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Wellbeing and Emotional Support Team
[img width=150 [SiteIcon]]<br/>WEST
<div style="margin-bottom:2em;margin-top:2em;">
[img width=160 [$:/_AFC/grey-wordmark.svg]]
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<$reveal type="nomatch" state=<<folded-state>> text="hide" tag="div" retain="yes" animate="yes">
<div class="tc-xememex-tiddler-info tc-subtitle">
Bag: <$view tiddler="$:/state/federatial/xememex/tiddlers/bag" index=<<currentTiddler>>>(none)</$view>
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font-style: light;
font-weight: 200;
src: url('https://manuals.annafreud.org/fonts/$:/_fonts/Effra Light.woff') format("woff");
}
@font-face {
font-family: "Effra";
font-style: bold;
font-weight: 600;
src: url('https://manuals.annafreud.org/fonts/$:/_fonts/Effra Bold.woff') format("woff");
}
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font-family: "Verdana";
font-style: normal;
font-weight: 400;
src: url('https://manuals.annafreud.org/fonts/$:/_fonts/Verdana.woff') format("woff");
}
html {
font-family: "Verdana";
}
.tc-top-menu,
.tc-site-title,
.tc-site-subtitle,
h1, h2, h3, h4, h5, h6 {
font-family: "Effra";
font-weight: 600;
text-align: left;
}
.tc-site-title {
font-weight: bold;
}
body .tc-titlebar h2 {
font-weight: 700;
}
\define image(title,width,height)
<$image source=<<__title__>> width=<<__width__>> height=<<__height__>>/>
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\define embed-video(code)
<$reveal state="$:/state/consent-banner/accepted" type="match" text="yes" tag="div">
<iframe width="560" height="315" src="https://www.youtube.com/embed/$code$" frameborder="0" allow="autoplay; encrypted-media" allowfullscreen></iframe>
</$reveal>
<$reveal state="$:/state/consent-banner/accepted" type="nomatch" text="yes" tag="div">
<iframe width="560" height="315" src="https://www.youtube-nocookie.com/embed/$code$" frameborder="0" allow="autoplay; encrypted-media" allowfullscreen></iframe>
</$reveal>
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<<embed-video KtCUr83XgyE>>
afc-white: #ffffff
afc-black: #222222
afc-green: #147BD1
afc-pale-green: #6cbeaf
afc-blue: #155dac
afc-purple: #925195
afc-orange: #eb7837
afc-brown: #786e65
afc-light-grey: #e2e2e2
afc-very-light-grey: #f2f2f2
afc-mid: rgba(232, 232, 232, 0.84)
top-menu-background: <<colour afc-green>>
top-menu-foreground: <<colour afc-white>>
page-footer-background: <<colour afc-green>>
page-footer-foreground: <<colour afc-white>>
alert-background: <<color afc-white>>
alert-border: #147BD1
alert-highlight: #881122
alert-muted-foreground: #147BD1
background: #fff
blockquote-bar: <<colour muted-foreground>>
button-background:
button-foreground:
button-border:
code-background: #f7f7f9
code-border: #e1e1e8
code-foreground: #dd1144
dirty-indicator: #ff0000
download-background: #34c734
download-foreground: <<colour background>>
dragger-background: <<colour foreground>>
dragger-foreground: <<colour background>>
dropdown-background: <<colour background>>
dropdown-border: <<colour muted-foreground>>
dropdown-tab-background-selected: #fff
dropdown-tab-background: #ececec
dropzone-background: rgba(0,200,0,0.7)
external-link-background-hover: inherit
external-link-background-visited: inherit
external-link-background: inherit
external-link-foreground-hover: inherit
external-link-foreground-visited: #0000aa
external-link-foreground: #0000ee
foreground: <<color afc-black>>
message-background: #ecf2ff
message-border: #cfd6e6
message-foreground: #547599
modal-backdrop: <<colour foreground>>
modal-background: <<colour background>>
modal-border: #999999
modal-footer-background: #f5f5f5
modal-footer-border: #dddddd
modal-header-border: #eeeeee
muted-foreground: #bbb
notification-background: #ffffdd
notification-border: #999999
page-background: <<color afc-light-grey>>
pre-background: #f5f5f5
pre-border: #cccccc
primary: <<colour afc-purple>>
sidebar-button-foreground: <<colour foreground>>
sidebar-controls-foreground-hover: #000000
sidebar-controls-foreground: #aaaaaa
sidebar-foreground-shadow: rgba(255,255,255, 0.8)
sidebar-foreground: #acacac
sidebar-muted-foreground-hover: #444444
sidebar-muted-foreground: #c0c0c0
sidebar-tab-background-selected: #f4f4f4
sidebar-tab-background: #e0e0e0
sidebar-tab-border-selected: <<colour tab-border-selected>>
sidebar-tab-border: <<colour tab-border>>
sidebar-tab-divider: #e4e4e4
sidebar-tab-foreground-selected:
sidebar-tab-foreground: <<colour tab-foreground>>
sidebar-tiddler-link-foreground-hover: #444444
sidebar-tiddler-link-foreground: #999999
site-title-foreground: <<colour tiddler-title-foreground>>
static-alert-foreground: #aaaaaa
tab-background-selected: #ffffff
tab-background: #d8d8d8
tab-border-selected: #d8d8d8
tab-border: #cccccc
tab-divider: #d8d8d8
tab-foreground-selected: <<colour tab-foreground>>
tab-foreground: #666666
table-border: #dddddd
table-footer-background: #a8a8a8
table-header-background: #f0f0f0
tag-background: #147BD1
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
<$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);
}
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@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%);
}
""">>
}
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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;
}
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.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>
</$list>
\rules only filteredtranscludeinline transcludeinline macrodef macrocallinline macrocallblock
.tc-survey-banner {
background: #aaa0cd;
color: #000;
fill: #000;
padding: 1em;
text-shadow: none;
border-radius: 8px;
line-height: 1.2;
text-decoration: none;
display: block;
margin-right: 1em;
}
.tc-survey-banner:hover {
background: #fff;
}
.tc-survey-banner-heading {
font-size: 2em;
font-weight:bold;
margin-bottom: 0.5em;
}
.tc-survey-banner-heading svg {
width: 1em;
height: 1em;
vertical-align: text-bottom;
}
<hr/>
<$button class="tc-btn-invisible">
<$set name="tags" filter="[<currentTiddler>]">
<$action-sendmessage $message="tm-new-tiddler" tags=<<tags>>/>
Create new tiddler tagged '<$text text=<<currentTiddler>>/>'
</$set>
</$button>
\rules only filteredtranscludeinline transcludeinline macrodef macrocallinline
.tc-tag-navigation-buttons {
clear: both;
display: flex;
font-size: 1em;
border: 1px solid #c1e1ea;
}
.tc-tag-navigation-button-previous,
.tc-tag-navigation-button-next {
cursor: pointer;
border: none;
background: #c1e1ea;
border-radius: 4px;
padding: 5px; color: white;
}
.tc-tag-navigation-button-middle {
flex: 1; font-size: 100%;
}
.tc-tag-navigation-body {
padding: 0.5em;
border-left: 1px solid #c1e1ea;
border-right: 1px solid #c1e1ea;
}
.tc-tag-navigation-button-previous:hover {
background-color:#94d2e3;
}
.tc-tag-navigation-button-next:hover {
background-color:#94d2e3;
}
\define tag-navigation-buttons()
<div class="tc-tag-navigation-buttons">
<$list filter="[<__tag__>tagging[]allbefore<currentTiddler>limit[1]]" variable="ignore">
<$button class="tc-tag-navigation-button tc-tag-navigation-button-previous">
<$action-setfield $tiddler=<<state>> $value={{{ [<__tag__>tagging[]before<currentTiddler>] }}}/>
{{left}} previous
</$button>
</$list>
<$button class="tc-tag-navigation-button tc-tag-navigation-button-middle tc-btn-invisible">
<$action-navigate $to=<<__tag__>>/>
(<$text text={{{ [<__tag__>tagging[]allbefore<currentTiddler>count[]add[1]] }}}/> of <$text text={{{ [<__tag__>tagging[]count[]] }}}/>)
</$button>
<$list filter="[<__tag__>tagging[]allafter<currentTiddler>limit[1]]" variable="ignore">
<$button class="tc-tag-navigation-button tc-tag-navigation-button-next">
<$action-setfield $tiddler=<<state>> $value={{{ [<__tag__>tagging[]after<currentTiddler>] }}}/>
next {{right}}
</$button>
</$list>
</div>
\end
\define tag-navigation(tag)
<div class="tc-tag-navigation">
<$set name="state" value=<<qualify "$:/state/tag-navigation">>>
<$set name="state" value={{{ [<state>addsuffix[/]addsuffix<__tag__>] }}}>
<$tiddler tiddler={{{ [<state>get[text]] ~[<__tag__>tagging[]first[]] }}}>
<<tag-navigation-buttons>>
<div class="tc-tag-navigation-body">
<h1><$text text={{!!title}}/></h1>
<$transclude mode="block"/>
</div>
<<tag-navigation-buttons>>
</$tiddler>
</$set>
</$set>
</div>
\end
<textarea readonly="readonly" style="width:100%;height:10em;"><$text text={{!!text}}/></textarea>
<$button message="tm-login" class="tc-consent-button tc-btn-invisible">
Login
</$button>
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<title>afc-black-wordmark</title>
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<path d="M566.161,124.702 C566.851,125.331 567.757,125.855 568.88,126.274 C570.004,126.694 571.089,126.904 572.138,126.904 C573.097,126.904 573.891,126.784 574.52,126.544 C575.149,126.304 575.464,125.841 575.464,125.151 C575.464,124.882 575.397,124.635 575.261,124.41 C575.126,124.185 574.879,123.975 574.52,123.781 C574.16,123.586 573.658,123.384 573.015,123.174 C572.37,122.965 571.554,122.724 570.566,122.455 C569.757,122.246 568.955,121.969 568.161,121.624 C567.367,121.28 566.663,120.852 566.049,120.343 C565.435,119.834 564.941,119.22 564.567,118.501 C564.192,117.782 564.005,116.943 564.005,115.984 C564.005,114.996 564.23,114.104 564.679,113.31 C565.128,112.517 565.749,111.828 566.544,111.243 C567.337,110.659 568.28,110.21 569.375,109.895 C570.468,109.581 571.644,109.424 572.902,109.424 C574.699,109.424 576.273,109.626 577.62,110.03 C578.969,110.434 580.211,111.026 581.35,111.805 L578.609,116.074 C577.92,115.625 577.133,115.22 576.25,114.861 C575.366,114.502 574.369,114.321 573.262,114.321 C572.273,114.321 571.554,114.464 571.105,114.749 C570.655,115.034 570.431,115.416 570.431,115.894 C570.431,116.584 570.895,117.093 571.823,117.422 C572.752,117.752 574.01,118.127 575.599,118.546 C577.755,119.145 579.32,119.969 580.294,121.017 C581.268,122.066 581.755,123.459 581.755,125.196 C581.755,126.364 581.492,127.369 580.968,128.207 C580.443,129.046 579.739,129.742 578.857,130.297 C577.972,130.851 576.969,131.262 575.846,131.532 C574.722,131.802 573.576,131.936 572.408,131.936 C570.521,131.936 568.737,131.681 567.061,131.173 C565.382,130.664 564.02,129.885 562.971,128.836 L566.161,124.702" id="Fill-47" fill="#888"></path>
<path d="M44.938,42.563 C22.86,49.808 5.289,68.335 0.141,91.78 C-0.157,93.137 0.044,94.535 0.499,95.683 C0.635,95.627 15.185,90.516 15.185,90.516 C15.997,88.161 16.772,85.849 17.888,83.526 C20.285,78.536 23.48,73.938 27.302,69.934 C31.38,65.662 36.171,62.08 41.414,59.36 C41.657,56.234 42.112,53.103 42.8,49.987 C43.361,47.449 44.105,44.986 44.938,42.563" id="Fill-49" fill="#888"></path>
<path d="M101.577,69.849 C100.289,68.52 98.934,67.279 97.535,66.106 C96.72,68.466 95.773,70.798 94.607,73.066 C88.751,84.457 79.176,93.141 67.408,97.865 C66.228,98.339 65.032,98.787 63.809,99.179 C60.072,100.379 56.267,101.137 52.451,101.49 C42.566,102.405 32.609,100.513 23.566,95.866 C20.599,94.342 17.793,92.55 15.185,90.516 C14.566,90.735 1.061,95.471 0.499,95.683 C1.405,97.688 2.556,98.806 3.492,99.697 C4.543,100.697 5.906,101.632 7.351,102.676 C10.86,105.141 13.362,106.567 17.082,108.479 C26.798,113.474 37.342,115.974 47.961,115.918 C52.708,115.892 57.468,115.326 62.176,114.273 C64.175,113.826 66.168,113.317 68.143,112.683 C71.547,111.59 74.818,110.235 77.95,108.656 C90.482,102.337 100.679,92.272 107.219,79.551 C107.496,79.012 107.744,78.464 108.001,77.92 C107.967,77.867 107.938,77.81 107.903,77.757 C106.069,74.956 103.96,72.306 101.577,69.849" id="Fill-51" fill="#888"></path>
<mask id="mask-4" fill="white">
<use xlink:href="#path-3"></use>
</mask>
<g id="Clip-53"></g>
<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>
</g>
</g>
</svg>
<$vars
text-outer-line-1-nne="Managing"
text-outer-line-2-nne="risk"
text-outer-line-1-ene="Working in"
text-outer-line-2-ene="multiple domains"
text-outer-line-1-wnw="Individual keyworker"
text-outer-line-2-wnw="relationship"
text-outer-line-1-nnw="Scaffolding"
text-outer-line-2-nnw="existing relationships"
text-outer-line-1-ssw="Respect for local"
text-outer-line-2-ssw="practice and expertise"
text-outer-line-1-wsw="Keyworker well-"
text-outer-line-2-wsw="connected to the team"
text-outer-line-1-ese="Keyworker responsible"
text-outer-line-2-ese="for integration"
text-outer-line-1-sse="Respect"
text-outer-line-2-sse="for evidence"
text-inner-line-1-n="Working with"
text-inner-line-2-n="your CLIENT"
text-inner-line-small-1-n="(Active Planning, etc)"
text-inner-line-1-e="Working with"
text-inner-line-2-e="your"
text-inner-line-3-e="NETWORKS"
text-inner-line-small-1-e="(Addressing"
text-inner-line-small-2-e="disintegration, etc)"
text-inner-line-1-s="LEARNING"
text-inner-line-2-s="at work"
text-inner-line-small-1-s="(Wiki-manualization, etc)"
text-inner-line-1-w="Working"
text-inner-line-2-w="with"
text-inner-line-3-w="your TEAM"
text-inner-line-small-1-w="(Supervisory"
text-inner-line-small-2-w="structures, etc)"
text-middle="Mentalizing"
link-ring-outer-nne="Managing Risk"
link-ring-outer-ene="Working in multiple domains"
link-ring-outer-wnw="KeyWorker"
link-ring-outer-nnw="Scaffolding existing relationships"
link-ring-outer-ssw="Respect local practice and expertise"
link-ring-outer-wsw="Keyworker well-connected to wider team"
link-ring-outer-ese="Addressing Dis-integration"
link-ring-outer-sse="Respect for Evidence"
link-ring-inner-n="Working with your CLIENT"
link-ring-inner-e="Working with your NETWORKS"
link-ring-inner-s="LEARNING at work"
link-ring-inner-w="Working with your TEAM"
link-middle="Mentalization"
>
<$transclude tiddler="$:/_AMBITWheel/Template" mode="inline"/>
</$vars>
\define ambit-wheel(size,language:"English")
<$vars
wheel-size="$size$"
>
<$transclude tiddler="$:/_AMBITWheel/$language$" mode="inline"/>
</$vars>
\end
\define ambit-wheel-iconic(ring,language:"English")
<$vars
svg-classes="no-text faded unfade-$ring$"
wheel-size="50px"
>
<$transclude tiddler="$:/_AMBITWheel/$language$" mode="inline"/>
</$vars>
\end
\define colour-outer-ring-background() #6D6D6D
\define colour-outer-ring-background-faded() #E8E8E8
\define colour-inner-ring-background() #302F30
\define colour-inner-ring-background-faded() #D8D8D8
\define colour-north-text() #F29898
\define colour-east-text() #7BD332
\define colour-south-text() #BCD8F4
\define colour-west-text() #D4D600
\define colour-middle-background() #FFFFFF
\define colour-middle-text() #4D4D4D
\rules only filteredtranscludeinline transcludeinline macrodef macrocallinline macrocallblock
/* Variants */
.ambit-wheel.faded .path-ring-outer {
fill: <<colour-outer-ring-background-faded>>;
}
.ambit-wheel.faded .path-ring-inner {
fill: <<colour-inner-ring-background-faded>>;
}
/* Remove default link styling */
.ambit-wheel a.tc-tiddlylink-missing {
font-style: normal;
}
.ambit-wheel a.tc-tiddlylink:hover {
text-decoration: none;
}
/* Ring colours */
.ambit-wheel .path-ring-outer {
fill: <<colour-outer-ring-background>>;
}
.ambit-wheel .ring-outer-nne:hover .path-ring-outer,
.ambit-wheel .ring-outer-nnw:hover .path-ring-outer,
.ambit-wheel.unfade-outer-nne .path-ring-outer-nne,
.ambit-wheel.unfade-outer-nnw .path-ring-outer-nnw {
fill: <<colour-north-text>>;
}
.ambit-wheel .ring-outer-ene:hover .path-ring-outer,
.ambit-wheel .ring-outer-ese:hover .path-ring-outer,
.ambit-wheel.unfade-outer-ene .path-ring-outer-ene,
.ambit-wheel.unfade-outer-ese .path-ring-outer-ese {
fill: <<colour-east-text>>;
}
.ambit-wheel .ring-outer-sse:hover .path-ring-outer,
.ambit-wheel .ring-outer-ssw:hover .path-ring-outer,
.ambit-wheel.unfade-outer-ssw .path-ring-outer-ssw,
.ambit-wheel.unfade-outer-sse .path-ring-outer-sse {
fill: <<colour-south-text>>;
}
.ambit-wheel .ring-outer-wsw:hover .path-ring-outer,
.ambit-wheel .ring-outer-wnw:hover .path-ring-outer,
.ambit-wheel.unfade-outer-wnw .path-ring-outer-wnw,
.ambit-wheel.unfade-outer-wsw .path-ring-outer-wsw {
fill: <<colour-west-text>>;
}
.ambit-wheel .ring-outer:hover .text-outer {
fill: <<colour-outer-ring-background>>;
}
.ambit-wheel .path-ring-inner {
fill: <<colour-inner-ring-background>>;
}
.ambit-wheel .ring-inner-n:hover .path-ring-inner,
.ambit-wheel.unfade-inner-n .path-ring-inner-n {
fill: <<colour-north-text>>;
}
.ambit-wheel .ring-inner-e:hover .path-ring-inner,
.ambit-wheel.unfade-inner-e .path-ring-inner-e {
fill: <<colour-east-text>>;
}
.ambit-wheel .ring-inner-s:hover .path-ring-inner,
.ambit-wheel.unfade-inner-s .path-ring-inner-s {
fill: <<colour-south-text>>;
}
.ambit-wheel .ring-inner-w:hover .path-ring-inner,
.ambit-wheel.unfade-inner-w .path-ring-inner-w {
fill: <<colour-west-text>>;
}
.ambit-wheel .ring-inner:hover .text-inner {
fill: <<colour-inner-ring-background>>;
}
.ambit-wheel .text-outer-nne,
.ambit-wheel .text-outer-nnw,
.ambit-wheel .text-inner-n {
fill: <<colour-north-text>>;
}
.ambit-wheel .text-outer-ene,
.ambit-wheel .text-outer-ese,
.ambit-wheel .text-inner-e {
fill: <<colour-east-text>>;
}
.ambit-wheel .text-outer-sse,
.ambit-wheel .text-outer-ssw,
.ambit-wheel .text-inner-s {
fill: <<colour-south-text>>;
}
.ambit-wheel .text-outer-wnw,
.ambit-wheel .text-outer-wsw,
.ambit-wheel .text-inner-w {
fill: <<colour-west-text>>;
}
/* Middle colours */
.ambit-wheel .middle .circle-middle {
fill: <<colour-middle-background>>;
}
.ambit-wheel .middle .text-middle {
fill: <<colour-middle-text>>;
}
.ambit-wheel .middle:hover .circle-middle {
fill: <<colour-middle-text>>;
}
.ambit-wheel .middle:hover .text-middle {
fill: <<colour-middle-background>>;
}
/* Text styles */
.ambit-wheel .text-outer,
.ambit-wheel .text-inner-large,
.ambit-wheel .text-inner-small,
.ambit-wheel .text-middle {
text-anchor: middle;
font-family: Helvetica-Bold, Helvetica;
font-size: 14px;
font-weight: bold;
}
.ambit-wheel .text-inner-small {
font-size: 10px;
}
.ambit-wheel .text-middle {
font-size: 17px;
}
/* Variants */
.ambit-wheel.no-text {
pointer-events: none;
}
.ambit-wheel.no-text text {
display: none;
}
\define image-link-body(image,caption,width,height,color,background-color,icon)
<div class="tc-thumbnail-wrapper" style="width:$width$px;height:$height$px;">
<div class="tc-thumbnail-image">[img[$image$]]</div><div class="tc-thumbnail-icon" style="fill:$color$;color:$color$;">
$icon$
</div><div class="tc-thumbnail-caption">
$caption$
</div>
</div>
\end
\define image-link(link,image,caption,width,height,color,background-color,icon)
<$link to="""$link$"""><$macrocall $name="image-link-body" icon=<<__icon__>> color=<<__color__>> background-color=<<__background-color__>> image=<<__image__>> caption=<<__caption__>> width=<<__width__>> height=<<__height__>>/></$link>
\end
\define image-link-ext(link,image,caption,width,height,color,background-color,icon)
<a href="""$link$""" target="_blank" rel="noopener noreferrer"><$macrocall $name="image-link-body" icon=<<__icon__>> color=<<__color__>> background-color=<<__background-color__>> image=<<__image__>> caption=<<__caption__>> width=<<__width__>> height=<<__height__>>/></a>
\end
\define link-doc(caption,url,type:"docs")
<a href="""$url$""" class="tc-ext-doc-link" style="" target="_blank" rel="noopener noreferrer" title="Open in Google Docs">
{{$:/core/images/chevron-right}}<$image source={{{ [tag[$:/_GoogleDocsIcon]caption<__type__>] }}}/> $caption$
</a>
\end
\define link-pdf(caption,url,colour:"#55c6a7")
<a href="""$url$""" class="tc-btn-big-green" style="background-color:$colour$;" target="_blank" rel="noopener noreferrer">
{{$:/core/images/file}} $caption$
</a>
\end
\define embed-video(code)
<iframe width="560" height="315" src="https://www.youtube.com/embed/$code$" frameborder="0" allow="autoplay; encrypted-media" allowfullscreen></iframe>
\end
<div class="tc-table-of-contents">
<<toc-selective-expandable 'HomeContents'>>
</div>
<div class="tc-table-of-contents">
<<toc-selective-expandable 'LocalPracticeContents'>>
</div>
<div class="tc-table-of-contents">
<<toc-selective-expandable 'UsingTheManualContents'>>
</div>
<div class="tc-table-of-contents">
<<toc-selective-expandable 'WellbeingTrainingContents'>>
</div>
! 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.
---
!! Analytics cookies
We’d like to set non-essential cookies, such as Google Analytics, to help us to improve our website by collecting and reporting information on how you use it. The cookies collect information in a way that does not directly identify anyone. For more information on how these cookies work, please see our <a href="https://www.annafreud.org/your-privacy/" class="tc-tiddlylink-external" target="_blank" rel="noopener noreferrer">Cookies page</a>. If you are 16 or under, please ask a parent or carer for consent before accepting.
