out predictions and testing out thoughts with actions 
!!!Q&A 
*Think about GSH as a course, there is clear information they need to go through and that there will be an end. If they aren't ready by the end of the 'course' then thinking about stepping up or down is important. 
*Emphasis is on young person and parents on doing the activities, the EMHP is there to trouble shoot and to guide clients to relevant information 

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. 

!!!@@color:red;THIS PAGE IS CURRENTLY BEING WRITTEN AND IS AWAITING REVIEW@@ 
!!!!Source: Supervisors course

!!!CWP supervisors were asked: What advice would you have given yourself at the start of the course?
*Prioritise more time to know the intervention models 
*Have a written agreement/statement about the what is supervision and what is leadership 
*Develop clear understandings about the difference between a team leader and supervisor 
*Ensuring more time to transition into role from full time clinical role and to make sure this is planned with managers in the service 
*Set boundaries which work for SSDL especially if there is long travel times 
*Have access to their learning i.e. presentations 
*Learn as you go along and not to expect to know everything at once 

!!! 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 

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

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

!!!!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]]">>

Source: Healthy London, NHS England, Amplified programme, Young Minds

As part of the NHS England funded Amplified programme, YoungMinds worked together with
Health London Partnerships to:

* Collect existing pupil insights work from London schools around mental health and analyse these to identify key themes

*Facilitate a workshop session to review these insights and develop a top ten summary of ways young people want schools to support their mental health

For the ''full report'' please go to: 

https://www.healthylondon.org/wp-content/uploads/2019/03/Amplified-and-HLP-School-Insights-Report-2018-1.pdf

For the ''Amplified Poster'' - 10 ways young people in London want schools to support their mental health. Please got to:

https://www.healthylondon.org/wp-content/uploads/2019/03/YP.amplified.Poster-1.pdf

''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 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[jack-b-oRNMgnvQsNw-unsplash (2).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 him 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

!!!''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[close_up_pen_writing.jpg]]

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

!!!''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). Even if an assessment has been conducted by another service it may still be helpful to do your own session 0 to develop SMART goals and check on risk.

!!!Session 0
This session may be called may different things by different services. You may hear it be referred to as a choice appointment, assessment 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).

!!!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
<<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. 

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


Headspace is an Australian mental health charity.. The [[Headspace website|https://headspace.org.au/health-professionals/clinical-toolkit/depression/assessment/]] provides information, videos and guidance on how to conduct assessments. 

---

Please note: The information provided on this website is based in Australia. Local services may also have assessment proformas or guidelines and these should be followed. 

----

For guidelines in this guide on what to cover and the main areas/aims that need to be considered when conducting a session 0 or an assessment session please see the [[Helping]] pages. 

!!!!!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 

!!!@@color:red;THIS PAGE IS CURRENTLY BEING WRITTEN@@

Please see:

*[[What is a Session 0]]
* [[Session 0 for Adolescents: General Assessment]]
*[[Session 0 for Younger Children: General Assessment]]

 

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

For more information on what ASD is 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.


!!Videos:
For videos relating to ASD please go to [[Autistic Spectrum Disorder (ASD)]]

!!Links to other pages


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

<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">>

!!Helpful links
Please see research carried out by Rebecca Wood (2019) "Autism, intense interests and support in school" above.

!!!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 [[Videos: Autistic Spectrum Disorder (ASD)]]

!!Links to other pages:

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



For more information on ASD specifically relating to mental health implications please go to:
[[Autism Spectrum Disorder (ASD) and Mental health]]

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 is a tag tiddler 
<<list-links "[tag[Basics]]">>

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[water2.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">>

-----

__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. For more infomration on the core manuals and materials used by practitioners see [[Helping: 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 EMHP, it requires a mixture of kindness and confidence. In general, starting slowly is best but not so slowly the EMHP 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 

*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

Goals and goal based outcomes (2013) brief guide co-authored by Duncan Law

<<link-doc "Goals and goal based outcomes" "https://drive.google.com/file/d/1qQLN3_oN0FTApeju_TARdjnboZ5wOp5d/view?usp=sharing">>

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 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.

!!!!Source: Helen Aspland, ~DoE, Kidscape, Anti-Bullying Alliance

---

!!!''Overarching practice point: ''Always follow the schools policies regarding behaviour, bullying and safeguarding. If the bullying is serious, discuss with school staff about contacting the police. 

---

For more information on what bullying is and looks like as well as prevalence rates and risk factors please go to [[What is Bullying: Prevalence and Impact]]


!!Your Role:
Your job as an EMHP is to signpost young people, parents/carers and schools to support and resources (please find linked: [[Bullying: Resources]]). 
You may be working with those being bullied or those bullying others so you need to have an understanding of the MH implications bullying has on the victim as well the reasons someone may bully (please go to [[What is Bullying: Prevalence and Impact]]).

*''Always follow your school site’s policies regarding behaviour, bullying and safeguarding.''
*''If the problem is serious enough, contact the police. If at all possible, discuss with the school first. ''

!!Working with CYP:
*Reporting bullying: Agree upon who needs to be informed to help resolve the bullying. 
*Encourage them to not retaliate or reply to any nasty messages received.
*Record cases of direct bullying: what happened and when. 
*If by phone or social media: keep a record of the time of the call, and do not delete the messages, show them to someone you trust and block that contact to reduce the risk of further harm.

!!Working with parents and schools:

*CYP are more likely to tell their peers and parents that they are being bullied: parents perspective may be very useful!
*You should be an advocate for the family and CYP whilst maintaining compassion for, and relationship with, the school
*Enable a positive home-school relationship 
*Support schools to consider youth participation in reviewing of anti-bullying policy
*Explore with schools plans for anti-bullying whole school approaches (anti-bullying week)
*Support delivery of workshops/activities or anti bullying curriculum 

!!Videos:
Please find a list of video resources on [[Bullying: Resources]] which you may find helpful to share with CYP, teachers or parents 

!!!Intervention examples:

Please see below a few examples of school interventions tackling bullying:

The anti-bullying program [["Steps to Respect"|https://www.youtube.com/watch?v=FWsbzPfMt2M&feature=youtu.be]] 


[[KiVa™|https://youtu.be/Rb6klcdFq1E]] universal and indicated actions (An emphasis on the role of they by-stander) 


!!Further reading
Please go to the anti bullying alliance [[website|https://www.anti-bullyingalliance.org.uk/]] for more information and guidance on bullying.

!!Links to other pages:

Please go to [[Bullying: What do Schools do?]] for information around schools bullying policies.

Please go to [[What is Bullying: Prevalence and Impact]] for more information on bullying and the MH impact of bullying.

Please go to [[Bullying: Resources]] for resources you can share with CYP, parents and schools.

!!!!Source: Helen Aspland.

---

!!!''Overarching practice point: ''Always follow the schools policies regarding behaviour, bullying and safeguarding. If the bullying is serious, discuss with the school about contacting the police. 

---

Please go to [[What is Bullying: Prevalence and Impact]] for information on Bullying

Below is a list of resources which you may find helpful to share with CYP, teachers or parents. For video resources go to the 'Videos' section of this page.

!!For Parents/ schools:

The DoE published non-statutory advice for schools on [[Preventing and Tackling Bullying (2017)|https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/623895/Preventing_and_tackling_bullying_advice.pdf]]. It makes clear that schools can discipline pupils for bullying outside of school

Article by 'Education and behaviour' regarding [[19 tips for parents and teachers|http://www.educationandbehavior.com/suggestions-to-protect-kids-from-bullying/]]

[[ZAP|https://www.kidscape.org.uk/programmes/zap-anti-bullying-workshops/]] is a free one-day workshop for children and young people aged 9-16 who have experienced bullying. Please find the link below: 

Kidscape provides information for classroom activities which may help to reduce bullying please find it linked below: 

<<link-pdf "'Recognising and dealing with anger'" "https://www.kidscape.org.uk/media/1022/classroom_activities_dealing_with_anger_ks2-ks3.pdf">>

!!For CYP:

CYP setting up their own whole school approach as [[Anti-bullying Ambassadors|https://www.antibullyingpro.com/join]] 

[['Tips for kids'|http://www.educationandbehavior.com/how-to-end-bullying-in-classrooms/]] this article by  'Education and behaviour' outlines ways which you may want to advice young people to combat bullying: 

Advice for young people who are experiencing bullying from [[Kidscape|https://www.kidscape.org.uk/advice/advice-for-young-people/dealing-with-bullying]]

!!!Online/ Cyber bullying:

Please see below for the non-statutory advice from the Department for Education for headteachers and all school staff on how to protect themselves from cyber bullying:

<<link-pdf "Cyberbullying: Advice" "https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/374850/Cyberbullying_Advice_for_Headteachers_and_School_Staff_121114.pdf">>

Bullying and cyberbullying: [[Advice for parents and carers|https://www.nspcc.org.uk/preventing-abuse/child-abuse-and-neglect/bullying-and-cyberbullying/]] to help keep children safe from bullying from NSPCC.

The Child Exploitation and Online Protection Centre (CEOP) maintains a [[website|https://www.thinkuknow.co.uk/]] for children and young people, and parents and carers about staying safe online.

[[CEOP website|https://www.ceop.police.uk/CEOP-Reporting/]] to report inappropriate actions that have occurred online.  It could be sexual or threatening chat, or being asked to do something that makes you feel uncomfortable or someone asking to meet up. 

!!Video Resources
Please find below a list of video resources which you may find helpful to share with CYP, teachers or parents. 

Anti-Bullying [[Top Tips for Teachers|https://www.youtube.com/watch?v=pzKXRuKNd8Q&feature=youtu.be]] by the Anti-Bullying Alliance


Antibullying alliance: [[Stop, Speak, Support|https://youtu.be/qrZnAAVQDDA]]:  A 60 second video from their anti-bullying week campaign

!!Links to other pages

Please go to [[Bullying: What do Schools do?]] for information on how you can support schools with Bullying.

Please go to [[What is Bullying: Prevalence and Impact]] for information on Bullying

Practice tips on what to do as a practitioner please see: [[Bullying: Practice Points]]

!!!!Source: Helen Aspland, ~DoE, Kidscape, Anti-Bullying Alliance

---

!!!''Overarching practice point: ''Always follow the schools policies regarding behaviour, bullying and safeguarding. If the bullying is serious, discuss with school staff about contacting the police. 

---

For more information on what bullying is and looks like as well as prevalence rates and risk factors please go to [[What is Bullying: Prevalence and Impact]]

!!School policy
There is no legal definition of bullying but the government sets out, by law, all state schools must have a ''behaviour policy'' in place that includes measures to ''prevent all forms of bullying'' among pupils. This policy is decided by the school and all  teachers, pupils and parents must be told what it is. 

!!!Bullying outside of school
Head teachers have the legal power to make sure pupils behave outside of school premises (state schools) this includes bullying. School staff can also choose to report bullying to the police or local council.
Some forms of bullying are illegal and should be reported to the police. These include:

* violence or assault
* theft
* repeated harassment or intimidation (name calling, threats and abusive phone calls, emails or text messages)
* hate crimes

The ~DoE published non-statutory advice for schools on [[Preventing and Tackling Bullying (2017)|https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/623895/Preventing_and_tackling_bullying_advice.pdf]]. It makes clear that schools can discipline pupils for bullying outside of school.

~DoE Guidance for school staff on [[cyberbullying|https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/374850/Cyberbullying_Advice_for_Headteachers_and_School_Staff_121114.pdf]]


!!Who do CYP tell?
Rigby, K (2013) found that just over half did seek help, sometimes from a variety of people, most often from peers and parents. Bauman et al (2016) outlines some of the reasons why CYP may not tell their teachers:

* The bullying is not serious enough. 
* Feeling that others could probably help more (peers, parents, counsellors). 
* Teachers seen as not interested/ capable of helping
* Fear that they may make matters worse and unclear of how the teacher may help

!!Creating an ‘anti-bullying’ culture
* Having a culture where social, emotional and mental health needs are openly and frequently discussed
* Involve parents and pupils- child friendly anti bullying policy
* Regularly evaluate/ update approach
* Implement disciplinary sanctions
* Openly discuss differences between people that could motivate bullying.
* Use outside agencies or resources to target issues 
* Provide effective staff training to include legal responsibilities
* Work with the wider community
* Make it easy for pupils to report bullying 
* Create an inclusive environment

!!A whole school approach
A strategic whole school approach tackles bullying from many angles across the school and includes:

* A whole school approach, along with school leadership, needs to be monitored and reviewed on a regular basis.
* senior leadership, pupil and parent voice
* a strong whole school anti-bullying policy, values and ethos 
* cross curricular approach
* training and staff development
* prevention, reporting and response strategies


!!Are schools based interventions effective?
* School-based mental health interventions have generally evidenced positive effects over the past decade (Hetrick, Cox & Merry, 2015; Merry et al., 2011). 
* Preventative anxiety and depression interventions are effective over 12 months, but not proven benefits at longer-follow-up.
* Whole-school bullying prevention programmes can reduce victimisation by up to 20% (Olweus et al.).

!!!Videos:
Please find a list of video resources on [[Bullying: Resources]] which you may find helpful to share with CYP, teachers or parents 

!!!Intervention examples:

Please see below a few examples of school interventions tackling bullying:

The anti-bullying program Steps to Respect: <html><iframe width="560" height="315" src="https://www.youtube.com/embed/FWsbzPfMt2M" frameborder="0" allowfullscreen></iframe></html>



~KiVa™ universal and indicated actions (An emphasis on the role of they by-stander):

<html><iframe width="560" height="315" src="https://www.youtube.com/embed/Rb6klcdFq1E" frameborder="0" allowfullscreen></iframe></html>

!!Further reading
Please go to the anti bullying alliance [[website|https://www.anti-bullyingalliance.org.uk/]] for more information and guidance on bullying.

!!Links to other pages:

Please go to [[Bullying: Practice Points]] for more information and guidance on how to work with CYP and families who are affected by bullying.

Please go to [[What is Bullying: Prevalence and Impact]] for more information on bullying and the MH impact of bullying.

Please go to [[Bullying: Resources]] for resources you can share with CYP, parents and schools.

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

<<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”. 

!!!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 

<html><iframe width="560" height="315" src="https://www.youtube.com/embed/k96-DISPP88" frameborder="0" allowfullscreen></html>

!!!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''
----
@@color:red;PLEASE NOTE – THERE HAVE BEEN SOME RECENT UPDATES IN CATHY’S MANUAL.  THIS MEANS SOME OF THE SUMMARY SESSION GUIDES AND HANDOUTS ON THE WIKI ARE DIFFERENT FROM THE NEW MANUAL@@

All of these pages will be revised in due course.

----

''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/]]
----

''__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">>

----

''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]]

@@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]]">> 

!!!''Child and adolescent development''

<<list-links "[tag[Child and adolescent 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 is meant by a 'low intensity' intervention?]]

!!!Creswell model 
*Assessment with the parent and the child then no contact with child after that. unlikely for EMHP 
!!!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[wave-unsplash (1).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]]">> 
 

https://www.unicef.org/publications/files/SOWC_2017_ENG_WEB.pdf

!!!!!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

!!!!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.

!!General
*Knowledge of schools, learning needs to be separated out. @@color:red;(Done)@@
*Glossary of terms within education and mental health @@color:red;(Done - set up in guide)@@ 
*Culture and language for different agencies - e.g. confidentiality, pace, avoidance of mental  health language @@color:red;(Added)@@ 
*Dispelling myths of improvement - recognising long term conditions @@color:red;(Noted)@@
*Knowledge of all aspects of school systems. @@color:red;(Already in)@@
*Knowledge of what schools are measured on @@color:red; (added to teaching programme)@@
*Knowledge of the roles of others who are supporting  pupils in the school (team around the school) @@color:red;(made more specific in teaching programme)@@
*Divide knowledge into three groupings: knowledge of schools, knowledge of mental health, knowledge of interventions. @@color:red;(Done)@@
*Why focus on bullying rather than attendance? @@color:red;(Changed)@@
*Some competencies much too broad: need to make competencies appropriate to level of expertise - does it recognise their level of experience @@color:red;(noted in introduction)@@. 
*Are they working with children out of school? @@color:red;(yes this is in service specification)@@
*Competencies suggested are a lot less specific than CWP @@color:red;(wider role compared with CWP)@@
*Need to have more competencies @@color:red;(aim is to develop a self rating competency scale which is approximately 25-30 items in order to support self raring on POD. Appreciate this does not cover all competencies)@@
*Like CWP ones - more systemic
*Overstating the competencies of these inexperienced staff (@@color:red;noted earlier)@@
*Knowing how to work collaboratively @@color:red;(Included)@@
*Knowing about thresholds for access to other services @@color:red;(Added as part of existing competency)@@ 
*Adapting outcomes monitoring to local school setting @@color:red;(Crucial! Added)@@


!!Specific items
*10. Knowledge of the mutual impact between educational attainment and attendance bidirectional  
*25.  Working on network
*13. Ability to set up and deliver ....
*introductions to systems theory - relations, hierarchies and power in schools 
*Knowledge of theories of change - systemic formulation 
*Number 2, 24 25 from CWP
*Delete 10 change the way its written 
*Delete consultation @@color:red; (Done)@@
*Pastoral care 
*14 think about what is shared with parents. 
*15 skills in collaborative practice @@color:red;(done)@@
*delete 5 @@color:red;(Done)@@ 
*18 valuing rather recognising @@color:red;(removed whole item)@@
*22 modify - be sensitive to the mental health needs @@color:red;(Done)@@
*Some apply to competency of the whole team @@color:red;(Not included in competency framework)@@
*Competency for handling referral processes in a sensitive way @@color:red;(Added)@@
*What happens for children multiple interventions for the EMHP? @@color:red;(not covered in competency)@@
*How does it relate to four week wait? @@color:red;(not part of copmpetency framework)@@

!!!!!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@@

Meetings, options and timetables

[img[phone.jpg]]

For information regarding the EMHP course and how to apply please go to 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 a [[User Guide]] it as well as an overview of the core aspects of EMHP's work.

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

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

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

!!![[More]]:
Which contains information on UCL [[Teaching]] and 
background to the [[Training]] of EMHP'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 should include ADHD, ASD, LD. 

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}}

!!!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 "Guidelines for Parent Support Manual" 
"https://docs.google.com/document/d/1YVAXcYyWF5_4wxM1BfUOoogXwpxro3sSwLLoRg4zP3Y/edit#heading=h.gjdgxs">>

!!!!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

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/]]

Carry out group SWAT analysis on the programme. 


<<link-pdf "17th October 2018" "https://drive.google.com/file/d/1NIXNKYCjopTJ5ABXCYMgWrcP8W8BOcgd/view?ths=true">>

The group were provided with an update of the preparation work for the course in January. 

Detailed consideration of the overall system. 
1. Identifying stakeholders - Project managers; Headteachers; supervisors; mental health leads in schools
2. Importance of supporting local developments and sites
3. Training for Mental health leads in schools
4. Importance of avoiding conflict for EMHPs between stakeholders 
5. Relationship of EMHPs to local site leads. 

Events need to be planned to invite stakeholders to understanding the national curriculum and the expected roles of EMHP. 

<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/]]

!!!!''Source: Peter Fuggle and Charlotte Hepburn, AFNCCF'' 

Care is taken to try to ensure that the material linked to this guide from the web meets a number of criteria. This material may be videos from youtube, websites and or specific documents.  Feedback to material linked on this guide is always welcome and should be sent to: mailto:EMHPguide@annafreud.org

!!!Five Key criteria
The material 

#should be relevant to the purposes of the training
#should contribute to learning about children, young people and parents/carers
#does not show offensive behaviour (unless this is consistent with the explicit training purpose of the material) 
#does not promote discriminatory behaviour or thinking
#must be consistent with London Child Protection Procedures [[Safeguarding guidance: London Child Protection Procedures]]

All material from outside sources are subject to our copyright policy (see [[Copyright matters]]) 

!!!! 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’

Home

!!!!Source: Lili Ly
!!Key practice points/ tips/ things to remember when delivering low intensity intervention sessions:

!!!Preparation:
*Prepare prior to the session so you are clear on the structure and purpose of the session
* Go to sessions with assessment questions/ planning notes to help keep the session focused
* ''Setting up the room'' – consider: position seating (next to client not opposite -encourages collaborative working), use the same/ similar chairs, proximity of chairs (not too close or too far apart), sitting by the door, keep personal items away from sight, having a clock in view, is having a table is helpful or not, can people look into the room (may be helpful to use blinds), can client be seen by people walking past the room.

!!!During session:
* Spend time exploring the current problem ''in detail'' (coming to session with pre-planned questions is helpful here)
* Tune into what’s happening in the room e.g. clients (and your) body language, posture etc.
* ''Pacing'' – giving space for clients to think/ process.  Do not be afraid of silences!  It allows time for the client (and you!) to think.
* Thoughts may play a role in the intervention but the focus is more on ''targeting the behaviour'': for low mood the focus is on behavioural activation, for anxiety this is exposure.
*The aim is to be curious about how a young person thinks about things 
* ''Normalising'' feelings and experience is important. 
*''‘Extend validation’ ''of their experiences by mentalising what you think might be happening for them.  
*Make ''specific reflective statements'' to what the client is experiencing e.g. rather than: //‘that must be difficult for you’// or //‘that’s really common’// be specific: //‘that must be really difficult feeling you don’t fit in’, ‘it’s really common for people of your age to feel anxious at this time of year, you’ve got exams, worries about getting into university and on top of this, you also feel your parents don’t understand and are on your case.  I can see how difficult it must be for you’//

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">>

This  document provides guidance for the trailblazer sites drafted by the central team in December 2018. 

<<link-pdf "Delivery Support Pack " "https://docs.google.com/document/d/14XeFD0q6LzRAMe48QbNQrb4KkCIQEbHe8CNqXu7dfZM/edit#heading=h.gjdgxs">>

!!!!''Source:Notes from meeting with Brenda ~McHugh and Neil Dawson''

!!''Developing training in group work''
*Skills separate from specific curriculum
*Core learning skills in creating a learning environment 
*Developing partnerships with school staff
*Work systemically in a school setting. 
*Groups for 
**Parent
**Child 
**Teachers 
**Parents and children together 

doing groups with similar themes.

Using a basic method of 'Planning, action and reflection' 

Focus on transfer and transition of learning 
 Importance of confidentiality  

Example of impulse control and how classroom expectations related to impulse control. 

Having similar themes across groups. 

''The coaching method'' 

*demonstrate, 
*role play
*practice 
*observe 
*feedback 

Helping parents to observe children in the school setting. 
Also supporting home learning. 

Possible timng. Pre-summer training on groups. 
(Rodney Street) 

!!''Other issues''

Engaging and young people to contribute to teaching and learning. 

Parents teaching on their experience of being parents who have had children who have struggled in schools. 

!!!''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@@

<html><iframe width="560" height="315" src="https://www.youtube.com/watch?v=NHCp4SmEwuU" frameborder="0" allowfullscreen></html>

''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.

!!!!@@Color:red; THIS PAGE IS CURRENTLY BEING WRITTEN AND IS AWAITING REVIEW@@ 
Source: Lili Ly, UCL

----
Material from this page has drawn on material developed by MIND and we are grateful that they have shared this with us in considering this issue. 

----
!!What to keep in mind?
*Being aware of aspects of your own identity and potential ‘blind spots’
*Be genuinely curious
*Approach conversations as an opportunity for learning
*Seek feedback, check things out
*Developing a strong [[‘therapeutic’ relationship|Therapeutic Alliance]] of trust, empathy, respect and acceptance
*Being aware not to deny or minimise someone’s experience

!!Diversity: impact on CYP
Social inequality comes with difference - the need to be aware of this difference and when you are working you need to have an awareness that when you are working with a young person or family they may have experienced social inequality and the potential impact of this on their mental health and accessing support.

*The importance of representation in the media- considered the ‘norm’, but often does not include those from diverse backgrounds.
*children want to 'fit in', a persons feeling of security and safety, impacting a persons well being
*intersectionality- the point in which these groups crossover- different layers of diversity and the issues this may cause.

!!!__Recent Findings__

A recent study by NHS England found high rates of mental health needs in white British population compared to minority groups. Please go to the [[NHS website|Survey of the Mental Health of Children and Young People in England, 2017]] to read this survey in full 

!!!__Disability:__

*Disability often isn’t considered -a hidden diversity
*People with LD are more likely to suffer MH concerns 
*less able to maintain and develop supportive relationships- key to wellbeing 
*May be more vulnerable to bullying - effects wellbeing . 
*Effects functioning everyday- self-esteem
*Exclusion rates higher - missing out on education and friendships, causes tension within family. 
*Parents trying to navigate services can be difficult and stressful - advocate for children– parents may have a LD 

!!!__Gender__

*may limit what CYP feel they can do. 
*Gender stereotypes: toxic masculinity.
*Social media accelerating gender stereotypes, issues of identity.


!!!__LGBTQ__

*current issue: transgender people- rejection/ bullying
*Being accepted/ respected for who people really are = well being
*Higher suicide rates of transgender population - bullying, family rejection etc. 
*everything changes- register, changing rooms- may never do PE.
*May get into trouble - saying it through their behavior.
*YP who are gay have higher rates of mental health needs
*In practice- complex with confidentially- hidden from parent 

!!!__Faith__

*Can be a huge sense of strength for some people- shared community of support.
*need to honour this as an aspect of support for CYP

!!!__Ethnicity__
*Mixed race or grown up in UK but have different culture- don’t fit into either group
*sense of belonging and safety. – young people just want to fit in.

BAME (Black, Asian, Minority Ethnic) :

*Alienated/ don’t quite fit into the majority. 
*Battling stereotypes that may be associated with your race. 
*People always 'where are you from'. – well-being effect: exhausting to have to validate self. 
*Always considering their difference- constant voice- on top of other issues such as anxiety 
*Being a white male – talking about difference may feel uncomfortable -issue not just located with minority - everyone’s issue.
* barriers to service such as trust, cultural differences and representation

!!!__Culture__

*have different ways of constructing MH difficulties – present/ describe in different ways. - don't stereotype parents before you meet them.
*Parenting styles may also differ.
*Cant ask the child what is your parents parenting style is- but can ask around the question. 
*Parents may have different cultures to each other- can cause stress for CYP.
*Interpreter issues- language barriers 
*Domestic violence: threshold of safety, normalizing of behaviors, one of the biggest factors of severe mh problems. 
*Domestic abuse can be perpetrated by the CYP. - unseen statistic.


!!Practice points:

[[Diversity: Practice Points]]


!!Videos:

Please go to [[Diversity: Exploring Stereotypes]] for some interesting videos of people talking about their experience of stereotypes.

!!!Toxic masculinity:

[['Man up'|https://www.youtube.com/watch?v=gpxqXZvH0kI]] TV campaign from Australia 

[[Man Up Speak Up|https://www.youtube.com/watch?v=2MegTWpay2w]] video by Kent Union

!!!Transgender 
[['Butterfly'|https://www.youtube.com/watch?v=L2iSPxdDRbM]] (tv programme by ITV) about the experiences of a family as their youngest child transitions to a girl. This series provided a good insight into the issues that can arise through a persons transition. 

!!Links to other pages 

Please go to [[Diversity]] for a list of pages relevant to this topic.

[[Survey of the Mental Health of Children and Young People in England, 2017]]

!What is the DoE?
''The Department for Education'' is responsible for children’s services and education, including early years, schools, higher and further education policy, apprenticeships and wider skills in England.
Working closely with; national and local agencies who look after children, local authorities and professionals who work in schools and further and higher education institutions, children’s services and health services.

!!Responsibilities

* teaching and learning for children in the early years and in primary schools and secondary schools, young people and adults in higher education, apprenticeships, traineeships and further education
* supporting professionals who work with children, young people and adult learners
* helping disadvantaged children and young people to achieve more
* making sure that local services protect and support children

Please use the link below to visit the DoE offical website.

https://www.gov.uk/government/organisations/department-for-education

Source: DoE

Please see below for the DoE: National Teachers Standards. 

<<link-pdf "~DoE Teachers Standards" "https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/665522/Teachers_standard_information.pdf">>

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. 