---
<$list filter={{$:/core/Filters/Drafts!!filter}} >
<div class="tc-menu-list-item">
<$link><$view field="title"/></$link> <$list filter="[all[current]frombag{$:/plugins/federatial/xememex/config/recipe}]" variable="listItem"><span style="display:inline-block;background:#ff4;border:1px solid #cc0;color:black;padding:0 2px;border-radius:4px;font-size:0.8em;line-height:1.3;">local</span></$list>
</div>
</$list>
\define lingo-base() $:/language/ControlPanel/
\define config-title()
$:/config/PageControlButtons/Visibility/$(listItem)$
\end
<<lingo Basics/Version/Prompt>> <<version>>
<$set name="tv-config-toolbar-icons" value="yes">
<$set name="tv-config-toolbar-text" value="yes">
<$set name="tv-config-toolbar-class" value="">
<$list filter="[all[shadows+tiddlers]tag[$:/tags/PageControls]!has[draft.of]]" variable="listItem">
<div style="position:relative;" class={{{ [<listItem>encodeuricomponent[]addprefix[tc-btn-]] }}}>
<$checkbox tiddler=<<config-title>> field="text" checked="show" unchecked="hide" default="show"/> <$transclude tiddler=<<listItem>>/> <i class="tc-muted"><$transclude tiddler=<<listItem>> field="description"/></i>
</div>
</$list>
</$set>
</$set>
</$set>
<$transclude tiddler="$:/core" subtiddler="$:/core/ui/ViewTemplate/subtitle"/>
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
\whitespace trim
\define print-button()
<$button tooltip="print" aria-label="print" class=<<tv-config-toolbar-class>>>
<$action-sendmessage $message="tm-open-window" template="$:/plugins/federatial/print/window" windowTitle={{$:/config/plugins/federatial/print/window-title}}/>
<$list filter="[<tv-config-toolbar-icons>prefix[yes]]">
{{$:/core/images/print-button}}
</$list>
<$list filter="[<tv-config-toolbar-text>prefix[yes]]">
<span class="tc-btn-text">
<$text text="print"/>
</span>
</$list>
</$button>
\end
<$list filter="[<currentTiddler>tagging[]role[heading]limit[1]]" variable="ignore" emptyMessage=<<print-button>>>
<$text text=""/>
</$list>
\rules only filteredtranscludeinline transcludeinline macrodef macrocallinline
.tc-export-controls {
background: #dfddf9;
margin: -1em -1em 0 -1em;
padding: 1em;
border-bottom: 2px solid black;
}
.tc-export-controls textarea {
width: 100%;
}
.tc-export-header {
margin-top: 1em;
padding: 1em;
border: 1px solid black;
}
@media print {
.tc-unprintable {
display: none;
}
}
<$transclude tiddler="$:/plugins/federatial/print/template/inner" mode="block"/>
! <$view field="title"/>
{{!!text}}
\whitespace trim
<$set name="themeTitle" value={{$:/view}}>
<$set name="tempCurrentTiddler" value=<<currentTiddler>>>
<$set name="currentTiddler" value={{$:/language}}>
<$set name="languageTitle" value={{!!name}}>
<$set name="currentTiddler" value=<<tempCurrentTiddler>>>
<$importvariables filter="[[$:/core/ui/PageMacros]] [all[shadows+tiddlers]tag[$:/tags/Macro]!has[draft.of]]">
<div class="tc-unprintable tc-export-controls">
<$button message="tm-print" tooltip="Print this page">
Print
</$button>
</div>
<$transclude tiddler="$:/plugins/federatial/print/template" mode="block"/>
</$importvariables>
</$set>
</$set>
</$set>
</$set>
</$set>
!! This tiddler is present to disable the default login status pill that Xememex provides
{
"tiddlers": {
"$:/config/Comments/EnableFilter": {
"title": "$:/config/Comments/EnableFilter",
"text": "[all[current]!is[system]]\n"
},
"$:/plugins/tiddlywiki/comments/above-story": {
"title": "$:/plugins/tiddlywiki/comments/above-story",
"tags": "$:/tags/AboveStory",
"text": "<$reveal state=\"$:/config/Comments/EnableWikiComments\" type=\"match\" text=\"yes\" default=\"no\">\n<$tiddler tiddler=\"$:/SiteTitle\">\n<$transclude tiddler=\"$:/plugins/tiddlywiki/comments/comments-template\" mode=\"inline\"/>\n</$tiddler>\n</$reveal>\n"
},
"$:/plugins/tiddlywiki/comments/add-comment-button-actions": {
"title": "$:/plugins/tiddlywiki/comments/add-comment-button-actions",
"text": "<$set name=\"username\" value={{$:/status/UserName}} emptyValue=\"(anonymous)\">\n<$set name=\"target\" filter=\"[<currentTiddler>]\">\n<$action-createtiddler $basetitle={{{ [[Comment by ']addsuffix<username>addsuffix[' on ']addsuffix<currentTiddler>addsuffix[']] }}} role=\"comment\" list=<<target>> text=\"\" edit-mode=\"yes\"/>\n</$set>\n</$set>\n"
},
"$:/plugins/tiddlywiki/comments/add-comment-button": {
"title": "$:/plugins/tiddlywiki/comments/add-comment-button",
"text": "<$reveal state=\"$:/status/IsReadOnly\" type=\"match\" text=\"no\" default=\"no\" tag=\"div\" class=\"tc-comment-button\">\n<$button class=\"tc-btn-invisible\" actions={{$:/plugins/tiddlywiki/comments/add-comment-button-actions}}>\nadd comment {{$:/core/images/add-comment}}\n</$button>\n</$reveal>\n"
},
"$:/plugins/tiddlywiki/comments/comments-template": {
"title": "$:/plugins/tiddlywiki/comments/comments-template",
"text": "<div class=\"tc-comments\">\n<ol class=\"tc-comment-list\">\n<$list filter=\"[all[tiddlers+shadows]role[comment]contains<currentTiddler>sort[created]!has[draft.of]]\">\n<li>\n<div class=\"tc-comment-entry\">\n<div class=\"tc-comment-entry-heading\">\n<$link>{{!!creator}} at <$view field=\"modified\" format=\"date\" template=\"0hh:0mm:0ss DDD DDth MMM YYYY\"/></$link>\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/CommentToolbarButton]!has[draft.of]]\" variable=\"listItem\">\n<$transclude tiddler=<<listItem>> mode=\"inline\"/>\n</$list>\n</div>\n<div class=\"tc-comment-entry-body\">\n<$reveal type=\"match\" state=\"!!edit-mode\" text=\"yes\">\n<$edit-text tiddler=<<currentTiddler>> tag=\"textarea\" focus=\"true\"/>\n</$reveal>\n<$reveal type=\"nomatch\" state=\"!!edit-mode\" text=\"yes\">\n<$transclude tiddler=<<currentTiddler>> mode=\"block\"/>\n<$transclude tiddler=\"$:/plugins/tiddlywiki/comments/add-comment-button\" mode=\"inline\"/>\n</$reveal>\n</div>\n</div>\n<$transclude tiddler=\"$:/plugins/tiddlywiki/comments/comments-template\" mode=\"inline\"/>\n</li>\n</$list>\n</ol>\n</div>\n"
},
"$:/plugins/tiddlywiki/comments/config": {
"title": "$:/plugins/tiddlywiki/comments/config",
"text": "\\define select(description,filter)\n<$button>\n<$action-setfield $tiddler=\"$:/config/Comments/EnableFilter\" $value=<<__filter__>>/>\n$description$\n</$button>\n\\end\n\n! Wiki Comments\n\n<$checkbox tiddler=\"$:/config/Comments/EnableWikiComments\" field=\"text\" checked=\"yes\" unchecked=\"no\" default=\"no\"> <$link to=\"$:/config/Comments/EnableWikiComments\">Allow wiki-level comments as well as tiddler comments</$link> </$checkbox>\n\n! Tiddler Comments\n\nThis filter expression determines which tiddlers will have commenting enabled:\n\n<$edit-text tiddler=\"$:/config/Comments/EnableFilter\" tag=\"input\"/>\n\nOr you can choose a preselected filter:\n\n* <<select \"All tiddlers except system tiddlers\" \"[all[current]!is[system]]\">>\n* <<select \"Only tiddlers tagged 'commentable'\" \"[all[current]tag[commentable]]\">>\n* <<select \"Disable all commenting\" \"\">>\n"
},
"$:/plugins/tiddlywiki/comments/filter-all-comments": {
"title": "$:/plugins/tiddlywiki/comments/filter-all-comments",
"tags": "$:/tags/Filter",
"filter": "[role[comment]!sort[modified]]",
"description": "All comments",
"text": ""
},
"$:/plugins/tiddlywiki/comments/footer-view-template-segment": {
"title": "$:/plugins/tiddlywiki/comments/footer-view-template-segment",
"tags": "$:/tags/ViewTemplate",
"list-after": "$:/core/ui/ViewTemplate/body",
"text": "<$list filter={{$:/config/Comments/EnableFilter}} variable=\"ignore\">\n<div class=\"tc-comments-segment\">\n<$transclude tiddler=\"$:/plugins/tiddlywiki/comments/add-comment-button\" mode=\"inline\"/>\n<$transclude tiddler=\"$:/plugins/tiddlywiki/comments/comments-template\" mode=\"inline\"/>\n</div>\n</$list>"
},
"$:/plugins/tiddlywiki/comments/header-view-template-segment": {
"title": "$:/plugins/tiddlywiki/comments/header-view-template-segment",
"tags": "$:/tags/ViewTemplate",
"list-before": "$:/core/ui/ViewTemplate/body",
"text": "<$list filter=\"[all[current]role[comment]]\" variable=\"ignore\">\n<div class=\"tc-is-comment-header\">\nThis tiddler is a comment on:\n<ul>\n<$list filter=\"[list<currentTiddler>sort[title]]\">\n<li>\n<$link to=<<currentTiddler>>><$text text=<<currentTiddler>>/></$link>\n</li>\n</$list>\n</ul>\n</div>\n</$list>\n"
},
"$:/plugins/tiddlywiki/comments/readme": {
"title": "$:/plugins/tiddlywiki/comments/readme",
"text": "This plugin provides a simple means for adding threaded comments to tiddlers.\n\n* Click the \"add comment\" button to make a new comment, and then click the \"save\" button to save it\n* You can comment on a tiddler itself, or add a comment to an existing comment\n* The sidebar tab ''Comments'' lists a timeline of all comments\n* Comments are attributed to the username stored in the system tiddler [[$:/status/UserName]]\n* By default, comments are available on all non-system tiddlers. The ''config'' tab lets you customise which tiddlers can accept comments by specifying a filter extension\n* The buttons for adding and editing comments are only available if the system tiddler [[$:/status/IsReadOnly]] is not set to `yes`\n* Use the \"All comments\" option in the $:/AdvancedSearch ''Filter'' tab to see or export all comments\n\n!! Data Model\n\nThe data model employed by the comments plugin is very simple:\n\n* Comment tiddlers are identified by the `role` field being set to `comment`\n* The `list` field of comment tiddlers lists the tiddlers to which this comment applies\n** It is thus possible for a comment to be applied to multiple tiddlers at once\n** The links between comments can be preserved when renaming them by using the relink checkbox in the edit template\n* The `edit-mode` field of comment tiddlers is set to `yes` to display it in edit mode, or `no` to display it in view mode\n* The `saved-text` field is updated when switching to edit mode so that it can be restored if the user cancels\n\n"
},
"$:/plugins/tiddlywiki/comments/sidebar-segment": {
"title": "$:/plugins/tiddlywiki/comments/sidebar-segment",
"tags": "$:/tags/SideBarSegment",
"list-after": "$:/core/ui/SideBarSegments/site-subtitle",
"text": "<$reveal state=\"$:/config/Comments/EnableWikiComments\" type=\"match\" text=\"yes\" default=\"no\">\n<$tiddler tiddler=\"$:/SiteTitle\">\n<$transclude tiddler=\"$:/plugins/tiddlywiki/comments/add-comment-button\" mode=\"inline\"/>\n</$tiddler>\n</$reveal>\n"
},
"$:/plugins/tiddlywiki/comments/sidebar": {
"title": "$:/plugins/tiddlywiki/comments/sidebar",
"tags": "$:/tags/SideBar",
"caption": "Comments",
"text": "<div class=\"tc-timeline\">\n<$list filter=\"[all[tiddlers+shadows]role[comment]has[modified]!sort[modified]eachday[modified]]\">\n<div class=\"tc-menu-list-item\">\n<$view field=\"modified\" format=\"date\" template=\"DDth MMM YYYY\"/>\n<$list filter=\"[all[tiddlers+shadows]role[comment]sameday:modified{!!modified}!sort[modified]]\">\n<div class=\"tc-menu-list-subitem\">\n<$link>Comment by '<$view field=\"modifier\">(anonymous)</$view>'</$link> on\n<$list filter=\"[list<currentTiddler>sort[title]]\">\n<$link to=<<currentTiddler>>><$text text=<<currentTiddler>>/></$link>\n</$list>\n</div>\n</$list>\n</div>\n</$list>\n</div>\n"
},
"$:/plugins/tiddlywiki/comments/styles": {
"title": "$:/plugins/tiddlywiki/comments/styles",
"tags": "[[$:/tags/Stylesheet]]",
"text": "\\rules only filteredtranscludeinline transcludeinline macrodef macrocallinline\n\n.tc-is-comment-header {\n\tbackground: #c1e1e9;\n\tpadding: 0.25em;\n}\n\n.tc-comments-segment {\n\tborder-top: 2px solid #c1e1e9;\n}\n\n.tc-comment-button button {\n\twidth: 100%;\n\ttext-align: right;\n}\n\n.tc-sidebar-scrollable .tc-comment-button button {\n\twidth: auto;\n\ttext-align: right;\n}\n\n.tc-comment-button button svg {\n\tfill: #26cb56;\n\theight: 2em;\n\twidth: 2em;\n}\n\n.tc-comments {\n}\n\n.tc-comment-list {\n\tlist-style: none;\n padding-left: 0;\n}\n\n.tc-comment-list .tc-comments {\n\tpadding-left: 1em;\n}\n\n.tc-comment-entry {\n\tborder: 1px solid #c1e1ea;\n\tmargin: 0.5em 0 0 0;\n\tbackground: #dbf6ff;\n}\n\n.tc-comment-entry-heading {\n\tfont-size: 0.7em;\n\tfont-weight: bold;\n\ttext-transform: uppercase;\n\tbackground: #c1e1ea;\n\tcolor: #5B6D80;\n\tpadding: 0 0.5em;\n}\n\n.tc-comment-entry-body {\n\tfont-size: 0.8em;\n\tpadding: 0 0.5em;\n}\n\n.tc-comment-entry-body textarea {\n\tfont-size: 1.1em;\n\twidth: 100%\n}\n"
},
"$:/tags/CommentToolbarButton": {
"title": "$:/tags/CommentToolbarButton",
"list": "[[$:/plugins/tiddlywiki/comments/toolbar-button-cancel]] [[$:/plugins/tiddlywiki/comments/toolbar-button-delete]] [[$:/plugins/tiddlywiki/comments/toolbar-button-save]] [[$:/plugins/tiddlywiki/comments/toolbar-button-edit]]"
},
"$:/plugins/tiddlywiki/comments/toolbar-button-cancel": {
"title": "$:/plugins/tiddlywiki/comments/toolbar-button-cancel",
"tags": "$:/tags/CommentToolbarButton",
"text": "<$reveal state=\"$:/status/IsReadOnly\" type=\"match\" text=\"no\" default=\"no\" tag=\"span\">\n<$reveal type=\"match\" state=\"!!edit-mode\" text=\"yes\">\n<$button>\n<$action-setfield $tiddler=<<currentTiddler>> $field=\"edit-mode\" $value=\"no\"/>\n<$action-setfield $tiddler=<<currentTiddler>> $field=\"text\" $value={{!!saved-text}}/>\ncancel\n</$button>\n</$reveal>\n</$reveal>\n"
},
"$:/plugins/tiddlywiki/comments/toolbar-button-delete": {
"title": "$:/plugins/tiddlywiki/comments/toolbar-button-delete",
"tags": "$:/tags/CommentToolbarButton",
"text": "<$reveal state=\"$:/status/IsReadOnly\" type=\"match\" text=\"no\" default=\"no\" tag=\"span\">\n<$reveal type=\"match\" state=\"!!edit-mode\" text=\"yes\">\n<$button>\n<$action-deletetiddler $tiddler=<<currentTiddler>>/>\ndelete\n</$button>\n</$reveal>\n</$reveal>\n"
},
"$:/plugins/tiddlywiki/comments/toolbar-button-edit": {
"title": "$:/plugins/tiddlywiki/comments/toolbar-button-edit",
"tags": "$:/tags/CommentToolbarButton",
"text": "<$reveal state=\"$:/status/IsReadOnly\" type=\"match\" text=\"no\" default=\"no\" tag=\"span\">\n<$reveal type=\"nomatch\" state=\"!!edit-mode\" text=\"yes\">\n<$button>\n<$action-setfield $tiddler=<<currentTiddler>> $field=\"edit-mode\" $value=\"yes\"/>\n<$action-setfield $tiddler=<<currentTiddler>> $field=\"saved-text\" $value={{!!text}}/>\nedit\n</$button>\n</$reveal>\n</$reveal>\n"
},
"$:/plugins/tiddlywiki/comments/toolbar-button-save": {
"title": "$:/plugins/tiddlywiki/comments/toolbar-button-save",
"tags": "$:/tags/CommentToolbarButton",
"text": "<$reveal state=\"$:/status/IsReadOnly\" type=\"match\" text=\"no\" default=\"no\" tag=\"span\">\n<$reveal type=\"match\" state=\"!!edit-mode\" text=\"yes\">\n<$button>\n<$action-setfield $tiddler=<<currentTiddler>> $field=\"edit-mode\" $value=\"no\"/>\nsave\n</$button>\n</$reveal>\n</$reveal>\n"
}
}
}
<div class="tc-timeline">
<$list filter="[all[tiddlers+shadows]role[comment]has[modified]!sort[modified]eachday[modified]]">
<div class="tc-menu-list-item">
<$view field="modified" format="date" template="DDth MMM YYYY"/>
<$list filter="[all[tiddlers+shadows]role[comment]sameday:modified{!!modified}!sort[modified]]">
<div class="tc-menu-list-subitem">
<$link>Comment by '<$view field="modifier">(anonymous)</$view>'</$link> on
<$list filter="[list<currentTiddler>sort[title]]">
<$link to=<<currentTiddler>>><$text text=<<currentTiddler>>/></$link>
</$list>
</div>
</$list>
</div>
</$list>
</div>
{"tiddlers":{"$:/plugins/tiddlywiki/consent-banner/banner":{"title":"$:/plugins/tiddlywiki/consent-banner/banner","tags":"$:/tags/PageTemplate","text":"\\whitespace trim\n\n<$reveal state=\"$:/state/consent-banner/accepted\" type=\"match\" text=\"\" tag=\"div\">\n\n<div class=\"tc-consent-backdrop\">\n\n</div>\n\n<div class=\"tc-consent-banner tc-consent-banner-left\">\n\n<$transclude tiddler=\"$:/config/plugins/tiddlywiki/consent-banner/greeting-message\" mode=\"block\"/>\n\n<div class=\"tc-consent-buttons\">\n\n<$list filter=\"[all[shadows+tiddlers]tag[$:/tags/ConsentBanner/Button]]\">\n\n<$transclude tiddler=<<currentTiddler>> mode=\"inline\"/>\n\n</$list>\n\n</div>\n\n</div>\n\n</$reveal>\n"},"$:/plugins/tiddlywiki/consent-banner/blocked-embed-message-wrapper":{"title":"$:/plugins/tiddlywiki/consent-banner/blocked-embed-message-wrapper","text":"\\define styles()\nwidth:$(width)$;height:$(height)$;\n\\end\n\n<div class=\"tc-blocked-embedded-content\" style=<<styles>>>\n<div class=\"tc-blocked-embedded-content-inner\">\n<div class=\"tc-blocked-embedded-content-inner-inner\">\n<$transclude tiddler=\"$:/config/plugins/tiddlywiki/consent-banner/blocked-embed-message\" mode=\"inline\"/>\n</div>\n</div>\n</div>\n"},"$:/plugins/tiddlywiki/consent-banner/buttons/accept":{"title":"$:/plugins/tiddlywiki/consent-banner/buttons/accept","tags":"$:/tags/ConsentBanner/Button","text":"<$button message=\"tm-consent-accept\" class=\"tc-consent-button tc-consent-button-default tc-btn-invisible\" tooltip={{$:/config/plugins/tiddlywiki/consent-banner/buttons/accept/hint}}>\n{{$:/config/plugins/tiddlywiki/consent-banner/buttons/accept/caption}}\n</$button>\n"},"$:/plugins/tiddlywiki/consent-banner/buttons/decline":{"title":"$:/plugins/tiddlywiki/consent-banner/buttons/decline","tags":"$:/tags/ConsentBanner/Button","text":"<$button message=\"tm-consent-decline\" class=\"tc-consent-button tc-btn-invisible\" tooltip={{$:/config/plugins/tiddlywiki/consent-banner/buttons/decline/hint}}>\n{{$:/config/plugins/tiddlywiki/consent-banner/buttons/decline/caption}}\n</$button>\n"},"$:/config/DefaultColourMappings/consent-banner-backdrop-background":{"title":"$:/config/DefaultColourMappings/consent-banner-backdrop-background","text":"rgba(0,0,0,0.2)"},"$:/config/DefaultColourMappings/consent-banner-background":{"title":"$:/config/DefaultColourMappings/consent-banner-background","text":"#009677"},"$:/config/DefaultColourMappings/consent-banner-button-background":{"title":"$:/config/DefaultColourMappings/consent-banner-button-background","text":"transparent"},"$:/config/DefaultColourMappings/consent-banner-button-border":{"title":"$:/config/DefaultColourMappings/consent-banner-button-border","text":"#fff"},"$:/config/DefaultColourMappings/consent-banner-button-default-background":{"title":"$:/config/DefaultColourMappings/consent-banner-button-default-background","text":"#fff"},"$:/config/DefaultColourMappings/consent-banner-button-default-foreground":{"title":"$:/config/DefaultColourMappings/consent-banner-button-default-foreground","text":"#009677"},"$:/config/DefaultColourMappings/consent-banner-button-foreground":{"title":"$:/config/DefaultColourMappings/consent-banner-button-foreground","text":"#fff"},"$:/config/DefaultColourMappings/consent-banner-button-hover-background":{"title":"$:/config/DefaultColourMappings/consent-banner-button-hover-background","text":"#fff"},"$:/config/DefaultColourMappings/consent-banner-button-hover-border":{"title":"$:/config/DefaultColourMappings/consent-banner-button-hover-border","text":"#fff"},"$:/config/DefaultColourMappings/consent-banner-button-hover-foreground":{"title":"$:/config/DefaultColourMappings/consent-banner-button-hover-foreground","text":"#009577"},"$:/config/DefaultColourMappings/consent-banner-foreground":{"title":"$:/config/DefaultColourMappings/consent-banner-foreground","text":"#fff"},"$:/config/DefaultColourMappings/consent-banner-hr-background":{"title":"$:/config/DefaultColourMappings/consent-banner-hr-background","text":"rgba(255,255,255,.25)"},"$:/config/DefaultColourMappings/consent-banner-link-foreground":{"title":"$:/config/DefaultColourMappings/consent-banner-link-foreground","text":"#fff"},"$:/config/plugins/tiddlywiki/consent-banner/block-embedded-content":{"title":"$:/config/plugins/tiddlywiki/consent-banner/block-embedded-content","text":"yes"},"$:/config/plugins/tiddlywiki/consent-banner/blocked-embed-message":{"title":"$:/config/plugins/tiddlywiki/consent-banner/blocked-embed-message","text":"Blocked embedded content from<br/><a href=<<url>> class=\"tc-tiddlylink-external\" target=\"_blank\" rel=\"noopener noreferrer\"><$text text=<<url>>/></a>\n\n<hr/>\n\n{{$:/plugins/tiddlywiki/consent-banner/buttons/accept}} cookies to unblock"},"$:/config/plugins/tiddlywiki/consent-banner/blocked-raw-message":{"title":"$:/config/plugins/tiddlywiki/consent-banner/blocked-raw-message","text":"<div class=\"tc-blocked-embedded-content\" style=\"width:100%;\">\n\n<div class=\"tc-blocked-embedded-content-inner\">\n\n<div class=\"tc-blocked-embedded-content-inner-inner\">\n\nBlocked raw content\n\n<hr/>\n\n{{$:/plugins/tiddlywiki/consent-banner/buttons/accept}} cookies to unblock\n\n</div>\n\n</div>\n\n</div>\n"},"$:/config/plugins/tiddlywiki/consent-banner/buttons/accept/caption":{"title":"$:/config/plugins/tiddlywiki/consent-banner/buttons/accept/caption","text":"Accept"},"$:/config/plugins/tiddlywiki/consent-banner/buttons/accept/hint":{"title":"$:/config/plugins/tiddlywiki/consent-banner/buttons/accept/hint","text":"Accept cookies"},"$:/config/plugins/tiddlywiki/consent-banner/buttons/clear/caption":{"title":"$:/config/plugins/tiddlywiki/consent-banner/buttons/clear/caption","text":"Clear"},"$:/config/plugins/tiddlywiki/consent-banner/buttons/clear/hint":{"title":"$:/config/plugins/tiddlywiki/consent-banner/buttons/clear/hint","text":"Clear cookies"},"$:/config/plugins/tiddlywiki/consent-banner/buttons/decline/caption":{"title":"$:/config/plugins/tiddlywiki/consent-banner/buttons/decline/caption","text":"Decline"},"$:/config/plugins/tiddlywiki/consent-banner/buttons/decline/hint":{"title":"$:/config/plugins/tiddlywiki/consent-banner/buttons/decline/hint","text":"Decline cookies"},"$:/config/cookie-consent-required":{"title":"$:/config/cookie-consent-required","text":"yes"},"$:/config/plugins/tiddlywiki/consent-banner/greeting-message":{"title":"$:/config/plugins/tiddlywiki/consent-banner/greeting-message","text":"! Our use of cookies\n\nWe use necessary cookies to make our site work. We’d also like to set optional analytics to help us improve it. We won’t set optional cookies unless you enable them. Using this tool will set a cookie on your device to remember your preferences.\n\n---\n\n!! Necessary cookies\n\nNecessary cookies enable core functionality such as security, network management, and accessibility. You may disable these by changing your browser settings, but this may affect how the website functions.\n\n---\n\n!! Analytics cookies\n\nWe’d like to set non-essential cookies, such as Google Analytics, to help us to improve our website by collecting and reporting information on how you use it. The cookies collect information in a way that does not directly identify anyone.\n\n---\n"},"$:/plugins/tiddlywiki/consent-banner/tv-block-embedded-content":{"title":"$:/plugins/tiddlywiki/consent-banner/tv-block-embedded-content","tags":"$:/tags/Macro","text":"<$set name=\"tv-block-embedded-content\" value={{{ [{$:/config/cookie-consent-required}else[no]match[yes]then{$:/state/consent-banner/accepted}!match[yes]then[yes]] }}}/>\n"},"$:/plugins/tiddlywiki/consent-banner/config":{"title":"$:/plugins/tiddlywiki/consent-banner/config","text":"! [[Greeting Message|$:/config/plugins/tiddlywiki/consent-banner/greeting-message]]\n\n<div style=\"\">\n\n<div style=\"display:inline-block;vertical-align:top;width:45%;\">\n\n<$edit-text tiddler=\"$:/config/plugins/tiddlywiki/consent-banner/greeting-message\" tag=\"textarea\" class=\"tc-edit-texteditor\"/>\n\n</div>\n\n<div style=\"display:inline-block;vertical-align:top;width:45%;margin:0.5em;border:1px solid black;padding:0.5em;\" class=\"tc-consent-banner\">\n\n<$transclude tiddler=\"$:/config/plugins/tiddlywiki/consent-banner/greeting-message\" mode=\"block\"/>\n\n</div>\n\n</div>\n\n! Buttons\n\n|[[Accept caption|$:/config/plugins/tiddlywiki/consent-banner/buttons/accept/caption]] |<$edit-text tiddler=\"$:/config/plugins/tiddlywiki/consent-banner/buttons/accept/caption\" tag=\"input\"/> |\n|[[Accept hint|$:/config/plugins/tiddlywiki/consent-banner/buttons/accept/hint]] |<$edit-text tiddler=\"$:/config/plugins/tiddlywiki/consent-banner/buttons/accept/hint\" tag=\"input\"/> |\n|[[Decline caption|$:/config/plugins/tiddlywiki/consent-banner/buttons/decline/caption]] |<$edit-text tiddler=\"$:/config/plugins/tiddlywiki/consent-banner/buttons/decline/caption\" tag=\"input\"/> |\n|[[Decline hint|$:/config/plugins/tiddlywiki/consent-banner/buttons/decline/hint]] |<$edit-text tiddler=\"$:/config/plugins/tiddlywiki/consent-banner/buttons/decline/hint\" tag=\"input\"/> |\n\n! [[Consent Accepted Status|$:/state/consent-banner/accepted]]\n\nCurrent status: {{$:/state/consent-banner/accepted}} (blank indicates that consent has not yet been granted or declined)\n\n<$button message=\"tm-consent-accept\" tooltip={{$:/config/plugins/tiddlywiki/consent-banner/buttons/accept/hint}}>\n{{$:/config/plugins/tiddlywiki/consent-banner/buttons/accept/caption}}\n</$button>\n\n<$button message=\"tm-consent-decline\" tooltip={{$:/config/plugins/tiddlywiki/consent-banner/buttons/decline/hint}}>\n{{$:/config/plugins/tiddlywiki/consent-banner/buttons/decline/caption}}\n</$button>\n\n<$button message=\"tm-consent-clear\" tooltip={{$:/config/plugins/tiddlywiki/consent-banner/buttons/clear/hint}}>\n{{$:/config/plugins/tiddlywiki/consent-banner/buttons/clear/caption}}\n</$button>\n\n! Embedded Content Blocking\n\n//Requires page reload//\n\n<$checkbox tiddler=\"$:/config/plugins/tiddlywiki/consent-banner/block-embedded-content\" field=\"text\" checked=\"yes\" unchecked=\"no\" default=\"no\"> Block all embedded content such as <iframe>, <embed> and <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 {{$:/config/DefaultColourMappings/consent-banner-link-foreground}})\n\n! Embedded Content Blocking\n\nUnless disabled via the config tab, content embedded via <iframe>, <embed> or <object> is blocked until the user consents to accept cookies.\n\n!! Implementation Details\n\nEmbedded content is blocked if the variable `tv-block-embedded-content` is set to `yes`. It is set to the current consent status by a [[global macro|$:/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":"$:/plugins/tiddlywiki/consent-banner/readme","text":"The ''consent-banner'' plugin helps make websites that are compliant with \"cookie legislation\" such as the [[EU General Data Protection Regulation|https://gdpr.eu/cookies/]].\nIt presents a banner inviting the user to accept or reject cookies, keeping track of their consent in local storage so that the banner can be hidden on subsequent visits.\n\nBy default, content embedded with <iframe>, <embed> and <object> is blocked unless the user consents to accept cookies.\n\nConsent status is available via a configuration tiddler so that it is possible to construct content that behaves differently depending upon whether consent has been granted. As an example, a macro is provided for embedding ~YouTube videos that automatically uses the youtube-nocookie.com variant of video URLs unless the user has accepted cookies.\n\nPlease note that using this plugin does not guarantee compliance with any particular legislation. You will need to understand the technical issues specific to your situation, and if necessary seek legal advice.\n"},"$:/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"}}}
3316699902_c3d93e61ce.jpg
!! Using the AIM cards for Active Planning
<center>{{AIM cards pic1.jpg}}</center>
The AIM cards are an example of applying the [[Active Planning]] triangle in practice.They are used to ''sensitively attune'' to the clients' perspectives, to ''broadcast our intentions'' as the worker, and to begin developing a focus or structure for work together. The AIM cards can be used as a goals-based outcome measures to develop and measure specific goals based on what matters most to the client.