[img[lightbulb(1).jpg]]

!!!The EMHP 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 new Education Mental Health Practitioner (EMHP) role is an exciting opportunity to deliver evidence-based early interventions for children and young people, working across educational settings in England. (Taken from [[London and South East CYP-IAPT Learning Collaborative|https://cypiapt.com/2019/03/13/educational-mental-health-practitioner-2019-update/]] please follow the link for more information)

!!!This Guide:
The guide is an open resource for any Education Mental Health Practitioners both in training and those who have qualified. EMHP supervisors may also find the information on this guide helpful.

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 EMHP 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]] 

To find out more about the wiki manuals and how they are being used across the Anna Freud Centre please refer to the animation below:

<iframe width="560" height="315" src="https://www.youtube-nocookie.com/embed/ah90xbtH0Do" frameborder="0" allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe>

{{chatting women small.JPG}}


!!Supervisors: 

This area of the guide is for information and resources about all aspects of supervising and supporting service development leads on the EMHP programme. 

Below is a list of the pages within this section aimed to support supervisors:


!!! Core Information for Supervisors
<<list-links "[tag[Supervisor Core Information]]">>

!!!General EMHP information
*[[Outcomes]]
*[[EMHP Role Specification (JD)]]
*[[EMHP Person Specification (PS)]]

!!!Supervisor Resources
Please see [[Resources]] for a list of useful resources for supervisors.

!!!Knowledge from previous CWP supervisors 

Please see [[Knowledge from CWP Supervisors]] for a list of useful answers to questions from previous CWP supervisors.

This is a tag tiddler
<<list-links "[tag[EMHP]]">>

!!Introduction to practice and learning competencies.

A comprehensive framework for competencies working with children and young people was produced in 2011 commissioned by the NHS Scotland in collaboration with UCL. 

The resulting competency framework became known as the Roth and Pilling framework (named after the two leads of the project)  and this can be accessed at http://www.knowledge.scot.nhs.uk/home/learning-and-cpd/competence-framework-for-child-and-adolescent-mental-health-services.aspx

The specific descriptions of the competencies can be accessed here. 

http://www.ucl.ac.uk/clinical-psychology/competency-maps/camhs-map.html

Two more specific competency frameworks for EMHPs have been developed to support the training process. These are entirely consistent with the  Roth and Pilling model but were also influenced by the National Curriculum for EMHPs and also the CBT Competency  Framework developed at UCL for the CBT Masters Course and which is well designed for applying to low intensity self help models of intervention. 

1. ''Learning Competency.''  This provides a checklist of knowledge and skills that the trainee is expected to gain during the training. [[EMHP Learning Competencies]]

<<link-pdf "Learning Competencies" "https://drive.google.com/open?id=1dsz9CqnSiUQhMKOHdPiKHFa7SF2qchzv3w0xViGeW4I">>


2. ''Practice Competency.''This provides a framework for assessing competencies used in direct work with children and parents either in individual work or in groups. 


<<link-pdf " Practice Competencies " "https://docs.google.com/document/d/1peRSF-Ov9Yz7mo3PeRIVL5AWjSdeMs3V0Fbqo_U7hjg/edit#heading=h.gjdgxs">>

!!!''EMHP LEARNING COMPETENCIES'' 
!!Introduction
This learning competency framework is based on extrapolating a succinct number of core learning outcomes form the National Curriculum. It has been devised as a way of supporting the EMHPs during training to self monitor their own progress of learning during the course. It has not been subject to psychometric testing and will be revised following the first year on the basis of feedback from the group. 

A first version of the measure was examined by the UCL EMHP Development Group and a large number of amendments were made on the basis of their expert feedback. 


The competencies are divided into two groups, knowledge and skills. 

!!''Knowledge'' (12 competencies)

!!A.Knowledge of schools and education 

1. Knowledge of the education system, key education legislation and special needs procedures. 

2. Knowledge about key performance outcomes for schools and colleges and how these are assessed

3. Knowledge of the range or roles that can be taken by education staff in managing children with mental health needs.  

4. Knowledge of safeguarding procedures and practice in an educational setting

!!B. Knowledge of mental health 

5. Knowledge of systems theory about  how systems impact on relationships and forms of help for children, young people and practitioners.   

6. Knowledge of the needs that are likely to be presented to EMHP in a school setting and those which should be referred to more specialist help.  

7. Knowledge of how children present who have experienced traumatic events or who are are subject to bullying behaviour by their peers. 

!!C. Knowledge of interventions for children, young people and parents. 

8. Knowledge of how to collaboratively engage children, young people and their parents/cares around mental health matters in a school and college setting. 

9. Knowledge of the how to carry out a mental health assessment in a school setting in a collaborative way with young people, parents and teachers.  

10. Knowledge of how to facilitate groups for  children, young people, parents and educational staff around  emerging mental health problems in schools.

11. Knowledge of a peer support programme and how to implement in a school setting. 

12. Knowledge of the role of outcomes monitoring  in order to support evidence based individual interventions for common mental health problems in an educational  setting. 



!!''Skills'' (13 competencies)

13.	The ability to deliver mental health interventions for an individual child or young person supported by outcomes monitoring in a school setting. 

14.	The ability to demonstrate collaborative practice with teaching staff in addressing the mental health needs of children and young people.  

15. The ability to develop a future support plan for the child and young person that includes school staff, the family and the wider network (where appropriate). 

16.	The ability to run groups for children, young people, parents and educational staff in a school setting. 

17.	The ability to train and support peer mentors in a school setting. 

18.	The ability to carry out whole school surveys or audits of mental health needs use outcome monitoring in my sessions with young people and parents. 

19.	The ability to design and deliver psycho-educational workshops with teachers, parents and/or young people around a range of mental health matters. 

20.	The ability to engage young people in developing mental health  projects in a school setting. 

21.	The ability to effectively contribute to the pastoral care system within the school and to provide effective contributions to such settings.  

22.	The ability to be sensitive the mental health needs of school staff and to work in ways that recognise the stresses of school life.

23. The ability to promote effective links with local CAMHS and handle referrals to this service with sensitivity.  

24.	The ability to support parents active engagement in school life particularly around the wellbeing of pupils in the school. 
 
25.	The ability to develop reflective practice in order to make the most effective use of supervision and other forms of support. 


<<link-pdf "EMHP learning Competencies" "https://drive.google.com/open?id=1dsz9CqnSiUQhMKOHdPiKHFa7SF2qchzv3w0xViGeW4I">>


. 

!!!''Qualifications''

#Ability to study at degree level.
#Proven record of previous academic attainment.
#Good solid basic literacy and numeracy qualifications at a minimum of level 2

!!!''Skills and competencies''

#Ability to learn in a variety of settings and using a variety of learning methods
#Computer literate
#Ability to study as a self-motivated learner who can formulate their own progress towards learning objectives and negotiate pathways to achievement with supervisory teams

!!!''Knowledge''
#Knowledge of the educational system in England

!!!''Previous experience''

#Previous experience of working with children and young people (desirable) 

!!!''Specific attributes''
#Full, enhanced and current satisfactory DBS disclosure for the role
#Ability to personally manage a sensitive, traumatic and potentially emotionally distressing caseload
#Excellent oral and written communication skills

!!!''Personal attributes''
#Self-motivated
#Able to travel to meet the requirements of the post
#Team player
#Excellent time management and organisational skills
#Able to meet the physical requirements of the role after reasonable adjustments have been made for any illness or disability.

!!!''Key deliverables''

To allow the postholder, under supervision and with support, to develop knowledge and practice skills in;

#Delivering evidence-based intervention for children and young people in education setting with mild to moderate mental health problems
#Helping children and young people within these settings who present with more severe problems to rapidly access more specialist services
#Supporting and facilitating staff in education settings to identify and where appropriate manage issues related to mental health and wellbeing
#Working with and within education environments to afford better access to specialist mental health services

To evidence development of those skills with associated knowledge acquisition to record and evidence progression towards an academic award and demonstrable practical ability.

!!!''Key duties''
!!!!''Therapeutic practice'' 

#Be supervised, supported and assessed oneself to assess and deliver outcome focused, evidence-based interventions in educational settings to children and young people experiencing mild to moderate mental health difficulties.
#Developing skills in supporting children and young people experiencing mild to moderate mental health difficulties, their families and educators in the self-management of presenting difficulties. 
#Developing and practicing skills under supervisory support of working in partnership with children, young people, their families and educators in the development of plans for the specific intervention and agreeing outcomes. 
#Developing and learning the skills required in order to enable children and young people in education to collaborate and coproduce their own agreed plan of care.
#Show evidence in a variety of forms that at all times intervention is provided from an inclusive values base, which recognises and respects diversity.
#Discuss with supervisors and agree to accept appropriate referrals for children and young people in educational settings, according to agreed local and national and local referral routes, processes and procedures. 
#Under supervision, undertake accurate assessments of risk to self and others.
#Learn, understand, rationalise and adhere to the protocols within the educational service to which the postholder is attached.
#Engage along with more senior staff in the signposting of referrals for children and young people with more complex needs to the relevant service. 
#Engage in robust managerial and clinical supervision, identifying the scope of practice of the individual postholder within the role, and working safely within that scope. 
#Gain and practice a range of interventions related to provision of information and support for evidence based psychological treatments, primarily guided self-help.
#Practice, evidence, reflect on and demonstrate an ability to manage one’s own caseload in conjunction with the requirements of the team. 
#Attend multi-disciplinary and multi-agency meetings relating to referrals or children and young people in treatment, where appropriate, both for personal educational benefit in discussion with supervisors, or to provide direct assistance. 
#Keep coherent records of all training and clinical activity in line with both health and education service protocols and use these records and outcome data to inform decision making.
#Complete all requirements relating to data collection. 
#Show evidence of working within a collaborative approach, involving a range of relevant others when indicated. Specifically, work in collaboration with teachers and other educational staff, parents, children, young people and the wider community to enhance and broaden access to mental health services. 
#Contribute to the development of individual or group clinical materials or training materials and go on to develop further such materials as falls within own degree of competence.

!!!''Training and supervision '' 
#Attend and fulfil all the requirements of the training element of the post including practical, academic and practice-based assessments. 
#As well as attendance at the University for training, fulfil private study requirements to enhance learning and prepare assignments for examination, for at least one day a week.
#Apply learning from the training program directly to practice through the course. 
#Receive practice tutoring from educational providers in relation to course work to meet the required standards.
#Prepare and present case load information to supervisors within the service on an agreed and scheduled basis, in order to ensure safe practice and the governance obligations of the trainee, supervisor and service are delivered. 
#Respond to and evidence the implementation of improved practice because of supervisor feedback. 
#Engage in and respond to personal development supervision to improve competences and practice.
#Be involved in the evaluation of the course
#Disseminate research and service evaluation findings through presentations and supervisory discussions.
!!!''Professional''
#Ensure the maintenance of standards of own professional practice according to both the postholder’s employer and the Higher Education Institution in which they are enrolled.
#Ensure appropriate adherence to any new recommendations or guidelines set by the relevant departments. 
#Ensure that confidentiality is always protected.
#Ensure that any risks or issues related to the safety and wellbeing of anyone the postholder comes into contact with in the course of their professional duties are communicated and shared with appropriate parties in order to maintain individual safety and the public interest. 
#Ensure clear objectives are identified, discussed and reviewed with supervisor and senior colleagues on a regular basis as part of continuing professional development. 
#Participate in individual performance review and respond to agreed objectives. 
#Keep all records up to date in relation to Continuous Professional #Development and the requirements of the post and ensure personal development plans maintains up to date specialist knowledge of latest theoretical and service delivery models/developments. 
#Attend relevant educational opportunities in line with identified professional objectives.


<<link-pdf "EMHP role specification " "https://drive.google.com/open?id=1ejJwJYRILh1MGsSCfqhG3-Hk0euphOeX">>

!!!''EMHP and Agenda for Change Job Criteria''. 
This job description is a training post banded on a Agenda for Change band 4 job description.

Qualified practitioners will progress to Band 5. 

Criteria for job evaluation against Agenda for Change criteria can be found in the NHS Guide for this. 

 "<<link-pdf "~AfC Job Evaluation Guide " "https://drive.google.com/open?id=1L8arEYS_SxWhNEGzCYVkXBEE0i8-uh3I ">>

The Site Map below describes the ''six key areas'' that this Guide is split into and which can be accessed through the row of tabs at the top of the screen - This is what we call the ''contents bar''.

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.

The Guide has hundreds of pages of information (including handouts, self-help materials, videos) about the EMHP programme, however, for some users, they experience the Guide as being hard to find things and to know what is available in the guide. 

We hope that having this overall framework in mind, you will be able to find things more easily in the manual!

[img[site map updated sep 2019.PNG]]


We will only discover how much this works through your ''feedback!'' 

Every time you can’t find something is a learning opportunity for us. Please use the tab to the right of the screen to give us feedback! In such situations, let us know what you couldn't find or when you got lost in the guide. Following core CYP-IAPT principles of learning from feedback, we will do what we can to address these problems.

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

!!!!Source: Wendy Geraghty 

!!!The EMHP role
The role of the EMHPs will be to work within Mental Health Support Teams in Schools as part of designated Trailblazers sites. See [[EMHP Role Specification (JD)]]

!!!Why?
This workforce has been developed as a result of the implementation of the Government [[Green Paper|The Green Paper on Mental Health in Schools]]. 

!!!Training
The Education Mental Health Practitioner (EMHP) Programme is a ''''Post Graduate Taught Diploma commissioned by Health Education England with mandatory funding from the Department of Health via NHS England. The aim of the programme is to train a new workforce of mental health practitioners in educational settings. Graduates of the Programme will complement the work of existing CAMHS practitioners by providing direct, rapid access to low intensity evidence-based treatment interventions, for mild to moderate mental health difficulties, as part of a stepped care model of service delivery in schools help to children. This workforce will be trained to offer one-to-one sessions, bespoke groupwork within the school setting, as well as signposting on to other appropriate interventions for children and young people with mental health difficulties when needed.

This new program is closely linked to the Well Being Practitioner Programme and builds on the principles of to the CYP-IAPT Programme for Psychological Therapies.

!!!Trailblazer sites and training 
Students will be placed in Trailblazer sites selected by the Government to participate in this initiative from across London and the South East.Students will work directly with children, young people and parents as part of their work in the Mental Health Support Teams (MHSTs) at their Trailblazing sites.
They are expected to adhere to their employing NHS Trust’s procedures, policies and guidelines (and the Code of Ethics of their Professional Body if this applies), and also to the procedures and policies of the host agency managing the trailblazing sites. In general, policies and procedures for both the employing agency and the host agency will be sufficiently similar for there to be no problems in guiding practice and decision making about the trainee placement. However, where discrepancies occur, these need to be raised with their CAMHS supervisor/site supervisor.

Students will have clinical skills practice tutoring provided by the university course for cases they bring to the skills workshop days. Training cases and other work will be supervised by a supervisor in the MHST working in the service where the child, young person or parent is being seen. Clinical skills tutoring provided by the university course is not a substitute for any case management supervision i.e. reporting and accounting that should occur in routine care, and clinical responsibility for all children, young people and parents seen by students during the course remains with the MHST where the intervention is being delivered.


!!!Specific aims for the training are:
# To equip the students with the necessary knowledge, attitude and competence to operate effectively in an inclusive, values driven service. 
# To equip students with the fundamental skills to assess cases using appropriate and effective assessment tools and engage with children and young people (CYP) and their families. 
# To equip students with knowledge and skills in effective, brief (low-intensity) interventions for CYP and family systems based on the most up to date evidence. This will include knowledge of a range of interventions and services available to CYP and families across CYP agencies. 
# To equip students with the necessary knowledge, attitude and competence to assess and engage CYP with mental health difficulties, their families and education staff within an education setting, including an understanding of legislative and policy frameworks, how education settings are organised, specific special educational needs (SEN) roles, and development. It will equip them to recognise and work with existing expertise within the education setting. 
# To equip students with the knowledge and competence to understand common problems and processes in education settings which have adverse effects on wellbeing (including, but not limited to bullying, examination stress, loss, family conflict, trauma and abuse), and the skills to develop and increase support from their community of teachers, peers and family members. Students will also learn to identify risk factors for common problems and knowledge of vulnerable groups such as SEN and Looked After Children (LAC). It will equip students to use psychological theories and psychoeducation to help CYP to understand and tolerate negative emotions, and support education staff with training, implementing peer mentoring approaches and supporting classroom management in education settings. It will equip them to become aware of the limitations of their professional role and when to seek advice or signpost clients to other organisations such as CAMHS where appropriate.
# To equip students to develop an awareness of emerging mental health difficulties in education settings and support/carry out evidence-based group interventions with CYP, parents/carers and school staff. They will demonstrate consultation skills to advise and support education staff about the psychological effects of common problems in CYP. It will also equip students to train others in basic mental health intervention skills, and to develop skills in coordinating with health care and other service providers. Key skills will be developed through teaching, experiential learning, role play, observation and supervised practice. 

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

EMHP topics are possible topics for either teaching sessions, or as parts of teaching sessions or for discussion in practice tutor groups. It is not possible to include all possible topics in the teaching programme but all suggestions about possible topics will be tagged here.  

!!!''Introduction''
In London there will be 60 trainees, 30 registered with UCL and 30 registered with KCL. 

The salaries for these posts will be Agenda for Change Band 4. Salary scales are shown in link below. 


<<link-pdf "NHS payscales" "https://www.nhsemployers.org/your-workforce/pay-and-reward/agenda-for-change/pay-scales/including-hcas">>


The recruitment process for the trainees will be done collaboratively in London between UCL and KCL. 

All recruit to train staff will be employed in trail blazers sites or Pilot Sites in London. 

All trainees will be employed by two Employing NHS Foundation Trusts in London.

#SLAM (30 trainees)
#Camden and Islington Mental Health Trust (30 trainees)

*The new workforce comprise Mental Health Practitioners in Schools (education) who will be graduate entries in to the workforce and who will be part of the pilot (‘Trailblazer sites’) in London. 
*These sites will not be agreed until November. 
*Recruitment has to begin before this has happened as recruitment for recruit to train takes approximately four months. 

!!!''Contract between HEE and NHS Employing Trust''

The plan is to agree a contract between HEE and a NHS  Foundation  Trust. This contract will need to cover relationships between:

*Health Education England (HEE)
*The Employing NHS Foundation Trust
*The agencies running the Pilot Sites.
*The universities (UCL and KCL) through the London UCL/KCL Workforce Team 
  
 
The following issues need to be considered:  

#This contract between the HEE and the Employing Trust would only be for one year as in future years the EMHP trainees would be employed by the services themselves. 
#The trainees would be offered 12 month fixed term contracts with the Employing Trust. 
#Trainees would be employed at Band 4. 
#There would be one designated manager within the Employing Trust who would take an oversight of this. 
#The recruitment task would be carried out by the CYP-IAPT Workforce Team jointly for KCL and UCL in collaboration with the Employing Trusts. 
#The recruitment process will need to be carried out in a way which is consistent with the Employing Trust HR policy
#The job description will need to be clear about lines of accountability. We suggest that the postholder would be required to have an honorary contract with the Pilot Site who would hold accountability for professional conduct etc as this could not be carried out effectively by the Employing Trust. 
#The Pilot Site would take responsibility for providing sickness and absence monitoring that would be required by the Employing Trust. 
#DBS checks would need  to be done at the point of recruitment by the Trust as  the DBS agency would not  accept enquiries from a non-employer. 
#The contract between HEE would need to agree that attendance at mandatory training would need to be agreed between UCL/KCL, the Employing Trust and the Pilot Sites in order to ensure a sensible induction programme and mandatory training programme.  
#Attendance at Trust induction for these staff would not be required if induction in Pilot Sites is agreed as more sensible.  
#Appropriate HR costs for the Employing Trust should reasonably be included in the contract. 
#The Trust would need confirmation of this funding before any recruitment could begin. 
#The recruitment process needs to start in September so agreement in principle needs to take place in the first two weeks of September.  

 

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.

 

Please see below for the current process for creating pages in the wiki. It is the aim to review all pages within the wiki to ensure they are relevant and accurate.


[img[Flow chart of review process.PNG]]

Please see the page [[Copyright]] for the copyright guidance followed for editing the Wiki.

<<list-links "[tag[Education Knowledge]]">>

<<list-links "[tag[Education Practice]]">>

<<list-links "[tag[Education Research]]">>

<<list-links "[tag[Education Resources]]">>

See link below for systematic reviews carried out by educational psychology students on a range of topics relevant ot work in schools 

<<link-pdf "Educational Psychology systematic reviews" "http://www.ucl.ac.uk/educational-psychology/decpsy/index.html">>

!!!!!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.

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

!!!!!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.

!!!!Source: AFNCCF

Research shows that if parents and carers are actively involved in their children’s learning and activities at school, they will be more likely to thrive both in terms of academic performance and in their general wellbeing. 

This page provides information about a helpful booklet developed by teachers, clinicians and parents and carers, including the Anna Freud National Centre for children and Families Parent Champions. This booklet is aimed at schools and provides a range of innovative ways that schools can help children by successfully engaging with parents and carers. It includes tips as well as case studies that show both parents’ and schools’ perspectives. 
Topics featured in this booklet include:

*Building rapport with parents and carers
*Having difficult conversations with parents and carers
*Managing your feelings

This booklet is available in both an interactive online version which includes videos, audio and extra links to trainings and resources. and a pdf version. 

!!!Please find both versions of the booklet on the Anna Freud Centre's website [[here.|https://www.annafreud.org/what-we-do/schools-in-mind/resources-for-schools/engaging-with-all-parents-and-carers-booklet/]]

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. 

!!!! 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/

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

Include attachment and Mz as contributing to capacity to learn. 

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? 

''Learning tasks in the school setting''. . 

#Interview a school SENCO. 
#Classroom observations using a structured observation tool.
#Observation of a targeted intervention for language literacy and or numeracy in groups of for individuals literacy 
#read behaviour management policies and comment on links to evidence based practice. 
#observation of targeted intervention for social emotional and behavioural development 
#observation of a child who is identified and complex and challenging needs and discuss their needs with the teacher and or SENCO. 
#attend multi-agency meeting 
#Interview a child of their experience of school and their aspirations of the future. 
#interview a whole group. 
#report writing - do locally. 

 
''Working tasks''. 

All tasks will be closely managed by Mental Health Lead and SENCO

@@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 Feedback and Outcome Tools]] 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 

[img[question mark.jpg]]

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

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

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

{{thinker3.PNG}}


!!!''Introduction to the 'Finding Out' pages''
This area of the guide is about providing knowledge and skills to support the work of EMHP's. The purpose is to develop and expand the EMHP's knowledge, skills, practice and understanding of the theory and research which sits behind EMHP practice. 

!!!EMHP 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
EMHP supervisors may find these pages helpful in providing information about the low intensity guided self help approach that EMHP's are trained to deliver. 

!!''Main Topics ''
The pages in the Finding out area are organised into topics areas. These topics are listed below.

#[[Child/Adolescent Mental Health Problems]] - the nature of child and adolescent mental health problems. 

#[[Working in Schools]] - how the education system works and how to within schools.

#[[Working with Parents]] - supporting the key role of parents 

#[[Child and Adolescent Development]]- aspects of child and adolescent development

#[[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]] - Guidance on how to conduct Assessments 

!!!''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. 

This page provides editors with guidance on how to format pages in the wiki, keeping in mind the accessibility of our readers

!!''General format''
*All manuals to have a Top Menu 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
* Avoid the following colour ''combinations ''as they are commonly unfriendly to those with colour vision deficiencies: 
**green/red, blue/purple and light green/yellow

!!''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''
*Use headings correctly to give structure to pages and make content scannable. Do not use bold text //instead //of headings (choose H2, H3, etc.) 
*All word in headings to begin with upper case except for joining words such as: a, and, of 

* ! (H1): ''don’t use'' in page text as too big (same size as page title)
* !! (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)
* Headings should not include any symbols such as ':' or full stops

!!''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 ]]

!!Videos & Images

*Use captions for video content & images
*Do ''not ''convey meaning via visual media alone – especially avoid text on images (this is not screen reader accessible and won’t respond well to resizing on different devices.) 

!!Other
*''Never use'' ‘click here’, ‘read more’ or ‘here’ for your hyperlink titles. Use a short and descriptive title that describes the link destination e.g. 'Manual on Anxiety & Depression'
*Remember reading is more difficult online than in print 
*Keep copy concise and meaningful

!!!''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 EMHP 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. 

This is a very useful website with information  about the Green Paper implementation.

https://future.nhs.uk/connect.ti/CYPMH_GrP/grouphome?done=GRPJustJoined

This site is restricted to those who have registered as members so link wont work unless you are a member. 

To inquire about membership please contact:

NHS-E CYPMH Shared Mailbox: England.cyp-mentalhealth@nhs.net

!!!!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 

This could be included in session on diversity and also in relation to children and young people with exceptional needs. 

<<list-links "[tag[General Resources]]">>

! Planning
* first hour- Learning objectives outlined check in, (Two stars and a wish), assignments ect. 
*middle - content 
*end- summarizing, revising learning 
 !!!Each week 
*two stars and a wish? on the key content/ learning for the previous week- reflective practice - not only focus on the negative! sharing ideas and experiences 
*questions 
! expectations for trainees 
to reflect on your learning - feedback at the beginning of every sessions
to be independent practitioners 

!!Overview
Practice tutor groups at UCL will be co-facilitated by two practice tutors working in pairs in each group. 

The aim is that one has is from an  educational background and one is from a mental health background. Throughout the course these two perspectives are constantly explored and made explicit. 

For example, the way behaviour problems might be described in an educational framework is likely to be quite different from how it is described from a mental health perspective. 

!!Structure of the day: a beginning, middle and an end. 

There will be two 2 hour and 15 minute practice tutor group each Wednesday.

''A beginning''. The first practice tutor group will start with a check-in period of approximately an hour when students will be invited to feedback about their experiences on placement and their progress on the course. The intention is that 

''A middle''. Each day will have some general themes to be explored and the amount of time that each theme takes up in the session will be flexible according to what is needed.

As the course progresses this time will also be taken up with sharing videos of work carried out in school. 

''An end''. The last part of the second session should involve a process of summarising and consolidating learning. What has been learnt, what discussed that was already known etc. The aim would be for each trainee to be able to identify learning outcomes for themselves or to reflect on what were the barriers or previous knowledge that did not support this. 

!!Planning the practice tutor groups 

Each practice tutor group day will be planned the previous Wednesday at a meeting of the practice tutors from 3.45-4.45. This meeting will also be attended by the Programme Director and by the Assistant Psychologist for the EMHP Course. 

The aim of this meeting is to consider the current progress of the students and to plan the next session. Each week will have one or several themes for consideration and the purpose of this meeting will be work out together how best to bring these themes to life with the trainees. 

Materials that need to be prepared for the following week will be put together by the Assistant Psychologist over the coming week.  


 

!!!!@@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 in relation to the EMHP role.

!!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 [[Observing pupils in the classroom]]
* 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]]

Definitions of terms will be listed here and linked to pages where they are used. 

!!!!!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.
More information can be found on the CORC website 
 [[CORC|https://www.corc.uk.net/outcome-experience-measures/]] (Children Outcomes Research Consortium) and in the goals in therapy website [[https://goals-in-therapy.com]]
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-Orientated Practice]], [[Outcomes]] and [[POD]] for relevant pages.

!!!''Goal-orientated Practice''

<<list-links "[tag[Goal-Oriented Practice]]">> 

!!Feedback from trainees 

Once a week the assistant will feed back the feedback on the teaching session of the previous week  to the group.  This will happen at the beginning of the teaching day. this will usually happen at the beginning of the teaching session on Fridays. 

The week after the teaching session the assistant psychologist will provide a summary feedback to the tutor on their teaching session. 


!!Preparation for teaching sessions 
1. All teaching staff should have a brief phone call with the Programme Director prior to the teaching session to discuss the relevant content and to clarify learning objectives. 

2. Teaching staff are required to provide their teaching slides and notes to the Programme Officer at least two weeks prior to the teaching slot. This is to ensure that there is consistency across sessions and that all parts of the curriculum are covered. 

3. Practical queries about location, timings etc of the teaching session should be directed to the Programme Officer. 


!!Structure of teaching sessions

1. The session will be supported by the assistant psychologist for the course who will be present throughout the session. Her role will be to help summarise the content of the teaching. With the permission of the tutor, this summary will be uploaded on to the on-line wiki guide for EMHPs.  