>//This is an example of a page that has been ''cloned and customised'' from the original work by the ''AMASS team in Islington'' - to whom we are immensely grateful.//
*This video produced by the AMASS team in Islington (@ambit-amass) shows an example of how the cards can be used in a session with a client:
<html><iframe width="420" height="315" src="//www.youtube.com/embed/wG9Of1PCHPI" frameborder="0" allowfullscreen></iframe></html>
The AMASS Team have developed a framework for using the AIM cards. Their suggested steps and learning points are set out below. Here we also highlight examples of the ''active planning triangle'' with the intention of showing how active planning may look in practice.
''Please note this framework can be adapted according to the client and service context''.
''When to use the AIM cards''
The AIM cards are usually used fairly early on in the contact with the client, as part of efforts to build a relationship. It is usually helpful that the client has met the worker at least once before using the cards. Exactly when they're used will vary according to the degree to which the worker thinks that the client would find it ok to share a bit about how things are with someone who they don't know/yet trust and the extent to which they are actively help-seeking.
It can be helpful to hold in mind that using the cards can help build [[Epistemic Trust]], if the worker takes care to reflect back what they are learning about the clients' perspective from completing the cards ''(senisitive attunement)''
Similarly, a client does not have to be actively or explicitly help-seeking in order for the cards to be used. In fact, it can be more helpful for the worker not to assume any help-seeking on the part of the client when using the cards, instead holding in mind that their first priority is to understand how life is currently from the clients' perspective ''(sensitive attunement'')
''1. Introducing the cards''-
the worker should explain to the client what the cards are and their purpose. This is an example ''[[Broadcasting Intentions]]''.
>//I've bought some cards along that I do with lots of young people when I'm trying to get to know them. These cards have got different topics on that relate to different areas of a young person’s life//
>// I'd like to try to understand a bit how life is for you at the moment, to see if there's anything I could be helpful with - how does that sound?//
>//If you're not sure, you can take a look at the cards and then decide if you'd like me to bring them again another time - that's totally fine too
''(sensitive attunement)''//
''2. Agree how to look through the cards'' - Would they prefer to read through the cards themselves? or if they would like them to be read out by the worker? Remind them they can always ask for help with reading and can ask you questions if there are any that they are not sure about.
''Agree on how to divide up the cards - as a first step, usually 3 piles:''
*Things that are difficult/a problem
*Things that are going well/are strengths, and
*It doesn't apply to me
''3. Client sorts through the cards''-
allow the client to take the lead.
The worker should try to notice how actively the client looks to involve the worker in the process, and attune to this. The worker should hold in mind that using the cards is about understanding the clients' ideas about their life ''(sensitive attunement)'' rather than the worker seeking to influence these.
Quite often, some extra piles can develop (i.e. sometimes a problem; not sure etc).
Pay attention to how much the client seems able to tolerate naming something as a difficulty – some people will describe thngs in a high impact way “Really hard for me”; others will only be able to acknowledge something being difficult, but with minimal impact (i.e. sometimes a problem). Either way, we consider anything that is labelled as a bit of a difficulty as something that constitutes a “problem” and we don't talk it up or down in terms of severity or frequency - go with the clients' current description ''(sensitive attunement'').
Similarly, notice how easy the client finds it to identify strengths and attune to their level of comfort with this.
Check in on how they found the process of sorting and if it would be ok for you to ask a bit more about some of the cards.
''4.Exploring the strengths pile''-
start with the strengths – explore each of these in detail. The purpose is to show interest and build a bit of an understanding about areas of life that are going well.
It can be helpful to offer some summaries back about what you feel you are learning about them, their skills, strengths and abilities as you look through this pile ''(sensitive attunment)''.
In time, it can be helpful to support the client to think about how their strengths might help with some of the areas they are finding more difficult. Time spent focusing on strengths may also help them to feel comfortable in the session and potentially more open to move onto exploring aspects of their life that might feel more difficult.
''5. Exploring the difficulties pile''-
lay out the difficulties cards on the table. Ask them if they would be ok with talking you through why they chose these cards as difficulties. If so, ask where they would like to start.
Again, attune to how much exploration the client can tolerate, so that they are not feeling pressured into talking about things that are too uncomfortable or difficult ''(sensitive attunement)''.
Comment on the process in a sensitive manner - i.e. let them know how well they are doing about thinking about something that’s difficult; notice if they are finding it hard; check if they are ok to continue.
Follow the clients' lead in terms of how much they wish to share about these cards at this stage. Using the cards can help us learn how able the client is to think about themselves and their situation and how much they feel willing/able/ready to accept some help with these matters ''(sensitive attunment).''
''6. Exploring how the cards fit together''- it can be helpful to explore whether the client feels that there are any links between the cards that they have chosen.
Ask them to arrange the cards around to reflect this – for example, difficulties at school or with family might go together with a series of other cards.
Let the client take the lead in this. Usually, this process results in the cards being sorted into a smaller number of groups, around particular themes (e.g. how things are at home or at school or with friends, for example). The worker can ask questions to gain an understanding of why the client feels that certain cards go together, supporting them in the process of trying to make some sense of how these areas of difficulty might fit together and be influencing each other.
''7. Explore whether there is anything that the client might want help with''-
it is important that workers do not assume that a client wants to have help (from them) just because they have identified something as an area of difficulty.
With this in mind, it can be helpful for the worker to:
Ask the client whether there are any of the difficulty cards that they would like to see looking a bit different. Are there any areas that they would make a change to if they could? If they identify some, check in about whether its something that they think you could be useful for by meeting together. Which cards would be their priority to focus on (usually 2-4 cards is realistic).
Here is a point where we may ''broadcast intentions''
>// I’d really like to be helpful if I can, so if there were any of the cards here that you feel you would like some help with, then I would be happy to try to help if I can//
Attune to the degree to which the client seems comfortable with the idea of being in need – it may be more appropriate to position them as the expert.
>// You’ve got a lot of strengths/things you’re good at; maybe we can figure out a way that those could help with the things that are feeling more tricky at the moment//
''8.Contract what help might look like and where to start''-
think with the client about how to turn these cards into goals, decide which they would like to start with and think about how you might begin to work on these cards together ''(making a plan!)''.
!!Using AIM cards to measure outcomes:
*The client can rate the severity of the problem indicated on the card (or cards) that they feel are most important to change or to focus on. They are able to rate how much this affects them at the moment, using the numbers on the cards. This can then be used as a goals-based outcome measure and tracked over the course of the work together. This is a helpful way of checking 'how are things now?' in relation to what matters most to the client in comparison with the beginning of the work together. If the clients' rating is not changing, or getting worse this is also really important, as it can open conversations about why this might be, what might need to change for the ratings to move from x to x. Ratings can be plotted on a graph showing progress or change over time. This can also be shared and reflected on with the client.
*At the end of the intervention the AIM card session can be repeated and the ratings of the chosen cards can be compared from the pre-intervention AIM card session.
* Being curious about what the young person brings, rather than assuming things or trying to jump to solutions straight away
* Being curious about the card they have chosen – not assuming that you know why they have chosen a particular card or what it might have meant to them.
* Not making assumptions about what links together – taking time to explore it
* Being curious about the process of using them – mentalizing what is it like to have things bought up that they might not have usually bought; what might it be like to see a big pile of challenges or not many strengths etc
* Being curious about what thoughts/feelings might come up for a young person while doing the task – tuning in to what it seems like for the young person to do the cards. Not just about the end point of finishing the cards; remembering to sensitively attune. Taking responsibility as a worker for supporting a young person to remain in a regulated zone.
* Could use to support perspective taking – what do you think your Mum/teacher would pick? Do you think anyone else would see this differently? What do you think your teacher would say if he/she could see which ones you’d picked?
We have produced 3 sets of <<tag [[AMBIT playing cards]]>> for use within supervision or case discussion contexts, which are based on ideas from several different AMBIT teams who had developed and used such cards in their team meetings. Each of these card sets is described below.
''AMBIT stance cards''
The AMBIT stance playing cards were developed by the CASUS team, a substance use service for adolescents in Cambridgeshire.
{{AIM cards pic1.jpg}}
Each area of the AMBIT stance is printed on individual cards which are dealt out to team members. Each team member is responsible for holding that particular area of the stance in mind during the discussions. The purpose of this is to support a team to remain "on balance" by attending to the four different domains of AMBIT - Client, Team, Network and Learning - within the discussion taking place.
''AMBIT Marking the Task cards''
The AMBIT Marking the Task cards are based on cards developed by the AMASS team in Islington, an edge of care team for adolescents, for use in their weekly group supervision.
{{AMBIT Marking the Task cards}}
The purpose of the cards is to assist team members in [[Marking the Task]], which is the first of the four steps in [[Thinking Together|Thinking Together]]. The cards contain a number of different categories of task that a worker might want help with. Sometimes selecting a clear and specific task can be a challenge for workers, particularly since the experience of having a dilemma or feeling stuck is often related to a loss of mentalizing, which can make it more challenging for a worker to think through "//What exactly do I need help with?//". The intention of getting a worker to select the relevant card and place it on the table is therefore to help with both the identification of the task and to create a playful way of helping the worker and the team hold the boundary around being clear about task //before //moving into [[Stating the Case|Stating the Case]] i.e. ("//You can't start until you've chosen your card and helped us understand what the task is//!").
''AMBIT usual suspects cards''
Developed by CASUS workers, the AMBIT usual suspects cards are intended to be given out to team members who are wanting to assist a worker in thinking about ''Dis-integration'' within a network.
{{AMBIT usual suspects cards}}
The worker can select the relevant professionals from the pack of cards, assign each of these cards to a member of the team and ask each team member to mentalize that worker's perspective in the discussion that follows. This may help to identify areas of agreement, dis-integration and possibilities for Connecting Conversations that may be helpful. Additionally the cards may be used within a group discussion or individual supervision to “sculpt” a network in order to make sense of the client’s system of help, visually map out dis-integration and consider the the differing perspectives. This is a quick and easy alternative to the [[Sculpting a Network]] exercise and use of [[The AMBIT Pro-Gram]].
This page provides you with a list of all the pages that are relevant to the AMBIT Training. You may come across some broken links as these pages have been copied across the AMBIT manual - bear with us while we try to sort through these!
!!Pages on AMBIT
<<list-links "[tag[TrainingCore]tag[TrainingCore]]">>
!!Pages from training
<<list-links "[tag[AMBIT Training]tag[AMBIT Training]]">>
[[AMBIT Wiki|https://manuals.annafreud.org/ambit/index.html]]
[[AMBIT learning at work|https://manuals.annafreud.org/ambit/index.html#LEARNING%20at%20work:%5B%5BLEARNING%20at%20work%5D%5D]]
{{nathan-anderson-kTaIjvHsyJg-unsplash.jpg}}
!!''What is AMBIT? ''
* A Mentalization-based approach, designed for teams and services who work with clients presenting with multiple and complex problems
*AMBIT has been developed with a focus on those for whom help-seeking, or using conventional forms of help, can be particularly challenging
* AMBIT works to support services in developing systems of care adapted to their local context and client group
*AMBIT is guided by a central theory- [[Mentalization]]- which is applied in a conscious and deliberate way to 4 areas of practice:
**''In direct face to face work'' - Applying a [[Mentalizing Stance|The Therapist's Mentalizing Stance]] to therapeutic work.
**''Between members of the team'' - The ways in which colleagues support each other in their work to foster a [[well-connected team|Keyworker well-connected to wider team]].
**''To the wider professional network'' - The way in which the service relates to and supports the complex network of professionals that often develop around this client group.
**''To the way in which teams learn about their work'' - Through encouraging a culture of continuous learning and adaptation.
The range of problems that AMBIT-influenced services address are varied, there may be many different treatment aims- addressing clients' fundamental Relationship to help is often one of the core treatment aims shared by the many services that use or adapt this approach.
!!!(<4 mins) A very brief introduction
By AMBIT Trainers Liz Cracknell and John Lincoln
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!!!(10 mins) The AMBIT model
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!!In summary…
''AMBIT is NOT:''
* A ''"one-size-fits-all"'' rigidly-determined "tick-box" approach to therapy
* A new form of individual therapy
* A template for team structure and organisational arrangements
* An approach for specific psychiatric disorders
* An approach that can only be delivered by statutory services
''AMBIT is:''
* A ''mentalization based approach''
* A team approach
* An approach for clients with severe and complex problems including mental health problems
* An approach for clients who may have a very poor or negative relationship to help
* An outreach approach, but one which can be adapted for other types of service delivery
* An approach that emphasises relationship building and uses ideas from Attachment theory
* A manualized framework with a strong emphasis on supporting local adaptations and further development of the model within a local context (see[[ Manualization|Manualization]])
AMBIT's name changed recently from Adolescent Mentalization Based Integrative Treatment to ''ADAPTIVE Mentalization Based Integrative Treatment'', because many of the clients that teams using this approach are working with now fall outside the category of adolescence.
''The Core Features of AMBIT''
For the worker the [[Core Features of AMBIT]] are intended to be practical "grab-rails" - which describe a STANCE - and important features of PRACTICE, that are designed to help the worker stay 'on track' - especially at those times of high stress or anxiety that are common in this work. The AMBIT Wheel is an attempt to present them in a simple and memorable way.
!!!(<10 minutes) Walking through the Wheel
See the [[Core Features of AMBIT]] for more
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''For those who would like to read and watch more, below you will find more text and links explaining in further detail (and in slightly different ways) what AMBIT is, as well as directing you to other useful pages////.''
*In 2017, a 'book of the AMBIT wiki' was published by Oxford University Press - and there are a number of publications too, find these at Academic references
!!''Feedback from AMBIT-influenced teams''
Here are some comments received in a 2014 survey of teams who have undertaken AMBIT training.
>>"//AMBIT has been helpful in bringing together a shared sense of purpose for a team while under re-organisation//"
>>"//Team was newly set up when AMBIT training was attended so it has been key to the team's development and ethos from the beginning.//"
>>"//We continue to use AMBIT as a focus to ensure that we work in a different way. AMBIT is becoming the language by which we do this//"
>>"//Has offered a set of principles for working with complex systems organised around mentalizing which we can compare ourselves against and relate to as we develop how we work//".
>>"//We are growing a pilot multidisciplinary young person's service (including support for providers of youth services) ... and find that AMBIT helps us better support young people as well as build non-adversarial and positive working relationships with colleagues from other services//"
----
!!Relevant links
# [[Core Features of AMBIT]] - This should be your next step in understanding AMBIT - it provides the main "grab rails" for a practitioner to remember that determine his or her STANCE in the work, and the key features of PRACTICE that flow from this.
# [[Mentalization]] - This is the key supporting theory, that shapes specific work with the young person and family, and the work of the team.
!!''What is Active Planning ? ''
<center>{{ap..png}}</center>
* Active Planning is a practice that underpins how we make plans together with clients
* It is a way of helping maintain an appropriate balance between having a purpose, being open about our intentions, and attuning to what's happening in the here and now
*It involves applying [[Mentalizing|Mentalization]] to the process of making and working to plans
This is a 10 minute teaching session on Active Planning by Dickon Bevington at a training for AMBIT Local Trainers:
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!!Why focus on planning?
Evidence-based approaches tell us that having clear and jointly constructed goals and plans are essential to creating change.
However, there are a number of factors that can make planned work difficult in the contexts within which AMBIT influenced teams work.
''These can be related to both:''
''1.Worker barriers'',
for example:
*Challenging work in isolation or without strong connections to team members ([[Keyworker well-connected to wider team]]) to help think about where the work is headed and what might need to happen next
*Working within a team where members do not feel confident or supported adequately to raise and address difficult issues with their clients
*A stressed or overwhelmed worker (and/or team) meaning there is less capacity to ''mentalize'' the client and attune to what might be important or helpful for them in the 'here and now'.
''2. Client barriers'',
for example:
*For people who have complex and multiple problems and a fragile Relationship to help, trusting that a plan is well intentioned or that it may be useful, can be a significant challenge
*Motivation can fluctuate and there may be important reasons for keeping things as they are
*States of mind may shift rapidly and the ability to focus on a plan changes
*Intentions or priorities shift
*Previously unknown problems or crises can arise which need attending to.
''In practice these barriers can look a bit like.....''
* Meetings overun and things that were agreed don't get thought about
*The focus seems to change constantly between or within meetings
*Lots of talking but not much action
*A worker imposing their own ideas about what would be helpful, or allowing the client to lead without any particular purpose or input in our mind.
!!How do you do it?
''Active planning is about holding a balance between 3 key points:''
1. In any therapeutic interaction the worker having a ''purpose'' (i.e. a plan) in mind about 'what we're trying to do here and why', is essential
2. Our purpose or intention should be made open and explicit. We call this [[Broadcasting our intentions|Broadcasting Intentions]]
3. At the same time, we aim to attune to the clients situation and state of mind 'in the moment'. We call this ''sensitive attunement''.
We can apply these principles to any planned work with a client, from making a brief phone call, to setting overarching care plans (which some teams use to guide their work towards goals).
Below is an example of how we might structure the start of a session or a meeting with a client, holding in mind the active planning triangle:
>// Last week you were talking about how cutting down the self-harm is the most important thing that you want to change in your life right now....I was thinking that it would be really helpful for us to understand more about the self-harm and why it happens ''(purpose/ plan)''. If we can understand better some of the things that lead to self-harm, we can start to think more about what might need to change ''(Broadcasting intentions)''. How do you think that would be for you to think about today?...are there other things we might need to talk about too? ''(sensitive attunement)''//
We suggest using the [[AIM cards|AIM Cards]] as a way of applying active planning in practice to develop collaborative plans with clients. The AIM cards give a structure to support clients think through and prioritise the most important areas for them, whilst the worker listens and attunes to the clients' perspective (sensitive attunement). The cards then allow workers to contribute their own ideas (Broadcasting intentions) in designing a joint plan about the way forward.
!!Holding the balance
The 3 points of active planning do not follow any particular order. Rather, by the worker mentalizing themselves and their client, we attempt to hold an appropriate balance between them.
If we can maintain sensitive attunement to the clients' state of mind and situation it is more likely they will experience our offers of help as 'fitting' with where they are at (whether our offer of help is ''contingent'').
For example, rigidly sticking to a plan from last week, with a client who arrives overwhelmed by an argument at home, may well undermine the client-worker relationship. This would be an example of a worker in teleological thinking or ''Quick fix'' one of the Features of unsuccessful Mentalizing.
At the same time, if we were only focusing on sensitive attunement, this would risk losing the worker (and teams') perspectives on other factors, such as risks, or situations that can't be ignored. This might take on a kind of Pretend mode thinking where we are not addressing some important realities.
The above points are held in balance with , [[Broadcasting Intentions|Broadcasting Intentions]]. Here the worker is explicit and open about their purpose, in order to make their behaviour understandable. We assume that our intentions and behaviour are not clear to our client, (or, that they may expect that we have negative intentions). In this sense, we try to increase the chances that a client can clearly understand our intentions (i.e. mentalize us, the worker), and opt in or out of a plan, rather than it being experienced as something done //to them//. Again, the worker attempts to balance this appropriately, as over-reliance on broadcasting intentions would be another example of Pretend mode (or ''waffle'') and not connected with the experience of the client in the 'here and now'.
''Please see here for a tool to support active planning with clients:''
The Egg and Triangle is a tool that we would usually use after early contact with a client as a way of explicitly sharing our 'best efforts at understanding so far' (broadcasting our intentions and sensitve attunement). This allows the opportunity to 'correct' and further adapt this understanding together (sensitive attunement), based on the clients' perspective. This helps us begin shaping a collaborative plan about the work ahead.
<<image [[ {{ActivePlanningTriad}} ]] width:560 height:480>>
!!''Video example: Active Planning in action''
Balancing sensitive attunement with the need for work towards a planned focus is a constant dilemma for the worker, and one which may need help from Supervisory Structures in the team.
Here, a worker's initial plan is clearly out of sync with the dilemma that the young person is wrestling with, and adjustment is required:
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----
''The Active Planning Triangle is not only applied to face to face client work. We can equally hold this stance in any situation where we are working towards plans in relationship with others.''
For example;
*A meeting with professionals in the network around a client,
If these three points become un-balanced there is a risk that network meetings fall into lots of discussion or broadcasting of intentions, without any clear plans or actions taking place (''pretend mode''). On the other hand, losing balance could mean too much rigid setting of plans without sensitive attunement to the clients' immediate situation (or to the workers' current state of mind). We suggest that this can be a helpful stance when chairing or running meetings in this context.
This page gathers together our ideas about how we are applying [[Active Planning|Active Planning]] in our work.
In a helping interaction, there is a worker, the client and the plan. The plan (both the overall plan for the work and what is going to happen in each interaction/session) needs ideally to be collaboratively agreed between worker and client. This involves the worker showing curiosity towards the client in trying to understand what they might be thinking/feeling, as well as sharing with the client what is going on in their own mind, to help the client make sense of their behaviour and intentions. This is an example of applying the idea of mentalizing to collaborative working - neither the client nor the worker can read each other's minds! Reaching shared understandings upon which to base plans is the purpose of holding an active planning stance.
''__Active Planning during the engagement and assessment phase__
''
When we are meeting clients for the first time, we are [[broadcasting our intentions|Broadcasting Intentions]] to help them make sense of our behaviour. This might include explaining who we are, what our role is and most importantly why we are there. Most of the time, it is useful to be explicit about our intention to be helpful and we might also be able to be specific about what we are there to be helpful with (i.e. helping school to work a bit better for you; to help with how you are feeling at the moment). We should be mindful to balance transparency with not imposing a focus for the work on the young person which may be coming from someone else, not them.
The first phase of the work focuses on building engagement and getting to know the young person. It might be possible to do this through a more structured assessment process or a young person may be more easily about to share things about themselves and their current situation through more creative activities, such as games or quizzes. Either way, the principle that we are holding in mind is that of ''sensitive attunement'' - we want to understand how things are for the child or young person at the moment, which we imagine will include a mixture of things that are going well and things that feel a bit more tricky.
Some young people may find it hard to tell a worker about how things are for them through just being invited to talk or being asked questions, so we might need to find ways to scaffold this process. It is helpful for a worker to try to mentalize the likely experience of the young person - what is going to the best way for this child to share how things are for them? Some workers may choose to ask the client this directly or to think with those who know the client (i.e. the referrer) for any ideas they have about how this might be best facilitated.
For adolescents, we can use the [[AIM cards|AIM Cards]] to help with building an understanding about how things are for them in terms of current strengths and needs, how these fit together and whether there are any particular needs that they would like to have some help with. We are going to trial using these online.
For younger children, we have made an adapted version of the AIM cards, to help provide some structure to help them both think about and express how things are for them at the moment.
Using active planning to set session agendas
It is helpful for the worker and client to have agendas for the sessions. Generally speaking, the worker will have some objectives in mind that they may want to achieve through the session. It is helpful to share these with the young person, both to check that this ok and also to ask them what else they feel it would be helpful/important to cover.
Workers should remember to be clear about WHAT they want to do and WHY this might be helpful. If goals have already been set, it is useful to explain how the plan links to the goals:
//"One of your goals is to get some help with anger, so I have bought an activity today to help us work out the kinds of things that make you feel angry"//
! __Dilemmas that come up that active planning might help with__
Although the above description talks about applying these ideas to interactions with children and young people, they are helpful for interactions with other "clients" that we have (i.e. parents, teachers, other professionals).
*''I attended a school meeting and didn't get to ask the questions that I wanted - the teachers were just giving me a lot of information, talking about how difficult things are and asking me what I was going to offer!''
It is very understandable that this might happen, given how stressed referrers might be when they come to us for help. It might be hard for them to organise their own thinking about what information it might most feel relevant to share, particularly if there are strong feelings around. Generally speaking, it is helpful to start meetings by broadcasting your ideas about how the meeting might most usefully run, so that the meeting has some structure and that people are talking about the same things at the same time rather than everyone going into different aspects of the situation simultaneously, which may be hard to keep up with.
//'Today I thought we could use the time for me to hear about your concerns about the young person, things that are going well and what you are hoping to get from a piece of work from the WEST team. We can go through each of those things in turn - where do you want to start?'//
*''I explained some breathing exercises to a young person but I don't think they were really that bought into them. How can I get them to use them?''
In our efforts to be helpful, we can sometimes forget that something that might seem helpful to us is not necessarily perceived as helpful by someone else. Strategies are a good example of this - they are simply some things that some people have found to be helpful. We can ask young people from their own ideas about what might help the with a particular issue, before making suggestions. If we are going to make suggestions, we should mark this explicitly (//"I could share some things that other young people have found helpful"//). It is really important to remember to offer strategies in a collaborative way - to broadcast clearly the thinking behind them, but to balance this with sensitive attunement, i.e. to check in what the young person thinks about them. We can still take a position of providing encouragement to young people to try things out and a spirit of experimentation around this -
//' I thought I would show you x, which some young people have found helps them with y. Here's a bit about what it is and how it works. We could try out an example now and you can tell me what you think about it.... Do you think this is something that you'd like to try out this week and then you could let me know how you found it?'//
The clearer we are about the purpose of particular strategies that we are sharing, the easier it will be to find alternatives if they don't fit for the young person. We should avoid falling into positions of certainty (i.e. //"I think that this strategy is helpful/the evidence says this strategy is helpful and therefore it must be"!//)
<<tag [[Addressing Dis-integration]]>> brings together the practices and tools that AMBIT influenced teams may use when working with their networks, trying to work in integrated ways and reduce Dis-integration.
!!Firstly.....
To address Dis-integration effectively, we propose that first of all we need to re-shape our expectations...
!!//Anticipating// misunderstanding and conflict
A fundamental assumption is that network differences and conflicts should be ''//anticipated as inevitable//'' and not be seen as an indication that people in the network around the client are somehow //''getting it wrong''//.
AMBIT adopts a position that ''actively anticipates the likelihood of conflict and contradiction between agencies or professionals'', and promotes the explicit view that this is //understandable//, as an aspect of ''our best intentions and best efforts'' to provide services for the client.
<a class="tc-float-right">[img width= 600 [Dis-integration pic.jpg]]</a>
!!What to do?
With shared understanding of the problem, agreed intervention and collaborative relationships, effectiveness will improve
!!The Dis-integration Grid
The [[Dis-integration grid]] is a practical tool aimed at supporting Mentalizing of the network. It helps us to think about which parts of the system may be helping or hindering integration and where we may be able to bring a helpful influence towards integration.
!!Sculpting a network
The Sculpting a network exercise which is a way of physically mapping and making sense of network dis-integration. This is an exercise that can be carried out with your team.
!!AMBIT Pro-Gram
[[The AMBIT Program|The AMBIT Pro-Gram]] is a tool for workers to use with clients to help them map out and make sense of their network. It is a way of thinking with clients about which relationships are most helpful for them, who members of the network are and what they do. It is also used for the worker to understand how the client see's these areas and to guide the worker in how they might support or scaffold the existing relationships.
!!Training Exercises
There are other training exercises on working with your network here that explicitly encourage workers to practice mentalizing the network or each other in your team. These include wearing different hats exercise and the what's it like to be exercise.
!!Why do we do this?
The purpose of paying close attention to the wider network is partly to improve the effectiveness of interventions, but it also consistent with the overall mentalizing stance of AMBIT. One of the core aims for the keyworker is to help the client //make sense of the professionals' behaviours// - by encouraging the client and family to mentalize.
In our view, [[Mentalization]] provides a crucial technique in trying to help professionals to make sense of each others' behaviour, and hence reduce mis-understandings in the same way. We believe this opens up opportunities for authentic collaboration between members of the network.
!!Addressing Disintegration Video
Liz Cracknell
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''Examples of Behaviours''
*Being defiant
*Oppositional
*Impulsive
*Answering back
*Rude
*Shouting
*Not doing what asked
*Passive within relationships with parents
*Leaving house without permission, and not sharing with whereabouts (Push vs. Pull factors)
*Parent relationships – not having helpful conversations e.g. annoyed at young person, low mood themselves
''Understanding the context - network vs. family''
*Distinguish a plan of where the work is going to be focused. Is the behaviour manageable via parents, or does it involve the network and fall under, e.g. social care
''Thinking about the intervention''
*Strengths and weaknesses
*Trying to identify the causes
*Shared agreement on goals
-Agreement initially about what is going on in the house e.g. “Let’s think about why … might be …” (Rules too harsh / no rules / implementation of rule – praise?)
-Once you have secured a goal, you need to secure agreement on how it is going to be solved. “Not always helpful for one person to do something, everyone can do something differently – this will help the work to occur faster
-Key to involve parents as much as possible
*Asking for help from network
*Thinking about teams involvement with family - Is it appropriate for one person to work with young person and one person to work with Parent/Guardian
*Setting rules / agreements:
-Parent sending message reminders of when they are due back home / where are they going and with who / consequences of what will happen if they don't follow rules / Diary to fill in when they get back - monitoring expectations / Reward charts
*Identifying positive communication that goes on, and what negative communication goes on: Pie chart
*Sequences - why behaviour has happened
*Monitoring to find examples of when things go well some of the time. Parents/Guardians may often find it difficult to find positive points and feel that bad behaviour is the only thing that is happening. Asking parents to explicitly look out for good examples of behaviour
''Common issues''
*Parent and child disagree on what is needed to done and who is responsible for that
*Thinking about your relationship with young person and how to make it a 'trusting' and open, whilst bringing in parents: Frame parents' involvement / think about your positioning - "It's quite annoying that rules exist, how are we going to manage following them".
There are many GSH manuals that could be used to help guide practice.
!!!Adolescent Anxiety:
''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">>
The Anna Freud National Centre for Children and Families is a charity dedicated to ''Innovation'' in the the treatment of mental health difficulties in Children and Young people, ''Evaluation'' of new treatments, and the ''Dissemination'' of effective techniques to the widest possible audience. Further information can be found at the Centre's [[website|http://www.annafreudcentre.org/]].
[img width= 300 [AF-logo-RGB-Green.png]]
<<list-links "[tag[Assessments]]">>
Attachment Theory brief re-capp
Here we have reviewed key elements of attachment theory as part of our training/discussions in working with Looked After Children
Re-introduction for attachment theory:
Biological innate mechanism that humans have developed for keeping safe.
Having a secure base to explore the world and develop relationships and come back to the base for safety. But when the main caregiver is unsafe and not predictable, attachment difficulties arise.
The process of repairing makes it a safe base.
Attachment styles can vary between cultures.
A secure base/ 'safe base' is really important to help one learn about who they are; what's going on inside - this is the basis of mentalization.
''Strange situation'' - a way to measure of attachment. Can the child be settled by the parent, and then carry on exploring? This can be a helpful way to establish whether the child feels they have a safe base.
''Avoidant attachment'' - more independent, withdrawing, not seeming bothered when parents leave (although cortisol is actually shown to raise in these situations).
''Anxious/ resistant attachment'' - often when caregiver is inconsistent. These children can often be very clingy - very push/ pull; carer struggles to settle them. Preoccupied with the caregiver's availability.
High percentage of LAC will show a ''disorganised attachment style''. Distressed DUE TO carer, yet they are all I have for safety, despite being scared of them. Often seen where there's severe neglect/ violence/ drug/ alcohol abuse. Will often be hyper-alert and in survival mode; high fight/ flight response. Called disorganised because there isn't much consistency/ organisation in their attachment.
''Earned Secure'' - if a caregiver can provide enough security and consistency later in life, can encourage re-learning of attachment and relationships.
Attachment styles don't seem to change, unless there are big changes in behaviour and safety felt with caregiver.
''Mirroring'' is an important part of development - particularly in terms of developing mentalisation. This is when a caregiver reflects the expression/ emotion shown on a LAC' face. LAC may not get this experience; may change between different foster care or not experience this with their parents/ caregivers.
<<list-links "[tag[Autism]]">>
!!What we can do as a service
*For new referrals coming to WEST that are clearly for an ADHD or ASD assessment, we or the original referrer will refer on to CAMHS
*For open cases where we are querying ADHD or ASD, we would try to gather additional screening information from parents, school and sessions with the child, depending on service capacity (e.g. SCQ, ASSQ, school report / information, brief neurodevelopmental history etc. using the above) and write these up and refer on to CAMHS
<<link-doc "Autism Pre Screening Documents" "https://drive.google.com/drive/folders/151AL84y0vSzeRnTL00gFO8pVi084X7bV?usp=sharing">>
Build up a developmental History so that you can produce a CAMHS Report
!!Developmental history
!!!!Ask about this historically and currently
*family context
**who they live with, where, siblings, who looks after child
**relationship with both parents
*history of Autism / ADHD
**Pregnancy, Delivery, Milestones
**language development- any unusual
*medical problems
*activity level
*social interactions
**friendships how many, how close to friends
**how do they play - on their own, with others
*unusual interests/ obsessions
*Eating
**any unusual habits - textures of foods, colours, touching
**Unusual sensory responses- covering ears, rocking
!!Sending the report to CAMHS
*Contact CAMHS Gateway and attach the screening report
!!!What is BOAT?
* Mainstream service of 2-18 yr olds servicing 800 children who have a diagnosis of Autism
* Do not discharge young people
* funded to be ''support with schools'' but work closely with families
*usually involved with families and young people throughout their school career
*anyone who has a diagnosis of ASD who live in Brent and in a mainstream education (and have consent from parents).
*only get discharged if go to a special school or leave the borough.
*currently applying for funding to work with children and families pre-diagnostically which will include support groups and support with the diagnostic process.
!!!Parent support?
* Parents often also have a lot of need
*offer a ''post diagnostic sessions'' (run each term depending on need) in which BOAT explain what autism is, which are run by the allocated practitioners. These are now being run virtually
*no time limit on how long after the diagnosis they can attend post diagnostic sessions
*Post diagnostic sessions focus on the strengths of autism and discuss key aspects of difficulties such as sleep, eating etc.
*run sessions on supporting ''choosing and transitioning to secondary schools''
*support families with the grief cycle through developmental / life changes cause changes in the child's wellbeing and behaviour
!!!Supporting sharing the diagnosis
*believe in ''sharing the diagnosis'' with the child/ young person
*often advocate for families to share this with children before going to secondary school
*''peer support sessions'' -we offer sessions in schools to support the school class/ peers understand the differences in a child who has autism.
*have a lesson plans for schools to run a autism session
*we ''support parents to explain the diagnosis'' to the children in a calm way
!!!Other support groups
* ''Cygnets'' which is a group for parents - 6-7 weeks and do not need to be in a special school
* ''Pegasus'' course run by CAMHS which is run jointly with parents and young people - usually older young people
* ''Barnet- resources for Autism'' - offer for respite, art and music therapy
* ''Harrow- centre for autism'' - drop ins for parents, speakers/ presentations.
* ''Autism education trust'' - online platform lots of information for parents and shows what the government is funding for children on the spectrum
* ''Reachout afc'' - free resources for parents and families, you can subscribe for £10 a month
* ''Support for girls with autism'' - yellow lady bugs and lavender Facebook groups
!!!Supporting schools
*Support schools but often need to challenge practice in some schools
*Build good relationships with schools
*Focus on the priority and needs of the child '''we are the child's advocate'''
*support the schools to understand the parents experiences in the past.
*Supporting school to shift in what they do
!!!Graduated approach document
* outlines the types of support for autistic children
*''universal support'' - expected that school can offer this level of support
* ''targeted support'' - things that BOAT can help schools to manage
* ''specialised support'' - for things such as school refusal and mental health distress
!!!Strategies
*thinking about individualised adaptions/ strategies that can be used for children in the class
*ABC chart
*the bucket analogy- things that fill the bucket and empty the bucket. What is adding to dis-regulation and what helps regulate.
*considering the conflict in what the teacher need and what the child needs are and finding a compromise
*helping schools understand that behaviours are a form of communication
*reverse exclusions- wasted time in class mean staying longer after school and involving mum in this
*simplifying choices
*helping people remember that it is difficult the put into words how they are feelings and expecting them to answer difficult questions.
!!!Resources
Tony Atwood - circles
roadmaps different roads that lead us to positivity or misery - the choices we make
<<list-links "[tag[Behaviour Problems]]">>
__Examples of boundary struggles__
* What's an appropriate way to be in a friendship?
* What's an appropriate way to be in a romantic relationship?
* Appropriate social boundaries in school and with friends?
*CYP understanding the boundaries of our working relationship with them and how we help them to remain within those
__How do we learn boundaries?__
* Learn from what you see - life experiences
* How the other person in the relationship behaves - e.g. leader and follower
* What you ultimately want - boundaries may be bypassed in pursuit of something - ''motivation''
* Who you care about and how much you care about what they think of you
* Reinforcement - vicariously and directly - how others react to our behaviour (or how others respond to others' behaviour)
* What others tell us (or don't tell us) - we may be given strong messages about developmentally or socially appropriate boundaries
* Sometimes we may disregard boundaries:
__When do boundaries fall down?__
* When behaviour is driven by how you feel then boundaries may not be taken into account
* Boundaries may be bypassed in pursuit of something
__What maintains boundaries__
* Might not get back reaction that helps boundaries to be held
* Reinforced - got the goal you wanted
* Reputation 'points' may reinforce for teenagers - i.e. it's 'cool' to get into a fight/ have an older boyfriend
* More/ longer boundaries continue, the more they are normalised
__How can we help with teaching healthy boundaries?__
* Modelling to them via our relationship
* __Map out__ current relationships - what are the current boundaries and expectations?
* Often difficulties with boundaries will be raised by others, not usually by the YP themselves
How might we map this out with people in the network to understand it better?
* What is the problem with boundaries? What does it look like? - ''Creating a picture''
//Explore strengths and exceptions - Is this something that happens all the time? Are they able to manage some relationships/ boundaries well?//
* What is it ''supposed'' to look like in these relationships (as far as everyone can agree)
//Being as clear and explicit as possible with the YP - trying to help them see the perspective from others (i.e. what is it they're doing that you don't like/ would like to see//
* Sometimes may need to be the ''worker'' that brings out discussion around relationships and boundaries, if its something that the worker is noticing in the stories that the CYP is bringing (e.g. arguments with friends; stories about boyfriend/girlfriend etc) - may do this by being strategic in reflections (to try and get shared agreement to open up this topic for discussion)
__Asking:__ //What does a good friend look like? What helps people to like each other? What helps people to get on/ not fall out? What do you think would make a good boyfriend/girlfriend? How could you be a good boyfriend/girlfriend?//
We want to elicit what THEY think - helps us to know what they've got in their head about it already, before we start assuming that they need "education" around boundaries (might be more that they do have appropriate ideas, but we need to explore what's making it hard to act within these in this particular relationship)
* Check out/ narrow down on their ''beliefs'' around relationships/ boundaries and what is OK/ not OK - could bring materials to sessions to stimulate discussion if it would be harder for them to generate this themselves - e.g. power and control wheel/ consent/ assertiveness/ what's a good friend (explore whether they agree)
* OK to ''share'' the dilemma a little with them - validating that it IS really hard sometimes to know the best way to be in certain relationships, but also encouraging YP to have their own mind about it so that they don't feel you are another adult "telling them", but that you're open to discussing it, as well as sharing some advice
//"a lot of the other YP I've spoken to, sometimes we've done a lot of work on what to expect from situations/ how we might behave etc. - how would you feel about that?//
* Moving away from constantly hearing the story about things and moving towards actively do something to help - ''interrupt the constant story telling'' if you feel that you are only ever hearing examples of the problem.
* Be strategic in your validations/reflections - which bits of what you are hearing might you want to amplify in order to move towards being able to focus in on some of the general themes of what you are hearing, rather than each specific example.
**The friendship stuff sounds quite tough at the moment!
**I'm just thinking back on some of the other things you've told me about how it is with these friends and it feels like you're never quite sure why they end up reacting like this to you?
**It often sounds like you end up having to go along with things that you're not exactly sure about / comfortable with - is that a bit how it feels?
* Aim to come to ''shared agreement'' to talk about it, so that you're on the same page about this being relevant (does it connect to a goal they already have?)
* Worksheets to support what you discuss could be helpful
__Our own boundaries__
We talked about how tricky it can feel when CYP refer to you as a friend or where you are being treated in a way that you imagine they might more treat a friend (e.g. updating you on the latest gossip).
When they refer to it being good to have someone like you to talk to, as they don't have many friends.
As workers, it can feel hard to know how best to respond - don't want to invalidate what they are saying, but also want to help them understand what the limits are of the relationship.
Extra hard when working remotely - we are at home or chatting on whatsapp, so might feel like the boundaries are more blurred.
''Ideas''
* Whatever "positive feedback" they give about you and the relationship, ask them who else they have that they notice this with - //what other people do you feel the same way with? //. You can say that its good that they notice what they find helpful in other people/relationships and part of what you want to help with is getting that happening in more relationships in their life.
//It's good that you see me as someone you can talk a bit to, but I wouldn't want to be the only person that you feel you can do that with.//
* It can be helpful to gently draw some differences as to why you are also NOT like a friend! You can use your humour too. This can help to remind them of the boundary in a way that might not feel as rejecting.
//I get that I do a lot of things that a friend might, but there's also lots of things your friends do that I wouldn't do too! You probably wouldn't want me turning up at Nandos for example! (remind them of ways you're different)//
You can acknowledge that you are glad they find you friendly, a good listener etc as it's important to you to hear whether they are finding you helpful.
* Can be hard to have this feedback or know how to handle it when you have a sense that the CYP is more isolated and genuinely isn't that well-connected to other relationships. Not so much as making the relationships they have better as it might be helping them to find people who they could connect up with. Many ways to explore this - e.g. helping them to become more aware of their interests etc to think about new activities they could take up. Could also use the network to help think about "scaffolding" more friendships in school (not necessarily with the YP's knowledge if you feel that this would be counter-productive)
<center>{{broadcasting Pic.jpg}}</center>
Broadcasting Intentions is a key part of the active planning stance. This is when the KeyWorker makes an effort to be EXPLICIT and clear about their intentions or ideas to their client. In other words, the worker is open about 'what my intention or purpose is, and why'.
The point of this is that we cannot assume that our clients will have the kind of relationship to help in which they would experience our approaches as well-intentioned. It may be that our behaviour does not make sense, or represents something more threatening or troubling, in relation to their past experiences of others.
//In the anxiety of the therapeutic encounter it is often hard for young people to [[Mentalize|Mentalization]] their therapist accurately.//
So, we Broadcast our Intentions in order to;
*Prevent an intention from being misunderstood.
*Help an intention be understood
* Resolve a misunderstanding
*Build trust
This is also a key element in the process of Engagement:
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!!How to broadcast our intentions
The AMBIT KeyWorker is encouraged to verbalise his/her intentions.
This might be in terms of their general aims of the intervention such as "being helpful" to the young person, or the specifics, such as //"to register for a college course"//..
My invitation to consider registering for a college course might be well-intended, but might be read my client as a move to separate her from her boyfriend, or to humiliate her mother, etc... If those were my true intentions, then it would make sense for my client to resist them, and I am unlikely to have any influence in that sphere!