2. Sessions should begin with explicit learning objectives. 

3. At the end of the session, there should be a collaborative process of summarising the key learning points of the session which should involve both the trainees and the teacher.  

4. For the last part of the session, the trainees need to provide feedback on the session using POD.


!!Content of teaching. 

1. Teaching should, wherever possible,  include tangible examples which relate to what the EMHP will be doing either with respect to children, young people and parents or with respect to skills around the particular subject matter. 

2. Wherever possible, sessions should be interactive with trainees with a combination of didactic teaching and small group or whole group discussions and other methods of learning.  

3.Trainees will be invited to reflect on how they are going to use the teaching in their work in schools? 

!!!!Source: Charlotte Hepburn and Peter Fuggle 

This page is only relevant to those involved in editing pages of the guides. It explains how pages in the EMHP and CWP guides can be written so that the the exact same page appears in both guides. It covers an important but technical aspect of editing. 

!!!What is the shared bag and why use it?
Pages which contain information applying to both CWP and EMHP manuals go in the 'shared bag'.  This is a wiki but is set up in a particular way so that pages written in this wiki automatically go into both EMHP and CWP guides. 

Editing pages that should automatically go into both guides should be done on the 'shared bag' wiki and not separately in the individual CWP/EMHP manuals. This is currently only done by Charlotte Hepburn and Peter Fuggle. 

!!!What pages go into the shared bag?
Below is a list of the types of pages that should be in the 'shared bag'. 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 guides go in the shared bag such as copyright and consent policies

* Core pages about measures used by both CWP's and EMHP's.

All pages regarding outcome measures will generally be on the shared bag over time. Best practice for individual mental health support teams about outcomes may develop over time and such differences can be integrated into local versions of the manual. 

!!Editing Health Warning!

The EMHP and CWP guides are designed to be experienced as completely separate. However, behind the scenes, many pages of each guide are shared between the two. This is not obvious as shared and unshared pages look exactly the same. This is deliberate. 

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'. 

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 contact Charlotte to discuss this in order to make this edit in the 'emhp-cwp-shared' bag. If you want to make an edit that only changes the page in one guide, then you can do this by editing the page in the individual guide itself.  This is very clever technology but potentially very confusing if the person editing doesn't know which type of page is being edited.  

!!Editing the shared bag

To avoid confusion editing of the shared bag is currently been restricted to Charlotte Hepburn and Peter Fuggle.

*local guides = CWP and EMHP guides 
*Shared bag= shared bag wiki 
!!!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 in the local manual. 

!!!Deleting a page 
Deleting pages on either the CWP or EMHP manual- first 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. 

!!!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 first. 

#create a new page in the shared bag manual.
#copy and paste the title, main text and all relevant tags into the new page.
#save this new page in the shared bag.
#delete the old page from the local manual you copied it from
#refresh your browser 

Once you have completed all these steps, the page you wanted to be in the shared bag should appear in both guides. Any editing of this page would then need to happen on the shared bag wiki to ensure local copies aren't created which will overwrite the shared version.

!!!@@color:red;(Please note these pages have not been reviewed for EMHP supervisors)@@

!!Pages from the CWP manual:

!!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?]]

Guide to Using Outcomes and Feedback Tools with Children, Young People and Families (2014) Co-Edited by Duncan Law

<<link-doc "Using Outcomes and Feedback Tools" "https://drive.google.com/file/d/13HAEgeDq9uY_4DDW1LsLPSFBwUyjbXtx/view?usp=sharing">>

!!!!Source: Natasha Byrne and Duncan Law
!!!@@color:red;(Please note these pages have not been reviewed for EMHP supervisors)@@
Excerpt from CWP [[Operational Guidance|https://drive.google.com/file/d/1KXOkFEFMGyJ3h5EHPP6MKyl3T0Gs_cCM/view?usp=sharing]] for London and South East



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

[img width=100% [countryside-2371480_960_720.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]]. 

!!!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. 
<<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]]">>

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>

https://www.healthylondon.org/wp-content/uploads/2018/10/HLP-Primary-Care-and-Early-Help-Children-and-Young-People-Mental-Health-Compendium.pdf

Review of 51 studies of primary and child mental health 
https://www.healthylondon.org/wp-content/uploads/2018/10/UCLPartners-Literature-review-of-CYP-mental-health-services-in-primary-care.pdf

[img[joshua-ness-225844-unsplash.jpg]]

!!!!!Source: Peter Fuggle and Charlotte Hepburn
!!!EMHP Practitioners
This area of the guide supports EMHP practice, providing resources, session plans and manuals for EMHPs to use with a young person or a parent. 

!!!Supervisors
May find this area of the guide useful to familiarise themselves with the content of guided self help sessions EMHP are trained to deliver.  


!!!Main pages for Guided self help sessions.
Please follow the link for a comprehensive list of ALL the [[core intervention manuals|Core Intervention Manuals]] and the core [[Interventions]] used by EMHP'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[jack-b-oRNMgnvQsNw-unsplash (2).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[laptop typing.jpg]]

!!!Overview:

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, whilst also checking in on risk.

Please see below for a brief assessment structure:
[img[Assessment structure.png]]

!!!Conducting an Assessment:
Please find below guidance on how to conduct an assessment session which is relevant to all of the interventions covered in the EMHP programme.

*[[Assessment: Session Plan]]
* [[Assessment: Key Questions to Ask]]
*[[What is a Session 0]]
*[[How to Conduct Assessments]]

[img[water2.jpg]]

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 five (or more) sessions. These aim to:

#promote the child’s development, child’s attachment and the parent-child relationship
#keep children safe in their exploration through limits and positive discipline
This approach follows the manual developed by Deb ~McNally and the Manchester Collaborative which can be found below.


!!!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[jack-b-oRNMgnvQsNw-unsplash (2).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.

!!!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[pebbles.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]]

@@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 Online Guide for Education Mental Health Practitioners</center>@@''

!!!<center>(often known as the EMHP 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 for button.jpg" "About" "220">><<image-link "Contents" "books-icon.jpg" "Contents" "220">><<image-link "Interventions" "pad of paper icon1.jpg" "EMHP Interventions" "220">><<image-link "User Guide" "navigate icon.jpg
" "User Guide" "220">><<image-link "Contact us" "phone icon.jpg" "Contact us" "220">>''</center>


<center>''The guide is open resource for any Education Mental Health Practitioners both in training and those who have qualified. EMHP supervisors may also find the information in the [[Supervising]] tab helpful.

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


!!!''The information in this guide does not replace national guidance and is not  definitive. It is intended to be a working guide and a place for resources and information to EMHPs and their supervisors in the delivery of EMHP services. ''

!!Helpful Links




[[The Green Paper on Mental Health in Schools]]

For information on the copyright policies for this guide please go to: [[Copyright matters]]

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

{{logo2.jpg}} 

You can have as many pages open as you like. You 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- 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!

Another way to think about this is that the pages open in such a way that creates a 'Story River' i.e. as you read pages and click on links to other pages (which then open below the page your were on) you are creating a river of pages (which you can scroll back up to the top to see the beginning of the river and scroll down to see the end). By pages opening in this manner you come to create a story of the information you have read.  

This session is planned for 25th February 2019. 


Introduction 
0 - 5 - Pre school assessment tools.  

[[Initial assessments. |https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/596629/EYFS_STATUTORY_FRAMEWORK_2017.pdf]] 

Example of assessment age 2-3 years

Increase in number of children at year 1 with pre school characteristics.
Child as part of community. Family knowledge. History of children and family within the same school.  'It's the dark haired Gants that you have to watch!'

Initial meeting with the school - 

Assessment systems

Methods of recording: MIS: recording of school events : empirical by teachers

Welfare systems: within schools: variation of terminology
Progress manager; head of year; head of key stage, class teacher, Teaching assistant; Learning support assistant; Curriculum Leader; Head of subject;
Leadership

School counselors

-------------------------------------

Learning Activities

Diamond Nines using reception assessment criteria
2 stars and a wish
?? do the students have digital learning portfolios? Can I drop resources into an area for them?

Schools have to constantly differentiate.  EMHPs work with an environment where teachers are constantly trying to get [[this|Rule 1 Life is not fair - get used to it!  Rule 2 The world won't care about your self-esteem. The world will expect you to accomplish something BEFORE you feel good about yourself.  Rule 3 You will NOT make $60,000 a year right out of high school.   Rule 4 If you think your teacher is tough, wait till you get a boss.  Rule 5 Flipping burgers is not beneath your dignity. Your Grandparents had a different word for burger flipping: they called it opportunity.  Rule 6 If you mess up, it's not your parents' fault, so don't whine about your mistakes, learn from them.  Rule 7 Before you were born, your parents weren't as boring as they are now. They got that way from paying your bills, cleaning your clothes and listening to you talk about how cool you thought you were.   Rule 8 Your school may have done away with winners and losers, but life HAS NOT. In some schools, they have abolished failing grades and they'll give you as MANY TIMES as you want to get the right answer. This doesn't bear the slightest resemblance to ANYTHING in real life.  Rule 9 Life is not divided into semesters. You don't get summers off and very few employers are interested in helping you FIND YOURSELF. Do that on your own time.  Rule 10 Television is NOT real life. In real life people have to leave the coffee shop and go to jobs.  Rule 11 Be nice to nerds. Chances are you'll end up working for one. If you can read this - Thank a teacher!]] message across!

!!!!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).

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-Oriented 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 pages that are tagged with this title. Click on the tags below to see the drop down lists:

!!<<tag [[Adolescent Anxiety]]>>
!!<<tag [[Child Anxiety]]>>

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/

Once you have been set up with a login you will receive an email from //no-reply@verificationemail.com// asking you to follow the instructions to register your account. Once registered you can then login on the manuals signposting site (https://manuals.annafreud.org ) or when you are in the EMHP manual (https://manuals.annafreud.org/emhp/) using the login box at the top.

Once you have logged in you will then be able to access training videos in the 'locked section' of the wiki by clicking on the padlock along the top bar.

Interpersonal psychotherapy for depressed adolescents (IPT-A) is a time-limited (12–16 sessions) individual psychotherapy for adolescents ages 12–18 who are suffering from depression. 

*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)


For more information please go [[here|https://childadolescentpsych.cumc.columbia.edu/articles/interpersonal-therapy-adolescents-ipta]]

!!!@@color:red;THIS PAGE IS CURRENTLY BEING WRITTEN@@ 

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]]

This is a tag tiddler. 

@@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.

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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[pink and orange.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 (6 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:

*Behaviour Problems (5-8 years)
*Childhood anxiety (5-11 years)
*Adolescent anxiety (12-17 years)
*Low Mood (12-17 years)

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

!!!!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]].

!!!@@color:red;THIS PAGE IS CURRENTLY BEING WRITTEN@@ 

Here is a list of some words and acronyms and their meaning. Please add any that 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

//''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!).//

[img[books.jpg]]

!!!@@color:red;THIS PAGES ARE CURRENTLY BEING WRITTEN AND ARE AWAITING REVIEW@@ 

<<list-links "[tag[CWP Supervisors]]">>

could they help with teaching?  

!!!''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.  

Louise (Lewisham) EP. 
Connect with UCL. 

Please see link to UCL Educational Psychology here. 

<<link-pdf "Educational Psychology at UCL" "http://www.ucl.ac.uk/educational-psychology/decpsy/index.html">>

<<link-doc "Course Handbook UCL" "https://drive.google.com/open?id=1xZkdv-jVplLLX-bxtrp-N11lXgPEisXc">>

<<link-doc "Course Handbook UCL" "https://drive.google.com/open?id=1xZkdv-jVplLLX-bxtrp-N11lXgPEisXc" "sheets">>

<<link-doc "Course Handbook UCL" "https://drive.google.com/open?id=1xZkdv-jVplLLX-bxtrp-N11lXgPEisXc" "slides">>

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}}

[img[pebbles.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 Finding Out section 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.


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!!!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 outcome measures
The outcome measures used in this manual are 

* Full RCADS
* RCADS low mood subscale
* Goal based Outcome (GBO)
* Session Feedback questionnaire (SFQ)
*Evaluation of Service Questionnaire (ESQ)

!!!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 Guide: Low Mood" "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]]

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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]]

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!!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">>

 <<link-doc "Guided Self-Help for Low Mood: Full Manual WORD VERSION" "https://drive.google.com/file/d/1rZLRAEO4g3NTGGVPgCuAufg5nC2Tfn8k/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.


---

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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]]

!!!!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]]">>

<<list-links "[tag[Low Mood practice]]">>

Related Pages: 

<<list-links "[tag[Behavioural Activation]]">>

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">> 

@@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-'' demonstrate insincere and vague praise "that's good", "well done", "good job". Ask the parent did they know what they were being praised for? How did the praise feel? 

//''Key point:'' children only accept praise if they believe it!! children need to know what you're praising them for and need specific feedback to give a specific and sincere praise statement (Use handout 5 for parents to complete during the session).//

''Given immediately'' after the behaviour has occured- ask the parent "how soon should we praise a childs behavour? Why is it important we praise straight after?"

//''Key point: ''Younger children will forget what it is you're praising them for- they need to make the link between the behaviour/ attribute and your praise/ attention//

''Praise should focus on mastering skills and not comparing themsleves to others'' - e.g. demonstrate through social comparison "you are such a fast running, you are much better that Chris" 

//''Key point:'' You want the parent to just focus on the child and that they are doing well, rather than always comparing themselves to others.// 

''Avoiding criticism-'' demostrate following praise with criticism "well done for tidying your toys, why cant you do it like that every time? Ask the parent how that made them feel?

//''Key point:'' if we follow praise with a criticism, we are paying attention to the behaviour we dont want to see/ the negatives. What will the childs attention be drawn to? And what will they remember?//

''Avoid waiting for perfection to praise-'' ask parent why is it important to praise steps in the right dircetion?

//''Key point:'' children need to be praised for their efforts e.g. if you ask a child to put all their toys away, but they only put most away, you would still praise them for this.//

!!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. 
*[[The Hot Cross Bun Technique]]

<<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.

---
''Please note:'' if the young person is at school during this conversation please ensure you contact the ''schools safeguarding lead''. And have the contact information of the school/ safeguarding lead before conducting a phone call conversation.

---

!!!__FACTORS TO CONSIDER EXPLORING DURING TELEPHONE CONVERSATION__

__''Consent/confidentiality''__

__''Details about the young person and engagement''__

*Contact details (of YP/parent/ safeguarding lead) 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/ school safeguarding lead
**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
*If the young person is at school the safeguarding lead is to be contacted.

__''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 safety plan with young person send 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.

!!!!!Source: Joanne Woodford, Catherine Gallop, Jonathan Parker, Dr Rob Kidney, Dr Fin Williams, Hollie Gay & Laura Daniells
!!Education Mental Health Practitioner: Data Handbook  

The following handbook has been compiled to assist with data collection relevant to the Education Mental Health Practitioner (EMHP) role  for EMHPs working in the South West of England.   The handbook has been designed to support with the collection of both sessions clinical outcomes as well as tracking data for EMHP's trained at Exeter University. For EMHPs, the data management systems are likely to be different in different parts of the country. The information about measures is invaluable wherever the service is located. 

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 to them for sharing this excellent information here. 

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/1P1eQyWCXHqw-zjziH-hVCShqnCdTJ2bI/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)  

!!!''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.   
 
Reliable change criterion is calculated using the formulae below.

Reliable change criterion = SE(diff) times 1.96

SE (diff)  is the Standard Error (difference). This is a statistic which  estimates the amount of measurement error in a sample. Large measurement error indicates that changes may be due to measurement error rather than 'real' change. Small measurement error enables more confidence to be placed on changes in scores over time.  

For more information on calculating reliable change 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/]]

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. 

[[Mental health toolkit|https://www.healthylondon.org/resource/schools-mental-health-toolkit/]]

Mental Health in Schools Project: [[Mapping Exercise Overview Report|https://www.healthylondon.org/wp-content/uploads/2018/11/Mental-Health-Support-in-Schools-Mapping-Exercise-Report.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.

Source Healthy London Partnership

For a video and more information and links about the announced plans to expand access to mental health care for children and young people. Please go to:

https://www.healthylondon.org/our-work/children-young-people/children-and-young-people-mental-health-trailblazers-in-london/

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. 

<iframe width="560" height="315" src="https://www.youtube.com/embed/_y97VF5UJcc" frameborder="0" allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe>

!!!!Source: Joe Hickey and Peter Fuggle

!!What is mentalizing?
Mentalizing is the process by which we understand our own and others’ actions as reflecting states of mind.
The ability to mentalize develops through childhood, through caregiver interactions and is linked to secure attachment bonds.
Mentalizing adequately in therapy is essential for [[engagement|Engagement and First Meetings]] and [[relationship-building|Therapeutic Alliance]], as it relates to hearing and being heard.

!!Practice points:
* You and your clients already mentalize to some degree
* Strong feelings make it harder to mentalize
* Pay attention to your own levels of mentalizing
* Support self-mentalizing before other-mentalizing in the CYP and parents/carers you work with

!!Links to other pages 
Mentalizing is part a range of practices around [[Engagement]] and maintaining engagement. 

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

!!!!Source: EBPU

!!!''The implementation of ~ReZone for the self-management of overwhelming feelings among young people in schools''

This new [[paper|https://formative.jmir.org/2019/2/e11958/]] by authors from the Evidence Based Practice Unit (EBPU), published in the journal JMIR Formative Research, examines the implementation of an mHealth intervention, ~ReZone, for young people in schools. 

[[ReZone|https://www.annafreud.org/what-we-do/schools-in-mind/research-and-opportunities-for-schools/rezone/]] is an app designed to be used in mainstream primary, and alternative provision/SEN primary and secondary schools with 10-15 year olds.
The app aims to help students manage their emotional wellbeing in the classroom by supporting them to re-focus if they are feeling angry, stressed or anxious.  

There is increasing research on mobile health (mHealth) interventions to provide support for the mental health and education of young people, however nonadoption and inadequate implementation of such interventions are prevalent barriers to such trials. This study aimed to help bridge this gap.

Preliminary data for 79 students collected as part of a larger trial were analysed, and consultations with teachers in participating schools were also conducted, providing additional data. ~ReZone was used 1043 times by 36 students during the study period. The paper explores the need for implementation strategies, barriers, and facilitators for digital interventions to be considered to limit nonadoption and inadequate implementation in larger trials. 

<<list-links "[tag[Module 1]]">> 

!!!''Key Learning Outcomes''

1.	Engage and involve children, young people and parents in a way that maximises their collaboration and engagement in mental health services and related settings and contexts 
2.	Understand and effectively convey the core principles of CYP-IAPT and the active outcomes frames and use of routine outcome measures

3.	Support access to child and adolescent mental health services and support to the whole population and minimise disadvantage and discrimination

4.	Be able to explain the key principles of core, evidence-based therapies

5.	Effective use self refection and supervision to enhance their clinical work

!!!''Content'' 
*CYP services context & principles – local & national 
*Service role of the EMHP & overview of other relevant mental health 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. 

!!!''15 Credits'' 

<<list-links "[tag[Module 2]]">> 

!!!''Key Learning Outcomes''

1) Demonstrate knowledge, understanding and critical awareness of concepts of mental health and mental illness, diagnostic category systems in mental health and a range of social, medical and psychological explanatory models. 

2) Demonstrate knowledge of, and competence in applying the principles, purposes and different types of assessment undertaken with CYP with common mental health disorders
 
3) Demonstrate knowledge of, and competence in using ‘common factors’ to engage CYP, gather information, build a therapeutic alliance with people with common mental health problems, manage the emotional content of sessions and grasp the client’s perspective or “world view”. 

4) Demonstrate knowledge of, and competence in ‘CYP-centred’ information gathering to arrive at a succinct and collaborative definition of the ~CYP’s main mental health difficulties and the impact this has on their daily living. 

5) Demonstrate knowledge of, and competence in recognising patterns of symptoms consistent with diagnostic categories of mental disorder from a CYP-centred interview. 

6) Demonstrate knowledge of, and competence in accurate risk assessment to CYP, Parent or others. 

7) Demonstrate knowledge of, and competence in the use of standardised assessment tools including symptom and other psychometric instruments to aid problem recognition and definition and subsequent decision-making. 

8) Demonstrate knowledge, understanding and competence in using behaviour change models in identifying intervention goals and choice of appropriate interventions. 

9) Demonstrate knowledge of, and competence in giving evidence-based information about treatment choices and in making shared decisions with CYP. 

10) Demonstrate competence in understanding the CYP’s attitude to a range of mental health treatments including prescribed medication and evidence-based psychological treatments. 

!!!''Content''

*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  (psychoeducation)
*Pharmacology  - assessment and awareness of medication that may be prescribed for CYP for common mental health problems 

!!!''15 credits''

<<list-links "[tag[Module 3]]">> 

!!!''Learning Objectives''

1) Critically evaluate a range of evidence-based interventions and strategies to
assist CYP and their parents manage their / their child’s emotional distress and disturbance.

2) Demonstrate knowledge of, and competence in developing and maintaining a
therapeutic alliance with CYP and their parents / carers during their treatment programme, including dealing with issues and events that threaten the alliance.

3) Demonstrate competence in planning a collaborative low-intensity psychological
treatment programme for common mental health problems, including managing the ending of contact.

4) Demonstrate in-depth understanding of, and competence in the use of, a range
of low-intensity, evidence-based psychological interventions for common mental
health problems with CYP and their parents / carers

5) Demonstrate knowledge and understanding of, and competence in using
behaviour change models and strategies in the delivery of low-intensity
interventions.

6) Critically evaluate the role of case management and stepped care approaches to
managing common mental health problems including ongoing risk
management appropriate to protocols.

8) Demonstrate competency in delivering low-intensity interventions using a range
of methods including face-to-face, telephone and electronic communication in education settings.

!!!''Content''
*Behaviour change: Theories and models 
*Critical evaluation of the evidence base 
*Functional analysis & formulation of presenting difficulties 
*Goal setting and monitoring
*Collaborative working 
*Guided self-help – content and suitability. Sign-posting: when & how 
*Problem solving 
*Pharmacology – monitor impact  / 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 / carers : to include 1:1 supported self help with parents / carers in the context of behavioural difficulties  / parent led CBT for anxiety
*To be able to assist with Parenting training for conduct problems – social learning theory & application in practice. 
*Therapeutic endings
*Delivery of interventions for anxiety, depression, behavioural difficulties and low level regulatory issues via a range of communication methods. 

!!!''30 credits''

Total number of teaching days for this module is 7 days (14 half day sessions) 

Possible teaching topics for this module.

<<list-links "[tag[Module 4]]">>

!!!''Understanding the Education System''	
*Understanding Education context: education structure, different types of schools
*Overview of teacher training
*Legislative and policy frameworks
*Schools and college organisation including roles and responsibilities
*Schools and college policies and procedures and ethos
*Schools and colleges mission, aims and values and how these are maintained
*Wider context in which schools operate
!!!''Bringing education and health staff together around CYP and their families'' 
*Engagement of CYP & families and teachers
*Understanding  of whole school approaches
*Promoting diversity and inclusion in schools/colleges
*Working with CYP , families  and staff within education settings
*Challenges working with education and mental health
*Transitions and learning
*Developing professional relationships with CYP and families
*Effective communication and professional relationships with CYP and families and education staff.
*Role of EMHP in education
*Multiagency working
*Signposting
!!!''Working with pupils'' 
*@@color:blue;Therapeutic relationship skills, ability to engage and communicate across the age range@@
*Engagement of harder to reach students in education settings
*@@color:blue;Interviewing & questioning skills@@ 
*Observational skills in education settings
*Understanding impact of difficulties on educational life and attainment
*@@color:blue;Risk assessment, safeguarding & management@@ 
*@@color:blue;How to use measures, goal-setting & goal based outcomes@@ •	
!!!''Recognition of developmental, cultural and mental health factors in children's difficulties'' 
*Child development includes:
**understanding normal development and deviations from this including: differences of culture, ethnicity, gender and sexuality. .
**Speech and language development
**Recognition of developmental stages and education background
*Neurological development - How children learn and learning problems
*Auditing and assessment of mental health need in education settings  
!!!''Common mental health problems relevant to education''
*Common mental health problems in CYP relevant to education settings:
**attentional difficulties, 
**sleep disturbance, 
**emotional dysregulation, 
**self harm, 
**substance misuse	
** Learning assessment to include dyslexia, dyscalculia, dyspraxia

!!''Module Aims'' (15 credits) 

!!!''General aims''
#To equip the EMHP with the necessary knowledge, attitude and competence to operate effectively in an inclusive value driven education context.
#To possess the relevant knowledge and ability to  assess and engage  mental health difficulties in the context of education environments in collaboration with CYP, their families and education staff. 
#Recognize and work with existing expertise in education settings

!!!''Specific aims''
1.	To be able to assess and identify areas of difficulty (including risk) and establish main areas for change. 

2.	Establish and maintain a working therapeutic alliance & engage the child/young person/family and education staff to support them in self-management of recovery 

3.	Identify and differentiate between common mental health problems in CYP

4.	Identify and differentiate learning problems in CYP: including dyslexia, dyspraxia and dyscalculia 

5.	Navigate & signpost to appropriate interventions 

6.	Use Routine Outcome measures and standardised assessment tools effectively in education settings

Total number of teaching days for this module is 7 days (14 half day sessions) 

Possible teaching sessions for this module.

<<list-links "[tag[Module 5]]">>

!!''Module Aims''
1.	To acquire knowledge and skills in supporting school staff, parents and young people @@color:red;to identify common problems experienced by children and adolescents in schools@@ and colleges and which have adverse effects of well-being.  These include (but are not limited to): 

*bullying, 
*examination stress, 
*bereavement and loss, 
*family conflict and breakdown, 
*relocation, 
*trauma and abuse.  

2.	To develop @@color:red;skills in identifying children and young people who are at risk of or are experiencing these common problems@@

3.	To develop skills and knowledge to help schools, parents and young people @@color:red;anticipate and manage common problems and support those who are experiencing them@@.   Interventions to support and manage common problems in schools include:

*peer support,
*CBT informed anxiety / exam stress management

4.	To include CYP with SEND and Vulnerable groups including  LAC

!!!''Developing mental health assessment skills for individual children'' 
*Understand child and adolescent development and the impact of adverse life events on psychological well-being and mental health
*Critically evaluate the impact of risk and protective factors on the well-being and mental health of children and young people
*Identify indicators of distress or impaired well-being in in children and young people and demonstrate awareness of the distinction between transient distress and symptoms of mental ill-health
*Understand how peer support and interpersonal relationships are related to well-being and mental health in children and young people.
*These assessment skills should be particularly for common problems in educational settings
**common adverse experiences
**Traumatic events
**bullying, 
**exam stress
**problems with social media

!!!''Training the school community about mental health matters''
*Training others by providing:
**structured workshops and training, based on principles of cognitive behaviour therapy, to help children, parents, young people and teachers to manage anxiety and stress. 
**Emotional health promotion  in education settings
**Working with school staff using supervision and reflective practice
*Understanding and promotion of whole school approaches
*Through outcomes informed practice 
*By auditing and assessment of mental health need in education settings
*Through multi agency co-ordination and working including signposting and stepping up / down

Total number of teaching days for this module is 11 days (22 half day sessions) 

Possible teaching sessions for this module.

<<list-links "[tag[Module 6]]">>

!!''Module Aims''
*To develop competence in addressing early indicators of emerging mental health problems in an educational setting
*To acquire skills of particular value in a school and college context working with large numbers of at risk children and young people
*To learn to harness self-help and peer-support potential of CYP in educational settings
*To train others in basic mental health intervention skills
*To develop skills in coordinating with healthcare and other service providers   

!!!''To gain the knowledge and skills to deliver early intervention approaches in education settings'' 

''Consultation to education staff'' 

*Demonstrate competence and skill in offering consultation to school staff in relation to common problems that children and young people experience.   
*Draw on a formal model of consultation to structure the consultation.
''Group work'' – specialist skills required for working with children in groups

''Peer mentoring'' - critically evaluate the evidence for the effectiveness of structured peer support as an intervention to promote well-being and improve mental health.  Train and support students and staff to provide structured peer support in schools and colleges for children, young people and teachers who are experiencing common problems

''Classroom skills'' including contingency management

''Parenting groups'', parenting groups universally available for working with behavioural difficulties.(e.g. EPEC)

These should be focused on addressing problems of:

*Attentional difficulties
*Affect dysregulation
*Self harm
*Substance misuse
*Sleep

[img width 100% [redd-book.jpg]]

!!!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.