Intention can be expressed in moment to moment interactions, for instance:
>//"My intention here is just to try to understand more accurately what you are feeling, and why."//
or
>//"What I am trying to do here is to be helpful, or at least to think of some new ideas about this familiar problem, and definitely to to avoid being unhelpful!"//
Being clear about moment to moment interactions would be adopting an explicitly intentional stance.
>//"I may not have got things quite right yet, but these are the things that at the moment seem to me the most important ones for me to try to help you deal with... ...I would like to hear from you which bits you think I have got about right, and which bits I still need to work on so that you can recognise them more clearly..."//
!! A tool to help this:
The Egg and Triangle (also known as the Egg and Triangle) is about helping the worker to share their "first effort" in
'"what I have understood from you", then inviting the young person to help improve it. When you are sharing your first effort, ''that'' is Broadcasting Intentions!.
Go to [[this link|https://docs.google.com/file/d/0B5h_CVBdhJPYNkJNamFPVXhsYXM/edit?usp=sharing]] to download this in PDF format, or just use the back of an envelope!
[img[https://lh5.googleusercontent.com/-loMP5VnnI1Q/URG08pJR4OI/AAAAAAAAGpY/o21-QH6rBw0/s640/ActivePlanningSheet.jpg]]
[img[https://lh5.googleusercontent.com/-EXERk6bOad4/URG07sRVqzI/AAAAAAAAGpc/W6cVjCoCoHA/s640/ActivePlanningSheet_DEMO.jpg]]
.
* What things we need to do?
* Closing letter that needs to be written by Wellbeing Practitioners and then sent to Eleanor, who sends it to the relevant people (eg. referrer, GP, family members).
* Ending summaries/reports/portfolios.
* ESQ outcome measure and written feedback, SRS of the last session, SDQ follow up.
* Clinician outcome case closure done by practitioner.
* Pod and PSS closure: end contact.
PSS: look up the contact, double click your name, put the end date.
POD: Go to status, and change from current to completed intervention.
* Put the date of closure in the spreadsheet.
!!'''Helping Your Child with Fears and Worries 2nd Edition: A self-help guide for parents ''
PLEASE NOTE – BOTH THE MANUAL AND BOOK HAVE BEEN RECENTLY UPDATED. THIS IS THE MOST RECENT VERSION OF CATHY'S BOOK. THIS MEANS SOME OF THE PREVIOUSLY DEVELOPED CHAPTER SUMMARIES AND TRANSLATED VERSIONS ARE BASED ON THE PREVIOUS VERSION.
----
''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/]]
----
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 developed by Cathy Creswell. 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.
For translated version of the Cathy Creswell book please go to [[Cathy Creswell's 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">>
<<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">>
<<list-links "[tag[Clinical Framework/ Principals]]">>
!! What different ways can we collect SRS feedback?
* Directly on the phone/video call
* Via text message/WhatsApp following session
* Via email
!!! Collecting SRS feedback directly on a phone/video call -
* Prior to asking for it, encourage honesty and tell them that it will help to improve the sessions
* If using video call you can get their POD up on your screen and share the screen and fill it out with them there
* If just speaking over the phone you can ask them to rate each scale out of 10
!!! Collecting SRS feedback via text message/WhatsApp -
* You can send a screenshot of the SRS form to the client via text message/WhatsApp and ask them to edit it and put a cross on the scale where their response is
* You can send the feedback questions one by one and ask for a rating out of 10 for each question
!!! Collecting SRS feedback via email -
* This is the least effective way of getting SRS feedback (according to team)
* Attach the SRS form to the email and ask for responses as a scale from 1-10
!! Who do we need to ask for feedback from?
* Children and young people we are working with
* Parents
* Professionals
The team find that it is easier to get feedback from the CYP and parents than from professionals. A suggestion is to ask for the feedback in a follow up email and put it at the beginning, before the summary of the call and any actions.
!! How do we keep track of feedback not obtained?
* Change the format of our record keeping template so that after each session/intervention we can note whether //SRS was obtained//; //SRS requested and not received//; //SRS not asked for//.
* During admin catch up sessions with each practitioner we should keep a note of the SRS feedback that has not been obtained (so that we can report on this eventually in the report).
<center>{{Community of practice pic.jpg}}</center>
!!Developing and sharing learning within a community of practice
The “evidence-base” (e.g. core content of this manual) tends to develop slowly over time. However, the innovation, development and learning within local practice-based evidence can move along at a much quicker pace (as the hares and tortoise picture above tries to highlight !)
This is a core idea underpinning the AMBIT community of practice- to learn, develop and share local expertise.
!!''What is a community of practice ?''
This is a way of describing how groups of practitioners (from many, even any, fields) can function in collaborative ways - to compare and share ways of working so as to sustain and grow knowledge about "what works, for which situations".
AMBIT and the wiki Manuals that support it are significantly influenced by this simple idea, that ''practitioners like to get better at what they are doing, and, given the chance, they like to share their expertise with other practitioners''.
''This is why every team trained in AMBIT gets its own local version of the AMBIT manual which it is encouraged to use as a 'practice scrapbook' to document and share its present expertise and ongoing learning about "//what works for whom, __here__//."''
!!''Membership of the AMBIT ~CoP''
You can see a list of all the teams who have received AMBIT training on the manuals sign posting site.
The Wiki Manuals that support AMBIT, function as “windows” upon the work of other teams, encouraging ''//curiosity//'' and the ''//sharing of emerging expertise//'' between services that, although geographically remote, frequently address similar clinical dilemmas.
This aspect of [[Manualization]] builds on themes opened by ''Lave and Wenger (1991)'' in their landmark study of ''apprenticeship'' that has led to the theory of ‘Communities of Practice’ - the establishment of which is an explicit goal for AMBIT.
If you would like to read more about Communities of Practice, theory and how they apply to AMBIT please see
<<tag [[Extended learning]]>>
!!!Contact us for help connecting:
Feel free to email us and we can direct you to teams who are manualizing and who may be of a similar service. mailto:ambit@annafreud.org
!!How to complete your data on the caseload spreadsheet
You should be completing every column on the spreadsheet in relation to your child including date of first contact regarding the referral (for example, with the referrer, another professional or the child or family) for example as Elly will not have this information.
!!!__Direct Session – face to face, telephone or video__
This includes the following:
*Individual assessment or intervention session with a child or young person
*Session with family
*School observation (see ‘please note’ below for more information)
*TAC meeting if family present (see ‘please note’ below for more information)
!!!__Indirect Session - face to face, telephone or video__
This includes the following:
*Session with professionals (school, social care, Family Solutions, CAMHS etc.)
!!!Please Note:
*If you have conducted a school observation and a meeting with a teacher this is two sessions
*the school observation is direct work and the meeting with the class teacher is an indirect session
*If two members of our team conduct a meeting with a parent/child you would both enter this as a direct session i.e. on each of your spreadsheets. The last column on the spreadsheet asks whether there was involvement from any other member of our team ‘other WEST clinician involvement’ please note here who did the session with you and how many sessions you did together and whether you are referring to direct or indirect sessions. Example: ‘1 indirect session with CHe’
*If two members of our team conducted a session with a professional then you would both record this as an indirect session as above
*If a session was conducted where a child/family member and a professional was involved (for example a Team around the Child meeting etc.) then this should be recorded as a direct session. If following the meeting you then had a conversation with the involved professional(s) about the child/family you would note this as an additional indirect session.
*All group work should be noted in the ‘groups’ tab as direct work but all meetings regarding group work with schools, virtual school colleagues etc. should be noted as indirect work in the inter/intra team columns on the spreadsheet.
!!!__Wellbeing Review - Direct Session – face to face, telephone or video__
This includes the following:
• A direct wellbeing review is with the family or child
!!!Please Note:
*A wellbeing review is when you are checking in with children/young people and their families and offering structured social support, checking how things are going – you might be helping them notice that things are going well and checking that they are happy with the current support.
*If we are talking to a professional about the child/family then all of this contact should be counted as an indirect session (see above) and not an indirect wellbeing review as previously stated. Once we have updated the spreadsheet this will be removed as an option.
!!!__Supervision __
This includes the following:
• If you are offering supervision to a member of another team (not an individual within WEST) then this should be recorded under the ‘supervision tab’ on your spreadsheet.
!!!Please note:
*This is for ongoing supervision. Any one off supervision support is a consultation and should be recorded as one in the consultation tab.
!!!__Cancellations/ DNA__
This includes the following:
*If your child/young person or any member of the family or professional network let you know they will not be able to meet/talk at their allocated time (even if they text you just before or during the allocated time) this should be counted as a cancellation
*If they do not pick up the phone at the allocated time and do not notify you at all that they cannot speak – this should be counted as a DNA
!!!This will be reviewed continuously. We need to consider how we will represent number of sessions conducted over the phone and face to face.
! This page contains the discussions held within the team about our consultation process
!!! A discussion between Jyoti, Scott & Eleanor to clarify our consultation service and the process of initial consultations (19/11/2020).
* ''Telephone consultation service ''– advice about a CYP not known to the service
*'' Assessment ''– telephone conversations around referrals, more fluid, we already have a lot of the information
!! Telephone Consultation Service
We will stick with our previous model of -
* Someone call/email enquiring about the service
* They complete screening form on phone with Eleanor or via email
* Book in 1.5 hours in Scott or Jyoti's diary (half hour to read, half hour for consultation, half hour to write up afterwards)
* Write summary letter/email
* SRS form taken (add to POD using name of consultee)
* Send over referral form if the consultation resulted in referral
!!! To consider -
* How do we get more uptake for telephone consultation?
* Haven’t had many requests for consultation service
* We would like to have more consultation service consultations, so that they have a conversation before referring, as many referrals are not suitable
!! "Assessment" stage of referrals
Previously described this as Initial Consultation but we agreed on calling this Assessment to avoid confusion.
!!! To consider -
* We need to discuss this section with the wellbeing practitioners so we can understand what is useful for them to know.
* Do we need to change the initial assessment section of the record keeping template so that it prompts the right kind of questions to ask?
* This could be based on the Three Houses?
* Could we create a scaffold sheet to represent where the family fit in?
* What is the model of the Schools Remote Therapy Service?
!! Discussion with Wellbeing Practitioners (20/01/2021)
!!! To consider -
* What is working well?
* What is not working well?
* What do we need to know from consultations?
!!! Discussed -
* Good information received from Scott if you call to discuss referral
* A lot of notes to write up about initial assessments done by Scott. Can we support this process?
* When Scott discusses therapeutic plan during assessment process, important to clarify that the type of work is subject to change. Once they speak with wellbeing practitioner there may need to be flexibility for what we offer.
* Sometimes parents are not prepared for the work that will be involved (in partivular with child anxiety referrals)
!!! Points to cover during assessment
* How willing the parents are to be involved
* Face/face or virtual?
* What is going well/what is not going well? (Expand on the referral form)
* What does the referrer envisage the support to be?
* What has Scott offered? What are their expectations?
* Who is in the network?
* Address/clarify complexity factors
* What are the next steps for the practitioner? What has Scott informed the referred will happen? When do they expect to hear from the practitioner?
* Which people in the CYP network has he spoken to?
!! Training Sessions with James
The team decided to use the wellbeing practitioner training session to continue discussions regarding what a consultation is -
!!! 21/01/2021
!!! Focus of discussion -
* Clarifying initial consultations/assessments
* Looking at the process, how would the wellbeing practitioners feel doing them
* Use fishbowl exercise; Jyoti, James & Scott will discuss consultation, wellbeing practitioners to observe and question/discuss after
!!! Consultation defined by Scott & Jyoti -
Notes from Scott -
* A discussion in an open and transparent way, with the referrer or another member of CYP network
* Practical thinking about the next steps
* Filtering down process
* Use the Signs of Safety and Wellbeing model (this is always in his mind when Scott is consulting)
* Is the work about the young person or the parent?
* What will our role in the work be?
* Is there an existing relationship that we can strengthen?
Notes from Jyoti -
* Depends what the other person is asking for / what their intentions are
* It works well when it is an open and curious conversation
* Think through some of the dilemmas they have
* Who is who in the network? What can they all offer?
* The role of the person offering the consultation is a neutral role, to provide an outside perspective and to problem solve
* Does this person even need extra support? If so, who would be best placed for this?
* Often the person at the other end just wants us to take on a referral (pass on risk)
!!! Themes
* Defining what the problems are
* Taking a curious stance
* Dialogue between two professionals
* Importance of networks
* Understanding difficulties and strengths
*How we broadcast our intentions as the consultant- structure the conversation
*Use analogy- ripples in the pond- helping the consultee to make sense of the situation and problem solve
!!! Thoughts from wellbeing practitioners -
*Consultations make people feel heard, and like their problems have been recognised
* Good aspect to our service that not a lot of other services have
* Not a clear cut/definitive thing
* It helps the referrer to understand the challenges
!!! Reflections
* Sometimes there is a long time between agreeing the work and then starting the work. Situations for families can change in this time
* Important to be curious, validate their feelings and support them in their own problem solving ability.
* Use the method of marking the task, and coming back to this at the end.
* When you notice that someone has come along with a different idea to how the consultation will go/what will come out of it, how do you redefine the conversation?
* There can be an expectation that you will be able to provide them with an answer they have never heard before/a new solution
* How can I provide help/insight to someone like a social worker with so many more experiences than myself?
!!! Next week - Focus on the practical questions surrounding consultation.
When is it a consultation? When is it something else? Are there different types of consultation?
Clarify our language within the team.
!! 04/02/2021
James provided some definitions of consultations
School consultation -
* Collaborative problem-solving approach
* Emphasis on consultant leading and structuring but holding a balance of power
Sometimes by just validating and listening to the experience of the consultee we can allow themselves to problem solve. By going straight into strategies you often get met with "I've already tried that"
!!! Overlap between assessment and consultation
Assessment -
* Looking at other nuances of complicating factors
* Things can be different to how they appear in consultation
* Look at goals and how to move forward
* Can go on for a few weeks, multi-modal, can use a wide variety of sources and questionnaires
Consultation -
* Finding bare bones and information
* Focused and targeted piece of work
* Shorter piece of work than an assessment
* Ask about network
* One off snapshot of situation
* Nailing down what the help is that is needed
Ideas to draw from other services -
* Support the mentalizing of the worker who is holding the case
* Create reflective and curious space
* Pro-active stance as support to the worker
* Emphasis on working through the existing relationship (rather than overburdening with more new relationships)
* Be careful not to affect any relationships between other networks that are already existing
!!! Reflections
* How do we get schools to recognise consultation as an intervention in itself?
* Use a diagram to illustrate the network?
* People in the network have different ideas about the problem and what they expect from you
* Can use AMBIT disintegration grid to map out different ideas of people in network
* In our referral form the views from the child are often written by the parent/professional so they aren't actually the views of the child
What happens when things change -
* Focus of work changes or more difficult to find focus of work, how do we work around this?
* //It is okay// for the direction of work to change
* Share with network that things have changed
* Put young person at centre (what is working for them)
<<list-links "[tag[Consultations]]">>
<center>{{Capturecon.PNG}}</center>
You can contact us at the AFNCCF by phone or email:
''T: +44 (0)20 7794 2313''
''E: info@annafreud.org''
or, if you have a login, please feel free to leave a ''comment ''on the manual. You will see the comment box at the bottom of each page!
In draft
The key outcomes from the contract.
Process outcomes
1. 100% of accepted referrals will have a consultation from one of the team. This will usually be done by phone.
2. 100% of referrals to be accepted. This is not possible or good practice as some referrals need to be directed to other services. For example child protection referrals or referrals of young people with sever mental health problems.
Wellbeing Outcomes
1. 70% of children, young people or parents to show improvement for the mental health need that they sought help for.
Generally, 50-60% of children show some improvement. 25-30% of children show no change. 5-10% get worse. To be discussed with commissioners.
We are developing a 6 - 8 session group for children and young people (YP) with mild / moderate behavioural and emotional needs.
At current, 9 YP have been identified for the group (8 who are care leavers, post-18, and 1 who is a looked after child, under-18).
The hope is to run the group face to face in the summer term (from 19th April), over an 8-week period. There will be a pre- and post- screen for participants to fill out outcome measures. This will make the group 10 sessions in total.
__Initial Tasks__
*Send email to keyworkers of YP who have been identified for the group to book in consultations
*Hold mini consultations with keyworkers of YP who have been identified for the group
**Ages of YP
**Learning needs - Cognitive reports
**How engaged in education are they? If they are?
**First language
**Who is in their network, and who would be important for us to feedback to?
**What change would they like to see in their YP or what change do they think that the YP would want?
*Connect others who work within learning disabilities, and see if they have any previous experiences of delivering groups and if so what was helpful / not.
__Ideas for what the group will aim to cover__
*Maintaining relationships - Social Communication
*Sense of belonging
*Self-esteem
*Life Skills
*Transitions
__Timeline / Steps of setting up Group__
*Initial Calls
*Connecting with others who work within LD
*Think about the actual content of the group
*Leaflet
*Referrals
*SDQ Goals
*Set up running of group (From April 19th 2021)
Pre-group meetings - do with YP
-Empowered and responsibility
-Go to meetings with structure
-Do a bit of explaining
-Structure their thinking around
-'If you talked about independence... what do you think about'
-We were thinking of doing this
Structure to build the group around
Friends - Classroom in
!!''AMBIT Core Features ''
''These are:''
* The five key elements of AMBIT practice (inner ring and centre of the AMBIT wheel)
* The eight elements of the AMBIT stance (outer ring of the AMBIT wheel)
* illustrated by the AMBIT Wheel
!!''The AMBIT Wheel''
<center>{{AMBIT wheel 2014_SMALL.png}}</center>
''Please scroll down for videos explaining the Core features''
!!''AMBIT Basic Practice (inner 5 sections of wheel)''
These aspects are key areas of practice and service delivery for an AMBIT-influenced team: if they were missing or not held in some kind of balance, this would imply that what is being delivered is not AMBIT. The practice of [[Mentalization]] is at the centre of the model. This is like the '''load bearing axle''' or '''hub''' of the model, as it underpins practice in each of the 4 quadrants around it.
#[[Mentalization]]
#[[Working with Your Client]]
#[[Working with Your Team]]
#[[Working with Your Networks]]
#[[Learning at Work]]
In AMBIT we emphasise the importance of a balance of activity across these areas of basic practice. We stress that each are important. However, it is sometimes inevitable that workers, teams and services can lose sight of any of these areas, given the complexity and intensity within which AMBIT influenced teams often work. It is also difficult to keep all of these in mind at the same time! For this reason the AMBIT wheel acts as a way of supporting services to hold onto and develop these key areas of basic practice.
AMBIT is not a one-size-fits-all approach, it works to help teams adapt the model, ideas and tools within each area of basic practice, to fit their own contexts and client groups.
!!''AMBIT Basic Stance (outer ring of wheel)''
''8 elements of a basic stance:'' These define the core "stance" of an AMBIT practitioner in their work - the stance describes the "way of being-with", or approaching work within each area of basic practice.
The stance elements are arranged in pairs, with one pair fitting into an area of basic practice.
Each pair of stance elements highlights points that can easily be experienced by workers as contradictory. In other words, points whereby workers and teams can experience a kind of 'tension' or 'push-pull' which can need balancing.
These stance points can be seen as "grab-rails", a way of keeping or regaining balance. They aim to help keep an individual or team 'on track' - especially when the situation is stressful, risky, or simply uncertain.
At times of high anxiety or confusion it is easy to find that one element of the stance has come to dominate, sometimes at the cost of losing other principles that would help if re-activated. //At any time we can ask a colleague, or ourselves, ''"am I holding the basic stance?"''//
# [[Individual keyworker relationship|KeyWorker]]
# [[Keyworker well-connected to wider team]]
# [[Working in Multiple Domains]]
# [[Taking Responsibility for Integration]]
# [[Scaffolding Existing Relationships]]
# [[Managing Risk]]
# [[Respect Local Practice and Expertise]]
# [[Respect for Evidence]]
!!''Practise makes perfect''
As a way of checking whether we are holding onto the AMBIT stance points, there is a questionnaire AMBIT Practice Audit Tool (APrAT). This is used to audit a specific case (perhaps with your supervisor) in relation to the AMBIT stance points.
Here also are a set of AMBIT Stance Exercises to help teams to practise the stance.
!!''A Very Brief Overviews of the Core Features''
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<<list-links "[tag[Core Skills]]">>
__''Portfolios''__
We looked through an example of a portfolio that was made for a young person to capture the work that they had done in their sessions.
__Format__
* Letter to young person to introduce the portfolio
* Overview of "assessment process" (i.e. AIM cards) and goals set
*Summary of work undertaken towards each goal
*Closing letter - to say goodbye
__Reflections from the portfolio__
* A helpful way of sharing the key ideas from the work
* Liked the emphasis on supporting the young person to develop their own ideas about what might be useful to try (rather than being an expert and giving strategies/ideas that may not work for them)
* Helpful to see how balance was held between following a plan, but making it personalised (e.g. using young person's interests)
* Useful that a trusted person from the network was brought in early on, referred to in the portfolio and that the portfolio was shared with them.
* Portfolios would help the likelihood of change sustaining post-intervention, as would give others in the network an idea about what to continue helping the young person with
__Ideas arising__
* How could we make our own wellbeing journals/workbooks for young people?
*Could we make a template that we could adapt?
*What resources/worksheets could we create that we could then include as relevant according to the young person's needs?
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See a readable summary of the terms of this license [[here|https://creativecommons.org/licenses/by-nc-sa/4.0/]]
!! To cover with team:
''Data: 2pm-2:45''
*what we need from from them data wise - direct, indirect and when we need this by
*new spreadsheet - presenting need and focus of work
*POD data when we need this
''Review of service: 3:00-3:30''
Spilt into two groups
*think about successes/ challenges over the last year
*What we need to keep same and what we need to change for next year
!!Groups:
# AS, CHe, Cha,
# JP, EJ, CL, RS
Data:
* Direct and indirect sessions, accurate in what counts as an email.
* Same spreadsheet used previously.
* Pod data: make sure SDQ, GBO, RCADS, SRS are up to date by the 30th September.
* Reporting period is from 1st July to 30th September.
* * Direct sessions are only with a parent and/or child. Indirect is with anyone else.
* The last day of data collection is 30th September. If your first day of work is the 30th September, then make sure data is entered the previous week.
!!Questions regarding data:
* ''When we work with LAC, who counts as direct and indirect?''
**direct: parents, Foster carers and young people.
**indirect: a key worker or another professional who are involved in the network would **There may be times you speak with a parent quickly to check in how things are going, that should be recorded as a well-being review.
*''what is a well-being review?''
**a type of direct session
**quick general check in
** Some of us can't work with the established goals or engage in the services they wanted to, so it is to check in how things are going.
** troubleshooting, if they managed to get to school well, and if they managed to do the homework you provided.
* ''Are all calls are recorded as sessions? ''
** not necessarily - could be to book in time for a session
* ''If you do not have an SRS and GBO, is that considered a session? ''
**Sessions do not have to have outcome measures to be counted as a session.
**The first direct sessions does not have to have necessarily goals established if you cannot identify them yet. Despite not having established goals yet, these conversations are still considered direct sessions.
* ''When do emails count?''
**indirect: to professionals
**direct: to parents/ CYP
** Emails do not count as another contact if they are summarising a conversation that has been had over the phone.
** It does not count if it is an email arranging contact with the family.
**it does count if you are phoning a social worker to find out more about the current problems
**Individual emails do not count, emails chains regarding a specific topic or information counts as 1.
**If you have an email chain with social care and school, that counts as one indirect session.
**An email to two different professionals, and then two phone calls about the same topic to different professionals, it is considered one indirect session.
**If we summarise the feedback in an email after a phone call, we do not record that, it is still one session.
* ''what if you split the session into two over the same week? ''
**If it is about the same intervention/ topic then it is one session but if its more than 1 intervention then it is considered 2 sessions.
* ''When a consultation is done, and you have different conversations with people, how does it count? ''
**That counts as 1 session.
* ''How do we count text messages?''
** They could disclose something risky over text message
** Difficult to maintain boundaries - some will only use text messages and will reply when suits them
** Some people are using text messages as main form of communication
** Difficult to decide what this counts as, session or well-being review? There is an element of relationship building, but goals have not been decided yet.
** Discussing how they feel, what are bad feelings etc. - this sounds like an intervention.
** Can count as a well-being review or a session based on the content of the text messages
!!Review of service:
* Clinician goals.
* LAC/Complex cases reporting.
!!What is here?
This is an introduction to this important concept, that sits at the heart of the AMBIT approach to [[Learning at Work]], which is part of the [[Core Features of AMBIT]].
!!AMBIT emphasises learning
Implementation science suggests that embedding research evidence in our day to day practice is a challenge.
There is also limited research evidence for what works with clients typically seen by AMBIT-influenced teams.
''Therefore we need to learn as much from our local experience as from the existing evidence.''
//''So how do we create organisations that genuinly learn together from their experiences, so they can adapt and work more effectively ?''//
AMBIT's ideas in this area are influenced by the work of Prof Peter Senge (Harvard Business School) - whose book "The Fifth Discipline" about learning organisations applies systemic thinking to the work environment.
Senge proposes that successful organisations are those which have the capacity for adaptation and learning. He emphasises that learning ''collectively'' as a group is at the core of this.
It advocates that teams:
*Fimd ways to promote the conditions that encourage team learning
*Develop shared mental models (ways of thinking about their practice) that underpin their work.
* In order to do that above, and for for learning and change, there needs to be a balance between 'enquiry' (about others' ideas) and 'advocacy' (being explicit about your own ideas). These need to be balanced NB this fits closely with [[Mentalization]]
*Learning needs to be given an explicit place in the everyday routine work of every team, with a focus on teams better understanding:
1.How they do things
2.Why they do things that they
3.How they could do things even better
''In AMBIT Manualizing is a vehicle to support this kind of team learning. Over time a team’s local version of the manual comes to represent the collective thinking and learning of the team.''
Please see here for a very brief overview by Peter Senge of some of the key themes of his work.
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Please see here for a video of Peter Fuggle discussing: 'Is the concept of a Learning Organisation useful in AMBIT?' (AMBIT conference 2013)
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In summary, the reasons for encouraging AMBIT teams to consider the ideas of Learning Organisations are:-
*To connect teams to some of the evidence base around organisational practice
*To emphasise that team functioning is a core aspect of AMBIT and will be affected by organisational factors
*To help teams consider their own values around learning
*To help teams think about conditions that promote openness to learning and barriers to learning in their contexts
*To highlight that many of these ideas over lap with [[Mentalization]] and that mentalization itself is an important part of a learning e.g. why do we do it like this and not this? What is it about our team that means we do things this way and not that way?
* What are the key dilemmas to cover in the next 4 weeks?
* Teenagers who previously struggled to engage in school and had attendance issues. It may present a problem if they have to go back to school now. Also children who used to have challenging behaviour at school.
* Parenting evidence based interventions for ADHD issues, in terms of supporting home and school, Adapt interventions to ADHD and practical ideas. Are there particular models that have been tested? Eg. focus on praise, communicate effectively. But it is important to have clear adaptions.
* How to help parents manage their time when there are other siblings in the room, eg. giving quality time.
* Self emotional regulation interventions, more specialised to each child's needs.
* relationship between home and school. When school and home have different ideas about their perception on behaviours.
* Have a shared drive or use the wiki to put the resources we use. Share the resources with each other.
* Someone can bring a case with questions, and invite the group to train each other and share their ideas. Applying theory to the actual case. We can do this according to the topic of the week.
* Do a session about ASD, ADHD, parenting relationships. More knowledge based and have discussions together about it.
* Go over anger work, emotional regulation, motivational interviewing, working with separation anxiety, working with parents and their relationships difficulties they have with their children and the children's school. Working with parents to support emotional regulation, self harm, work on self-esteem.
* How can we structure this?
1. One brings a case of emotional regulation. We can start by presenting the ideas to do with emotional regulation and what do we know related to the topic. Eg: what is emotional regulation, what ways are there to help parents regulate emotions, what other ways you can apply ideas for emotional regulation. Present the case and what has been done which has worked. Tie this with a specific issues you have encountered.
2. Invite more ideas to learn from each other.
* For next week each one can bring their own ideas about what they have worked on regarding self-esteem.
! Ideas to hold in mind when working with parents
!
''Parents who do not want to be involved in sessions''
It is helpful to think about how parents/carers can be involved in our work. Ideally we do not want to be setting up separate relationships with children and young people that their parents have no involvement in. Keeping linked into the child or young person's network helps to increase the likelihood of creating sustainable change. We can also miss out on important parts of the picture and perspectives if we do not try to include parents in our work.
Some points to consider:
**how can we understand parents' thinking behind not wanting to be involved or wanting someone else to "solve the problem" and how can we validate this to show that we can see why this perspective makes sense?
**when we feel that parents feel understood/recognised by us, how can we broadcast our own thinking about why we think it might be helpful to have them involved?
**helpful to broadcast //positive// reasons for parental involvement - they know the child the best; they might have ideas about what will/won't work; they will be around to support the YP during the week; you want to help them feel more able to understand/respond to the YP, rather than it being reliant on the worker, who will only be around for a short-time. Some parents may be sensitive to feeling judged or blamed, so we should be clear to avoid misunderstandings by naming things like having them involved is not about it being their fault, them being the problem etc. Generally the more people who are involved, the easier it can be to come up with ideas about what can help!
**having parents join for beginning or end of sessions can be helpful, so that worker and YP can share what they have been talking about and anything that can be tried out during the week before the next session
**workers could offer to update parents after sessions through a text/phonecall
**workers could collaboratively agree with the parent the plan for the session with the YP together - i.e. is there anything you'd like me to focus on this week?
''When parents are sharing negative feelings/thoughts about the child with us''
We want to respond to this in a way that is helpful to the parent, but does not collude or reinforce their view. How can we offer the parent a sense of feeling understood and mentalized? We can use our OARS/active listening skills to respond:
-//What is it that's making you feel like that?//
- //Can you give me an example of something that's happened that has left you feeling this way?//
- //I can see that being sworn at would make you feel completely disrespected and like he doesn't care.//
-//Its hard to remain calm and patient when you're not being listened to//.
- //Things are pretty stressful with him at the moment//
It might feel appropriate to move the conversation into acknowledging that it sounds stressful for //both// people, i.e. the parent and the child
- //Arguments are pretty stressful all round//
-//It doesn't sound like this situation was nice for either of you - there were things you were both unhappy about//
- //You both got quite worked up//
- //I'm really sorry that you both had such a difficult evening//
If you notice that the parent is calming or appearing to feel that you are understanding them well, you may feel that it is appropriate to move into exploring the young person's perspective, although this should be done very carefully as doing so prematurely may feel quite invalidating to the parent. Acknowledging that it might be helpful to see if we could understand why this happened or where the child might have been coming from, to help us work out the best way to respond can be a useful way of testing the waters before asking anything directly. Parents will not be able to mentalize their child or be able to make guesses about what might be going on behind their behaviour if they are feeling too emotional, so it might be about marking this as something to come back or offering to make enquiries with the YP in your next session.
Some relevant questions when the moment seems right could be:
- //did you have any ideas about what was going on for him that made him do that?//
-//what do you think was behind that?//
- //it seems to hard to understand why someone might do that. Do you have any ideas about what might have been going on for her?//
-//what do you think he might be meaning or trying to communicate when he does that?//
<center>{{Grid Pic.jpg}}</center>
The Dis-integration Grid is a downloadable tool for exploring and planning how to go about [[Addressing Dis-integration]] in the wider network.
This tool supports the worker (and client or family member) to [[Mentalize|Mentalization]] the different parts of the wider network of support.
It supports two particular elements from the stance of the ''Core Features of AMBIT'':
[[Respect Local Practice and Expertise]]
and
[[Taking Responsibility for Integration]]
!!''The Dis-integration grid:''
You can download this as a PDF file from [[here|https://docs.google.com/file/d/0B5h_CVBdhJPYOEpMRXZJd3E5V3M/edit?usp=sharing]]
{{Dgrid.png}}
!!''Using the grid''
The dis-integration grid is the basis of a simple brief exercise to
map out the understandings of everyone’s perspectives within a particular network around a client.
The worker does not require a proper form and might, for instance, draw up a grid on "the back of an envelope" during a meeting.
The grid invites the practitioner to map out and to ''Mentalize'' the network.
Firstly, we name the key people around the client (The network should include parent/carer). Secondly we use the grid to consider where are the areas of agreement and disagreement within the network?
We do this by asking ''three questions from the perspective of each person in the network''. This is the workers'//best guess//
of what //they think others think//.
The three questions are:
# ''What is the problem?'' (why is it happening?) - Looking for difference/dis-integration around the explanations/theories people hold
# ''What to do?'' (what could help this problem?) - Looking for dis-integration/difference around practice
# ''Who does what?'' (who should be helping with this problem or possible solution?) - Looking for disintegrations/differences in the wider system around understandings of people's responsibilities
NB Sometimes we realise we don’t actually know the
answer in some of these areas, which can be helpful to identify in itself.
!!''Finding the Connecting Conversations''
When filling in the grid, the keyworker will particularly be asking themselves...
*Where are the 'sticking points' in the network?
*Who may need to talk to whom and about what?
*Which parts of this picture can I influence, even if only a little?
So, the point of systematically mentalizing the different positions in a network is to spot the crucial few ''key conversations'' that need to occur between different parties within a care network in order to reduce dis-integration and increase integration where we can.
We call these ''Connecting Conversations''
So, having completed the grid, the keyworker considers:
#What ''Connecting Conversations'' (probably no more than two) might help the network to work better?
#What could I do to //facilitate// such conversations - so as to maximise the likelihood of improved understanding of roles and responsibilities?
!!''Additional information''
Please see [[Addressing Dis-integration]] for more explanation of the problem that this "back of an envelope" tool is designed to address.
This 2-part video gives a 40 min explanation on Addressing Dis-integration and using the Disintegration grid
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!!''Feedback from AMBIT-influenced teams (2014)''
>>"Disintegration grid has really helped in working with partner agencies and ensuring we identify when there are differing goals in the network. Also has helped greatly in understanding viewpoint of young person and family."
>>"Disintegration grid has been v useful. We are developing a network protocol to help us recognise familiar situations and to have a written aide memoir of things to do and consider."
This page provides you with a list of all the pages that are relevant to the AMBIT Training. You may come across some broken links as these pages have been copied across the AMBIT manual - bear with us while we try to sort through these!
<<list-links "[tag[TrainingCore]tag[TrainingCore]]">>
[[EMHP Wiki|https://manuals.annafreud.org/emhp/]]
! What is this page about?
These are some of our ideas about how to support families with home schooling during the period of lockdown.
''School work: mentalizing the parents' perspective''
Be curious and respectful in relation to parents' stance on school work at the current time. Check out what the arrangements are from the child's school with respect to getting on with work and the parents' view on how they want to respond to this. Some parents may feel that it is possible/helpful to them to have a set structure throughout the day; other parents may be prioritising things differently around work etc. Think about the balance of children being able to access some learning and educational opportunities through the day and consider how link up could happen with CYP's school if you feel that it would be helpful to think with them about how best the child's education should be supported at the current time.
!Questions to explore with parents
* What have the school set? What are the arrangements?
* What are you idea about what your child should be doing around education?
*What's the current communication between school and home, both with parent and child?
*Is there anything school could help with from the parents' or CYPs' perspective?
*Do parents need any support with education? Which parts do they feel they are able to manage? Are there parts they would like more help with?
*How could we involve the network in supporting schooling? It might be helpful to draw on others outside the home for remote support, ideas, to do some learning activities with children. Other parents might provide good moral support. Children might be able to work together with other children over the internet or work on things to then do "show and tell" with each other when they've finished etc. Remember to enquire about:
**Family members
**Older siblings
** Family friends
** school friends
**parents of school friends
! Ideas to help make school work more fun:
There might be lots of ways that parents could help to make the work more manageable for CYP. Not all of these would work for all children!
*Mixing up school work with things that are more fun!
*Visual timetable (CYP could design it)
*Put it in shorter chunks of time
* Sticker charts for progress
*Making certificates each week
* Praise board - sticking up notes/messages somewhere visible in the house to show positive feedback about how children in the house are doing with their learning
*Making a space for learning in the home (any ways that the child could personalise this, maybe make a sign to say "School time, do not disturb etc)
* Could they have a toy to keep them company? Could they set some work for their toy as well?
! Mentalizing the child/young person's perspective
How might they be feeling about the change for schooling?
!Other considerations:
*Some children might be missing school and their friends
*Help people to remember that home schooling isn't forever
*Helping boost confidence for those that it might feel harder to learn at home rather than in school environment (they might be getting less tailored help)
*remembering that parents might be feeling deskilled or unable to do it enquire what do they feel able to do.
*Could consider sharing with families ideas from online.
* Eligibility criteria will need to be different for the Wellbeing and Targeted Services
! Wellbeing Service
will be based on specific problems - mild to moderate difficulties with low mood, anxiety and behaviour. Less professional involvement. The problem may have a mild impact on functioning. Referrals likely to be received from self/parent/schools
!!Possible inclusion criteria:
# A parent or young person who is actively wanting help (not just a referrer identifying the problem but the parents/YP themselves)
# A parent who actively supports the process of help seeking for the young person.
# Some likelihood that the problem started within the last six months.
# Some indication that the problem is not part of multiple problems.
# The severity of the problem may be defined using a standardised questionnaire.
# A range of scores on the Parent SDQ could be agreed. So cases falling within the SDQ high range (the third highest of Goodman's four category model). Using this four band classification, we could take an Parent SDQ in the high range (emotional score 5-6: conduct score 4-5) as indicating a moderate level of severity.
#Similarly we could take an agreed cut off score on the RCADS.
# In practice, local services are likely to agree a combination of the above.
!!Possible Exclusion criteria:
# Evidence that problems have been around for over six months.
# Evidence of high level of family dysfunction and family conflict.
# Evidence of multiple problems.
# Extreme risk
# If engaged in other work, then may not be able to focus fully on the intervention
!Targeted Service
will be children and young people that fall in to one of the vulnerable groups. They may not need a direct intervention. The network around the child may need an consultation.
<<list-links "[tag[Emotion Regulation]]">>
''What might Emotion Regulation difficulties look like?''
* Externalising behaviour: aggression and violence towards others.
* Hard to label emotions.
* Hard to talk about emotions.
* Not being able to express how they feel using words.
* Might be hard to focus on tasks.
* Could be living in chaotic/stressful circumstances- children might be finding it hard to make sense of things going on around them.
* Impacting on their relationships – fallings out, conflict.
* Not being able to respond to people appropriately.
* Not being able to show emotions in an age appropriate way.
* Big feelings, but might not be seeing the other emotions that might be going on – either because they are getting misattributed by adults as anger or because children might not feel safe to express particular feelings (e.g. worry, sadness etc).
''What might be like for these children who struggle with emotion regulation?''
* Might be lots of negative interactions.
* People reacting to them in less helpful ways.
* Becoming isolated or not much space to talk/share with others.
* Might be not be being responded to with empathy and connection – underlying needs might be the same as a children who is withdrawn, but the child may attract less sympathy/understanding, rather a focus on their behaviour
* Might feel unable to control their behaviour easily, might feel powerless.
* Might feel that their point of view isn’t heard or asked for.
* So much focus on behaviour, that people might not sit down and explore much with them about how they feel.
* Misattributions around intentions – framed as doing things deliberately, on purpose, to wind people up, etc.
''How do children develop emotion regulation skills?''
* Through interactions with people around them – ie. Parents/carers are initially very important, but other adults can be influential too.
* When parents can make sense of what the child is thinking and feeling.
* Parents that help the child to manage their feelings and have sensitive responding. Then the child moves to being able to manage the feelings more independently.
* Having family members who help us by labelling/guessing how we might be feeling; using emotional labels about self/others.
* Family relationships where a range of emotions are expressed and examples of how these feelings get managed and resolved and how we can move on from them.
* Sensitive responding – parents being curious, empathic, trying to understand things from the child’s perspective.
* Modelling how conflict gets resolved.
* Teaching moment vs. discipline moment – trying to make sense of behaviour, rather than giving reaction.
* Setting appropriate boundaries and limits in an appropriate way.
* Adults might forget to think about the behaviour as being something that you might not yet have mastered or know how to manage independently.
* People might be responding in ways that are not attuned to the YP’s stage of development, so they are missing opportunities to do it.
* Might find it hard to use their parents for help (looking at circle of security).
''Parental/Family Factors
''
* Gender stereotypes – what families might expect of boys/girls.
* Culture – how are feelings talked about/expressed in the family?
''
Emotion regulation: questions to build an understanding''
* What are the current behaviours? What do they look like? Give an example? Explore onset, frequency, duration.
* How does it look at home, school?
* What does a good day look like?
* How often do they become dysregulated?
* Has it always been like this? When did it start?
* What helps them to calm down? How does it usually end?
* What do they do/do you notice when they are feeling x?
* What feelings are particularly problematic? What do they not notice much of?
* What do you notice about how it starts? What are the triggers?
* How do the other children respond? What’s the impact on others around the child?
* What are the relationships like? Siblings, who is it better or worse with?
* What are the rules/boundaries at home/school? How are these being communicated?
* What are the current strategies to manage the behaviour in the classroom?
* How are emotions spoken/shown about about in the family?
* What kinds of things prevent from happening or help?
* Are there things that make it worse or more likely to happen?
* Do parents/adults have a sense of what is going on behind the feelings?
* Is there anything going on that might have made them feel angry?
* What’s it like for you when that’s going on? I can imagine it would be hard to stay calm!
* Developmental history.
''Intervention Ideas''
* Play/creative methods can be useful to explore and intervene (What feelings do children know? Which ones come to visit them (at home, at school, with friends etc)?
* Using feelings cards – which one is this? How do people show this? What does someone look like when they feel this? What kinds of things might make someone feel this? Can you think of a time when you felt like this? Someone you know felt like this?
* Feelings charades – acting out what the feelings look like and having to guess.
* Using scenarios – give a picture/scenario and asking what the people involved might be feeling and why. Again using questions to link back to their experiences (have you felt like this?)
* Feelings backpack – which ones do they carry around, which ones weigh them down?
* How we manage different feelings: Understanding what might trigger them – what kinds of things make you feel x?
* What helps – what do you do, what do other people do that helps when you’re feeling x?
* Ideas of what might help – which have they tried, could they try, which have/haven’t previously helped.
* Using hot cross bun to explore the experience of a feeling in detail, in terms of accompanying thoughts, behaviours and body sessions.
* Metaphors like anger thermometer, volcano, racing car etc to explore the experience of the onset of the feeling – gradual, sudden, how can we spot the signs its coming and what could we do at different points before it boils over, gets too hot etc etc.
* Acting out stories/scenarios with the Lego people or toys to help explore situations, feelings, perspectives, behaviour and different endings – how people could have helped each other to make a different ending.
* When you’re like this, let’s pretend this one is your parent/carer, what can they do to help you? What doesn’t help etc.
''What might emotion regulation difficulties look like?''
* Externalising behaviour: aggression and violence towards others.
* Feelings of denial and resistance in last session.
* Perhaps many things will come up in the ending, finding more difficult to wrap things up. Maybe it is better to have a last session with the child and parent, to manage their feelings about the ending in a better way and for the parent to see how the child is managing the ending.
* Things can come out because of the ending, maybe young people panic it is the last session or because they know they will not be able to get into it as it is the last one.
* Some young people may project rejecting feelings into you, leaving you with all difficult feelings.
* Difficult endings when there is pressure from the rest of the system to carry on and becomes difficult to hold your own line and being firm about what you need to do, being realistic about the amount of sessions provided. Particularly when you are the good object in their perspective.
* Adolescents with higher needs: try to set relationships with people that were already working with them, those relationships can be left in a better state when you finish working with the adolescent.
* The end is also in the beginning: being clear about the amount of the sessions and the ending is hold in mind from the outset of the work.
* Prompt to express and name with your client how it is like to get to the end.
* It can be difficult to put the boundaries and to decide the end but authority is important too.
* Who can adolescents speak to if you are not there? Do the scaffolding relationships, improving connections in the network. What can you do if the young person says he/she does not want to speak to anybody else except you? Do pros and cons, do motivational interviewing that may influence that.
* Things that went well in ending sessions: portfolio, do a belcro for him to do activities to share things he does with parents. Have a final session, acknowledging things that went well and things that did not go well and why they didn't, and what will they do to reach those goals when you are not working with them.
* do a reflective task: reflected all the good things about working with the young person. What we would have done differently if it was face to face? Also acknowledging difficulties.
* Have a TAC meeting before the ending or send an email, to have everyone together to know what you have done with the young person and to support them how they can carry on. Leave the network with a clear idea of what has been done and what they can do next to be supportive.
! Building and sustaining engagement when working remotely
We want to capture our ideas about how we are approaching this, as we move to online/telephone working
! Paying attention to the space/structure
*Can the CYP talk freely in the space that they are in?
*Is it helpful to have the same time each week?
* Shortening the session according to what feels manageable for the YP (shorter sessions may help with concentration)
! Skills and stance
* Showing ''empathy'' about their situation - really trying to understand how things are for them at the moment. Acknowledging the difficulties that they might be raising (e.g. conflicts at home, boredom etc) and validating it
*''Sensitive attunement'' - getting the right balance between paying attention/inviting discussion about things that are important to them at the moment, rather than starting with things that might be important to us
*Being aware that we might need to spend a little longer ''building the relationship'' particularly when its people who we haven't met before.
! Practical ideas and activities
Which of these are helpful will depend on the age and stage of the child.
*Asking the YP to give you a virtual tour of their house and/or introduce you to family members
* Encourage them to draw while we were meeting and then the YP could show me (e.g. if they are struggling to sit down)
* Comment on something they are doing (e.g. eating cereal - what's their favourite etc?)
*Thinking with CYP about keeping a ''diary/record'' of things that have happened during the week so that they have something to refer to during the session
*Giving the parent enough space to ''mentalize'' their own perspective/position about the current situation, before expecting them to be able to mentalize their CYP's position.
*''Playing games'' - playing connect-4! Worker had a connect-4 set. YP was talking about what was on his mind as the game was being played.
* Asking the YP to show you drawings, their favourite game, something they like
* Kick ups - find a ball, ask YP to see how many kick ups they can do; how many they do determines which question they answer on the list of "getting to know you questions".
* Jenga - online version? Online spinners with getting to know you questions?.
*rolling a dice - number relates to a question.
*Physical activity challenges through the sessions to help provide movement breaks - roll the dice and see what the activity is (star jumps; lap of the house) - helps with regulation and concentration and also to support YP to start to notice when they need to have a movement break
*sentence starters/completion - could make a quiz out of those
*Setting ''tasks'' between sessions - asking child to draw a picture of something he's done during the week each day that he can then show during the sessions. Could then talk about "how were you feeling? when you were doing this?". This can help motivate them or build a connection to the next session
! Ideas for adolescents
*Quiz?
* Chatting about their week - what have they been doing?
*Might be easier than playing a game
! Barriers
__YP cancelling sessions__
Different options:
- Could just defer to the next scheduled session
- Could offer a shorter check in at an alternative time if this can be accommodated (perhaps especially if this is near the beginning, where you might be trying to build the relationship)
- Could have an explicit conversation to check whether the current arrangements are working or could be changed to suit the YP's circumstances better - what was the reason for the cancellation etc?
__Practical barriers - e.g. phone broken, no access to iPad, battery too low!!!__
-Send a reminder text/message (with enough notice!)
- Pre-empting technology problems or other practical problems - make sure your phone is charged and you've got a room etc
- Agree an alternative method; do some problem solving.
- YP could put the appt in their phone calendar or set an alarm to remind them
-Being persistent and problem-solve
__When YP don't want to use video, which makes it harder to pick up on non-verbal cues__
*Remembering that you can't see each other! Making your reactions verbal, as they won't be able to see you nodding etc. Might need to do more verbal cues that you are listening (e.g. mmm, ok, etc)
*If want to show the YP something - "I would like to put my camera on a bit so that I can show you something - you don't have to put yours on or you could put a sticker over it so I can't see"
* You always offer to show your face even if they don't want to use video
*Could use video for some of the session if that would feel manageable
*Be mindful that the camera could be a barrier in itself - e.g. might make a shy YP feel less confident
__Worker not being clear of the plan/ideas of how to engage them over the phone (i.e. in Active Planning terms the plan is not clear in our own minds!)__
*Talk to our supervisor to make sure we have specific plans for each of our clients
*Have more team discussions about how to adapt the resources that we have for remote working
* Ask the client (CYP or parent)
<center>{{Epistemic Trust image.jpg}}</center>
!!What is it?
''Epistemic'' (the greek word for //knowledge//, or //the roots of knowledge//) ''Trust'' refers to the specific kind of trust required by someone to allow learning to take place by one person from another person.
In other words, the kind of trust needed to learn //through// a relationship.
This concept is linked closely with the idea of the relationship to help, which conceptualises how a client may experience and relate to those attempting to offer help.
Epistemic trust describes a state in which the person who is the //learner// holds a sense of trust that what is being offered by the //teacher// has social value to them// i.e. a sense of trust that this information is meaningful and relevant //''for me''.
Epistemic trust is triggered by the experience that the person who is in the //teacher// position (known as the 'pedagogical stance') has authentically connected and understood the crucial things about the //learner// - not about people in general, but about ''__me in particular__'': the sense that "you have noticed and understood what it is like to be me, here, now, in THIS predicament."