NICE guidance for social and emotional wellbeing for children and young people in both [[Primary education|https://pathways.nice.org.uk/pathways/social-and-emotional-wellbeing-for-children-and-young-people#path=view%3A/pathways/social-and-emotional-wellbeing-for-children-and-young-people/social-and-emotional-wellbeing-in-primary-education.xml&content=view-index]]
and in [[secondary education|https://pathways.nice.org.uk/pathways/social-and-emotional-wellbeing-for-children-and-young-people#path=view%3A/pathways/social-and-emotional-wellbeing-for-children-and-young-people/social-and-emotional-wellbeing-in-secondary-education.xml&content=view-index]]

 

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. 


https://www.youtube.com/watch?v=hMyDFYSkZSU

!!!!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.

Please see link of National Audit Office report here

https://www.nao.org.uk/report/improving-children-and-young-peoples-mental-health-services/#

The national curriculum can be found through the following link. 

<<link-pdf "NATIONAL CURRICULUM" "https://drive.google.com/open?id=1IlRgKHS0yhze_rtO4_qGXaRUOtwzToDq">>

!!!''Key deliverables''

To allow the postholder, under supervision and with support, to develop knowledge and practice skills in;

#Delivering evidence-based intervention for children and young people in education setting with mild to moderate mental health problems
#Helping children and young people within these settings who present with more severe problems to rapidly access more specialist services
#Supporting and facilitating staff in education settings to identify and where appropriate manage issues related to mental health and wellbeing
#Working with and within education environments to afford better access to specialist mental health services

To evidence development of those skills with associated knowledge acquisition to record and evidence progression towards an academic award and demonstrable practical ability.

!!!''Key duties''
!!!!''Therapeutic practice'' 

#Be supervised, supported and assessed oneself to assess and deliver outcome focused, evidence-based interventions in educational settings to children and young people experiencing mild to moderate mental health difficulties.
#Developing skills in supporting children and young people experiencing mild to moderate mental health difficulties, their families and educators in the self-management of presenting difficulties. 
#Developing and practicing skills under supervisory support of working in partnership with children, young people, their families and educators in the development of plans for the specific intervention and agreeing outcomes. 
#Developing and learning the skills required in order to enable children and young people in education to collaborate and coproduce their own agreed plan of care.
#Show evidence in a variety of forms that at all times intervention is provided from an inclusive values base, which recognises and respects diversity.
#Discuss with supervisors and agree to accept appropriate referrals for children and young people in educational settings, according to agreed local and national and local referral routes, processes and procedures. 
#Under supervision, undertake accurate assessments of risk to self and others.
#Learn, understand, rationalise and adhere to the protocols within the educational service to which the postholder is attached.
#Engage along with more senior staff in the signposting of referrals for children and young people with more complex needs to the relevant service. 
#Engage in robust managerial and clinical supervision, identifying the scope of practice of the individual postholder within the role, and working safely within that scope. 
#Gain and practice a range of interventions related to provision of information and support for evidence based psychological treatments, primarily guided self-help.
#Practice, evidence, reflect on and demonstrate an ability to manage one’s own caseload in conjunction with the requirements of the team. 
#Attend multi-disciplinary and multi-agency meetings relating to referrals or children and young people in treatment, where appropriate, both for personal educational benefit in discussion with supervisors, or to provide direct assistance. 
#Keep coherent records of all training and clinical activity in line with both health and education service protocols and use these records and outcome data to inform decision making.
#Complete all requirements relating to data collection. 
#Show evidence of working within a collaborative approach, involving a range of relevant others when indicated. Specifically, work in collaboration with teachers and other educational staff, parents, children, young people and the wider community to enhance and broaden access to mental health services. 
#Contribute to the development of individual or group clinical materials or training materials and go on to develop further such materials as falls within own degree of competence.

!!!''Training and supervision '' 
#Attend and fulfil all the requirements of the training element of the post including practical, academic and practice-based assessments. 
#As well as attendance at the University for training, fulfil private study requirements to enhance learning and prepare assignments for examination, for at least one day a week.
#Apply learning from the training program directly to practice through the course. 
#Receive practice tutoring from educational providers in relation to course work to meet the required standards.
#Prepare and present case load information to supervisors within the service on an agreed and scheduled basis, in order to ensure safe practice and the governance obligations of the trainee, supervisor and service are delivered. 
#Respond to and evidence the implementation of improved practice because of supervisor feedback. 
#Engage in and respond to personal development supervision to improve competences and practice.
#Be involved in the evaluation of the course
#Disseminate research and service evaluation findings through presentations and supervisory discussions.
!!!''Professional''
#Ensure the maintenance of standards of own professional practice according to both the postholder’s employer and the Higher Education Institution in which they are enrolled.
#Ensure appropriate adherence to any new recommendations or guidelines set by the relevant departments. 
#Ensure that confidentiality is always protected.
#Ensure that any risks or issues related to the safety and wellbeing of anyone the postholder comes into contact with in the course of their professional duties are communicated and shared with appropriate parties in order to maintain individual safety and the public interest. 
#Ensure clear objectives are identified, discussed and reviewed with supervisor and senior colleagues on a regular basis as part of continuing professional development. 
#Participate in individual performance review and respond to agreed objectives. 
#Keep all records up to date in relation to Continuous Professional #Development and the requirements of the post and ensure personal development plans maintains up to date specialist knowledge of latest theoretical and service delivery models/developments. 
#Attend relevant educational opportunities in line with identified professional objectives.


<<link-pdf "EMHP role specification " "https://drive.google.com/open?id=1ejJwJYRILh1MGsSCfqhG3-Hk0euphOeX">>

!!!''EMHP and Agenda for Change Job Criteria''. 
This job description is a training post banded on a Agenda for Change band 4 job description.

Qualified practitioners will progress to Band 5. 

Criteria for job evaluation against Agenda for Change criteria can be found in the NHS Guide for this. 

 "<<link-pdf "~AfC Job Evaluation Guide " "https://drive.google.com/open?id=1L8arEYS_SxWhNEGzCYVkXBEE0i8-uh3I ">>

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

[[Hello]]

!!!!!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">>

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]]

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

!!!!Source: Michelle Samson

!!Why conduct a classroom observation?
As an EMHP working with primary school children the first 'meeting' you will have with the child is sometimes via observing them in the classroom. This can provide insight into the issues for this child that others may miss. It can:-

* Provide an outsider or ‘objective’ perspective to add to the information given by the parent/carer/teacher
* Look for things that are going well for the C/YP that others may have missed as focus may be on the issues for the child
* Observe behaviours against a checklist
* Notice what helps to support the C/YP in the classroom
* Consider the classroom experience from the C/YP’s viewpoint

!!Observation tools

There are different methods of carrying out a school observation. 

* ''Running Record/Descriptive Narrative Record'' – Detailed, objective, sequential written record. It is open ended – a continuous stream of behaviour is noted often against the time it took place.
* ''Antecedent Behaviour Consequence (ABC) Chart ''– Records particular behaviours, what caused/proceeded the behaviour and the result/consequence of the behaviour. Type of Event Sampling. Lies within a behaviourist approach.
* ''Tally charts ''– Measuring the frequency of a particular/targeted behaviour within a time (time sampling) or place. Quantitative method.
* ''Checklists ''– Looking for and noting behaviours against a checklist. Eg. Specified behaviours associated with Autism Spectrum Condition (ASC) as part of an ASC assessment. Checklists could include rating scales for comparison.
* ''By category'' – Use of broad headings to guide observation. Eg. Areas of developmental need (physical/sensory; cognitive; language and communication; social interaction; emotional skills).
* ''Media technique'' – Use of photographs, audio or video recordings to analyse what took place. Eg. Video Interactive Guidance.

!!Practical and ethical considerations
Issues that you need to consider in doing classroom observations. 

''Consent.'' Does the child understand what is taking place. 

* Parental/primary carer consent. Process for this needs to be discussed with the school/ supervisor
* School consent/teacher and class staff informed.
* Is the C/YP informed? A rationale needs to be developed for not/informing.
''Impact ''

* How will our presence impact on the dynamics of the classroom.

''Technique''

* Where will you position yourself?
* How will you introduce yourself to the students?
* Will you take notes? What notes are you taking?
* How will you use language during note taking?
* How will you anonymise your notes?
* Will you interact with the student you are observing?
* Will you speak to the teacher/other staff during your observation?
* How will you finish the observation? How will you exit?

!!Skills required for effective observation
* Excellent listening/ watchful
* Considered positioning to enhance what you see and hear, without imposing and causing others discomfort.
* Memory for detail or accurate and speedy note taking.
* Noticing the cause and effect of events.
* Comparison with peer group.
*'' Avoid assumptions.''- Tentative hypotheses.
* Noticing what is going well/difficulties.
* Drawing out the most relevant and important observations for feeding back and contributing to planned ways forward.

!!Practice points:
*View the classroom before child arrives
*position self in such a way to enhance what you see/hear, without imposing
*Choose a method for note taking beforehand
*Obtain consent from the teacher 
*talk to staff in the room before to explain who/why/what you are doing and how the can enable this (their behaviour)

!!Videos

Classroom observations are much more common with younger children. A useful video on this can be seen here.

https://www.youtube.com/watch?v=jNMsEEWxr_I


!!Links to other pages

Please go to [[Assessment]] for a list of pages on assessments

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 closeup.jpg]]This page focuses 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. 

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 the following:

[[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]]">>

!!!''Learning'' 
Assessments, exams and pupil achievements 

!!!''Wellbeing''
The PHSE curriculum 

!!!''Behaviour'' 
Exclusions 

This is a tag tiddler for pages to do with Outcomes practice as contrasted with pages that are about actual measures which come under Outcome measures. 

<<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>

Source: Lorraine Cullen

!!Types of schools:

There are many different types of schools so it is important  to know about the type of school you are working within and what this may mean in terms of the funding body, the curriculum and the mental health curriculum/ provisions. 

!!!Maintained schools

These are schools where funding and oversight is through the local authority. These are the majority of schools. 

!!!Academies

These are schools where funding and oversight is from the Department for Education. Academies are run by 'academy trusts' and don’t have to follow the national curriculum so have greater freedom.They still have to follow the same rules on  special educational needs ([[SEND|The SEND Framework]]) and exclusions as other state schools, and are required to provide a curriculum that is ''“balanced and broadly based, and includes English, mathematics and science”''

!!!Grammar schools
Thes are state-funded selective secondary schools. Most of these (140 out of 163) are now academies.
 
To see helpful diagrams and further explanations of the different types of schools in primary and secondary education please use the link below: 

https://fullfact.org/education/academies-and-maintained-schools-what-do-we-know/

!! School systems: Impact on Children and young people 

 !!!Children’s World Report 2015
__An Overview for the U.K:__

* Almost 60% of children in the UK do not feel that their teachers listen to them of take account of their views.
* The UK is the second to last in terms of children believing that their teachers treat them fairly.
* Almost 30% of our children do not like going to school.
* UK children have a low satisfaction with relationships with adults and children in their class.
* School experience and satisfaction is rated relatively low by UK pupils.
* Incidents of bullying were rated relatively low by UK children but the proportion of children being  feeling ‘left out’ was high.
* Our children do feel relatively safe at school.

For the full report please use the link below:

http://www.isciweb.org/_Uploads/dbsAttachedFiles/ChildrensWorlds2015-FullReport-Final.pdf

!!!Vulnerable students

Schools recognise vulnerability, map provision and closely track the attainment and progress of the following groups:

 *Children with additional needs ([[SEND|The SEND Framework]]) 
*Looked After Children (LAC)
*Other Children in Need
*Pupils eligible for Pupil Premium
*Children Affected by Migration 

!!!Transitions
 Pupils 'loose learning' during periods of transition, such as changing year group or school–  this is more noticeable for the most vulnerable of pupils.

Five markers of a successful transition are:

 # developing new friendships and improving their self esteem and confidence 
 # having settled so well in school life that they caused no concerns to their parents 
 # showing an increasing interest in school and school work  
 # getting used to their new routines and school organisation with great ease
 # experiencing curriculum continuity. 
 
(Institute of Education Research report 2008)

!!!Testing
Most primary schools have termly test across core subjects, as well as 

*At 4 years old - Baseline testing
*At 5 years old - Phonics screening
 *At 7 years old - reading/writing and math SATS
In secondary school there are GCSE's and A-levels as well as mocks and other tests carried out
Need to be aware of the emotional impact this can have on CYP as well as the impact it can have on parents, teachers and leadership.

!!!The PSHE curriculum and social emotional learning
 PSHE as a taught lesson benefits children and young peoples social and emotional learning (SEL). For an imaginative description of SEL see clip from Inside Out animation. 

https://www.youtube.com/watch?reload=9&v=CtiO3aF79cU


It is important to have a knowledge of the benefits on children and young peoples mental, social, and psychical health that PSHE can have. PSHE does not have the same statutory status as other school subjects, meaning that there is inconsistent provision. It could be really helpful insight for you to know how developed the PSHE programme is in the schools you are working with, as this could be a useful school resource to collaborate with.
Please go to the [[PSHE in Schools]] page for more information.

!!Practice points
 
 ''"Children and young people need a ‘tool kit to cope!’"''

Practically as a visitor to a school (with time constraints) EMHP's cannot necessarily have an impact on making the changes necessary to manage threats to positive mental health. Perhaps consider how you might have a positive influence to effect any changes in the following areas:

 # Helping the individual to self regulate to manage their response to external pressures
 # Engage with families to provide support
 # Provide sensitive challenges, support and advice to schools: Your role will cause ripples through the whole system.
 
!!!Working as part of the whole school:

 *Meet the senior team as they can create change.
 *Who can you influence? Mental health is now being advocated as everyone's business 
 *Know important dates such as Ofsted and exam dates.
 *Be aware of an individual school’s policy and practice guidelines 
 *Address schools lack of knowledge about attachment and looked after children.
 *Advise schools on how to reduce learning loss during transitions especially for vulnerable groups.
*Have an awareness of the role of a teacher and their level of training in MH [[DoE teachers' standards]]
*please go to [[Mental Health Toolkit for schools]] for resources you may want to use with schools
!!!Working with children and young people:

 *Show flexibility as they don’t fit in ‘boxes’
 *Instructional language used by school and parents- need to consider emotional language 
*Virtual world of learning and socializing (parents may not have the knowledge) important: Regulating use of social media- don’t demonize or dismiss it!
 *Different skill set for different age groups- get out of your comfort zone to get those skills



!!Links to other pages

*For more information on safeguarding in schools please visit the [[Safeguarding: Being a safe practitioner]] page. 

This is a tag tiddler that identifies all pages that are linked to POD

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

Source Lorraine Cullen

!!What is the PSHE?
The PSHE Association campaigns and researches the benefits on students social and emotional learning of teaching PSHE as a subject. 


!!Why is PSHE important for CYP?

A growing body of research shows that pupils who are emotionally healthy do better at school. PSHE education helps children and young people to achieve their potential by supporting their wellbeing and tackling issues that can affect their ability to learn, such as anxiety and unhealthy relationships. 

PSHE education also helps pupils to develop skills and aptitudes - like teamwork, communication, and resilience - that are crucial to navigating the challenges and opportunities of the modern world. 

!!!A curriculum for life: the case for statutory PSHE education
This document by the PSHE Association brings together evidence that PSHE, when taught well, helps keep children and young people safe, mentally and physically healthy and prepared for life and work. The report highlights support for statutory status from expert bodies, pupils, parents, teachers, business leaders and parliamentarians from across the political spectrum, and outlines key principles on how statutory status can ensure best practice.

For the full report please use the link below:

<<link-pdf "A curriculum for life" "https://www.pshe-association.org.uk/system/files/Curriculum%20for%20life%20December%202017%2012.06%2019%20Dec.pdf">>

!!!The PSHE Association’s five priorities for how PSHE should be taught:

*regularly – regular lessons on the timetable like other subjects
*as a whole subject – from RSE to mental & physical health, online safety to job skills
*by trained teachers – PSHE covered in teacher training and ongoing opportunities to learn
*in all schools – all schools including academies , free schools and independent schools
*to all pupils – from year 1 to finishing secondary school

!!Practice points for EMHPs

PSHE as a taught lesson benefits children and young peoples social and emotional learning.

It is important to have a knowledge of the benefits on children and young peoples mental, social, and psychical health that PSHE can have. 

PSHE does not yet have the same statutory status as other school subjects, meaning that there is inconsistent provision. 

It could be really helpful insight for you to know how developed the PSHE programme is in the schools you are working with, as this could be a useful school resource to collaborate with.

You may want to check the school you are working with about their PSHE provision against the PSHE Association’s five priorities for how PSHE should be taught. (As stated above)

For more information about the PSHE Association go the the full website here:
https://www.pshe-association.org.uk/what-we-do/why-pshe-matters

!!Links with other pages

There are a range of pages around schools and special educational needs which relates to PHSE and can be found in [[Working in Schools]]

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. 

!!!@@color:red;THIS PAGE IS CURRENTLY BEING WRITTEN@@ 
This will be covered as part of the Working in Groups sessions. 

''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. 

!!!''Participation''

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

!!!!Source: AFNCCF

For a plethora of useful resources, training slides and evaluation information to successfully refine or develop a peer mentoring programme to support the mental health and emotional wellbeing of children and young people in schools, colleges or community organisations please see the [[Peer support resources|https://www.annafreud.org/what-we-do/schools-in-mind/our-work-with-schools/peer-support-for-children-and-young-people-s-mental-health-and-emotional-wellbeing-programme/]] page on the Anna Freud National Centre for Children and Families website.

Peer Support for Children and Young People's Mental Health and Emotional Wellbeing Programme
This national Department for Education (~DfE) funded programme was piloted in 89 schools, colleges and community organisations in six different regions in England.  

The participating settings received evidence informed training and resources to help them to develop or refine a peer mentoring programme to support the mental health and wellbeing of the children and young people in their setting.

<<list-links "[tag[Peer support]]">>

Each member of the UCL teaching team will act as a personal tutor for approximately 4 of the trainees. 

<<list-links "[tag[Policy context]]">>

Children are experiencing increased levels of emotional symptoms in the context of the COVID-19 pandemic and are also struggling to access support and services because of the lockdown.
 
In response to these concerns, ''the National & Specialist CAMHS Clinic for Trauma, Anxiety, and Depression'' have prepared a set of ''short animations'' with practical tips that parents can use to help children with emotional symptoms. The tips are based on evidence-based Cognitive Behavioural Therapy (CBT) principles for the treatment of anxiety and depression in young people. 

----

''Watch all the videos on the [[KCL YouTube Channel|https://www.youtube.com/playlist?list=PLun2jODy9M2fz4KuSfEh4DLqEO0M-Klyd ]]
 OR on the on [[Families under pressure website|https://familiesunderpressure.maudsleycharity.org/]]''

----

The tips really came to life thanks to our collaboration with the production company TOAD and the narration by well-known parents. They are part of the "‘[[Families under Pressure|https://familiesunderpressure.maudsleycharity.org/]]" series that also includes some excellent animations on helping children with behavioural symptoms, which were prepared by Professor Edmund Sonuga-Barke and colleagues. We are thankful to ~SLaM and the Maudsley Charity for funding this project. You can find more details [[here|https://www.kcl.ac.uk/news/animated-parenting-tips-for-struggling-households-tips-9-12]] and 

<<list-links "[tag[Practice Points]]">> 

This is a tag tiddler 
<<list-links "[tag[Practice tutor groups]]">>

This page lists out all the topics for the practice tutor groups. These will undoubtedly change in response to the way the course develops. Topics which have been allocated a slot in the programme have a number after the practice tutor session title. Topics without numbers are topics which have been suggested and may be allocated a slot at some point. 

Topics for term 3 have not been allocated as it is expected that most of this time will be focused on case discussion and video practice.

<<list-links "[tag[Practice tutor topics]]">> 

* Explain to the child before using calm time what behaviours it is for. Calm time should be introduced in a brief and positive way as a space that will help the child to calm down.
* Identify an appropriate place for calm time to take place. This should be a relatively non stimulating area, that encourages a child to calm down e.g. a chair, the sofa
* Parent needs to be in the same room, or close to the child. This is to ensure the child is safe if they have become emotionally dysregulated and so they can see when the child has calmed down

!!Managing the Transition from Primary to  Secondary school

A parent/child workbook generously shared by the Islington Child Wellbeing (CWP) Service.

 <<link-pdf "Transition School Booklet" "https://drive.google.com/open?id=16z5iIyAHeLJwPAi5ppvZ6vaXubggMWFM">>


Please also see the useful resource '[[Transition suitcase|https://drive.google.com/file/d/1krbN3BKMIEAS_6Z4P7fS3gbc1C_s6XbS/view?usp=sharing]]', when working with young people regarding transitions. 

!!!!!Source: Cathy Creswell
!!''Key points''
Problem solving is a key technique in many areas of child mental health work. 
Problem solving is used in Cathy Creswell’s manual, in working with worry and in many other booklets to do with treating anxiety and generally follows these steps: 
#define the problem that requires solving
#think about all and every possible solution (no matter how strange it may seem at this stage)
#consider the pros and cons of each possible solution (short term & longer term)
#decide on a plan using one of the solutions 
#try it 
#evaluate it – how did it go?

!!!Problem solve anticipated problems
#''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 which is a telephone meeting. Send materials to young person if they agree. 
#''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. 
#''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 persistent with plan, focuses on relapse prevention in psycho-educational material.  
#''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. 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. 
#''Young person is relatively active and low mood has not impacted on behaviour significantly.'' Two things need to be reviewed. 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.  

[img[books with open book and pen.jpg]]
Please click on the relevant pages below for a list of useful materials and information aiming to help children, young people, families, teachers, schools and practitioners develop a better understanding of mental health and what it feels like to have mental health problems. 

*Core Knowledge: [[Psychoeducation Core Knowledge]]
*Workshops: [[Psychoeducation Workshops]]
*Resources: [[Psychoeducation Resources]] 
*Videos: [[Psychoeducation: Videos]]
*Self Help Materials/ Resources: [[Self Help Materials]]

<<list-links "[tag[Psychoeducation Core Knowledge]]">>

Two excellent websites with extensive material for use in schools can be found at: 

*[[Mentally Healthy Schools|https://www.mentallyhealthyschools.org.uk/]] - this website is aimed at primary schools to understand and promote children’s mental health and wellbeing. Our aim is to increase staff awareness, knowledge and confidence to help support pupils.
*Anna Freud Centre: [[Resources for Schools|https://www.annafreud.org/what-we-do/schools-in-mind/resources-for-schools/]]- this website aims to provide resources and information to help all teaching staff support the mental health and wellbeing of their pupils.

<<list-links "[tag[Psychoeducation Resources]]">>

<<list-links "[tag[Psychoeducation Workshops]]">>

Within this heading is a list of pages that contain various videos from Young people discussing mental health. These videos could be shared with CYP or families (to be discussed with supervisors beforehand). These video may also be used by practitioners to develop a better understanding of the issues discussed. 

<<list-links "[tag[Psychoeducation: Videos]]">>

Source: Peter Fuggle, AFNCCF, based on material made freely available by Bruce Chorpita and his team in the States.  

----
This information is drawn entirely from the work of Bruce Chorpita and his colleagues in the United States who have been an inspiration in making their work freely available to others. 

---
!!''The Revised Child Anxiety and Depression Scale (RCADS)''

This is a 47 item scale with items are rated on a 4 point Likert-scale from 0 (Never) to 3 (Always).

There are two versions, one for a young person (8-18 years) and one for a parent/carer. All versions of the RCADS are on [[POD]]. 

''The RCADS does not provide a diagnosis'' but it is extremely useful in gaining a wider picture of the young person's difficulties. This is one of the main questionnaires that EMHP should use with young people.

Paper copies of all the versions of the RCADS measures can be found on google docs here:

<<link-pdf "Paper versions of the RCADS  "  "https://drive.google.com/drive/folders/1w8qwEWrfooIXaw77eYpZdVmgnhT2_VLJ?usp=sharing">> 


!!''Subscales''

As well as generating a summary score about anxiety and low mood, the 47 items in the measure are divided into a series of subscales:

* separation anxiety
*social phobia
*generalised anxiety disorder
* panic disorder,
*obsessive compulsive disorder
*depressive disorder. 

There are also short subscale versions for each of these subscales which can be found in googledocs as above or on POD. These short versions are used for monitoring the targeted problem during the intervention.  

POD does not report the actual T score in the tables etc that can be shown to the young person. However, the threshold is clearly indicated in the line graph and the gauge presentation so that the young person can see if they are above threshold at any particular time.  

!!''Scoring the RCADS''

!!!''Raw Scores''

* A Total Internalising score is created from the sum of all 6 subscales, 
* A total anxiety score from the sum of the 5 anxiety subscales.
* A total depression score is taken from the depression subscale. 

Raw scores can range from 0-141. An aid to a quick interpretation of an RCADS scores can be found by looking at the 'Interpretation Aid' below. 

Scores are standardised by age and gender. In the attached table, age is shown in terms of the school year. The age of the child can be computed by adding 6 to the school year. So a child aged 10 years would be compared with children in school year 4. 

<<link-pdf "Interpretation Aid" "https://drive.google.com/open?id=0B-tACu2wi4-4dEdqbk93SlNvTE0">>


!!!''T Scores''   

For fuller interpretation of the RCADS, raw scores are converted to a T-score. This calculates how far the score is from the average for age and gender. A score of more than 65 indicates young person is in the highest 7% of the population. (This is a score of more than 1.5 standard deviation above the mean for that population of children and young people). This what is meant by a child having a score 'above threshold'.  

A very neat way of seeing T scores in practice can be found at the following website which has all the RCADS resources freely available.

 https://www.childfirst.ucla.edu/resources/

!!''Links to other pages'' 
 
Guidance on how to complete the RCADS with a young person can be found at  [[Completing the RCADS]] 

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

Please go to [[Outcome measures]] for a list of relevant pages

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 achieve them. Some find it useful to have a few large targets rather than many small targets if you feel overwhelmed. 

!!''Developing a new Reading Well Books on Prescription list to support children and family mental health''


Reading Well supports people to understand and manage their health and wellbeing using helpful reading. The books are all endorsed by health experts, as well as people living with the conditions covered and their relatives and carers.

The scheme is available free to access in 98% of English public library authorities.

If you are not already familiar with their work, you can find out more on their website. 

https://readingagency.org.uk/adults/quick-guides/reading-well/

!!Mood-boosting Books
Reading Well Mood-boosting Books is a national promotion of uplifting titles, including novels, poetry and non-fiction. The books are all recommended by readers and reading groups.
For a list of mood boosting book please use the link below:

https://reading-well.org.uk/books/mood-boosting-books

!!Evidence and evaluation

There is a huge evidence base around the value of reading to support health and wellbeing, as well as the value of libraries as a non-stigmatised space that is both welcoming and empowering for people with mental health problems.

The Reading Well programme is evaluated each year to ensure that it continues to deliver positive outcomes. Health professionals, library staff and users are surveyed on their experiences of the programme, as well as information on reach being calculated through book loans and book sales data. To date, The Reading Well programme has reached over 778,000 users.

Inspectors and Standards and Achievement Team (old LEA inspectors)

Ofsted inspectors.  

Source: Peter Fuggle, Lili Ly, Charlotte Hepburn

!!!@@color:red;This page will be continuously updated and is currently still being drafted but will aim to provide details of core materials central to the EMHP Programme. @@

!!Essential reading

!!!For low intensity interventions:
	
''Child Anxiety:'' 

Intervention manual: Overcoming Your Child's Fears and Worries: A Self-help Guide Using Cognitive Behavioural Techniques - Cathy Creswell. This is the core manual for this low intensity intervention and can be obtained [[here|http://centaur.reading.ac.uk/65537/]]

Book: [[Overcoming your child's fears and worries|Child Anxiety: Book]] by Cathy Creswell and colleagues. This is the book that the treatment manual above is based on. 

''Adolescent Anxiety:'' intervention manual 

<<link-pdf "Getting to grips with anxiety" "https://drive.google.com/file/d/1MhSkweHKlMx3gAHe8SyVqss4nSjzJhFd/view?usp=sharing">>

''Low Mood:'' intervention manual:

 <<link-pdf "Guided Self-Help for Low Mood" "https://drive.google.com/file/d/1Ua1L-0BUmNMBTJi2AkYQhdlmnWpKwl0g/view?usp=sharing">>  

''Behaviour Problems:'' Intervention manual: 

<<link-pdf "Manchester Behaviour Manual" 
"https://docs.google.com/document/d/1YVAXcYyWF5_4wxM1BfUOoogXwpxro3sSwLLoRg4zP3Y/edit#heading=h.gjdgxs">>

There are several levels of diversity that should be borne in mind: 

#Sessions should include prompts to consider content in respect to cultural, ethnic and sexual diversity of population of families that practitioners are working with. 
#Diversity of practitioners and opportunity for reflexivity around how their own culture and background impacts on material that is being considered. 
#Diversity of service settings. Practitioner services are going to have different service contexts.

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

This video tells the story of Red Riding Hood from the point of view of the flight or fight response. 

<html><iframe width="560" height="315" src="https://www.youtube.com/embed/GCL7tXawv50" frameborder="0" allowfullscreen></iframe></html>

!!! Relaxation techniques can be beneficial to our mental health, especially when we practice them regularly.

{{relaxing frog.jpg}}

!!! Why are relaxation techniques helpful?
When we experience [[Anxiety|What is Anxiety?]] or [[Stress]], our bodies are responding to danger in a way that used to be very helpful. This is often called the [[Fight or Flight]] response, which results in common symptoms of anxiety such as a fast heart rate, quickened breathing, trembling etc. When we are feeling this way, stopping or reducing the response in our bodies can be really helpful in making us feel calmer and more in control. 

There are lots of different relaxation techniques that can help with this, and some work better for some than for others, so it can be good to try them out and decide which one(s) work best for you.

''Below you will find some resources for relaxation techniques:''

* [[Breathing techniques]]
* 
* [[Visualisation]]
* 
* [[Mindfulness]]
* 
* [[Progressive Muscle Relaxation]]

[img[bookshelf.jpg]]

<<list-links "[tag[Supervisor Resources]]">>

This is a tag tiddler that identifies all pages that are currently under review. 

In reviewing pages, look at whether the page is in a shared bag or a local programme bags. 

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

This is a tag tiddler that identifies all pages that are currently under review 2. 

<<list-links "[tag[Review 2]]">>

<html><iframe width="560" height="315" src="https://www.youtube.com/embed/A97q7Xv7Tfg" frameborder="0" allowfullscreen></iframe></iframe></html>

!!!''Key points''
*In some ways this is an on-going process as much as a fixed session/part of the intervention. The practitioner should be on the look out for things that the young person has previously enjoyed or relationships that are valued and trusted. These need to be remembered as the young person may easily discount such things if asked directly. 
*For example, if asked about friendships, the young person may claim that they have no friends, often meaning that they have come to believe that their friends are distrustful or fickle or other things. This tendency to discount value in others (or in the situation that the young person is in) can be seen as part of the impact of low mood on the young person's judgement about his/her life circumstances. 
*It is also important to include interests and activities that may not be generally approved. Young people may have interests in trivial or dark areas of life. These need to be accepted (providing there are no child protection issues).  A stance of acceptance (without collusion) is important is this process. 
*Young people have an acute radar for adult disapproval and this will tend to diminish engagement if this is perceived to be the case.   

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

Source: Joe Hickey

''The purpose of this page'' is to provide information and practice points on conducting risk assessments 

!!What is risk?
The chances of something harmful happening to the CYP or another person

!!Potential risks for a  CYP

Main risks to self:

* Suicide
* Deliberate self-harm/Non-suicidal self-injury
* suicide contemplation/ intention, imagery, ideation
* Emotions: Hopelessness, defeat, despair
* Self-neglect
* Alcohol and substance use 
* Impulsivity

__Main risks from others:__

* Abuse
* Neglect
* Exploitation
* Bullying 
* Accidental harm
* Unsupervised at home
* Parental/ sibling mental health problems
*Criticism and/or avoidance of young person’s self-harm or suicidality

!!Protective factors for CYP:

* Existing coping mechanisms 
* familial support 
* peer support 
* emotional resilience 
* understanding potential risks 


!!How to conduct a risk assessment:

* Collaboratively identify the current protective and risk factors
* Ask direct questions and do not avoid the issue
* Explore connections between risk and protective factors
* Always evaluate level of risk with support from supervision and team
* Always discuss with your supervisor when unsure
* Make a safety plan if required
* Record your risk assessment and safety plan in the young person’s clinical notes
* Discuss information sharing with the CYP
* Communicate risk assessment and safety plan to other adults as needed

!!Links with other pages:

Please to go [[Safeguarding]] for a list of pages links to keeping young people safe.

Please go to [[Assessment]] for a list of pages relating to assessments 

!!!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 

!!!@@color:red;THIS PAGE IS CURRENTLY BEING WRITTEN@@ 

EMHPs to develop competency in running workshops with children and young people about what is mental health. 

SAPERE

https://www.sapere.org.uk/

!!!!Source Peter Fuggle 

!!The SDQ
The Strengths and Difficulties questionnaire (SDQ) is a brief behavioural screening questionnaire. 

It includes 25 items of psychological attributes: 

* emotional symptoms
* conduct problems
* hyperactivity/inattention
* peer problems
* prosocial behaviour. 

The first four subscales are added together to generate a ''Total Difficulties'' score.


For this programme, it was advised that the ''SDQ-Parent'' was used for parents of children
with anxiety or behavioral difficulties. 

The ''SDQ Impact'' was used in each session which measures if the respondent thinks the young person has a problem and prompts around: 

*chronicity, distress
*social impairment 
* burden to others. 

The ''SDQ Follow-Up'' can be used at the last session (Session 8) where two additional questions are included which ask whether discover if they intervention has reduced the problem
and if the intervention helped in other ways. 
 

*Different informant- carer, teachers or self-report  
*Scored into categories- Close to average, slightly raised, high, very high

<<link-pdf "Download Paper Versions of SDQ" "http://www.sdqinfo.com/py/sdqinfo/b3.py?language=Englishqz(UK)">>

!!Practice points

Please see [[Using Feedback and Outcome Tools]]

!!Links with other pages 

More general introduction to outcomes can be found at [[Outcomes]]

SENCOs may only be only primary or secondary experience. 

When setting goals, it is important that they are clear and achievable. 

They need to be : Specific – Measurable – Agreed (collaboratively) – Realistic – Time limited

<<link-pdf  "SMART Goal handout" "https://drive.google.com/open?id=1n-KiufWlI_3xIniCOtqv5iqNFe_ec-fDGYh_OumuvhE">>

1. by education professionals

2. value of rapid access. 

This is a tag tiddler
<<list-links "[tag[Safeguarding]]">>

 Source: The London Safeguarding Children Board 

''Purpose of the page'' This page provides links to authoritative guidance on safeguarding practice in London. 

!!@@color:purple;Safeguarding guidance@@  

The documents found through the links below give an overview of  safeguarding principles and practice and methods of promoting the welfare of children. It also contains useful information on how children and young people are 'tiered' into levels of need and why.  

The guidance is divided into two parts. 

1. Responding to concerns 
http://www.londoncp.co.uk/chapters/responding_concerns.html#conc

2. General practice and procedures 
http://www.londoncp.co.uk/chapters/B_contents.html

The London Child Protection Procedures are updated on a six monthly basis with the relevant changes to legislation, statutory guidance and local guidance.

Please go to the below webpage for access to the online legislation:

http://www.londoncp.co.uk/

!!@@color:purple;Practice points for EMHPs@@
As EMHP's it is important to understand about safeguarding procedures and how assessments are carried out resulting in a judgement of a 'level of need'.  

!!The Assessment Triangle
This is used to assess the child’s needs and form a judgement regarding the level of need.

 [img[Child protection assessment framework.PNG]]

!!The Four Levels of Need 

__Tier 1: No additional needs__

These are children have all their health and developmental needs met by universal services.

__Tier 2: Early help__

These children may be vulnerable and showing early signs of abuse and/or neglect; their needs are not clear, not known or not being met. These children may be subject to adult focused care giving. This is the threshold for a multi-agency early help assessment to begin. 

__Tier 3: Children with complex multiple needs__

These children require specialist services in order to achieve or maintain a satisfactory level of health or development or to prevent significant impairment of their health and development and/or who are disabled. They may require longer term intervention from specialist services. This is the threshold for an assessment led by children’s social care under Section 17, Children Act 1989 although the assessments and services required may come from a
range of provision outside of children’s social care.

 __Tier 4: Children in acute need__

These children are suffering or are likely to suffer significant harm. This is the
threshold for child protection. These children are likely to have already experienced adverse effects and to be suffering from poor outcomes. Their needs may not be considered by their parents.This is likely to mean that they may be referred to
children’s social care under section 20, 47 or 31 of the Children Act 1989. This would also include those children remanded into custody and statutory
youth offending services.

!!The Indicators of Possible Need 
The indicators within this document are outlined within a matrix/ table and are designed to provide practitioners
with an overarching view on what tier of support and intervention a family might need depending on the age group of the child. 


!!Please use the link below to view the full document:

http://www.londoncp.co.uk/files/revised_guidance_thresholds.pdf

!!@@color:purple;Links to other pages @@  

A list of other pages about safeguarding can be found at [[Safeguarding]]. 

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

!!Overarching practice point

''If you have a concern about the safety of a child or young person, you should always discuss such concerns with either a member of their team, or the school staff or their supervisor. This should take place on the same day that the issue arises, or as soon after as is possible.''

---
This page is general guidance on safeguarding and should not replace any specific safeguarding procedures in a school or locality.

---
!!What is safeguarding?


Safeguarding involves: 

 
*Protecting children from maltreatment; 
*Preventing impairment of children’s health or development 
*Ensuring children grow up in circumstances consistent with the provision of safe and effective care 
*Taking action to enable all children to have the best outcomes 

!!!Child Protection
This is a specific part of safeguarding and promoting welfare. It is the activity undertaken to protect specific children who are suffering, or likely to suffer, significant harm. 
The aim is to proactively safeguard so the need for action to protect children from harm is reduced. 

There are different levels of needs that have been carefully demarcated by guidance documents from social care.  Please see the page on [[Safeguarding guidance: London Child Protection Procedures]] for more information.

!!!Effective safeguarding
This is underpinned by two key principles: 

*Safeguarding is ''everyone’s responsibility'': for services to be effective each professional and each organisation should play their full part 
*A ''child-centred'' approach: for services to be effective they should be based on a clear understanding of the needs and views of children

!!!Key Points 
*Would you have shared 'the worst thing you have ever done' in front of the lecture? Recall how that made you feel. This may be how young people feel attending sessions. Important to develop relationships and empathy. 
*Safeguarding priorities can vary by local area, be sure to be aware what these issues are in your area.
* Be curious of safeguarding issues during assessment i.e. abuse (domestic, substance) and parental mental health in addition to vulnerability factors 
*Often work in grey areas, important to share information. It is a practitioners responsibility to share information to keep children safe. 
!!! Discussion on case study 
* If case is open, try to obtain more information 
*Be curious about potential triggers e.g. anniversaries 
*Think about the relationship you have with the young person (after a disclosure) 
*Don't be afraid to ask questions!  No question is ever silly or trivial 
*Safety plan- what is it? who will be involved? How can you make sure the young person is safe after they stop seeing you. 
*Safeguarding disclosure at end of session? Discuss with supervisor, may not be safe to end there. 
!!!Safeguarding 'hot topics'
*Child Sexual Exploitation
**The grooming process can be associated to gang culture 
**How to spot the signs? listening out for signs, can be straightforward e.g. who is bringing them to the session, is the phone activity out of the ordinary 
*Looked After Children 
**Experience health risks at a great degree 
**Language in referrals or reports- child is the victim! Be mindful of how we describe the interactions, keeping the child in the centre of things. 
*Cyber-bullying
** Can take many forms (aware of current issues such as 'Blue Whale', sexting) 
!!!Taking action  
* Be mindful of information sharing with other agencies. Poor communication increases the risk of serious case reviews. 
* We have a duty to safeguard children 
* Concerned about another professional? There is a Local Authority Designated Officer (LADO) who has a role in investigating staff abuse of children. 
*In such situations, speak to the local safeguarding lead 

Remember to safeguard yourself as well as the young people you see. 

!!Defining abuse
Children are at risk of many different forms of abuse (physical abuse, sexual abuse, neglect, emotional abuse, domestic violence (DV), forced marriage, female genital mutilation, child trafficking, online exploitation and radicalisation).

*''Acts of commission:'' Words or overt actions that cause harm, potential harm, or threat of harm
*''Acts of omission:'' Failure to provide needs or to protect from harm or potential harm

!!!Signs of abuse
Children are unlikely to report abuse themselves, due to fear of consequences and/or because may not know how to tell someone about what they are experiencing. As part of our duty of care, we therefore need to ''be aware of the signs'' both physical and behavioural.

!!Roles and responsibilities of health care staff

Useful guidance has recently been produced by the RCN on the roles and responsibilities of health care staff around safeguarding which can be applied to a school setting.

This can be found here:
<<link-pdf "Safeguarding guidance for health care staff""https://drive.google.com/drive/u/1/folders/1KrTJOiI1WuHsUlGl9i6jBBzJIiL-WiUJ">>

---
!!Practice points
*Always go back to how you define abuse-make sure that you are being consistent  with agreed definitions etc. 
*If in doubt: always defer to schools safeguarding procedures and talk to your supervisor
*''It is your duty to act - it is not a choice!''


!!!Working with families:
*It is important to build positive relationships with parents even when dealing with difficult issues. 
*It is essential to try to understand the context of families: i.e. the family's own experience of abuse, cultural norms, risk factors 

!!!Working within the school:
*It is essential to know the safeguarding procedure for the school you visit- ''if you are not told, ask!''
*You should know who the ''Designated safeguarding lead'' (DSL) 
*Don’t rely on a verbal conversation as this can be rushed in school setting- You have a right to follow it up via email (but don’t include any sensitive info). 
*Write down concerns in some form ASAP.
*''Be aware of the time!''- if you have serious concerns talk to DSL straight away- don't wait to 3:30 when child is going home.
 *Powerful feelings you will need to attend to- be compassionate and understanding about emotions provoked in others  

!!!Working with CYP:

*Treat every case individually 
*Have to always hold in mind it is a possibility and ''remain curious but don't assume!''

---
!!Links with other pages

Pages relating to Safeguarding are listed in the page [[Safeguarding]]

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


[[Beyond Blue|https://www.beyondblue.org.au/get-support/beyondnow-suicide-safety-planning/create-beyondnow-safety-plan]] is an Australian based website that provides information and support to help people achieve their best possible mental health. This website also allows people to produce their own safety plan online or through an app 
A safety plan is for people to use when they are feeling unsafe or suicidal – a plan to refer to and remind themselves of reasons to live, family and friends they can talk to, ideas of activities to do when they’re alone to aid when they are vulnerable. 

For more information please see this video concerning [[what is safety planning|https://www.youtube.com/watch?v=Bdlvr4gnSsk]] and how to use the safety planning app.

!!!@@color:red;THIS PAGE IS CURRENTLY BEING WRITTEN@@ 

This is a tag tiddler

!!!These are not the core materials used in the interventions found in the [[Helping]] section but may be helpful as additional materials. (To be discussed with supervisor).
For practitioner self help materials, handouts, outcome measures and paper documents that may be useful to print out, please see below.

<<link-pdf "Handouts for YP and parents" "https://drive.google.com/open?id=0B-tACu2wi4-4T21kOXlMYVQ5b0k">>

<<link-pdf "Self help materials and Practitioner Resources" "https://drive.google.com/open?id=0B2_m9ZgGWI-jVWZYcXh3c0x1OFU">>

Please see below for a list of useful self-help materials that may aid practitioners work. The use of these materials should be discussed with supervisor.
<<list-links "[tag[Self Help Materials]]">>

!!!!!Source: Moodjuice; Camden and Islington Mental Health Trust 
!!''Websites''
''Moodjuice self-help guide'':
Moodjuice have produced excellent self help materials for young people.
Available from their [[website|https://www.moodjuice.scot.nhs.uk/]].  

''Self Care'': there is an informative page from the MIX on [[self care|http://www.themix.org.uk/mental-health/a-guide-to-self-care-15574.html]].


!!''Guides''
''Camden and Islington Self Help Guides'' for the following:

*Stress and Worry
*Panic and Phobias
*Depression and Low Mood

<<link-pdf "Camden and Islington self-help guides" "https://drive.google.com/open?id=0B-tACu2wi4-4a0NocmRXaElfOHM">>

''Northumberland Tyne and Wear NHS Foundation Trust'':
an alternative guided anxiety Self-Help Booklet in which page 17 provides a brief description of facing anxiety in small steps:

<<link-pdf "Anxiety Self-Help Booklet" "https://drive.google.com/open?id=0B-tACu2wi4-4OVM4WUU0UlM5OWs">>

''Moodjuice self help guides'' for the following:

* [[Anxiety|http://www.moodjuice.scot.nhs.uk/anxiety.asp]]
*[[Depression|https://www.moodjuice.scot.nhs.uk/depression.asp]]



''Braintrain booklet'': which highlights the helpfulness of exercise in mental well-being.

<<link-pdf "Braintrain" "https://drive.google.com/open?id=0B-tACu2wi4-4SkE0TXBsbjlmS0U">>

!!''Videos''
Hertfordshire CWPs have found two Youtube videos helpful in workshops with young people exploring the difference between anger and anxiety. These can be found at

https://www.youtube.com/watch?v=yZBHbIGnGs4

https://www.youtube.com/watch?v=HBamFtLKO9M

!!''Apps''
Apps for relaxation: Mindshift, Headspace

'Grow' which is aimed at YP to help them manage personal goals

Please go to [[Self Help Materials: Apps]] for more information

!!''Podcasts''

The main approach is around behavioural activation and very helpful resources and ways of presenting behavioural activation approaches to low mood can be found on the [[Moodjuice website|https://www.moodjuice.scot.nhs.uk/]]
Please also find the  Moodjuice self help guide for [[depression|https://www.moodjuice.scot.nhs.uk/depression.asp]]

These may be different in some details from the main approach taught on the course.

The intention is to enable awareness of other sources of information about this approach. 

Please see the get self help [[website|https://www.getselfhelp.co.uk/privacy.htm]] for a list of free downloadable resources. These are listed in alphabetical order. 

Also see behaviour activation manual which has valuable materials for the BA approach. This manual is from the university of Michigan [[website|https://medicine.umich.edu/]]. 


<<link-pdf "Behaviour activation manual" "https://drive.google.com/open?id=1FEyuvgTeJDfZfZm9YfhGu-SgKqgogurN">>

Camden and Islington NHS Trust: Depression and low mood guide

<<link-pdf "Adapted Low Mood Booklets" "https://drive.google.com/open?id=0B2_m9ZgGWI-jMDhZdEl2MkRpV1E">>

!!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/]]

!!GO

''What is it?''

Aimed at 16-24 year olds, NHS Go was first developed in 2016, after young Londoners told us they wanted better and easier access to health and wellbeing information. They can now use it to search local health services and find information on health and wellbeing, including mental health, sex and relationships, healthy eating and puberty.

''How to access it?''

Download from the app store or from their [[website|https://www.healthylondon.org/our-work/children-young-people/nhs-go/ ]]

!!!''Recommended books by the Royal College of Psychiatrists''
For children under the age of 12, please go to their [[website|http://www.rcpsych.ac.uk/workinpsychiatry/faculties/childandadolescent/generalinformation/booksforyoungerchildren.aspx#anger]] for a list of books addressing mental health matters, written for children and parents. 


!!!''Further reading for children's books''
Parent guidance books about anger and difficult behaviour 

*It takes two to talk: a parent's guide to helping children communicate. A series of books on helping parents and children to communicate. 
*Toddler taming: a parent's guide to the first four years
*Understanding children's behaviour (Jennie Lindon)
*Taming the dragon in your child: solutions for breaking the cycle of family anger (Meg Eastman)
*When anger hurts your kids - quieting the storm within

!!!''Adult self help materials on anxiety and depression'' 
Self help materials from Camden and Islington Trust [[website|http://icope.nhs.uk/therapy-information/guided-self-help/]]


Please also see [[Reading Well: Books on Prescription List]]

Psychoeducation videos:

<<list-links "[tag[Psychoeducation: Videos]]">>

!!! Recommended Websites:
''[[The Mix|http://www.themix.org.uk/]]'' provides general information and advice for young people under 25 including sections on mental health and other areas of stress and difficulties. 
 

''[[Moodjuice|http://www.moodjuice.scot.nhs.uk/]]'' have produced excellent self help materials for young people experiencing anxiety problems. 

''[[Get self help|https://www.get.gg/index.html]]'' provides a very extensive range of self help using the CBT approach. The material is primarily for adults but much of this may be useful for working with young people. 

''[[On My Mind|https://www.annafreud.org/on-my-mind/]]'' from the Anna Freud Centre has information on a range of topics including supporting young people's active involvement in their own help and shared decision making. 

''[[Self-care|https://www.annafreud.org/on-my-mind/self-care/]]'' from the Anna Freud Centre has a plethora of ideas and advice about how YP could help themselves when they are struggling.

''[[Good Thinking|https://www.healthylondon.org/our-work/mental-health-transformation/good-thinking-digital-wellbeing/]]'': mental health and wellbeing service from Healthy London. This 24-hour online service finds people who may be struggling with a range of issues impacting on their mental health and directs them to resources that meet their personalised needs.

This page provides some sites where services could explore whether they would like to recommend or encourage use of these sites for on-line help. We are unable to assess the quality of the service provided on these sites but have tried to select sites that appear to have some recommendation form NHS providers for example, 

[[Kooth|https://kooth.com/]]: Free, safe and anonymous online support for young people

[[Mind Time Therapies|http://www.mindtimetherapies.co.uk/about.htm]]: team of clinicians trained in the use of psychological therapies to support people in their own home or wherever they choose to access the internet from. Delivered via interactive webinars enabling people access to professional support by PCs, tablets or smart phones.

[[Big White Wall|https://www.bigwhitewall.com/v2/Home.aspx?ReturnUrl=%2f]]: online mental health community

[[Be Mindful Online|https://www.bemindfulonline.com/]]: An onlone mindfulness course (please note this course does cost money)

[[WYSA|https://www.wysa.io/]] Co-designed by therapists, coaches, users and AI folk. provides the opportunity for an anonymous conversation. Think of it as an interactive journal meets life coach. 


!!!Linked pages
[[Barriers to Digital Forms of Help]]

Key messages: 

*Check data sources before you start 
*Try and embed digital resources to early doors interventions to reinforce learning and share widely 
*Services use too many jargon terms 

Source: Charlotte Hepburn, SLaM

!!The importance of self care for practitioners

As EMHP's you will be exposed to potentially distressing information and a potentially stressful job, especially as you are training. It is really important to be mindful of how this may impact you emotionally. 

Self-care is about the things we can do to look after our own mental health. This is vital to remaining working to your best ability; as if you are struggling then you cannot fully attend to the needs of those we are working with. Practicing things such as mindfulness can also improve you ability to be 'present', which has clear benefits as a practitioner. Furthermore, participating in good self care practice, models to those you are working with that there is value and benefits to practicing self care.

!!Well-being:

There are many ways to improve your well-being, such as; practicing mindfulness, getting creative, keeping active, eating healthily and reaching out to friends. 

Outlined below are all the aspects of life that can contribute to well-being. Please use it to structure the ways in which you could actively improve your well-being.


{{wheel of well-being.png}}

!!!!!//Wheel of Well-being is owned by South London and Maudsley NHS Foundation Trust (SLaM)//

Please go to the wheel of wellbeing [[website|https://www.wheelofwellbeing.org/]] for more information and tips on looking after your wellbeing:




!!Self care

The [[self-care|https://www.annafreud.org/on-my-mind/self-care/]] section of the Anna Freud Center's website, it has LOADS of useful ways to improve your well-being. It is designed for young people to manage their well-being, as such much of the information provided is relevant to improving practitioner well-being. 




!!Being reflective:
It is good practice to remain reflective about your work but it is also beneficial for your mental health to constantly reflect on how a situation or day left you feeling. It is important that you address these feelings in appropriate and beneficial ways. 

---
''Example:'' if a meeting with a young person has left you concerned then talk to your safeguarding lead and supervisor. It is always important to be honest with how you are coping and feeling about things, your supervisor is there to support your work and may be able to offer some advice.

----
!!!Keeping an activity log
You may find it useful to keep a log of the things you are finding stressful or a 'night diary' to write out all the things in your head before you fall asleep at night so they don't keep you awake.

One way to keep track of how the activites in your day have impacted your wellbeing is by keeping an activity log:

By using the form below or noting in a diary, keep track of all the activities that you do across a day, then rate these activities as 'nourishing' or 'depleting'. This could be done by putting a '-' or a '+' next to the activity. Then every week try adding more '+' to your activity list.

 This is a really easy way to become more reflective about the impact the activities you participate in have on you. 

Please feel free to use the document below as a guide or make your own! 

<<link-pdf "Activity Log" "https://drive.google.com/file/d/1TEGuxDTahAemZxaCcvwytg20FbwAbnPE/view?usp=sharing">> 


!!Support:

It is really important to have a '''back up team''' people who can support you emotionally if work gets tough. It can be really helpful to map out these people visually and to think of potential situations that you would take to specific people. 

Who is there in your life that supports you? Please use the document below to map out who your support circles are: 

<<link-pdf "Interpersonal Inventory" "https://drive.google.com/file/d/1g2qgkS0dh4AZhl1JYjHg2nn1chHM4Z-g/view?usp=sharing">>

!!Links with other pages
Further pages on practitioner care will be developed in due course.  


!!!Copy right statement:
!!!!!//Wheel of Well-being is owned by South London and Maudsley NHS Foundation Trust (SLaM) and is licensed under a Creative Commons Attribution Non-Commercial Share-Alike 4.0 International License. Information on this license is available at www.creativecommons.org/licenses/by-nc-sa/4.0. For permissions beyond the scope of this license contact mhpt@slam.nhs.uk//

Here is a brief clip of a toddler who experiences anxiety when his attachment figure leaves the room. 

https://www.youtube.com/watch?v=Y6QtuU1L_A8

!!!!Source: Helen Barker 

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

!!!This is a general assessment session which does not need to be conducted if a CYP has received a full assessment from CAMHS or a similar service

Please see [[What is a Session 0]] for what to do if a CYP has already received a assessment from another service/clinician.

---

If a previous assessment has not been completed use this session 0 to complete a general assessment of the main problem/s the YP is seeking support for, see [[Guided Self Help practice]] for pages to support this process. Local services may also have assessment proformas or guidelines to follow. The guidelines below cover the main areas/aims that need to be considered. Session 0 can be completed either with the YP alone or with YP and parent/s or carer/s.

Outcome measures completed at this session will be captured in POD. In POD it will be the first completion of the measure. This is potentially a little confusing for practitioners and this note is just recognising this. 

The purpose of this session is assessment: to gather enough information about the child/young person’s (CYP) difficulties to enable the practitioner, in collaboration with the CYP/parent, to decide which of the four possible GSH interventions is the most appropriate to undertake. For more general information session 0 and when a practitioner would conduct one please see [[here|What is a Session 0]]. Please also see the section [[Guided Self Help practice]] which may provide useful information to support this session. 

---

''Please note:'' The general session 0 as outlined on this page can be used if you are yet to decide which intervention would be most suitable for the YP. For the rare occasion that it has been decided which intervention is most appropriate before you meet with the YP please use the specific session 0 material in the relevant intervention manual either the Low Mood Manual or Adolescent Anxiety Manual (both linked below).

----

!!!Key Tasks 

*To engage the YP, validate/ listen to their experience/concerns 
*Develop a 'problem list'/ agree on a main problem YP wants support with.
*Discuss a recent situation where YP has experienced distress/ anxiety- consider thoughts, feelings (physical sensations) and behaviours.
*Psychoeducation on GSH and CBT
*Assessment of development of the problem and on what is keeping it going.
*Discuss impact on YP’s life.
*[[Risk assessment|Risk and Safety Assessment]] and safety plan (if necessary).
*Discuss YP's strengths/ current coping strategies.
*Complete full ROMs
*In collaboration with the YP agree on a future intervention plan


!!!Resources
The main resources for the assessment can be found in the [[Assessment]] section o f the Wiki. Your site may also have additional assessment/risk assessment/safety plan proformas to use. Consider creative materials to help explain role of thoughts/behaviours on our feelings- please see [[Psychoeducation]].