''What this refers to, then, is the experience that a //teacher// has accurately [[Mentalized|Mentalization]] the //learner//.''
*It is this experience of //being mentalized// and feeling understood, that opens up a state of epistemic trust necessary to receive and learn new social knowledge. This knowledge then has the potential to change our perception of ourselves or the social world
* This is thought to be an //evolved mechanism// for helping humans to take on complex social learning from safe sources...//"When I saw in your eyes that you had accepted me, ''understood me'', right here, right now, it was as if the door opened and I was interested in what you had to say..."//
Below is an animated sequence briefly representing the concept of Epistemic Trust.
<html><iframe width="480" height="360" src="https://www.youtube.com/embed/5PabhW_8JoY?rel=0" frameborder="0" allowfullscreen></iframe></html>
It is possible to see how this kind of trust is important in the process of learning through many different types of relationships e.g. a student and teacher, a client and therapist, a parent/carer and child etc.
But, whilst the learning that goes on through one specific relationship can of course be very important, it is thought that there is a broader and more general benefit that may come from the creation of epistemic trust. ''This is the ability to generalize epistemic trust to other relationships and situations, which then open the capacity to continue learning about the social world in other contexts.'' e.g. outside of the therapy relationship.
!!What is the relevance to AMBIT?
Epistemic trust is a crucial concept in AMBIT ultimately because we want to support people to learn and move forward in life. However, many of the clients with whom AMBIT influenced teams work, can be in a state of being 'closed off to new learning' (known as epistemic hypervigilance) This means that adapting or changing based on new information is very hard. This may often be for good reason- that past experiences of relationships may not have been helpful or entirely trustworthy, hence it is adaptive //not// to trust what comes from relationships.
So, a key challenge for AMBIT influenced teams is the creation of epistemic trust between a client and a member (or members) of their helping network so that new learning can take place. Much of AMBIT focusses around how a team around the worker can //support// a Key worker to do this. However, in AMBIT we emphasise that 'workers' energy must be balanced between developing that crucial keyworker relationship, and, conversely, ensuring that there is a [[Keyworker well-connected to wider team]]'' - AMBIT is not individual therapeutic work, but using a team to support individual helping relationships.
<html><iframe width="560" height="315" src="https://www.youtube.com/embed/ZBeEOkwLToM" frameborder="0" allowfullscreen></iframe></html>
Below is a video clip of Prof Fonagy explaining this concept in 15 minutes.
<html><iframe width="640" height="360" src="https://www.youtube.com/embed/X1TBqEJMe3k?rel=0" frameborder="0" allowfullscreen></iframe></html>
This theory derives from experimental work by Gyorgy Gergely, Gergely Csibra and colleagues. You can find a link to a key academic paper by the authors titled ''The social construction of the subjective self''.
*YP wants help to manage his anger. Parent wants the YP to manage their anger better
* To help parent manage child's behaviour (angry outbursts) - how to prevent situations from escalating to that point
* To increase stucture, routine, boundaries
*Parent asking for their CYP to have different ways to put their feelings into words
We would like to write a page to reflect on our experiences of practicing in a culturally-sensitive way, so that we can ensure we maintain this focus in the new service
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
* Something that you might do near the beginning, to help you pull together information about a young person
*There are different approaches to formulation, depending on model
** CBT - might be focused on understanding how people's perception of events (thoughts, beliefs etc) might be contributing to their emotional distress and unhelpful patterns of behaviour.
** Systemic - deconstructing problems and understanding patterns. How does the problem fit in context. Attempted solutions to problems keep the problem going
* A formulation is a hypothesis or set of hypotheses - its a best guess and can always be changed/revised.
* Formulation is ideally a collaborative thing
*5Ps approach to formulation - a broader way of formulating.
**Presenting Problem
**Predisposing factors - things that has made them vulnerable to having this problem (early experiences)
**Precipitating factors - triggering events, more recent things that have happened (around the time of onset)
**Perpetuating factors - things that keep the problem going in the here-and-now
**Protective factors - things that are going well, that might be going well, resilience factors,
* Aim of formulation - to come to shared understanding of the problem
* Can you do another formulation at the end to see if anything has changed?
!!!''Summary of the Green Paper''
This summary is provided by the ~DoE and ~DoH as a short guide to the Green Paper.
{{Audit Age distribution.PNG}}
''1. About the green paper''
This green paper is about what we want to do to help children and young people with their mental health. A green paper is a document where the government states what it wants to do, so that people can tell the government what they think.
In this quick read version of the children and young people’s mental health green paper we explain what changes we want to make. The changes will affect:
*pupils, students and staff at schools and colleges
*specialist mental health services
*families and communities
''2. Plans for schools and the NHS''
2.1 ''A mental health lead in every school and college''
We want every school and college to have a designated lead in mental health by 2025. The designated lead will be a trained member of staff who is responsible for the school’s approach to mental health.
This designated lead will:
*oversee the help the school gives to pupils with mental health problems
*help staff to spot pupils who show signs of mental health problems
*offer advice to staff about mental health
*refer children to specialist services if they need to
The designated leads will be offered training to develop their skills in leading mental health work. We will use the Teaching and Leadership Innovation Fund to look at developing training to build the skills of the designated leads and support them in delivering whole school approaches.
We also plan to ask for people’s views on how children and young people should learn about mental health in school.
2.2 ''Mental health support teams working with schools and colleges''
Mental health support teams will be trained staff linked to groups of schools and colleges. They will offer individual and group help to young people with mild to moderate mental health issues including anxiety, low mood and behavioural difficulties.
The support teams will work with the designated mental health leads and provide a link with more specialist mental health services. This will mean that schools and colleges will find it much easier to contact and work with mental health services.
Mental health support teams will be the link between the NHS and schools. They will work alongside other people who provide mental health support including:
*school nurses
*educational psychologists
*school counsellors
*voluntary and community organisations
*social workers
2.3 ''Shorter waiting times''
The government wants to reduce the time it takes to get treatment from children and young people’s mental health services. Some of the areas with new mental health support teams will try out ways of bringing this time to 4 weeks (quicker for young people who need very urgent help).
2.4 ''Mental health of 16- to 25-year-olds''
We will set up a new national partnership to improve mental health services for young people aged 16 to 25. The partnership will start by deciding which areas to focus on. This might be student mental health, and looking at how universities, colleges, local authorities and health services work together.
3. ''Improving understanding of mental health''
3.1 ''Internet and social media''
We will work with the Children’s Commissioner to explore how social media affects the health of children and young people.
The Chief Medical Officer will produce a report on the impact that technology has on children and young people’s mental health.
3.2 ''Researching how to support families''
We want to know how we can give the best support to families who need more help. We will gather information to look at:
*how parents and carers can bond better with their children, which helps their mental health
*how we can support families where parents or their children have a higher risk of developing a mental health problem
We will use the results of our research to create guidance for local areas about the best parenting programmes. This will help local areas improve the support they give to families and get value for money.
3.3 ''Researching how to prevent mental health problems''
We will bring different mental health experts together to look at how mental health problems can be prevented.
The group of experts will consider the best evidence and look at where we need to do more research on how to prevent mental health problems.
The full Green Paper report and the government responses to the consultation can be found [[here.|https://www.gov.uk/government/consultations/transforming-children-and-young-peoples-mental-health-provision-a-green-paper]]
The service offer of providing group support to unaccompanied minors has had to change to online working.
!!!What hasn't worked well about this group
!!!What has worked well?
!!!What ideas do we have to improve the running of this group.?
*Needs to be held in school time
*Need to have one key contact at school or schools that helps to organise the time for the young people
*Need to organise the support groups by age and by languages spoken - more than 1 non English speaker in one group can become complicated with interpreters.
!!Update on the UM group - tree of life 2020
*patchy engagement
*we feel this is for different reasons; late getting home after school, appropriateness of referral; how much the referral was explained to them before-hand; prior comments- both school and social services/immigration service meetings.
*''Ending letters to be sent''
!!New group- 2021
*to take some of the TRT material - particularly strategies and bereavement
*to make every session a stand alone session within itself so that we are not having to recap
*we will need to consider if the DAlanguages company have any other multi-language
*pre-referral meeting - to screen them before the referrals are discussed with the YP/ made to our service.
*To make a referral protocol/pathway that can be shared with prospective referrers.
*to create a leaflet to share before referrals
*To pull referrals from different schools- need to be clear with Jo and Nayna about this.
!!Referral pathway
#''WEST to meet with Nayna''- to screen potential schools and young people. To also include the change in the type of group.
#''WEST to meet with school leads'' NCC/ other schools DSL/SENCOS to think with them regarding potential referrals
#''School lead and Nayna to have a discussion with the YP'' regarding a potential referral to group
#''For school lead to JOINTLY create a referral form with YP''
#''Initial individual meetings with YP'' during school hours for school leads to support these.
''NOTE:'' To have a key contact that we bring any concerns/ information - for this to be either school or Nayna?
__''Considering the inclusion team''__
*Need to consider the expertise of the inclusion officers and how they could be brought in to support schools
*what is our role or would it be our role along with the inclusion team
__exploring concrete strategies with the school __
* What does a good day look like? what does a bad day look like? What made the good day look like that?
* What strategies have you tried?What is working well what isn't working well? What part of the things that you've tried that aren't working?
* Whats been done in the past with children that have similar problems? How did this work?
* Involve others in the network from the school that may be less emotionally effected by the behaviour such as the SENCO or deputy head. These people may then step in to support the teacher or may be able to give a different less emotionally charged perspective (on the shore of the pond).
* create a record of the suggested strategies and refer back to it if/when school struggle with the behaviour again. - more often than not the strategies haven't been executed/ tried fully.
___How to we feel about trying these thing?__
* Concern that the school are looking for specific answers and we are asking them more questions. - try to be as transparent/ broadcast intentions- the plan is a summary of stuff that have been developed through these questions.
* Not always as simple as strategies so I just need to be clear on what you have tried already to make sure we are trying something that hasn't already been done.
*children that do not have an EHC - schools may feel reluctant to 'treat the child differently' or providing different support. - however if doing the same as everyone else isnt working we may need to change this. could state something like we would hope they could learn to behave the same as everyone else but may need to put in temporary solutions/ a bit of flexibility so that we can get them to this place.
*schools may have concerns that they wont be able to explain the difference in treatment- put the question back to them - how could we explain this ? how would we explain physical/ visually seen differences to others in the class?
*adolescents may feel embarrassed of having additional time/ support/ special treatment. - needs to be done in negotiation with school and the young person - finding the middle ground getting some support that feels acceptable and balancing this against the level of support that teachers feel is needed.
__The pandemic have caused specific issues with managing behaviour ___
* Inclusion team may have ideas/ suggestions that other schools are using
*'reintegration' plan may need to be created with school with support from inclusion team.
*everything is uncertain for schools at the moment
*schools are making decisions not to accept children with behaviour problems to come back to school at the moment as they cannot 'stay in their bubble' space. Including those that are 'in need'. School have a right to protect their staff but this is difficult for families and us supporting them.
*what is a realistic task for schools to take on at the moment?
*what are schools able to adapt at the moment with al the other adaptions
*Schools are aware that the situation is unlikely to change even once the summer holidays are over -not feasible for children with behaviour problems to just not come in. Not entirely our remit- need to consider networks.
*children with EHC plans
*not empirical workers need a network approach
*lots of children will be getting new teachers in September- good opportunity to 'start fresh'
___Specific strategies___
*most strategies will be similar for most children as the setting of school is similar.
*Checking the expectations of the day/ classroom/ school are clear to the children. - class rules etc. in the language of the school
* Making sure that the expectations of school and the tasks being asked are accessible to the child (print outs etc.)
*considering the reason why a child may go off task - how long can they concentrate? What is ability and what is behaviour?
*consider if the structure of the day/ lesson is feasible for the child.
*reward charts
*Time out that is less punitive- give them a 'task' or a 'calm room'.
*zone of regulation plan - green, amber, red - could create a document about what keeps them in these zones/ go into these zones
*can they have something to fiddle with or is this more of a temptation to misuse these
*fidget cushions/ calming weights
*chunking work into small tasks.
*TA support- what is the right amount of adult support?
*the mindset creating cycles/ patterns of behaviour. i.e. when they are doing the right thing are they chosen for tasks/ get picked when they put their hands up etc. How can we catch them being 'good'.
*exit cards
*where is the child sat? review where they are sat and who they are around, positioning of the table/ chair etc.
*sitting on the carpet- can they wonder around in a non disruptive way?
*good to give children 'special jobs' to be noticed for 'good' things.
*Are there additional adults in the school that could support the child with a space to go or someone to talk to- could do some work in their office etc.
*parent/ school link - sometimes the communication to parents only involves the negative behaviour. - could create a chart or diary that both the parent/ teacher write in.
*documenting/ using these systems reveal positive anomalies and positive moments more so than were previously thought.
__''ASC specific strategies''__
* Help drawing an understanding of ''where specific behaviours come from'' to try and understand what they're communicating. Similar to the iceberg - behaviours have so many different causes. The aim is to understand the causes/ triggers of specific behaviours to try and reduce them
* ''Low arousal approach'' - reducing stimulus within the environment (e.g. noise, number of people in the space) and increasing things like space and use of distractors
* ''Distractors'' - should be motivating for children and individualised for each child. Examples might be going to their favourite place - aim is to help them self-regulate by changing their environment. Another aim is to help the emotion pass so that you can reflect on the event in a calmer state
* Think about ''language'' when children are struggling (e.g. //'you look really upset, shall we go to the swing to distract ourselves//') - sharing your thought process to help model for them how they can think about the situation and validating their feelings whilst also encouraging them to move on to something else
* ''Talking out loud'' - help children to recognise their own emotions in the moment. This can be done by commenting on the child's emotions, or your own emotions or other children's emotions. This depends on child's stage of emotional development
* ''Normalising the experience of emotions'' - this can be done by noticing and pointing out others' emotions as well as your own to demonstrate that it's OK to have emotions and that everyone has them
* ''Timetables'' - giving children different things throughout their day that are motivating to help make other subjects within the timetable feel more rewarding to complete. These things within the day will be different for each child
* ''Routine/ consistency'' in activities throughout the day is important
* ''Movement break cards'' - used to say //'I'm struggling so I need a few minutes out'//
* ''Working for boards'' - reward scheme with starts/ ticks that are velcroed on. Contains motivating item: //'I'm working towards...'//. Can also be another way of keeping child on timetable and very adaptable depending on the day and child's abilities. Can also help staff to recognise that we can't have the same expectations of some children every day
* ''Individual support plans'' - created by using Zones of Regulation. Has strategies helpful for each child - general but also specific but individualised at the same time
!!<center>Welcome to the WEST Manual! </center>
!!!Welcome to the Wellbeing and Emotional Support Team's Manual. This manual is for the WEST Service at the Anna Freud Centre who will be based in Brent.
<a class="tc-float-right">[img width= 500 [melissa-askew-tSlvoSZK77c-unsplash.jpg]]</a>
All the pages in this manual are connected via the following Tag
!!<<tag [[Wellbeing Service]]>>
Here are pages specifically from the Wellbeing Practitioner training sessions
!!<<tag [[Wellbeing Training]]>>
Here is a page with a list of tags for specific areas of our work...
!!<<tag [[Training Themes]]>>
When creating a new page, ''remember to tag the page with 'Wellbeing Service''' so that it appears in the list above.
!!How to Use & Edit the Manual
For more information on editing and using the manual see below.
<<image-link "How to edit your teams manual" "luciano-de-sa-ObwMZBdEWdI-unsplash (1).jpg" "How to edit your teams manual" "200">><<image-link "User Guide" "anastasia-petrova-xu2WYJek5AI-unsplash (1).jpg" "User Guide" "210">>
How do we learn from experience?
*Through supervision
* Could do more to draw from services around us to understand what works/what doesn't work. Probably is a lot of local expertise in practitioners who have worked in the communities for a long time, which we could learn more from and be more influenced by
** How could we learn how they have build relationships with particular communities, particular schools etc?
* How could we learn more from people's knowledge in the team?
* Do we make enough connections between getting a lot of referrals from a particular school/area and understanding what might be going on?
''Always start with what do you think it is?''
SEE: [[What we think wellbeing is]]
!!14+
#everyone has wellbeing
#WB is out emotional and social health and how we can look after this
#somethings can cause our feelings or emotions to become more difficult to deal with- which can affect our everyday life. (activities, friends etc.)
#together we can think of ways that might help you cope with these feelings better and so get the most out of everyday life.
#we can develop some helpful skills and tools that you can then use to maintain your wellbeing
#what helps your wellbeing is individual to you so it is important to try lots of different things out until you find what works best. - this is something I can help you with.
!!Under 14's/ younger children
#everyone has WB
#WB is how we feel and how we look after our feelings to help us feel good and enjoy our lives
#sometimes feelings can get in the way of the things we enjoy doing or wan to do (link to childs interests/ challenges)
#when this happens we can talk to people which can help us com eup with activities and things that can help us to feel better
!!Parents
#explain in the same way that we might explain to a teenager
#explain it in the same way we would explain to a child and explain this is how you would explain it to the child.
!!Teaching staff
#could us the patchwork idea to think about why a YP may be behaving a certain way and relate this to the things that help maintain good wellbeing.
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.
LINKED PAGE: [[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:
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<html><iframe width="560" height="315" src="https://www.youtube.com/embed/OiJ0i1mAoZ4" frameborder="0" allowfullscreen></iframe></html>
Some of the work that we had already agreed to undertake with families will need to be adapted, as much of this was planned to be face-to-face.
The format of meeting will change (i.e. moving to telephone or video sessions), but for some families there may be other changes.
Some families may wish to pause the intervention, as they are not able to prioritise this at the current time. These decisions should be made in conjunction with members of the team and others in the professional network.
Some families may wish to adjust the goals that had been agreed (e.g. focusing less on education goals and more on home/relationship goals). New goals may also be more relevant to address, depending on particular challenges that the situation is bringing.
Wellbeing goals will likely be still relevant to work on, although again the impact of the wellbeing need may now be different for the child, young person or family member. There now may also be additional challenges that they are facing around wellbeing (e.g. anxiety, boredom, low mood, etc) which they may feel that it is more relevant to focus on.
! How do we approach these conversations with families?
It can be helpful to hold in mind the [[active planning]] stance. This can remind us to both check out what is in the client's mind about the plan, as well as to share what is in our own mind about it.
For example, we might be feeling unsure as to whether the goals that we have set are still relevant for the family or we might be aware of needing to change our plan of how we are going to work on them.
We can be explicit about our state of mind with families, by sharing our questions and thoughts with them about this ([[broadcasting intentions]]). We might say something like:
//"I know we had made a plan together of what we were going to work on. I wanted to check in with you about this, as you might have changed your mind about some of the things in the plan, like what the goals are. We had agreed to work on x, y and z. Do those things still feel relevant or would you like to make some changes?"//
Other questions we might ask:
*Which of these feels like the priority at the moment?
*Do you want to make any changes to any of these?
*Do you want to pause working on any of these for now and pick them up later?
*Is there anything new that you want to add that I could be helpful with?
Things we might want to broadcast:
* I still want to be helpful to you during this time if you feel that there's a way that I can be
* I don't want to create any extra stress or pressure
* I realise your priorities and situation might have changed, so i don't want to assume you feel able to commit to what we had already agreed
* Your situation may also continue to change, so it would be ok to let me know if that's the case and you don't feel able to stick to the sessions
!!A Guide to Editing the Manual
{{CapturePEN.PNG}}
(a) check that you, the individual responsible for typing, are logged in
(b) check that you are in your teams manual
(c) Create a new page by clicking the plus sign just above the search engine- give your page a title, write some text and click the tick in the top right hand corner to save your edits.
Go to the [[manuals guide|https://manuals.annafreud.org/guide/]] for details on how to do more complex editing!
!!Videos showing you how to do the basics:
!!!How to add a new tiddler (page)
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!!!How to edit & delete tiddlers
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!!!How to tag tiddlers
<html><iframe width="560" height="315" src="https://www.youtube.com/embed/_96GxO6Kk5Y" frameborder="0" allowfullscreen></iframe></html>
!!!How to add documents using google drive
<iframe width="560" height="315" src="https://www.youtube.com/embed/L_clqTP3GBg" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe>
!!Points to consider -
* Who are we talking about?
* Who do we want to be more connected to?
* Could we host a virtual meet and greet to share what we do and who we are?
!!!How have people been connecting recently?
* Quite a lot of this happens during individual work.
* Jyoti and Chantal have recently developed better relations with social care
* Rumour recently worked with SENDIAS, and passed on a personal email address rather than a generic one
* Sharing key contacts when we find them out
!!! Ideas for the team -
* Flow chart of different services
* Make more of an effort to reach out to these people
* Look at different localities and induction page that gives more info about this
* EJ to look at Local Offer
* Rolling agenda item about new contacts people have made recently
* Once a month we use our service development section to bring in someone from a different team (start with Sharon Bourla?)
* Invite new team leader of Inclusion Support
* Rotate attending the inclusion support meetings
* Clarify crossover and differences between us and other services
* Wellbeing practitioners joining more meetings with Jyoti with other services
* How to explain their purpose to a young person (i.e. to see if what we are doing together is helping you)
* How can outcome measures be helpful?
#a measure of progress
#can help keep focused on goals
#can start a conversation about how things are from the young person
#exploring changes (e.g. what's been different that's made this week feel better/worse?)
* What's the most helpful stance to have as a worker about outcome monitoring? (showing enthusiasm)
* Practically, how to integrate into the session (don't give it at the end as a rush)
We identified this as a topic to come back to
Topics that we would hope to cover during an intervention around anger.
!Understanding anger
* What does anger look like for them?
*Exploring a hot cross bun
* Understanding triggers
* Doing an ABC chart to understand triggers and what responses
*Mapping physical sensations in the body
Setting a goal to work on in relation to anger
! Psychoeducation about anger
* Find age appropriate resources to share with young people
! Intervention ideas
*What could be some alternative ways of expressing anger?
* How to Stop and Pause
* Using a traffic light system to keep track of zones of regulation
* Calming down plans
* Who's in the back up team that can help when they are feeling angry? What can other people to that helps? What is less helpful?
* Challenging negative thoughts
* Relaxation exercises and techniques
*Anger bingo - anger management strategies bingo game
* Assertive vs. passive vs. aggressive - helping to work out different ways of communication that might be more effective. Could use a see-saw analogy - trying to be in the middle, being assertive, sometimes might be too passive/too aggressive. Could explore what they understand of those terms; use a worksheet to look at; explore incidents; what would a P/A/A response look like
! Monitoring anger throughout the week
* Keeping a diary of incidents to be able to reflect back on together - why did that happen and what could have gone differently?
! What is anger?
* Showing itself externally – displaying very heightened emotions that other people find it hard to know what to do with.
* Can’t tolerate frustration
* Being impatient
* Snapping at people
* Getting quickly into fight or flight
* Being very reactive
* Getting easily into fights
* Getting very annoyed by little things
* Might notice them being intolerant of other people
* Could make reasoning with them hard
* Not listening, being stuck in their own mindset
* Appearing inflexible
* Swearing
* Hitting, punching, kicking
* Tantrums
* Self-harming – banging head against wall, punching walls
* Shouting at people
* Breaking things
* Insulting people, being rude
* Being disrespectful
* Throwing things
* Damaging physical environment
* Pushing people’s buttons (e.g. trying to get a reaction)
* Being impulsive
* Short-term thinking
! What might make children and young people angry?
* Early trauma – e.g. parent with low mood who finds it difficult to tune into their baby, there might then be a gap in child’s emotional development. Parents are key to helping children learn about their feelings and how to manage them
* Misattunement – when the parent is not attuned to the child’s needs
* Being misunderstood
* Not getting their own way!
* Disagreeing with people
* Feeling powerless and that they don’t have control over their world
* Not being able to choose things for themselves – e.g. what they wear/eat etc
* Not feeling that they get enough attention
* Mismatch between expectations and reality
* Friendship issues
* School, homework and disagreement with teachers
* Particular lessons
* Can’t go out – e.g. disagreements about the rules
* Sibling rivalry – feeling that they get treated differently
! As you get older, expectations on CYP change...
* Expected to be able to say how you’re feeling
* To have more emotional control over your behaviour
* To have more awareness, to be able to put into words
* Expected to take more responsibility for getting things done
* More choice/freedom (hopefully!) about what you do
* Different things might start to become more difficult – (e.g. friendships in adolescent period)
* People expect you to be more accountable for your actions
* Consequences might be different, according to how far you’ve been perceived to do something outside of what’s expected for your age (e.g. hitting someone at nursery, vs. secondary school)
* ‘Acceptable’ ways to manage anger change as you get older
* Hormones have an impact on emotional state
! Theories of anger
! Social Learning Theory
People learn from one another; through observation, imitation and modelling
Some questions we might ask:
How do people around you express anger?