!!!Outcome measures
At assessment you should ask the young person to complete the full version of the appropriate ROM for their age/presenting problem. For adolescents this is most likely to be the RCADS. If possible ask parent/carers to also complete. 
Utilise SRS or similar to get feedback on the session. See [[Outcomes]]

----
Please not the pages referred to in the below document refer to the Adolescent Anxiety Manual however useful information for conducting a session 0 with a YP can also be found in the Low Mood manual. The session plan for conducting a general assessment or 'session 0' with adolescents:

<<link-doc "Session 0 plan: adolescents" "https://drive.google.com/file/d/1bGxWmGgEzuSwGD13lzAZIMyrDw0XBR4E/view?usp=sharing">>

---

For the rare occasion that it has been decided which intervention is most appropriate before you meet with the YP please use the specific session 0 material in the relevant intervention manual either the Adolescent Anxiety Manual:

<<link-doc "Getting to grips with anxiety" "https://drive.google.com/file/d/1MhSkweHKlMx3gAHe8SyVqss4nSjzJhFd/view?usp=sharing">>

OR the Low Mood manual:

 <<link-doc "Guided Self-Help for Low Mood: Full Manual" "https://drive.google.com/file/d/12bn3n53aWhm5_21Za460fp_qOtPsWY_N/view?usp=sharing">>  

----

!!!Linked pages:

For more information on conducting assessment session or 'session 0 please see [[What is a Session 0]]

!!!!Source: Vicki Curry
''This is a general assessment session which does not need to be conducted if a CYP has received a full assessment from CAMHS or a similar service''

Please see [[What is a Session 0]] for what to do if a CYP has already received a assessment from another service/clinician.

---

If a previous assessment has not been completed use this session 0 to complete a general assessment of the main problem/s the YP is seeking support for, please go to [[Guided Self Help practice]] for pages to support this process. Local services may also have assessment proformas or guidelines to follow. The guidelines below cover the main areas/aims that need to be considered. 

Session 0 can be completed either with the parent/carer alone or with the parent/carer and child.  In the two interventions for younger children (overcoming anxiety and behaviour management), the intervention sessions are mostly carried out with the parent. However, in most cases, if the child is not present in this initial assessment session 0, it will be helpful for the child to be invited to session 1, so the practitioner at least meets the child at some point.  

Outcome measures completed at this session will be captured in POD. In POD it will be the first completion of the measure. This is potentially a little confusing for practitioners and this note is just recognising this. 

The purpose of this session is assessment: to gather enough information about the child/young person’s (CYP) difficulties to enable the practitioner, in collaboration with the CYP/parent, to decide which of the four possible GSH interventions is the most appropriate to undertake. For more general information session 0 and when a practitioner would conduct one please see [[here|What is a Session 0]]. Please also see the section [[Guided Self Help practice]] which may provide useful information to support this session. 

---

''Please note:'' The general session 0 as outlined on this page can be used if you are yet to decide which intervention would be most suitable for the YP. For the rare occasion that it has been decided which intervention is most appropriate before you meet with the YP please use the specific session 0 material in the Behaviour Problems Manual (linked below).


!!!Key Tasks of session 0:
*To engage the parent and validate and listen to their experience/concerns 
*To understand the nature of the main problem(s) in the child that is causing the parent concern and they want help with 
*To explore a recent example of the problematic behaviour(s) – including thoughts/emotions/physical feelings/behaviour in the child if possible; as well as how others responded to this behaviour and what the outcome was. 
*To explore the history and development of these difficulties; as well as ideas about what might be keeping the problem going – the beginnings of an initial formulation
*To find other important background information about the history and current context –  child and family demographic information; child health and developmental/educational history; general functioning of the child (eg. social and school); family relationships and psychosocial details)
*Include assessment of risk and safeguarding issues. 
*To hear about strengths in the child/parent/system and identify current coping strategies.
*Completion of full ROMs – e.g. SDQ, RCADS
*To provide some psychoeducation on CBT and GSH and the CWP/EMHP service– including confidentiality – and to instil confidence in parents about this kind of approach 
*To hear about the difficulties are impacting on the child/parents’ lives; and to clarify the main problem the parent/child wants support with.  This may include setting specific goals for treatment.
*To use the above information to agree, in collaboration with the parent/child, whether the current approach would be helpful; and if so, which intervention is most appropriate to address the main identified difficulties. 
*Once an intervention has been agreed, the practitioner may provide the parent with some relevant reading to orient them in more detail to the approach and prepare them for session 1,

!!!Resources
The main resources for the assessment can be found in the [[Assessment]] section o f the Wiki. Your site may also have additional assessment/[[risk assessment|Risk and Safety Assessment]]/safety plan proformas to use. Consider creative materials to help explain role of thoughts/behaviours on our feelings- please see [[Psychoeducation]].

!!!Outcome measures
At assessment you should ask the parent to complete the full version of the appropriate ROM for their child's age/presenting problem. 
Utilise SRS or similar to get feedback on the session. See [[Outcomes]]

---

The session plan for conducting a general assessment or 'session 0' for younger children:

<<link-doc "Session 0 plan: younger children" "https://drive.google.com/file/d/1ocdR7bizZMVIZJyGRmr6RI3LI6GcWVBq/view?usp=sharing">>

---

For the rare occasion that it has been decided which intervention is most appropriate before you meet with the YP please use the specific session 0 material in the Behaviour Problems Manual.Please find the session 0 to be used specifically for behaviour problems as part of the full manual here:

<<link-doc "Behaviour Problems Manual" "https://drive.google.com/file/d/13kBzWKnq1kHeBF6zD-TRMhWTkEPX7aNy/view?usp=sharing">>


---

!!!''Reading prior to session 1 (Child Anxiety)''

If you have agreed with the parent that a Child anxiety Intervention is appropriate, suggest and encourage parents to have a go at reading the first chapter of the [[Child Anxiety: Book]] before session 1 (Parents should be given at least one week to do so). As the Practitioner will be referring to Part 1 of the Overcoming book in session 1. When services are unable to give families a copy of the book in advance, other options, such as a loaning service or asking families to access a copy through their local library, could be considered. This should be discussed and agreed with the supervisor.

!!!Linked pages:

For more information on conducting assessment session or 'session 0 please see [[What is a Session 0]]

!!''Overview:''
This session is face to face (up to 1 hour).  The full session plan can be seen in the [[paper manual|http://centaur.reading.ac.uk/65537/]]

For a breif summary of Session 1, see below:

<<link-doc "Simplified session plan" "https://drive.google.com/open?id=1F2mkItAECXDK2L4p_SN2TO5rE1ljkp548EXHoxfnIkw">>
!!!''Outcome measures:''
These will be completed on [[POD|https://pod-database.org/db3/login/]]
*At beginning of session:
**Primary Outcome Measure = Full Parent SDQ 
**Goal rating scale 
*At end of session:
**Session Feedback Questionnaire (SFQ) 
----
!!''Session plan:''
Reading covered in session: Part 1 (Chapters 1- 4)
!!!''Key tasks: ''
*To engage parent and child in the work 
*To develop a joint understanding  of the development and maintenance of the child’s anxiety 
*Complete parent SDQ.
*Provide information on treatment aims and set goals
!!!''Check In''
*How are you?
*Agree the agenda: outline content of session, provide opportunity for parent to add to agenda
*Discuss practicalities: Session dates/time
*Review homework: any questions/comments about Part 1 of book?
*If reading not completed, encourage problem solving for next week
!!!''Main content of the session''
*''Overview of therapy plan:'' Guided self-help based on CBT principles
*''Explain outcome measures:'' Used to track progress and inform sessions
*''Understand current difficulties:'' Establish main concerns
*''Psycho-education of anxiety'': Development and maintenance of anxiety 
*''Setting goals:'' Help family develop realistic and achievable goals
!!!''Parent 'homework' tasks:''
*Parent to record their child's anxious thoughts, feelings and behaviour on handout (My Child's Anxious Thoughts, Bodily sensations and Anxious Behaviour)
*Discuss goals with child and confirm next session.
''Reading:''
*Read Part 2, Steps 1 & 2 of the Overcoming book. 
*For younger children (aged 5- 8 years), ask the parent to read Chapter 14, Using This Book With Younger Children 
*For older children (aged 12 years+), ask the parent to read Chapter 15, Using This Book With Teenagers 
!!!''Review of the session''
*Complete Session Feedback Questionnaire (SFQ) on ''POD''
*Discuss ‘take home’ messages from session: e.g. no single cause of anxiety; what can be helpful is to change what is keeping the anxiety going; parents are best placed to do this.
----
!!'' Handouts ''
!!!''Core self help materials:''
*Book: Overcoming Your Child's Fears and Worries (either purchased by parent/purchased by partnership for parent/lent out to parent by partnership)
<<link-doc "Child’s anxious thoughts, feelings, behaviours record sheet" "https://drive.google.com/open?id=0B1hDLHd8syMsT1RJRkxyVVZSZWs">>
<<link-doc "Development and Maintenance of Anxiety Map" "https://drive.google.com/open?id=0B1hDLHd8syMsaXBldnFtYVJyT0k">>
<<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">>
!!!''Additional handouts:''
<<link-doc "School information sheet" "https://drive.google.com/open?id=0B1hDLHd8syMscGw5MEJFUEUyYVU">> (if appropriate)

!!!!Source: Caroline Bengo, Matt Woolgar, Sara Dawson and Jelena Crnokrak 

This page provides a brief session plan to be used as a reminder for practitioners. 

---

!!''Overview:''

''Goals and Attending'': This session is face to face (approx. 50-60 mins). The full session plan can be found here:

<<link-doc "Session 1: Goals and Attending" "https://drive.google.com/file/d/1MlHSjPeukPev-tRHtEc60rQtzN6SGURW/view?usp=sharing">>

The full manual can be found here:

<<link-doc "Guided self-help for behaviour problems" "https://drive.google.com/file/d/1vBNYY-hZtqIKHZucyZmbxZmfjTvYYoRZ/view?usp=sharing">>

!!!''Outcome measures''
These will be completed on [[POD|https://pod-database.org/db3/login/]]

* At beginning of session:
**[[SDQ]] (Full -dependant on assessment session)
**[[GBO|Goal-Based Outcomes (GBO)]] (+HIT)
*End of session:
**SFQ/SRS

----
!!''Session plan''

!!!''Key tasks''

* Introduce/clarify aims of program (if not covered in assessment).
*Determine main areas of concern (if not covered in assessment)
*Develop/ clarify goals (if set during assessment)
*Discuss the importance of play
*Introduce attending and positive attention as a strategy for appropriate behaviour
*Support parents in how to attend and plan how to use this at home

!!!''Check In''

*How are you? 
*Agenda setting and explain structure (each session focusing on different strategy)/ length of sessions and expectations (parents to try strategies at home) (If not done in assessment session)
 *Give parents a folder to collect weekly handouts as an aid memoire. 
* Agree 'ground rules'

!!!Review
*No homework to review but check if any questions/ concerns from initial assessment. 

!!!''Main content of the session''

PLEASE NOTE: During this session Use your ABC charts to unpick/understand processes and use modelling/ role play (really important). Listen and validate the difficulties that they face.



*''Role of parental attention:'' as an important reinforcer (parents so important to child) and problematic patterns -refer to attention table, examples and reasons why it is easier to attend to problematic behaviour (examples of parent traps)- important to normalise.
*''Aims of program:'' to support parents to provide positive attention for positive behaviour (praise, rewards, encouragement), decrease negative attention given for misbehaviour (criticisms, directions, questions), ensure expectations for behaviour are clear and responses are consistent. Desired results: Misbehaviour reduce and positive/prosocial behaviour increase.
*''Focus on play and positive attention first'' explain/ reassure why this is focused on first- link to research.
*''Set or review SMART Goals'' (Set Goals in assessment or this session) –3 main behaviours of concern (be specific and clear about behaviours), rate how often they occur. May also want to include a goal for themselves – use handout: concerns about my child
*''The Importance of Play'' Discuss impact on their relationship to parent and physical, cognitive, emotional and social learning. Attending as an investment (like putting money into a savings account). Current experiences of playing with child? Normalise concerns and role play different ways of playing.
*''Attending/Special Time'' demonstrate how play CAN NOT be a positive experience for children- short role play as parent - playing intrusively, overact and explain/ apologise for this afterwards. Re-demonstrate using attending strategies (Discuss this two experiences). Discuss AVOID and DO points (See full session plan).  Advise keep time short at first about 10 mins.
*''Ending special time''- can be very engrossing for child- parent to warn child of ending 2 mins before (discuss if additional warning needed). Parents to reassure child they enjoyed it. If child protests: focus on play for remaining time, if protests when time is up: be clear you need to stop but they can carry on explain you will check back with them, do not extend time. 
*''Practice'' Demonstrate attending and special time- with you as parent then switch with you as child. Normalise difficulties and stress it looks more natural than it feels
*''Develop home practice plan'' and troubleshoot any difficulties/identify and address potential concerns/ barriers (Other siblings, type of toys to use, time of day).

!!''Home-practice''

*Attend to their child for 10 minutes each day
*Parents to note down when they achieved this/how it went, to discuss next session


---

!!''Handouts''

*Concerns about my child
*Goals
*Attending/Special Time


<<link-doc "Session 1 Handouts" "https://drive.google.com/file/d/1zz7tslg-lr8BpbZX10yZU0AhmMnKWht3/view?usp=sharing">>

!!''Overview:''

''Learning about your child and their behaviour'' this is a face to face session lasting aprox. 50-60 minutes. The full session plan can be found here:

<<link-doc "Guidelines for Parent Support Manual" 
"https://drive.google.com/file/d/13kBzWKnq1kHeBF6zD-TRMhWTkEPX7aNy/view?usp=sharing">>


!!!''Outcome measures''
These will be completed on [[POD|https://pod-database.org/db3/login/]]

*Beginning of session:

**Parent SDQ (Full)

*End of session:

**SFQ/SRS

----
!!''Session plan''

!!!''Key tasks''

* Provide information on children’s behaviour and developmental context
* Help parents identify factors that impact on the reinforcement of behaviours 
*Discuss: parent’s beliefs about the problem behaviour, parenting style, and parental attention  

!!!''Check In''

*How are you?
* Agenda setting 
* Explain how long you will meet for (50-60 minutes)
* Explain general structure of sessions and expectations (parents to try strategies at home).
 *Give parents a folder to collect weekly handouts as an aid memoire. 
* Agree 'ground rules'

!!!''Main content of the session''

*''Identify problem behaviours'': parent to define behaviours that they are struggling with as specifically as possible (describe the behaviour). 
*''Generate a list of problem behaviours'': use the handout, encourage parent to write these down on (Handout 1). Lead to discussion on what drives/ causes these behaviours
*''Identify link between parent’s beliefs and thoughts on problem behaviour'': parents to think about what drives children’s behaviour- “Why do children have tantrums?” 
*''Generate a list'' with parent first before exploring these further.Parents may generate lots of different reasons which may help to identify any unhelpful beliefs- “they know what they’re doing” validate and acknowledge these.
* ''Introduce thoughts feelings and behaviour cycle'' (Handout 3) to help parents understand the impact of their thoughts on their feelings and behaviour. 
*''Overcome any barriers or resistance to the strategies'' use a thoughts feelings and behaviour cycle at any point to help with this.
* ''Hypothetical example'' to be used to socialise parents to this (Handout 2 as template if helpful)


*''Identifying alternative explanations'' for children's behaviour. Foster curiosity for alternative explanations for child’s behaviour. Can use the following ideas: 
**''Developmental stage'' – limited language, striving for independence and testing the boundaries.  Ask “What developmental stage was X at when they started this behaviour? Were they able to think “I’ll try to wind mum up!”?”
** ''Children wanting attention'' – help parent to understand that all children love attention, all of the time - this is normal. Identify the speed children gain attention for inappropriate behaviour vs appropriate behaviour (behaviours receiving attention will be repeated). Could use Handout 1 - how parents respond
** ''Trying to communicate ''– huge spectrum of things a child is trying to communicate, for example feelings (frustrated, sad) and needs (tired, hungry, unwell). 
** ''Modelling'' – children learn through watching other people. Research has shown that children copy the behaviours of those around them. 
** ''Routine'' – children thrive off consistency and predictability. Changes in their routine can make them feel insecure and evoke anxious feelings.

''Optional other tools''

Example 1- [[Dog Poo Analogy]]


* ''Behaviour Cake'' use to help explain the multiple factors that contribute towards a child’s behaviour 
	
!!''Home-practice''

*Recognise what behaviours are given attention (Handout 1)
* “This week, I’d like you to be a bit of a detective and notice your own thoughts and how these effect your responses to your child’s behaviour” (Handout 3)
*Give parents Handout 2 

---

!!''Handouts''

<<link-doc '"Handout 1 & 2" "https://drive.google.com/open?id=1KdAzw16tEprZvAROhVTaT96SpmHvAoke">> 

<<link-doc "Handout 3" "https://drive.google.com/open?id=1ZzupA0CQUrC1-cI926hMusLnXSt4viba">>

!!''Overview:''

!!!This page provides a brief session plan to be used as a reminder for practitioners, the full session plan can be found here:

<<link-doc "Session 1 Plan: Adolescent Anxiety" "https://drive.google.com/file/d/1CLJXa90m3nQGnoUdfUUHStEjlzBzyW7C/view?usp=sharing">>

This session is face to face (approx. 45 mins).  In this session you’ll support the YP to:

 *Find out more about anxiety. 
*Develop an understanding (formulation) of the development and maintenance. 
*You’ll also support them to develop goals and backup team. 

!!!''Outcome measures''
These will be completed on [[POD|https://pod-database.org/db3/login/]]

*At beginning of session:
**[[RCADS]] (Full)
----
!!''Session plan''


''Note: ''If you haven’t completed a session 0 for this YP as they have had an assessment elsewhere you will need to make some additions to this session, including checking with the YP they feel this is the appropriate intervention, a brief risk assessment and discussing the impact of the YPs anxiety on their life. See session 0 for support with this.

!!!''Key tasks''

*Discuss a recent situation where the YP felt anxious- thoughts, feelings and behaviours.
*Provide psychoeducation about anxiety.
*Discuss the YP’s ideas of development of problematic anxiety- what might be keeping it going. 
*Support the YP to identify helpful coping behaviours v’s unhelpful habits. 
*Discuss/agree goals for sessions and back-up team. 
*Complete ROMS and SRS

!!!''Check In''

*How are you?
*Complete RCADS
*Agree the agenda: content of session and give opportunity for YP to add to agenda
*Review any questions they had about psychoeducation materials they read between sessions.


!!!''Main content of the session''

*''Discuss specific situation'' the YP has experienced anxiety - thoughts, feelings, body sensations and actions (p18). 
*''Maintaince factors'' - avoidance, safety behaviours and unhelpful thinking. 
*''Psychoeducation'' on anxiety. Utilise p19/20 of manual- the fight/flight/freeze response and how the YP experiences this response. Use other resources – be creative! (YouTube etc.)
*''Cause and maintenance'' of problematic anxiety. Normalise/ validate the YP’s experience. Acknowledge any feelings of self-blame/ criticism - reassure it is not their fault. __Important:__ Once YP knows what is keeping it going they can do something to overcome it.  
*''Coping behaviours vs unhelpful habits:'' Utilise examples/analogies - Coping strategies previously used- which are helpful coping techniques /unhelpful habits. 
*''Suggest possible coping techniques'' (p.25/26 of manual).
*''Formulation'' (worksheet p.27) - pull together learning /understanding of cause or trigger and what is keeping it going. This will help when deciding which techniques to focus on and developing goals.  
* ''Develop up to 3 goals'' with the YP for sessions. Refine into SMART goals (p28/29). Aim for one to be a learning goal (e.g. to develop ways of coping with my anxiety). 
* ''Back-up team:'' Discuss who is going to support them between sessions. 

!!!''Things for YP to practice''
*Try out/practice coping strategies on p. 25/26. 
*Could read about the role of avoidance in maintain anxiety.

!!!''End of session review''

*Any questions? 
*Plan if anything needs to be shared with anyone on the back up team (e.g. parents/teachers who may need to support YP with home tasks or have been identified as doing things that are inadvertently maintaining the YP’s anxiety which needs to be discussed).
*Utilise SRS or similar to get feedback on the session.

----
!!''Handouts''
!!!''Core self help materials:''
The main resources are session 1 of the Getting to Grips with Anxiety manual:

<<link-doc "Getting to grips with anxiety" "https://drive.google.com/file/d/1MhSkweHKlMx3gAHe8SyVqss4nSjzJhFd/view?usp=sharing">>

!!!''Additional handouts:''
<<link-doc "SMART goals" "https://drive.google.com/file/d/1u3mrTagRhW23ZB5K6TEZwwJtZtEL2Cc7">>
!!!''Other resources:''
*You may want to utilise other self help materials in your work with YP. For self-help materials such as videos, websites, apps and booklets (in particular:'Panic and Phobias' or 'Stress and Worry' depending on difficulty) please go to: [[Self Help Materials for Adolescent Anxiety]]
*Apps: There is an app called 'Grow' which is aimed at YP to help them manage personal goals (see: [[Self Help Materials: Apps]])

Additionally please go to the [['get self help'|https://www.getselfhelp.co.uk/]] website for useful handouts and session materials.

!!Overview:
This session is face to face (up to 1 hour).  The full session plan can be seen in the paper manual which can be found here:

 <<link-doc "Guided Self-Help for Low Mood: Full Manual" "https://drive.google.com/file/d/12bn3n53aWhm5_21Za460fp_qOtPsWY_N/view?usp=sharing">>  

!!!Outcome measures:
These will be completed on [[POD|https://pod-database.org/db3/login/]]

*At beginning of session:
**Primary Outcome Measure = Full RCADS
**Goal rating scale 
*At end of session:
**Session Feedback Questionnaire (SFQ) 
----
!!Session plan:

!!!Key tasks:

*RCADS symptom tracker
*Set goals
*Psychoeducation
*Formulation

!!!Check in
How are you?
Agree the agenda: outline content of session, provide opportunity for them to add to agenda (This can be discussed in space at the end of the session, or integrated during a relevant part of the session)
Discuss practicalities: Session dates/time

!!!Main content of the session 

*''Complete RCADS'' symptom tracker on POD. Feedback RCADs results from previous week - discuss results.  

*''Goal Setting:'' Identify goals (SMART goals handout).  
*''Record the goal''- use the GBO 
*''Rate goals'' out of 10 for where they are currently with this goal and where they would like to aim to get to (10/10 might not be realistic!)
*''Psychoeducation: '' work through handout and discuss (“Depression and Low Mood: Psychoeducation” handout)

*''Normalise their difficulties'' by encouraging YP to tick which signs and symptoms they might be struggling with.
*''Vicious cycle'' of depression/low mood (also included in handout) Explain and wider formulation around development of low mood (“Development Map of Low Mood”)
*''Highlight importance of BA'' as part of their intervention.
*''Develop an individual formulation/cycle'' with the young person using the same handout, using a recent time  they felt low.    
*''Discuss the information'' on 'how I can overcome my low mood'. Emphasising that things can improve! 

!!!Home practice
*Read over the psychoeducation material on low mood that has been provided.

!!!End of session review
*Review of session, comments and questions. 
*Key learning points?

-----

!!Handouts 
!!!Core self help materials: 

<<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">>

!!!Additional resources:

[[The ‘Dog Poo’ analogy|Dog Poo Analogy]] is a useful way to describe the relationship between thoughts, feelings and behaviour.  This is included in session four where the role of thoughts is discussed. However, in some instances this may fit well following the vicious cycle where the thoughts, feelings and behaviour link is first illustrated. 

[[Black Dog Video clip (WHO)|https://www.youtube.com/watch?v=XiCrniLQGYc]]

 ----

!!''Overview: ''
This session is face to face (up to 1 hour).  The full session plan can be seen in the [[paper manual|http://centaur.reading.ac.uk/65537/]]
!!!''Outcome measures:''
These will be completed on [[POD|https://pod-database.org/db3/login/]]
*At beginning of session:
**Primary Outcome Measure: Parent SDQ IMPACT Sub-scale (short version)
**Goal rating scale
*At end of session:
**SFQ
----
!!''Session plan:''
Reading covered in this session: Part 2 (steps 1 and 2)
!!!''Key tasks: ''
*Helping parents support their children explore anxious thoughts
*Helping to test out fears
*Complete impact subscale of parent SDQ.
!!!''Check In''
*How are you?
*Agree the agenda: content of this session and give opportunity for parent to add to agenda
*Complete measures and review goals: Reflect on any changes
*Does parent have questions/comments about reading Part 2 (steps 1 and 2) of book? If not completed, encourage problem solving for next week.
!!!''Main content of the session''
''Review of maintenance cycles''
*To help parents recognise the maintaining role of thoughts in anxiety.
''Alternative ways of thinking''
*Introduce concept: Alternative ways a child might think about a situation and the ways parents can help a child with this
*To give parents strategies to help children think through negative thoughts independently (with support). 
''Methods of encouraging alternative ways of thinking''
*Give parents alternatives to reassurance or responses that may inadvertently promote avoidance. 
*Instead of reassurance, encourage parents to show empathy by validating child’s feelings (e.g. I can see that you are worried about x) and then ask questions to help child to think for themselves.
*Introduce Judge and Jury techniques: Identify evidence for the thought and alternative to the thought.
''Encourage testing out fears''
*Introduce behavioural experiments and encouraging children to think of ways to test their fears
*Emphasise importance of asking child what they think will happen before experiment and what actually happened after experiment so that they can think about what results mean 
''Give an opportunity to practice''
*Role play with parent (with you as parent and parent playing child first, then swap) 
*Discuss what felt like it worked/didn't work etc
!!!''Parent 'homework' tasks:''
*Parent to record their child’s anxious thoughts and their attempts at challenging these
*Parent to read remainder of Part 2 
*Parent to decide what fear should be the focus of the programme and step-by-step plan for their child, in preparation for session 3.
!!!''Review of the session''
*Complete SFQ
*Discuss ‘take home’ messages from session - reducing reassurance, asking questions and testing predictions. 

----
!!''Handouts''
!!!''Core self help materials:''
<<link-doc "My Child's Thoughts" "https://drive.google.com/open?id=0B-tACu2wi4-4LUFGSjc4ek05SWc">>
<<link-doc "Helping my child with unhelpful thoughts" " https://drive.google.com/open?id=0B-tACu2wi4-4TnZXaml6X2RsUkk">>
!!!''Additional handouts:''
<<link-doc "Judge thought challenging" "https://drive.google.com/open?id=0B-tACu2wi4-4MXFfN0Q1U3FwOVk">>

!!!!Source: Caroline Bengo, Matt Woolgar, Sara Dawson and Jelena Crnokrak 

This page provides a brief session plan to be used as a reminder for practitioners. 

---

!!''Overview:''

''Praise and Rewards'': This session is face to face (approx. 50-60 mins). The full session plan can be found here:

<<link-doc "Session 2: Praise and Rewards" "https://drive.google.com/file/d/1xVNpAfXMRTOLS5FdjJ6tpuVQAJKbneH0/view?usp=sharing">>

The full manual can be found here:

<<link-doc "Guided self-help for behaviour problems" "https://drive.google.com/file/d/1vBNYY-hZtqIKHZucyZmbxZmfjTvYYoRZ/view?usp=sharing">>

!!!''Outcome measures''
These will be completed on [[POD|https://pod-database.org/db3/login/]]

*At beginning of session:
**[[SDQ]] (IMPACT only)
**[[GBO|Goal-Based Outcomes (GBO)]] (+HIT)
*End of session:
**SFQ/SRS

----
!!''Session plan''

!!!''Key tasks''
*Review and troubleshoot attending
*Introduce specific praise and positive reinforcement strategies

!!!''Check In''

*How are you?
* Agenda setting 
* Explain how long you will meet for (50-60 minutes)
*''Review of home-practice'': aim is to increase parents’ awareness of the impact that they have on their child’s behaviour and the relationship between the attention that they give and their child’s behaviour. 

!!!Review
*how did attending go? What toys/activities were used? How did it feel while attending? How did the child respond? Troubleshoot any issues/ practice again if needed.
*Goals

!!!''Main content of the session''

*''The Importance of Praise''- highlight importance and explore current use of/feelings about giving praise. Explain it as another way of investing positive time, and tells children which behaviours we value (Focus praise on positive behaviours- in line with goals). Also builds child’s self-esteem, reminds them they are loved.
*''Giving Effective Praise'' Discuss difference of generic praise and specific labelled praise tied to a behaviour (reasoning for using the latter). Use/ share [[Making praise effective]] 
*''Rewarding behaviour'' introduce/ discuss use of social rewards, and tangible rewards (to be used in a sparing way) to reinforce positive behaviour. Discuss if reward charts are appropriate- good for establishing new routines. Encourage parents to use specific praise, even when using other forms of reward.
**''Social Rewards discuss types of social reward'': Verbal Praise, Physical Affection, Time with Child
**''Tangible Rewards'' (Used sparing) check clarity between bribe and reward. Discuss types: Inexpensive Items (stickers etc.), Special Choices and Privileges (Screen time etc.), Special Activities, Special Time with Child.
*''Practice'' think/note down with parents how they can increase praise for specific desired behaviours (refer to goals) for the following week. If no positive behaviours- encourage noticing child’s steps in the right direction or compliance with minor instructions.
*''Parents to praise themselves'' for something they have done well each day. Important to recognise steps in the right direction as can help to counter own inner critics.


!!''Home-practice ''
*Parents to select behaviours and praise these across the week
*Assist with a reward chart (if appropriate) 
*Notice one thing they did well (or in the right direction) every day

---

!!''Handouts''

*Praise
*Reward Charts
*Goals


<<link-doc "Session 2 Handouts" "https://drive.google.com/file/d/1XmmTnHbmynS-E9ujRk-jkNL4s8PLmfsn/view?usp=sharing">>

!!!!!Source: Deb ~McNally and the Manchester Collaborative 
!!''Overview:''
''Enhancing your relationship and supporting children's communication 
'' this is a face to face session lasting aprox. 50-60 minutes. The full session plan can be found here:

<<link-doc "Guidelines for Parent Support Manual" 
"https://drive.google.com/file/d/13kBzWKnq1kHeBF6zD-TRMhWTkEPX7aNy/view?usp=sharing">>

!!!''Outcome measures''
These will be completed on [[POD|https://pod-database.org/db3/login/]]

*Beginning of session:

**Parent SDQ

*End of session:

**SFQ/SRS

----
!!''Session plan''

!!!''Key tasks''
* Consolidate learning from the previous week about children’s behaviour and the attention that parents give
* To understand the importance of communication to support child’s learning and development 
* Help parents identify the importance of setting time aside to interact/ have special time with their child
* Link with self-esteem and confidence 
!!!''Check In''

*How are you?
* Agenda setting 
* Explain how long you will meet for (50-60 minutes)
*''Review of home-practice'': aim is to increase parents’ awareness of the impact that they have on their child’s behaviour and the relationship between the attention that they give and their child’s behaviour. 
!!!''Main content of the session''

*''Importance of interaction and playful opportunities'': Consider the physical, cognitive, emotional and social learning that can occur through interaction and play. 
*''Share information about interaction and play'':
**children’s cognitive development and emotional well-being are related to the quality of their play
** feeling valued and understood
** understanding how other people feel
** stimulation and exploration helps the young child’s brain development
** play helps children learn new skills and concepts
** encourages their creativity and imagination
** helps children make sense of the world; learning skills in problem solving
** encourages exploration and experimentation through play  

*''Special time with your child'' and play is an investment in the child. (Use metaphors) Interaction supports the development of a strong relationship, which lays the foundations for dealing with behaviours that are challenging. 
*''Experiences of playful opportunities'' as adults and children. do parents have positive experiences of communication and play or beliefs that might be barriers to effective communication.
*''Problem solve any difficulties'' parents have or beliefs they hold about spending time with their children- support them to feel confident and see the benefits.
*''Experiential learning'': explain to parents that you want them to ‘have a go’ at the strategies in the session, as this will help them feel confident to go home and put it into practice. 
*''[[Setting Up a Practice]]'' for an example of how to practice this with parents.

!!''Home-practice ''
*Support parent to think about when they can have special time with their child – what time of the day is best
*Support parent to think about what they can do with their child i.e. what is realistic and what does their child enjoy doing
*Complete special time diary (Handout 4)
---

!!''Handouts''

<<link-doc "Handout 4" "https://docs.google.com/document/d/1mp9YOvE3yMS0FUZEijJdn5muyYLOSXi61kpaAFvSj_E/edit">>

!!''Overview: ''
This session is face to face (approx. 45 mins).  
!!!This page provides a brief session plan to be used as a reminder for practitioners, the full session plan can be found here:
 <<link-doc "Session 2 Plan: Adolescent Anxiety" "https://drive.google.com/file/d/1H3psPPCGetG_4PJ_lqGvKvBfoCsU2uU6/view?usp=sharing">>

In this session you’ll support the YP to: 
*Address problematic anxiety through exposure in a step-by-step plan. 
*Discuss avoidance in maintaining anxiety 
!!!Outcome measures:
These will generally be completed on [[POD|https://pod-database.org/staff/select-project.php]]
*At beginning of session:
**Sub-scale on the [[RCADS]]
**Goal rating scale 
----
!!''Session plan''
!!!''Key tasks''
*Discuss role of avoidance in maintenance and how exposure can be used to address this.
*Identify situations /activities being avoided due to anxiety. 
*Agree activity they would like to address using exposure 
*Support them to create a step-by-step plan.
!!!''Check In''
*How are you?
*Complete outcome measure
*Agree the agenda: content of session and give opportunity for YP to add to agenda
*Review any questions they had about the last session or home task materials
*Review home tasks and what YP has learnt from completion. Set further practice if appropriate. 
*Problem-solve any barriers to completing home tasks
!!!''Main content of the session''
*''The role of avoidance'' in maintaining anxiety and the rational for exposure -Utilise metaphors /analogies to support this and p. 33 of the manual (examples from their own experience) __Key messages:__ 
**avoidance is a natural response and reduces anxiety short-term 
**Maintains it in the long-term 
* ''Identifying situations or activities'' -Support  YP to identify what they are avoiding/ escaping from due to their anxiety (p.34).
*''The fear thermometer'' (p.35) to gauge /rate fear levels for particular situations. Help the YP to decide anchor points for a few fear ratings.
*''Choose a situation/activity goal'' - one the YP is avoiding that they would like to do if they overcome anxiety. (Place the ultimate goal at the top of the step-by-step plan)
*''Break goal down into smaller steps'' Use the fear thermometer to help rate levels of anxiety to help guide where to place them on the 'fear ladder'. 
*''Discuss rewards'' for when they have completed each identified step successfully.  
*''Decide a plan for completing first step'' (p. 37). - should provoke some anxiety but feel achievable and likely to result in completion /success to boost confidence (work within the YP’s “window of tolerance”). Discuss safety behaviours - may need to be dropped and helpful coping skills used.
*''Talk through any problems'' that may get in the way of completing the exposure and plan for these.
*''Tip sheet'' to talk through with the YP on p.39.
''To note:'' If appropriate the first step can be completed at home or in the next GSH session. If YP plans to complete exposure at home ask them to complete the exposure rating sheet (p.44/45) as a record of changes in their anxiety during the exposure task. Be clear on what a successful step means - to remain in situation until anxiety reduces by half of original rating.
!!!''Things for YP to practice''
*May want to complete the first step on their exposure hierarchy at home if this feels manageable. If not - could discuss and plan rewards for their step by step plan with parents/carers and/or practice coping skills discussed in session one. 
!!!''End of session review''
*Review the main content of the session and check YP’s understanding or any questions. 
*Ensure YP is clear about any home tasks/practice that need to be completed before the next session.
*Plan if anything needs to be shared with anyone on the back up team (e.g. parents/teachers who may need to support YP with home tasks or have been identified as doing things that are inadvertently maintaining the YP’s anxiety which needs to be discussed).
*Utilise SRS or similar to get feedback on the session
----
!!''Handouts''
!!!''Core self help materials:''
All core handouts can be found in session 2 of the the treatment manual: 
 <<link-doc "Getting to grips with anxiety" "https://drive.google.com/file/d/1MhSkweHKlMx3gAHe8SyVqss4nSjzJhFd/view?usp=sharing">>
!!!''Additional Handouts:''
<<link-doc "Fear Thermometer" "https://docs.google.com/document/d/1mdOx9P-4TAJJ5Zx2D8dpyKtAviiih3cj8zUx02rjN2Y/edit?usp=sharing">>
<<link-doc "Thinking traps" "https://docs.google.com/document/d/1uKIB6vs687FCuoYUwK52yQIdqQHm1pky0wTkLl1tFpw/edit?usp=sharing">>
<<link-doc "Coping thoughts" "https://drive.google.com/open?id=0B-tACu2wi4-4dVNuelpUUVh6UWc">>
<<link-doc "Overcoming Avoidance" "https://drive.google.com/file/d/0B-tACu2wi4-4X3dSNzV3YzlXTTA/view?usp=sharing">>
!!!''Other resources:''
You may want to utilise other self help materials in your work with YP. For self-help materials such as videos, websites, apps and booklets please go to: [[Self Help Materials for Adolescent Anxiety]]. Additionally please go to the [['get self help'|https://www.getselfhelp.co.uk/]] website for useful handouts and session materials.

!!Overview:
This session is face to face (up to 1 hour).  The full session plan can be seen in the paper manual which can be found here:

 <<link-doc "Guided Self-Help for Low Mood" "https://drive.google.com/file/d/12bn3n53aWhm5_21Za460fp_qOtPsWY_N/view?usp=sharing">>  

!!!Outcome measures:
These will be completed on [[POD|https://pod-database.org/db3/login/]]

*At beginning of session:
**Primary Outcome Measure = RCADS (Subscale)
**Goal rating scale 
*At end of session:
**Session Feedback Questionnaire (SFQ) 
----
!!Session plan:

!!!Key tasks: 

•	RCADs symptom tracker & rate goals

•	Back up team 

•	Introducing Behavioural Activation and the Activity Diary

!!!Check in
* How are you?
* Agree the agenda: outline content of session, provide opportunity for them to add to agenda (This can be discussed in space at the end of the session, or integrated during a relevant part of the session)
* Discuss practicalities: Session dates/time

!!!Main content of the session 

*''Explain the back up team'' and different types of support different people might offer and begin creating their own back up team (‘The Back-Up Team’ handout). 
*''Sharing this discussion'' with people on the back up team (may require support in how to do this).

*''Introduce Behavioural Activation:'' (Behavioural Activation 1 handout). Cover key areas:
**Activity levels and low mood – leading into the ‘Vicious Cycle of Depression/low mood’.
**What happens in their own lives when they feel low? Have they stopped/ reduced activities?
*''Action before motivation'' (Handout). - Check understanding, thoughts? Have they ever done an activity that they didn’t want to do, but then felt better for it?  

*''Introduce the Activity Diary'' (Handout) Discuss idea of rating activities on scales; Achievement, Closeness to others, Enjoyment

*''This weeks activities'' What have they done- Practice scoring verbally on each of these areas for the activity.

*''PLEASE NOTE: values and the importance of values and activities are included in the following session.''

*Go through the sample diary (Mohammed). Any reflections?

*''Blank Activity Diary'' for the week ahead. - Complete a whole day together to practice. (try to use detail). BUT if the young person is particularly overwhelmed, basics of how they are spending their time is better than nothing at all.

!!!Home practice

*Fill in Activity Diary 
*If possible, share the session work with parents
!!!End of session review: 
*Comments and questions, key learning points?

-----

!! Handouts 
!!!Core self help materials:

 <<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">>  

!!''Overview: ''
This session is face to face (up to 1 hour).  The full session plan can be seen in the [[paper manual|http://centaur.reading.ac.uk/65537/]]
!!!''Outcome measures:''
These will be completed on [[POD|https://pod-database.org/db3/login/]]
*At beginning of session:
**Primary Outcome Measure: Parent SDQ IMPACT Sub-scale (short version)
**Goal rating scale
*At end of session:
**SFQ
----
!!''Session plan:''
Reading covered in this session: Part 2 (Steps 3 & 4)
!!!''Key tasks: ''
*Building up brave behaviour
*Devising a step plan to face fear
!!!''Check In''
*How are you?
*Agree the agenda: content of this session and give opportunity for parent to add to agenda
*Complete measures and review goals: Reflect on any changes
*Review homework: Does parent have questions/comments about homework? If not completed, encourage problem solving for next week.
!!!''Main content of the session''
''Building up brave behaviour''
*Discuss promoting independence in children 
*Discuss opportunities in everyday life where they can promote facing or testing out fears.
*Discuss attending to attempts made by child and praising/ rewarding this.
*Role models for child
''Devising a step plan to face fear''
*Discuss stepped-approach: building up behavioural experiments gradually to build confidence in facing fears.
*Consider graded exposure with parent (least anxiety provoking to most anxiety provoking). 
*Think of a reward for each step.
*Helpful thoughts: Encouraging child to come up with helpful thoughts that will help them to take the next step
!!!''Parent 'homework' tasks''
*Check the step-by-step plan with their child and alter if necessary
*Encourage the child to have a go at the first step on the step-by-step plan. 
*Parent to monitor own responses and complete handout (how anxious does my child feel?)
*Continue to encourage their child to challenge their anxious thoughts 
!!!''Review of the session''
*Complete SFQ
----
!!'' Handouts ''
!!!''Core self help materials:''
<<link-doc "Responding to My Child’s Anxious Behaviour" "https://drive.google.com/open?id=0B-tACu2wi4-4WkpPZ3pMNmxvRW8">>
<<link-doc "Praise and Rewards"" https://drive.google.com/open?id=0B-tACu2wi4-4UjFlTWhkY1hrVU0">>
<<link-doc "How Anxious Does My Child Feel Doing Each Step?" "https://drive.google.com/open?id=0B-tACu2wi4-4eV9JMjNMci1ONzA">>
<<link-doc "Step-by-step plan" "https://drive.google.com/open?id=0B-tACu2wi4-4OEFaMWFSTHFvUms">>

!!!!Source: Caroline Bengo, Matt Woolgar, Sara Dawson and Jelena Crnokrak 

This page provides a brief session plan to be used as a reminder for practitioners. 

---

!!''Overview:''

''Selective Ignoring'': This session is face to face (approx. 50-60 mins) ''OR ''telephone if ''NOT'' doing time out (approx. 20-40 mins).  The full session plan can be found here:

<<link-doc "Session 3: Selective Ignoring" "https://drive.google.com/file/d/1JpuKNrjwMYq1XpkIMct-rF-FkTEligKx/view?usp=sharing">>

The full manual can be found here:

<<link-doc "Guided self-help for behaviour problems" "https://drive.google.com/file/d/1vBNYY-hZtqIKHZucyZmbxZmfjTvYYoRZ/view?usp=sharing">>

!!!''Outcome measures''
These will be completed on [[POD|https://pod-database.org/db3/login/]]

* At beginning of session:
**[[SDQ]] (IMPACT only)
**[[GBO|Goal-Based Outcomes (GBO)]] (+HIT)
*End of session:
**SFQ/SRS

----
!!''Session plan''

!!!''Key tasks''
* Introduce selective ignoring as a strategy to reduce negative behaviours
*Support parents to use differential attention
*Support parents to use selective ignoring appropriately/calmly



!!!''Check In''

*How are you?
* Agenda setting 
* Explain how long you will meet for 

!!!Review

*Home Practice: how did specific labelled praise go? Did you remember to praise yourself? Still using special time? Troubleshoot any issues/ practice again if needed. 
*Goals

!!!''Main content of the session''

''Notes for practitioners:'' Selective ignoring not to be used for dangerous behavior/ behaviours that really push parents’ buttons. Works best for behaviour intended to elicit a parental response (and minor irritating behaviours). If possible: everyone in home is to ignore the behaviour. Must be used consistently (every time chosen behaviour occurs) and alongside positive attention/ praise/ rewards for positive behaviour. 

*''Selective Ignoring parental attention rewarding''. So major way to decrease unwanted behaviour is to completely remove attention from that behaviour but NOT the child. Benefits: extremely effective, maintains positive relationship, role modelling self-control/emotional regulation, and allows child to practice independently calming down. See [[Selective Ignoring Guidelines]] 
*''Choosing the right behaviour'' choose tolerable behavior to begin with - if they crack (eg. Shout etc.) provides powerful reinforcement of negative behavior 
*''Reinforcement strengthens behaviour'' so more likely to occur again. Two types - Continuous: rewarding behaviour every time it occurs (establishing new behaviours). Intermittent: rewarding every now and then (maintaining behaviour). Use [[The Slot Machine Analogy]]
*''May get worse before it gets better'' as the usual reward is withdrawn (your attention). If you stick with it, it will eventually reduce. Use behaviour extinction diagram (in full manual) to illustrate re-emergence and extinction (stress importance of consistency).
*''Practice:'' note down/discuss behaviours (handout: Selective Ignoring) parent is to selectively ignore. Practice (if helpful) with parent acting as child first then switch roles. Discuss/ problem solve getting the family ‘on board’, coping statements (Handout: Coping Thoughts) and (appropriate) distractions.


!!''Home-practice:''

*Practice selective ignoring for a mild irritating behaviour during the week.
*Continue using specific praise for the positive alternative to the behaviour being ignored.
*Continue special time

---

!!Handouts

*Selective Ignoring
*Coping Thoughts


<<link-doc "Session 3 Handouts" "https://drive.google.com/file/d/105KDpArw9_r1jLLVHNAlJe1hbOUo4UbS/view?usp=sharing
">>

!!!!!Source: Deb ~McNally and the Manchester Collaborative 
!!''Overview:''
''Building self-esteem and improving behaviour''
this is a face to face session lasting aprox. 50-60 minutes. The full session plan can be found here:

<<link-doc "Guidelines for Parent Support Manual" 
"https://drive.google.com/file/d/13kBzWKnq1kHeBF6zD-TRMhWTkEPX7aNy/view?usp=sharing">>

!!!''Outcome measures''
These will be completed on [[POD|https://pod-database.org/db3/login/]]

*Beginning of session:

**Parent SDQ

*End of session:

**SFQ/SRS

----
!!''Session plan''

!!!''Key tasks''
* Introduce praise to improve children’s self-esteem, confidence and behaviour 
* For parents to identify behaviours they want to praise
* Support parents to maximise the benefits of the praise they give  

!!!''Check In''

*How are you?
* Agenda setting 
* Explain how long you will meet for (50-60 minutes)
*''Review of home-practice'': consolidate learning from the previous week about special time with children. What they did /noticed. Problem solve any issues that arose.
!!!''Main content of the session''



*''Self-esteem and praise'' - Research demonstrates a child’s self-esteem and motivation is effected by the type of praise they receive. Praise which is generic and focused on the end product lowers motivation and self-perception. Ask parent “why do you think this is?”  (sets high expectations for the child). 
*''Making praise effective ''Praising the effort and motivation is more effective.


*''Identify Positive behaviours'' parents want to see more of. Emphasise the difficulties in describing wanted behaviours and attributes that human nature tends to focus on the negative behaviours. Use Handout 5. 

[[Example- Supermarket Bread]]

*''Positive vs negative behaviours''-  Ask “what do you think will happen to the behaviours and attributes that you give praise to?” 
 
[[Making praise effective]]

* ''Normalise'' – tricky to praise when children have been doing negative behaviours that day 
* ''Parents are important role models'' - model accepting praise when someone gives it to you
* ''Generate list of praise statements'' based on the difficulties they have described and behaviours they want to promote (use Handout 5)
* ''Experiential learning:'' use the list to generate a practice that will be helpful for the parent. 

*''Rewards'' (if deemed to be necessary/ helpful) rewards are an extra way of encouraging children’s behaviour. Younger children may not be necessary but children may need an additional incentive to motivate behaviour. 
* ''Proportionate rewards'' to the behaviour i.e. affordable, motivating, realistic. More effective motivators for low interest tasks
* ''Difference between a bribe and a reward''. Need to see the behaviour first. -,bribery is giving the child something to stop negative behaviour, rewarding is giving the child something for positie behaviour 

!!''Home-practice:''

*Identify behaviours and attributes they want to see more of encourage by using effective praise (use Handout 5)
*Identify the specific praise statements they will use with their child (use Handout 5)

---

!!Handouts
  
<<link-doc "Handout 5" 
"https://drive.google.com/file/d/1pthq5yC5RyjKKN4Ta1UbqV63dHnx_2NF/view?usp=sharing">>

!!''Overview:''
This session is face to face (approx. 45 mins).  In this session you’ll support the YP to: complete an exposure task on their step by step plan. 
For the full session 3 plan see below:

 <<link-doc "Session 3 Plan: Adolescent Anxiety" "https://drive.google.com/file/d/1saxbcbaa8R6vxTbNUWcE-w1rCeQQx6g6/view?usp=sharing">>
!!!''Outcome measures:''
These will generally be completed on [[POD|https://pod-database.org/staff/select-project.php]]
*At beginning of session:
**Sub-scale on the [[RCADS]]
**Goal rating scale 
----
!!''Session plan''
!!!''Key tasks''
*Plan and complete and exposure task in session with the YP. 
*Discuss any potential barriers to completing exposure and ways to overcome.
*Ensure YP drops any unhelpful habits (safety behaviours) during task.
*Validate/normalise any concerns but provide encouragement and confidence that they can do it. 
!!!''Check In''
*How are you?
*Complete outcome measure
*Agree the agenda: content of session and give opportunity for YP to add to agenda
*Review any questions they had about the last session or home task materials
*Review home tasks and what YP has learnt from completion. Set further practice if appropriate. 
*Problem-solve any barriers to completing home tasks
!!!''Main content of the session''
''Note:'' If YP completed an exposure task at home then this should be reviewed and learning from the task discussed. You will need to plan a further exposure task to then complete in the session or repeat the task. Utilise the step by step plan and YP current fear ratings to guide choice of task.
*''Complete an exposure task in session'' - track fear ratings during the task (page 42) use the fear thermometer to help with this. 
* ''During exposure''
**Be encouraging /supportive to increase YP confidence but validate concerns/anxiety.
**	Drop safety behaviours during task. 
**	Don’t talk too much but check in with YP about level of fear every couple of minutes.
**YP to remain in situation until their fear ratings drop by at least half of peak rating. Ensure there is enough time to complete task. 
**Work within the YP’s “window of tolerance” (should provoke anxiety but within a limit that feels manageable)
*''Review exposure task'' (how it went/ what they have learnt p.43). If you noted any anxious thoughts during the exposure look back at these and discuss.
*''YP to reward themselves'' for completing the step. 
*Plan another exposure task for their home task (p.46).  When setting up the exposure task discuss unhelpful habits (safety behaviours) that may need to be dropped and more helpful coping skills that can be used such as calm breathing and coping self-talk. Talk through any problems that may get in the way of completing the exposure and plan for these.
*''Review the tip sheet'' on p.39.
!!!''Things for YP to practice''
*The YP should complete the next exposure task on their step by step plan or repeat the current step until it becomes less anxiety provoking.
!!!''End of session review''
*Review the main content of the session and check YP’s understanding or any questions. 
*Ensure YP is clear about any home tasks/practice that need to be completed before the next session.
*Plan if anything needs to be shared with anyone on the back up team (e.g. parents/teachers who may need to support YP with home tasks or have been identified as doing things that are inadvertently maintaining the YP’s anxiety which needs to be discussed).
*Utilise SRS or similar to get feedback on the session
-----

!!''Handouts''
!!!''Core self help materials:''
The main resources are session 3 of the Getting to Grips with Anxiety manual: 
<<link-doc "Getting to grips with anxiety" "https://drive.google.com/file/d/1MhSkweHKlMx3gAHe8SyVqss4nSjzJhFd/view?usp=sharing">>
!!!''Additional handouts:''
<<link-doc "Graded exposure"  "https://drive.google.com/open?id=0B-tACu2wi4-4VEdGSWpxcHlOOHM">>
<<link-doc "Habituation" "https://drive.google.com/open?id=0B-tACu2wi4-4alB5aHBfOVJoaVE">>
!!!''Other resources:''
You may want to utilise other self help materials in your work with YP. For self-help materials such as videos, websites, apps and booklets please go to: [[Self Help Materials for Adolescent Anxiety]]. Additionally please go to the [['get self help'|https://www.getselfhelp.co.uk/]] website for useful handouts and session materials.

!!Overview:
This session is face to face (up to 1 hour).  The full session plan can be seen in the paper manual which can be found here:

 <<link-doc "Guided Self-Help for Low Mood: Full Manual" "https://drive.google.com/file/d/12bn3n53aWhm5_21Za460fp_qOtPsWY_N/view?usp=sharing">>  

!!!Outcome measures:
These will be completed on [[POD|https://pod-database.org/db3/login/]]

*At beginning of session:
**Primary Outcome Measure = RCADS (Subscale)
**Goal rating scale 
*At end of session:
**Session Feedback Questionnaire (SFQ) 
----
!!Session plan:

!!!Key tasks:

*RCADs symptom tracker & rate goals
*Review ROMs (RCADS DEP, GBO) 
*BA Continued

!!!Check in
* How are you?
* Agree the agenda: outline content of session, provide opportunity for them to add to agenda (This can be discussed in space at the end of the session, or integrated during a relevant part of the session)
* Discuss practicalities: Session dates/time

!!!Main content of the session 
*''Brief recap of behavioural activation'' introduced in the last session. Remind YP BA doesn’t happen overnight, but when it begins to work it can make a huge difference. 
*''Review the Activity Diary:'' Ask the YP to talk you through their Activity Diary. Why did they like something/see it as important? Reflections?
* ''Trouble shoot/problem solve'' if they didn’t complete activity diary. Consider following [[Tips for Completing Activity Log]]
*''Further BA'' (Behavioural Activation 2 handout) discuss:
**Importance of Values and linking activities to values- selecting activities/values that are important to you may increase success.
**Explore common areas of life people value (as per sheet).
**List of sample values: discuss which are important to them. Add to sheet.
**Support the young person in entering values into the blank areas of life sheet.

*''Translating Values into Activities'' (handout) Write in as many as possible, BUT will not be working on all of these in one go! Working gradually making step by step changes.
*''Plan one or two activities'' – depending on what feels best for the young person. Use the top tips (as per handout) to identify activities
''NOTE: ''

*May be necessary to break activities into small steps (it’s better to aim for smaller/achievable ones than overwhelming ones). 
*Early steps may involve things that the YP is already doing – but may want to do more of (to increase the likelihood of success).
*May be past activities they no longer do due to feeling low. These might be easier to get going with!

!!! Home practice
•	Continue completing Activity Diary

•	Complete the agreed one or two valued activities

•	If possible, share the session work with parents

!!!End of session review

*Review of session, comments and questions. 
*Key learning points?

-----

!!Handouts 
!!!Core self help materials:

<<link-doc "Behavioural Activation 2 (CYP)" "https://docs.google.com/document/d/1uQ6Ik8hd3PADOcBQWSvmOfhyh_Zs3Gw97O_TxJqZk1A/edit?usp=sharing">>   

!!''Overview: ''
Session 4, 5 and 6 are telephone sessions (approx. 20 minutes).
The full session plans can be seen in the [[paper manual|http://centaur.reading.ac.uk/65537/]]
!!!''Outcome measures:''
These will be completed on [[POD|https://pod-database.org/db3/login/]]
*At beginning of session:
**Parent SDQ IMPACT Sub-scale (short version)
**Goal rating scale
*At end of session:
**SFQ
----
!!''Session plan:''
!!!''Key tasks:''
*Review all homework tasks, be encouraging and highlight small successes. 
!!!''Check In''
*How are you
*Agree the agenda: Purpose of this session is to review how things are going. Remind parent that it will be 20 minutes.
*Check with the parent that they are in a position to discuss the material uninterrupted and are happy to proceed with the telephone call.
*Complete measures and review goals: Reflect on any changes
!!!''Main content of the session''
''Review goals''
*Challenging anxious thoughts: Is your child using thought challenging/ any difficulties?
''Experiments''
*Any further experiments to challenge anxious thoughts? 
*Was your child able to understand what the result of the experiment meant?
''Parent response to child’s anxious behaviour''
*Did they recognise anything they need to change e.g. needing to give less attention to anxious behaviours?
''Step by step plan and praise/reward'' 
*Check parent discussed plan with child
*Explore how plan is going and any difficulties
* Is child ready for next step?
!!!''Parent 'homework' tasks''
*Continue to record their child’s anxious thoughts and their attempts at challenging these on the ‘helping my child with unhelpful thoughts’ handout.
*Be on the lookout for opportunities for the child to conduct ‘experiments’ and encourage the child to test out fears and reflect on what happens. 
*Continue to record their responses to their child on handout. 
*Encourage the child to take the next step and to work through the step-by-step-plan. 
!!!''Review of the session''
*If any difficulties identified in session, use problem solving and set homework to try again
----
!!'' Handouts ''
!!!''Core self help materials:'' 
<<link-doc "Helping my child with unhelpful thoughts" " https://drive.google.com/open?id=0B-tACu2wi4-4TnZXaml6X2RsUkk">>
<<link-doc "Responding to My Child’s Anxious Behaviour" "https://drive.google.com/open?id=0B-tACu2wi4-4WkpPZ3pMNmxvRW8">>

!!''Overview:''
These sessions are briefer (20-30m) can be completed over the phone. The focus of these sessions is to support the YP to continue to work through their step-by-step plan of exposure tasks and review progress each session. 

It is good practice (if you have consent and you haven’t already done so) to check in with parents/carers/teachers about the YP progress at around session 4. This is an opportunity to discuss any concerns and ensure they understand the rationale for exposure and how best to support the YP.

For the full session 4-6 plan see below:

 <<link-doc "Session 4-6 Plan: Adolescent Anxiety" "https://drive.google.com/file/d/1PCzD8qC7hXlpr5FhcUU72UIy1OG8MS3z/view?usp=sharing">>
!!!''Outcome measures:''
These will generally be completed on [[POD|https://pod-database.org/staff/select-project.php]]
*At beginning of session:
**Sub-scale on the [[RCADS]]
**Goal rating scale 
----
!!''Session plan''
!!!''Key tasks''
*In each session you will need to review exposure tasks that have been completed at home and problem solve any difficulties.  
*Plan the next exposure task.
*Discuss any potential barriers to completing exposure and ways to overcome.
*Ensure YP drops any safety behaviours during the exposure task.
*Validate/ normalise any concerns but provide encouragement and confidence that they can do it. 
!!!''Check In''
*Briefly check how YP has been and agree agenda/plan for session
*Review any questions they had about the last session or home task materials
*Review home tasks and what YP has learnt from completion. 
*Problem-solve any barriers to completing home tasks
*Complete outcome measure
!!!''Main content of the session''
*''Review the exposure task/s'' YP completed at home utilising Facing your Fears review sheet (p.55). Discuss learning and/or problem solve. Refer back to any anxious thoughts/predictions YP and link new learning to these.
*''Ensure YP is rewarding themselves'' for completing the steps.
*''Ensure YP is repeating exposures'' until anxiety levels are reduced during anxiety provoking situation. 
*''Plan another exposure task'' for their home task utilising the facing your fear plan sheets - discuss safety behaviours that may need to be dropped. Talk through any problems/ barriers to completing the exposure and plan for these.
*''Review the tip sheet'' with the YP on p.39.
*''Ensure YP utilises exposure rating sheet'' (p.57) to keep track of the exposure tasks they complete and fear ratings during the tasks. 
!!!''Things for YP to practice''
*The YP should complete the next exposure task on their step by step plan or repeat the current step until it becomes less anxiety provoking.
!!!''End of session review''
*Review the main content of the session and check YP’s understanding or any questions. 
*Ensure YP is clear about any home tasks/practice that need to be completed before the next session.
*Plan if anything needs to be shared with anyone on the back up team (e.g. parents/teachers who may need to support YP with home tasks or have been identified as doing things that are inadvertently maintaining the YP’s anxiety which needs to be discussed).
*Utilise SRS or similar to get feedback on the session
-----

!!''Handouts''
!!!''Core self help materials:''
The main resources are sessions 4-6 of the Getting to Grips with Anxiety manual:

<<link-doc "Getting to grips with anxiety" "https://drive.google.com/file/d/1MhSkweHKlMx3gAHe8SyVqss4nSjzJhFd/view?usp=sharing">>
!!!''Additional Handouts:''
<<link-doc "Thinking traps" "https://docs.google.com/document/d/1uKIB6vs687FCuoYUwK52yQIdqQHm1pky0wTkLl1tFpw/edit?usp=sharing">>
<<link-doc "Coping thoughts" "https://drive.google.com/open?id=0B-tACu2wi4-4dVNuelpUUVh6UWc">>
<<link-doc "Overcoming Avoidance" "https://drive.google.com/file/d/0B-tACu2wi4-4X3dSNzV3YzlXTTA/view?usp=sharing">>
!!!''Other resources:''
You may want to utilise other self help materials in your work with YP. For self-help materials such as videos, websites, apps and booklets please go to: [[Self Help Materials for Adolescent Anxiety]]. Additionally please go to the [['get self help'|https://www.getselfhelp.co.uk/]] website for useful handouts and session materials.

!!!!Source: Caroline Bengo, Matt Woolgar, Sara Dawson and Jelena Crnokrak 

This page provides a brief session plan to be used as a reminder for practitioners. 

---

!!''Overview:''

''Effective Instructions'': This session is face to face (approx. 50-60 mins) ''OR ''telephone if ''NOT'' doing time out (approx. 20-40 mins).  The full session plan can be found here:

<<link-doc "Session 4: Effective Instructions" "https://drive.google.com/file/d/14fAQNeU5NS_NesEy072mpvRDLe_9EY2P/view?usp=sharing">>

The full manual can be found here:

<<link-doc "Guided self-help for behaviour problems" "https://drive.google.com/file/d/1vBNYY-hZtqIKHZucyZmbxZmfjTvYYoRZ/view?usp=sharing">>


!!!''Outcome measures''
These will be completed on [[POD|https://pod-database.org/db3/login/]]

* At beginning of session:
**[[SDQ]] (IMPACT only)
**[[GBO|Goal-Based Outcomes (GBO)]] (+HIT)
*End of session:
**SFQ/SRS

----
!!''Session plan''

!!!''Key tasks''

*Highlight instructions as a potential trigger for misbehaviour
*Support parents to learn how to give instructions effectively

!!!''Check In''

*How are you?
* Agenda setting 
* Explain how long you will meet for

!!!Review 
*Home Practice: How did Selective Ignoring go? What behaviour(s) used on? How did child respond? Able to return attention when misbehaviour ended?
*Still using attending/special time every day and continuing to praise prosocial behaviours frequently?
*Troubleshoot difficulties with any of the strategies introduced so far
*Goals

!!!''Main content of the session''

*''Instructions as Triggers'' Introduce concept using example of ABC chart. (Instruction often the ‘A’). Consider examples the parent has discussed with you to illustrate this.
*''Ineffective Instructions ''Discuss common mistakes made when giving children instructions as below, giving examples, normalising but highlighting problematic nature. 
**''Chain instructions:'' combining list of instructions- confusing (particularly for young children/ those with ADHD)- only retain first/last and overwhelming= no response.
**''Question Instructions:'' Instructions phrased as questions- confusing as suggests choice (it’s not).
**''Vague instructions'' (‘stop it’): May not understand what is being asked of them
**''“Let’s…” instructions'' (‘let’s go to bed’): confusing as not completing task together (child may wait for you before complying).
**''Instructions plus rationale'' (‘I need you to do…because…’): instruction gets lost in rationale, and child can get distracted/focussed on reasoning, instead of acting.
**''Repeated instructions:'' repetition unlikely to increase compliance and parent may get annoyed/angrier the more they repeat. (Also communicates parent’s instructions do not matter).
**''Unnecessary instructions'' (interrupting a favourite show for non-urgent tasks): Try not to give these, particularly if potentially triggering.
**''Poor body language'' (instructing while looking away/without ensuring attention): Issue of clarity- child unaware parent is speaking to them/too absorbed in activity. Also makes it seem instruction is not important.
*''Effective Instructions'' Discuss/demonstrate (Use example in full manual)
**''Decide ahead of time:'' is it necessary, realistic, fair? (don’t set the child up to fail) and be prepared to see it through (consequences for non-compliance covered next session).
**''Prevention better than cure:'' can we re-structure the day so compliance is more achievable (e.g. homework before screen time not after)
**''Ensure child’s attention:'' Parent stop their task, go to child, get down to their level, invite eye contact/ place a hand on their arm (as appropriate). 
**''Be simple, clear, and brief:'' keeping it straightforward (helps processing). Rehearse in head first to ensure its clear?
**''Be polite:'' modelling prosocial behaviour, add ‘please’/ use calm, pleasant tone of voice.
**''Ask child to do rather than not do something:'' more helpful (‘play quietly’ vs ‘stop shouting’).
**''Give child space to comply:'' allow processing time- wait 5 seconds after giving instruction (no discussion/argument/repeating during this time) – if still not started to comply, repeat once more. If begins to comply during either of these 5 seconds, praise immediately. If not followed, have consequence ready (introduced the next session). 
**''Break down longer tasks:'' into smaller tasks (where possible) and praise/encourage after each task is complete (e.g. lunch box in bag (praise), shoes on (praise) etc. rather a general ‘get ready’ instruction). Start praising as soon as they begin to comply (helps keep them focussed on task).
*Practice by using examples of triggering instructions (to their child), consider how to make instructions more effective (demonstrate with parent acting as child then switch). 
''Note for practitioners:'' Reassure ‘consequences’ will be covered next week, but ok to start practicing giving effective instructions now. If child does not respond to second instruction, leave it there, or use existing consequences (if safe and appropriate).


!!!Home-practice

*Parents to try giving effective instructions as practiced in session and note results
*Continue attending/special time and specific praise.

----

!!Handouts 
*Effective Instructions (Clear, Calm Commands)

<<link-doc "Session 4 Handouts" "https://drive.google.com/file/d/1EXZKPR3DDzWrDvYDV3pfd8vaMjJcCzU_/view?usp=sharing">>

!!!!!Source: Deb ~McNally and the Manchester Collaborative 
!!''Overview:''
''The importance of routine and boundaries''
this is a face to face session lasting aprox. 50-60 minutes. The full session plan can be found here:

<<link-doc "Guidelines for Parent Support Manual" 
"https://drive.google.com/file/d/13kBzWKnq1kHeBF6zD-TRMhWTkEPX7aNy/view?usp=sharing">>

!!!''Outcome measures''
These will be completed on [[POD|https://pod-database.org/db3/login/]]

*Beginning of session:

**Parent SDQ

*End of session:

**SFQ/SRS

----
!!''Session plan''

!!!''Key tasks''

* To help parents recognise that rules and routines make children feel safe
* To develop routines to promote compliance and build cooperation in your child 
* To help parents to communicate better with their children using clear and consistent instructions
!!!''Check In''

*How are you?
* Agenda setting 
* Explain how long you will meet for (50-60 minutes)
*''Review of home-practice'': any successful examples of using praise with their child. Problem solve any difficulties.
!!!''Main content of the session''

*''Routines and rules are important'': the benefits of routines and rules for children. Consider the cognitive, emotional and practical benefits for parent and child. 
*''Share knowledge about routines:'' 
**Help create a sense of safety and security for children
**Children tend to be calmer, more relaxed and easier to manage if there is a consistent routine
**Know what is happening next and what’s expected of them 
**Children thrive off predictability and consistency 
**Help children know what is expected of them
* ''Brainstorm current routines'' with their child e.g. [[Routines Around the Home|Routines Around the Home.png]]
*''The benefits'' of household rules to communicate acceptable behaviours (Wash hands before dinner) and not acceptable (Hitting).
*''Agree important rules for the family'' – involve the children if they are old enough.
*''Using commands to build cooperation''

*''Why are boundaries important?''
** Sends a clear message about what behaviour is expected.
**“predictable structure guides behaviour and an emotional climate that supports early development”
**Supports learning of limits 
**Improves socially and academically important behaviours 
**Compliance is “keystone” in reducing incidents of other inappropriate behaviours 

[[Making commands effective]]

*''Discuss how to make commands effective'': eye contact, firm and calm voice versus shouting, explanations should be given before the command, using the same words when repeating a command.
* ''PRAISE!'' after a child has complied with a command.
*''Following through with the command'' Why is it important? If they haven’t complied, then it’s important not to give in. 
*''NB: don’t start battles you can’t win''. Save no for when you really mean it and when you can follow it through (following through in a supermarket more challenging than at home). 
* ''Top tip:'' If parent and child in a shop and child has asked for some sweets and parent has said “no” and child starts to have a tantrum, the parent could say “OK you can have some sweets because you …e.g., held my hand this afternoon when I asked you to”.  This may avert a battle as the parents have not been taught the skills to deal with tantrums at this point.
*''Experiential Learning:'' use the above examples to generate a practice that will be helpful for the parent. The statements above will have helped you to scaffold the parent to be successful in this practice

!!!Home-practice

*Support parent to think about what behaviours they want to use commands for (the role play should help with this)
*Support parent to identify the words they will use (use Handout 6)

----

!!Handouts 
<<link-doc "Handout 6" "https://drive.google.com/open?id=1nDRMZWReiUKn36W5xymjGO57fQHsj_PG">>

!!Overview:
This session is face to face (up to 1 hour).  The full session plan can be seen in the paper manual: 

 <<link-doc "Guided Self-Help for Low Mood: Full Manual" "https://drive.google.com/file/d/12bn3n53aWhm5_21Za460fp_qOtPsWY_N/view?usp=sharing">>  

!!!Outcome measures:
These will be completed on [[POD|https://pod-database.org/db3/login/]]

*At beginning of session:
**Primary Outcome Measure = RCADS (Subscale)
**Goal rating scale 
*At end of session:
**Session Feedback Questionnaire (SFQ) 
----
!!Session plan:
!!!Key tasks:
*RCADs symptom tracker & rate goals
*Review BA work: continuous/ active part work alongside other intervention components.
*The Role of Thoughts 
*Unhelpful Thinking Styles/Thinking Traps
*Thought diary

!!!Check in
* How are you?
* Agree the agenda: outline content of session, provide opportunity for them to add to agenda (This can be discussed in space at the end of the session, or integrated during a relevant part of the session)
* Discuss practicalities: Session dates/time

!!!Main content of the session 

*''Review Activity Diary'' with the young person. Did they complete the scheduled activity/activities identified in last weeks’ session- how did they find it/did it impact on mood?
*''Reflect on balance of activities'' in terms of achievement, closeness & enjoyment
*''Back-up team:'' were they able to share this with them?
*''Problem solve'' any difficulties in completing activities:

**Explore obstacles
**Were activities chosen realistic?
**Do we need to break down into smaller activities?
**Is there any guilt getting in the way? For example, if values conflict with parents values/preferences. - may need to be supported to talk to their parents.

*''Identify Activity for next week'' that fit with the young person’s values. Select some easy and some which may be more challenging.  
NOTE: YP continue to complete activity diary (to be reviewed at each future session).

*''Revisit the role of thoughts'' highlighted in their individual formulation in session one. How negative thoughts can feed into low mood.  
*''Use [[Dog Poo Analogy]] ''to further emphasise the link between thoughts, feelings and behaviour.
*''Negative Automatic Thoughts:'' Sometimes we are able to create some shifts in our mood by identifying particular negative thoughts making us feel low, and using techniques to think a bit differently! 
*''Negative Automatic Thought Fact Sheet'' handout; key points:   
**Thoughts are not a fact
**Thoughts may not be true and they might be unreasonable and unhelpful
**Negative thoughts drive distress
*''Unhelpful Thinking Styles:'' When people become depressed their thinking often changes -develop unhelpful thinking styles. (Thinking Traps handout).
*''Identify common thinking styles'' in handout 
*''Discuss breaking patterns of unhelpful thinking'' by explaining 'thought challenging'.

*''Challenging Negative Thinking''(handout)- introduce and go through sample questions
* ''Thought Diary'' (handout)- think together about a time recently when the YP felt low and support to put in diary. 
*''Challenge the thought'' may be helpful to rate strength of thought before and after thought challenging.(Try to generate a more balanced thought together)
NOTE: Some questions may work better for certain young people. Ensure you are challenging a thought and not a feeling		
*''Thought challenging is hard '' recognise this- It’s like having to create a new path out of dense jungle (Use [[Jungle Analogy]])

''Extra Technique: //Positive Self Talk//'' (used to enhance thought challenging) identify phrases helpful for them to say to themselves during difficult moments.

----

__NOTE BECAUSE:__  Thought challenging can be very difficult when working with low mood. For some young people thought challenging can be effective, although requires practice. It may be that further techniques below will be of use in strengthening thought challenging skills. In some cases it requires additional techniques such as mindfulness or thought acceptance work. These could be used as optional extras with appropriate supervisory support. 

---
!!!Home practice

*Practice challenging thoughts for homework, and record on the form given (give a few forms).
*Continue completing Activity Diary
*Complete the agreed one or two valued activities
*If possible, share the session work with parents
*Complete thought diary. Begin to practice challenging thoughts using the ‘Thinking Traps’ and the ‘Challenging Negative Thinking’ sheet.
*Handouts: Negative Automatic Thoughts Fact Sheet, Thinking Traps, Challenging Negative Thinking and Positive Self Talk sheet (optional).

!!!End of session review

*Review of session, comments and questions. Key learning points?

-----

!!Handouts 
!!!Core self help materials:

<<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">>
 

!!!!Source: Caroline Bengo, Matt Woolgar, Sara Dawson and Jelena Crnokrak 

This page provides a brief session plan to be used as a reminder for practitioners. 

---

!!''Overview:''

''Consequences'': This session is face to face (approx. 50-60 mins) ''OR ''telephone if ''NOT'' doing time out (approx. 20-40 mins).  The full session plan can be found here:

<<link-doc "Session 5: Consequences" "https://drive.google.com/file/d/1DrhHnuvxOcznoHjV0v1lnTSx3D251Tk-/view?usp=sharing">>

The full manual can be found here:

<<link-doc "Guided self-help for behaviour problems" "https://drive.google.com/file/d/1vBNYY-hZtqIKHZucyZmbxZmfjTvYYoRZ/view?usp=sharing">>

!!!''Outcome measures''
These will be completed on [[POD|https://pod-database.org/db3/login/]]

* At beginning of session:
**[[SDQ]] (IMPACT only)
**[[GBO|Goal-Based Outcomes (GBO)]] (+HIT)
*End of session:
**SFQ/SRS

----
!!''Session plan''

!!!''Key tasks''

* Help parents understand the importance of boundaries
*Support parents to use consequences in a framework of positive discipline
*Support parents to use natural and logical consequences for unacceptable behaviour

!!!''Check In''

*How are you?
* Agenda setting 
* Explain how long you will meet for

!!!Review 
*Home Practice: Ask how using clear, calm instructions went. How did their child respond? Able to remember to praise? Able to use ‘do’ instructions? Problem solve any difficulties
*Are they still using special time?
*Goals

!!!''Main content of the session''

*''Routines and boundaries:'' creates sense of safety/security and helps children to know to expect/is expected of them. Often children calmer, more relaxed and easier to manage. 
*''Children are not innately obedient''- often test out rules /limits (healthy), but need to learn how to accept limits and boundaries. (session 6 will cover family rules/boundaries).
*''Current consequences'' that parents do? Check if appropriate (non-harmful, non-punitive). Do not promote smacking as models violence is acceptable/ possibly scares them and reinforces parent trap.
*''Natural and Logical Consequences'' often intervene to protect children from consequences of actions, but also need to support independence. Explain difference between natural and logical consequences.- use [[Logical Consequences Guidelines]]
*''Setting limits'' important parents model clear calm disciplinary strategies-Thinking about natural and logical consequences beforehand can help with- as reduces likeliness of acting out of anger which can lead to arguments, no actual limit setting, setting unrealistic consequences).
''Note:'' Habits can develop of only using consequences (not as effective as positive reinforcement) -practitioners to assist parents with introducing rewards for positive behaviours. If relevant use attention table. If relevant discuss using reward charts to establish new routines for example morning and bedtime.

*''Practice:'' discuss particular behaviours (following the guidelines) to use consequences for and practice with you as child and them as parent. Remind: consequences to be non-punitive delivered in a straightforward/ calm manner. These strategies only work alongside use of positive attention (special time) and specific praise. 

''Note:'' If a telephone session problem solve potential difficulties.

!!!Home Practice:
•	Parents to practice using identified consequences for behaviour
•	Keep a record of how this goes
•	Continue special time and specific praise 

---

!!Handouts

•	Logical consequences guidelines 

<<link-doc "Session 5 Handouts" "https://drive.google.com/file/d/1IyIjH52gFjcEbgWilUKT1mvYeozAo6YE/view?usp=sharing">>

!!!!!Source: Deb ~McNally and the Manchester Collaborative 
!!''Overview:''
''Reducing problematic behavior through withdrawing attention''
this is a face to face session lasting aprox. 50-60 minutes. The full session plan can be found here:

<<link-doc "Guidelines for Parent Support Manual" 
"https://drive.google.com/file/d/13kBzWKnq1kHeBF6zD-TRMhWTkEPX7aNy/view?usp=sharing">>

!!!''Outcome measures''
These will be completed on [[POD|https://pod-database.org/db3/login/]]

*Beginning of session:

**Parent SDQ

*End of session:

**SFQ/SRS

----
!!''Session plan''

!!!''Key tasks''

* To introduce the general skills required to handle misbehaviour.
* To support parents to identify the behaviours they want to see less of 
* To support parents to identify when it is appropriate to withdraw attention to reduce inappropriate behaviour 

!!!''Check In''

*How are you?
* Agenda setting 
* Explain how long you will meet for (50-60 minutes)
*Review of home-practice: how they have got on with routines or using clear commands? Now moving onto another strategy, review special time and praise. Problem solve any difficulties.
!!!''Main content of the session''

*''Why withdraw attention'' from inappropriate behaviour? What have they noticed since our meetings about the behaviours you give attention to? (see them more). Removal of attention can be a powerful way to reduce the inappropriate behaviours
*''Trying to reason with your child'' when they are emotionally dysregulated will only make them worse. And you are giving attention to a tantrum.
*''Withdrawing attention'' is a non-violent approach to behaviour management- alternatives such as smacking can have detrimental effects.
*''Managing their emotions'' - something they learn with support of adults. Withdrawing attention gives children the opportunity to practice and learn to emotionally regulate and calm down, independently. 

*''Which behaviours'' Identify negative behaviours then think about which behaviours they can withdraw attention from i.e. any that are not harmful or dangerous 

*''How do we withdraw attention effectively? ''

*''Coping strategies for withdrawing attention''

* ''identify coping thoughts and distraction'' techniques: Use Handout 7
*''Behaviour can get worse before it gets better!'' Demonstrate with the [[Vending Machine Metaphor]]

*''Experiential learning ''– tailor the practice to make it most useful for the parent by identifying the behaviour they find most challenging. Decide on a coping strategy parent will try to use.
	
!!!Home-practice 
*Use withdrawal of attention for behaviours that are not harmful or dangerous
*Use Handout 7 to identify behaviours parents will withdraw attention from and to identify coping thoughts

---

!!Handouts

<<link-doc " Handout 7" "https://drive.google.com/open?id=1vrOuJ26TrUytCgPhQnYOXzVKDCn0dWmh">>

!!!!Source: Caroline Bengo, Matt Woolgar, Sara Dawson and Jelena Crnokrak 

This page provides a brief session plan to be used as a reminder for practitioners. 

---

!!''Overview:''

''Time Out and Family Rules'': This session is face to face (approx. 50-60 mins) ''OR ''telephone if ''NOT'' doing time out (approx. 20-40 mins).  The full session plan can be found here:

<<link-doc "Session 6: Time Out and Family Rules" "https://drive.google.com/file/d/16WZvoTA5du1KH8QOlWit8jdDy1gZSR1R/view?usp=sharing">>

The full manual can be found here:

<<link-doc "Guided self-help for behaviour problems" "https://drive.google.com/file/d/1vBNYY-hZtqIKHZucyZmbxZmfjTvYYoRZ/view?usp=sharing">>

!!!''Outcome measures''
These will be completed on [[POD|https://pod-database.org/db3/login/]]

* At beginning of session:
**[[SDQ]] (Full- if not doing a session 7)
**[[GBO|Goal-Based Outcomes (GBO)]] (+HIT)
*End of session:
**SFQ/SRS

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!!''Session plan''

!!!''Key tasks''
*Help parents understand the importance of boundaries
*Introduce parents to using family rules as a way of creating clear expectations and limit
*Support parents to use time out (if appropriate) 

!!!''Check In''

*How are you?
* Agenda setting 
* Explain how long you will meet for 

!!!Review
*Review of Home Practice: Ask how they found using consequences?
*Problem solve any difficulties
*Check that they are still using positive strategies to promote pro-social behaviour
*Review Goals


!!!''Main content of the session''
*''Family Rules:''families rules may be implicit but helpful to have four or five explicitly stated family rules- family meeting can be helpful so that rules can be worked out together. Rules need to be
**Simple
**Fair (apply to everyone in the family)
**Easy to follow
**Positively Stated
**Enforceable

*''What is Time Out?''– extreme form of removal of attention. Can be used as a consequence for and to help reduce dangerous/destructive behaviours. Some may be familiar with/ have tried; if so discuss how/ if it works for them. If confident this is used in an appropriate way acknowledge – make suggestions if appropriate (e.g. changing phrase ‘naughty step’). If do no use/ didn’t work for them introduce the concept in more detail.
*''Effective time out'' when used infrequently but consistently. When specified period has finished return to providing positive attention. Strategy often means parents feel in control and calm (reducing likelihood of harsh discipline). Time out can also help emotion regulation.
*''introducing time out strategy'' (for families not already using it) 
*''Before Time Out:'' parents to discuss and/or role play with child (or toy e.g. ‘show me teddy being calm’) when things are calm before using so parent and child are clear- ask the child to repeat back (check understanding). Time out to be in a neutral/boring/safe place - parent extremely nearby so see when child calms down/ ensure safety.
*''During Time Out:'' 
**Parent gives child clear warning (opportunity to make a choice) [extreme violence= go straight to time-out]
**If continues, give clear instruction to go to time-out space
**Parent remains close, but does not give attention to child 
**Parent does not end time-out until child is calm [time depends on child -keep it brief, 30 secs to 2 mins]
**Return child to time-out space if they leave 
**Needs to be delivered calmly
*Trouble Shooting: 
**Refusing to go to calm time
***Small kids: pick them up
***Older children (or situation feels unsafe), give option of bigger consequence – then withdraw attention until misbehaviour ceases
**Leaving calm time early
***Calmly return them (if safe)
***Give option of bigger consequence
*Time Out for persistent non-compliance: show/discuss diagram in manual
*After Time Out: Do not revisit reason/no forced apology (risk of re-triggering/ not learning to be sorry and express genuinely) and Involve child in positive activity -praise behaviour ASAP. But- If time-out was for non-compliance, child still needs to comply [or time-out can be used to avoid tasks]
**Repair the relationship –behaviour was not ok, but they are still loved
**Prevent further misbehaviour – avoid re-triggering
**Give them a clean slate –the day is not ruined 
**Model good emotional regulation (and forgiveness)
Note: parents may use- minute per year of age for children in time out. If already using and works this is ok. If time out is new this is too long (will not work)-30 seconds to 1 minute advised. Child can leave time out as soon as they are calm, (long time may re-escalate).

Note: saying ‘sorry’ no forced apology (risk of re-triggering/ not learning to be sorry and express genuinely


!!!Home-practice

*Ask parents to use time out if appropriate
*Ask them to keep a record of how this goes
*Ask parents to set up some family rules with their household
*Problem solve any potential difficulties


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!!Handouts: 
*Time out

<<link-doc "Session 6 Handouts" "https://drive.google.com/file/d/1koHUDzpr04-6tda4LP5d7PfTXBJ085we/view?usp=sharing">>

!!!!!Source: Deb ~McNally and the Manchester Collaborative 
!!''Overview:''
''Supporting emotional regulation through calm time and deadline with non-adherence to commands in children over 5 years'' this is a face to face session lasting aprox. 50-60 minutes. The ful