How do people around you experience anger?
Have you seen anyone expressing anger in the ways that you’ve just described to me?
What happens when [someone they know] gets angry?
Who’s the most similar to you in your family in the way they show anger? Who is the most different?
! Positive and Negative Reinforcement
Positive reinforcement: giving a motivating/ rewarding response to a behaviour that makes the behaviour more likely to occur
Negative reinforcement: withdrawing an aversive stimulus after a behaviour is exhibited, which makes the behaviour more likely to occur
Some questions we might ask:
* How do other people respond when you are angry?
* What do other people usually do when you do that?
* What does x do?
* How does it make you think/feel when that happens? Did it make you want to stop doing it? Did you get what you were looking for? Would it make you more likely to do that again?
* How do you react when they are angry?
* What do you do when they are angry?
* What do you find has been helpful/unhelpful?
* What you do think the purpose of their behaviour might be?
* What happened before they got angry? What happened after?
* Are there rules? What are the house rules? What happens if the rules get broken?
* Are there consequences? What are they?
* What/are there any rewards for good behaviour?
* Are there any times when these behaviours don’t happen? What do you do at these times? What do you do/say if they haven’t done it?
How do you feel when they get angry?
! Emotion Regulation
* Self regulation: the ability to manage your emotions and your behaviour in a way that matches the demands of the situation
* Everyone has emotional reactions
* As we develop, we learn to manage these reactions with increasing independence from others; expressing emotion in a way that is proportionate to the situation and inhibiting extreme emotional reactions
* Children learn regulation skills through their interactions with their caregivers - children cannot self-regulate as infants, so they need adults to help them CO-REGULATE
* Did the child have the developmental building blocks to help them learn these skills?
Some questions to ask:
* Have you always acted in this way when you’ve been angry?
* How do you deal with emotions and feelings?
* Do you feel that you react in a similar or different way to others?
* Do you feel able to think about your reactions before they happen?
* How do you express your feelings?
* What situations do you react most strongly to?
* Is it possible to let people know when you feel like you’re going to “react”?
* Do you feel overwhelmed by your emotions?
* Could you tell me about a time when you felt overwhelmed? A time where you felt you were happy with how you managed your feelings?
* Which feelings come up at home/school/with friends? (use feelings cards)
* What do you do when you are feeling x feeling?
* Do you feel like you have the skills to manage?
* Is there anyone you makes you feel angry/happy/sad?
* How does your “family members” deal with anger/feeling scared?
* How do other people respond to you when you’re feeling x?
* Who do you feel helps you the most when you’re feeling x?
* Do you think there’s anyone who gets it?
* What does x do when you’re feeling x?
* Has the way that people respond to you changed?
* What is it that you would want people to do? What would be helpful when you’re feeling x?
* If you could imagine being angry, what would be the best scenario for what would happen?
* Creating a character and put it into a story context – what do you think would help this character?
! Emotion regulation - skills-focused approach, i.e. DBT perspective
Emotions are normal and everyone experiences them. Sometimes, particularly when we have had persistent, distressing experiences during our lives, we can emotionally react more often to situations that others may not find distressing, when we feel threatened. The distress can be very intense and it's difficult to manage ourselves and situations when things are feeling so overwhelming.
Learning emotion regulation skills will help us learn to effectively manage and change the way we feel and cope with situations.
* Sensory interventions – helping a young person to self-soothe through attending to their senses (i.e. strategies that appeal to sight, sound, smell, touch, taste)
* Safe space – a place that people can go that feels calming
* Something active – doing things to help channel emotional energy
* Using chain analysis – thinking about an event where anger (strong emotion) has happened. Look at the trigger event, to see if you could track back to see how the event unfolded. Looking at points where it could be possible to intervene at an earlier stage.
* Skills that help regulation in some way:
Zones of regulation – people helping you to recognise what state you are in. To help a young person understand how they are feeling in that moment, might not have the language/awareness to express and then linking this with a strategy to bring them back to a more regulated state
! Hostile Attribution Bias (Dodge and Crick)
More likely to attribute negative intent to ambiguous/ neutral situations
Some questions we might ask:
* What caused you to react in that way?
* What did you think that person was thinking/meant by doing x?
* What do you think was going through their head?
* What would someone else who was watching have thought about what happened?
* Can you think about any other reasons why the other person might have done that?
* Is that usually the case, that you feel like other people are (i.e. talking about you)?
* Does it remind you of other situations that you’ve been in?
* What do you think you find difficult about this person?
* Difference between banter/joking and what is a dig – how do you tell the difference? Might be quite hard to work it out sometimes.
* Have you tried asking them what they meant? Is there another way to work out what they were meaning?
* Have you asked anyone else’s perspective on it?
* Asking about previous negative experiences in relationships – to make sense of why they might be expecting things to go the same way.
! Anger and Mentalisation
The brain science behind mentalizing – it’s a capacity that is located within the pre-frontal cortex, a part of the brain that has most recently developed, in evolutionary terms. For that reason, it is a part of the brain which is quite fragile and prone to being overtaken or drowned out by other parts of the brain when they are activated, namely the part of the brain that deals with threat (known as the amygdala).
When the threat part of the brain is activated – and gets ready to kick us into fight, flight or freeze, it drowns out the PFC and its functions – which include our mz, our flexibility, our reflection our reason etc. And of course it does this for good reason – this is not a part of the brain that, were we to be using it permanently, would be particularly helpful to our survival!.
* Set goals and think what they want. Aim cards with older young people.
* Differences between being in the same room than online. Face to face you may absorb more what is going on for him, it brings up different feelings in approaching the work.
* Different energy when you are meeting the child in person which requires more energy from you, compared when working online.
* Being face to face you are more in the spot. You have to be more prepared, plus added intensity working face to face.
* When we first went face to face to working online, we were worried about how this would develop. It was unknown.
* Being face to face with people may feel less huge for the children as they are at school seeing everyone face to face.
* with a younger child it is important to keep the balance, how do you broadcast to the child who you are and what are you about? Broadcast intentions to them and their parents.
* Younger kids may not have an idea why they are there. Have someone there that can introduce you to the child.
* How to set up the session with the parent and teacher too?
* Ask the referrer to explain to the child why they are there. Ask the parent to ask the child what is his understanding of being here.
* One way could be that the first session is a remote session before they meet you in person. It is better for the child to see that your parent knows the practitioner, and it is a useful thing to be doing.
* Referrals are from schools and usually parents point of views are different. Parents have a right to know legally in terms of how the treatment is going and they have the highest impact on the child, therefore they have to be involved. Mapping out different perspectives, like our referral. Being aware of the different point of views and making them explicit. There might be not an easy way for both to agree on this.
* Active planning: balance different perspective and think what is the best way forward? You may get pulled too much on one way than the other. It is between school, family, child and practitioner.
* To a younger child, perhaps start that if they were by themselves, check and make sure they know until what time they are meeting and if they know how to get back to your classroom and where they would go. Try and let them take control of knowing where to go.
* When explaining about your role, keep it simple. Have you ever heard about what psychologists do? One of the things we do is trying to help young people about their feelings, or finding things difficult, we try to be helpful with that. We do that through talking as well with other people. Ask: Do you know why you are here?
* Setup of the room: get there a bit early to arrange it. Place two chairs opposite to each other with a table in between or chairs next to each other. It is better to have windows in the room, not door open.
* People can come to check in during the initial session, this may give a sense of security.
* Explaining confidentiality to a younger child: maybe ask them help what they know about the word ‘confidentiality’. There is stuff that is important to talk about. Use the word ‘private’, what we talk about is private and some things you can talk about your parents and teachers. This may be linked with mapping relationships: Who is important to you and who their roles are. Who would you speak to about something if needed?
* Also setting up a contract: safety of the setting. Decorating their box.
* Kit per child: 2 or 3 games that are interactive, such as uno, jenga and connect 4, snakes and ladders. Pens, paper, stickers and markers. For younger children get toys to act things out.
* Explain that we will do some talking drawing, playing, and ask ‘how does that sound?’ Let them lead, ask which one would they like to play.
* Explain to the child in case you finish the work abruptly: 'My job is that I go into different schools, but when things get difficult with covid we have to stop going into schools. So I wanted to let you know that this is something that might happen, but I will still see you online.'
* Being able to stop and think and to help understand / take on board other people's perspective / be curious about why other people might be acting the way they do. For example, why is the SENCO appearing anxious?
* Help improve my capacity to think about others: in my team, networks, young people / children, young people / children networks
* An ongoing learning process
* Develop a common language as a team
* How to work with other networks
* How to use the spaces that we have in our team in the most effective way
* How to communicate most effectively within the team - using the right channels (practically) and making sure we are communicating consistently with each other
* Learning from other members of the team
* Strengthen our relationships with the networks we work with
* Give some skills and ideas about how we might work within networks and how we might approach networks
* Give a shared understanding within the team about how we might approach cases and the work we do
*A shared model of how to approach the work and situations that we may come across in our work.
*A model that we can apply to a diverse group of people and groups (YP, parents, professionals, schools etc.)
*How we can share and promote this knowledge, rationale and model with other professionals we work with.
*connecting the team - having a shared language.
* Implementation of using the thinking together strategy in supervision and in team meetings.
* Implement in reflective practice space.
* Active structure in supervision to mentalize positions in the network, including young people and ourselves.
* Team around the family or child, keeping in mind the dis-integration grid as a tool to mentalize the different positions in the network.
* Making use of the different perspectives in the referral form.
* Implement the reflective space.
* Individual supervision space and group supervision.
* Holding in mind supporting each other when we are in the 'middle of the pond'.
* How we can create a culture to help and support each other within our team, utilising and understanding the different roles within the team.
* Staying connected by maintaining relationships with each other and develop trust. Develop spaces such as a 'tea break' to support each other and catch up.
* How we can ask for help in bits we don't do as well.
* Keeping relationships online with people we have not met before in person.
* Having an 'informal' 5-10 minutes at the beginning of the meetings to stay connected and to support our well-being.
* Keeping in mind the practicalities in the different roles and our different backgrounds, feeling more comfortable to share our skills with each other.
* Share with our team something we recently learnt and/or training courses we have done. Sharing our different experiences in the struggles we feel at work.
*
* Using the dis-integration grid and sculpting networks, we can bring these tools in supervision to understand what happened in meetings.
* Mentalize positions in the different people in the network to have a different perspective of why your relationship is the way it is.
* Mapping out professionals around the child and who the child can rely on.
* Being clear in an explicit way with other professionals about our role, what we do, and getting a clear understanding of what is their role.
* Keeping in mind what is the role of the whole service.
* Thinking about different services in Brent and how we connect with them. Also sharing new services in Brent with the rest of the team.
*
* Bring in shared language such as 'middle of the pond', 'iceberg', who is at the 'end of the rope' when we discuss cases and with each other in the different spaces we have.
* Keeping in mind the approach of thinking together.
* Ongoing reflective space and making sure we are using the shared language, we can prompt each other.
* Develop a shared language with clients, not making assumptions. Being more aware of how we can be more transparent about our thinking to the client and family.
* Notice when we 'bury our heads in the sand' or a 'quick fix' to draw us back.
* Bringing the word 'mentalizing' in discussions, normalize it.
* Our team that values collaborative practice, explaining our values in the right way.
* Sharing ideas of how we are doing the work.
* Manualizing in different spaces.
! Organisational Induction
* Need to complete AFC induction - check intranet for the checklist
*Brent new starters induction - JP to check with SM
* Mandatory training for AFC (including safeguarding)
*Mandatory training for Brent
* ID and IT equipment
* Training on POD
*Training on how to use the manual
* Training on [[recording systems|Recording systems]]
! Meet key stakeholders
* PF - AFNCCF
* JS - AFNCCF
* SM and JN - Brent
* JP
* Any other relevant partners
! Getting to know Brent
*Travelling around
*Getting to know schools
*Community services
*Local resources
! Induction to clinical work
* Assessment
* Consultation
* Goal-setting
* Phone-line
* Record keeping
* GP letters (assessment and discharge?)
* Lone working arrangements
* [[Outcome measures|Outcome measures]]
* Clinical spreadsheet
As needed:
* Intro to CBT
* Intro to positive parenting
* Intro to behavioural approaches
* Risk assessment
* Safety planning
* Working in a multi-agency context
* Working in schools
! Induction to team working
* Team values and ways of working
* Building and maintaining relationships within the team
* Team meetings
* Referral processes within the team
* Joint working
* Supervision
* Caseload
! Organisational Induction
* Need to complete AFC induction - check intranet for the checklist
*Brent new starters induction - JP to check with SM
* Mandatory training for AFC (including safeguarding)
*Mandatory training for Brent
* ID and IT equipment
* Training on POD
*Training on how to use the manual
* Training on [[recording systems|Recording systems]]
! Meet key stakeholders
* PF - AFNCCF
* JS - AFNCCF
* SM and JN - Brent
* JP
* Any other relevant partners
! Getting to know Brent
*Travelling around
*Getting to know schools
*Community services
*Local resources
! Induction to clinical work
* EMHP and CYP-IAPT manuals
* Goal-setting
* How to introduce yourself; confidentiality
* Engagement skills and building relationships (including toolkit)
* Assessment skills and process
* Intro to CBT
* Intro to positive parenting
* Intro to behavioural approaches
* Risk assessment
* Safety planning
* Working in a multi-agency context
* Working in schools
* Record keeping
* GP letters (assessment and discharge?)
* Lone working arrangements
* [[Outcome measures|Outcome Measures]]
* Clinical spreadsheet
! Induction to team working
* Team values and ways of working
* Building and maintaining relationships within the team
* Team meetings
* Referral processes within the team
* Joint working
* Supervision - what is it and how to use it
* Caseload
! What is the purpose of an initial meeting with parents?
*To explain our role and what our team offers help with
*To build a relationship with the parent/s
*To understand what the parent wants help with
*To understand what's difficult and what's working well
*To work out who's already involved (the network) and if there's a role for WEST
! Mentalizing the moment
*How might parents be feeling about an initial meeting?
**Unsure of what to expect
**Relieved that someone might be able to help
**Wanting to offload about the difficulties
**Wanting solutions
**Wanting someone to "fix" the CYP
*What might help?
**Us broadcasting our intentions clearly, in terms of our role, what WEST is and the process of how we will work out together if and how WEST can help
**Explaining the structure of the meeting
**Our stance - validating, showing empathy, trying to tune in to where the parent is at, trying to understand, checking out our understanding with the parent, being clear about what our next steps will be.
*How might we be feeling?
**Nervous, anxious - not sure what to expect
**Worried about being asked things/pressured into things we are not sure about
**Under pressure to get all the information we need
**Worried about parents thinking we won't be able to help them, as we don't have children or we look young.
*What might help?
**Preparing as best we can - on our own, as well as preparing with colleagues
**Practicing anything we need to practice before the session
**Being clear on our session plan!
**Setting an agenda to help structure the meeting
**Being clear about what we can and can't offer
**Being able to name the importance of partnership - the parent knows the child the best; the worker has some ideas that they have learned about things that can help families; together we can work out what fits and what doesn't.
! ''Areas to explore''
Outlining to the parent that you would like to cover these areas in the initial meeting/s is helpful and asking where they would like to start. Some parents may find it hard to start with what is going well, as problems might be at the forefront. Offer them the choice.
If there is a specific problem, you ''can'' ask more exploratory questions related to that problem (i.e. that we will have covered in other training sessions e.g. how to explore anger, anxiety, low mood, school difficulties, behaviour problems etc in more detail).
The responses to these questions can be captured using [[mapping|Mapping]].
* What's going well?
* What's not going so well/ What are the challenges?
* Who else is around in their lives and how do they help?
* What would the parents like help with?
! ''Mapping networks with parents''
See [[mapping networks with parents
|Mapping networks with parents]]
''Preparation''
*Familiarise self with referral. What's your understanding of what is being asked for? What is missing that you might like to find out?
''Making contact''
*Introduce self, role, team and reason for contact
*Set up initial meeting - be clear about who needs to be there from school (check in with school if unsure). Are parents/YP going to be included in this initial meeting or is a separate meeting more helpful?
''Planning for session''
*Think about what you would like to find out.
*Using [[mapping|Mapping]] to gather information is helpful. Maps (i.e. spider diagrams) that are useful can be:
**What are the problems/needs/concerns?
**What is going well?
**What help is being asked for from WEST? What would a good outcome look like?
**Mapping out the existing network around the family, in school and including any other professionals. What's the school's understanding of these people's roles?
''Mentalizing the moment''
*What might initial meetings be like for us as ''workers''?
**unsure about what to expect
**anxious about getting all the information
**being pressured to come up with solutions/quick-fixes
**being asked to provide certainty about what the problem is or what we will offer
**worried about meeting senior people from schools and feeling new to the service, without much experience behind us of doing WEST work.
*What will help us?
**Sharing how we are feeling in the team - with a peer, colleague or supervisor
**Planning as best we can so that we are prepared.
**Practicing any mapping/activities/conversations with a peer in advance
*What might initial meetings be like for ''schools''?
**Stressed, frustrated, hopeless, anxious about the situation
**Wanting to know what will be done to help- perhaps they have waited a long time
**Anxious to get everything across to us
**Worried about us "rejecting" the referral, so feeling like they need to persuade us
**Not necessarily able to be in a reflective space because of high emotion
**Relieved that there are people who might be able to help
**Worried about impact of ongoing situation on other pupils and staff - wanting someone to fix the CYP or family.
**Wanting strategies/solutions straight away because of their desperation
**Feeling that they have already tried everything, so might be mixed about whether interventions need to involve them
*What might help?
**Us remembering to validate the school's feelings. Try to tune in as much as possible to what they might be thinking/feeling (ask if unsure), rather than to assume or make statements which might sound bland.
**Naming some of the above (if relevant) - acknowledge that many schools are at end of their tether, feeling that they have tried things, that they probably want to get answers about what is going to happen next
**Broadcasting your intentions - we want to help; we want to understand a bit more about the situation first to help us make the best plan; I'll be able to be clearer about next steps when I've heard a bit more from you and spoken to the team.
''Facilitating the session''
*Be prepared to set an agenda and take a lead, in order to help structure the meeting. Remember the [[active planning|Active Planning]] stance - what is the "plan" for the session and why is this the structure that you will follow. Check this out with the attendees. For example
//"Thank you for inviting me, I'm x from the WEST team and we are meeting about the referral you made about [CYP]. We help CYP and families with wellbeing needs, so the purpose of today is for me to hear a bit more from you about the current situation, to help us make a plan together about next steps, which might include me taking this back to the team to discuss in more detail. I would like to cover 4 main areas; what the problems are; what is going well; who is currently in the network; what help you feel is needed. How does that sound? Would that cover everything you were hoping to? If so, where would you like to start - which order would you like to do those in?"//
''Broadcasting intentions'' is helpful in anticipation of how you will behave during the meeting. Explain that it can be helpful to work through one section at a time. There's a lot to cover, so you'll try to help keep everyone on track, which might mean interrupting occasionally - not to be rude, just to help make sure we cover all the important things.
''Closing the meeting''
*Summarise what you've understood - check for accuracy
*Thank people for participation and attendance
*Summarise your next steps and when people can expect to hear back from you
!!Child Anxiety:
Cathy Creswell therapist guide based on the [[book|Cathy Creswell's Book for Child Anxiety]] by Cathy Creswell and colleagues.
''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 follow the instructions.
[[Treatment Manual for Therapists|http://centaur.reading.ac.uk/87041/]]
!!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/1CFJ4RymiV2RIlE4qksaUYgGz1DQntLLp/view?usp=sharing">>
!!!Supplement Manuals for Adolescent Anxiety:
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/1Yzf2FE62B95fdgleePm88HA8GxMTdmjt/view?usp=sharing">>
!!Low Mood:
The manual used to guide practice is the 'Guided Self-Help for Low Mood'.
<<link-doc "Guided Self-Help for Low Mood: Full Manual" "https://drive.google.com/file/d/1Ua1L-0BUmNMBTJi2AkYQhdlmnWpKwl0g/view?usp=sharing">>
!!Behaviour Problems:
The brief guided self-help parenting intervention, the manual for this intervention can be found here:
<<link-doc "Guided self-help for behaviour problems" "https://drive.google.com/file/d/1vBNYY-hZtqIKHZucyZmbxZmfjTvYYoRZ/view?usp=sharing">>
ALL behaviour problems handouts:
<<link-doc "Behaviour Manual ALL handouts" "https://drive.google.com/file/d/1DdoY9H4Hpvp6nlKIPRSBckbTYpMx5Ld7/view?usp=sharing">>
!!!Related pages:
<<list-links "[tag[Intervention Manuals]]">>
! Introductions exercise
We worked in pairs (with the person we knew the least well so far in the team) and reflected on two questions:
#What do you enjoy the most about working with young people?
#What do you think you are worst at when working with young people?
After each question, we fed back our //partner's// responses to the questions to the group (rather than our own).
When reflected together on what it had been like to complete this exercise, both in terms of what it had been like to hear someone else feeding back our own perspective and what it had been like to represent someone else's perspective.
__''How does this relate to our work? Reflections from the exercise''__
* Felt under pressure to make sure we represented the other person's perspective accurately - "wanting to get it right"
* It wasn't always easy to work out which parts might have been the most important aspects to share - "wanting to make sure I've summarised/picked up on the right bits"
* Noticed that it was easier to answer the first question concisely (focused on a strength/interest) but harder to answer the second, which was problem-focused -
**found myself wandering into other topics
**harder to express myself as clearly
**became a bit avoidant of focusing on what //I// found hard - moved the conversation to a more general discussion about "what people might find hard about..."
*
<center>[img[https://lh4.googleusercontent.com/-LsLA8EGpIJ0/URYYBCsRgJI/AAAAAAAAGyY/D4GSq5YI-M4/s512/Stance-Relationship.JPG]]</center>
A central idea underpinning the AMBIT approach is that therapeutic change is achieved through engagement of the client in an ''individual therapeutic relationship''.
In order for a client to be open to new learning, they will need an experience of feeling understood ([[Mentalized|Mentalization]]) within this relationship.
Theory and research tells us that this experience can generate [[Epistemic Trust]] i.e. the kind of trust that is key to "//opening the doors to learning//" from another human being.
We know that mentalizing happens in relationships, and that mentalizing is most likely to happen in contexts where people feel contained, calmer and not overly anxious.
''So, therapeutic change, if it is to occur, is most likely to spring from a trusting, and safe relationship.''
For this reason much of AMBIT is devoted to how a key-worker can be supported by their colleagues to create and sustain the conditions for that kind of relationship to develop.
In order to support this aim, there are some principles that we apply to individual key-worker relationships. These are adapted in different ways across different AMBIT influenced services, but in general terms they include:
*The team works to reduce the burden on the client of multiple therapeutic relationships all happening at the same time
*We actively search out and prioritising pre-existing relationships which offer the potential to be supportive or helpful
* There is an explicit focus on supporting those workers who are in 'the key-relationship'. How this support happens, and what the key-worker will require to do the face to face client work will vary depending on the context. This principle is known as the team around the worker.
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!!Supporting the 'individual key-worker' relationship
''AMBIT is not individual therapeutic work, but about using a team to support individual helping relationships.''
So for the worker who is in the position of being 'key' to the client, the workers' energy must be balanced between developing that crucial relationship, and at the same time, ensuring that they are a [[Keyworker well-connected to wider team]].
This balance is highlighted by the pair of AMBIT stance points in the outer-ring of 'Working With Your Team'. The stance points highlight the balance between both needing close and trusting individual relationships with a client, for change to happen. But, at the same time it is critical that the worker is ''well connected to their team'' (in order that they can work in this client relationship safely and effectively).
!!How does this relate to the 'Team around the Worker' idea?
The team around the worker model describes how key-workers are very actively supported by a team of colleagues, who can provide ongoing supervision and consultation (as well as other forms of support) to do face to face work. The team of colleagues may have different roles and expertise in different areas. The idea is that they use their skills to support the key-worker to do the work that is needed through the relationship in which epistemic trust is present.
We use the idea of a team around the worker as much as the the more conventional idea of the "Team around a child".
So //from the perspective of the client and others involved, the work is carried out by one main person, but they will also be aware that their key-worker is supported by a team that is experienced as being active and present in the background.//
[img[https://lh6.googleusercontent.com/-Q--oDenShgU/UcD32HjdpVI/AAAAAAAAIlk/tGuG_Ps4QbE/s512/AMBITSpokes_B%252BW.JPG]]
This models to the client the way that we can all use our relationships to support the work that we do - AMBIT works very hard to avoid the dangerous illusion that any one person, //unsupported//, has the resources to sustain this work successfully.
!!So who is the 'key worker'?
Here we use the term 'key worker ', however many services do not use a specific 'key worker' system.
The Key-worker, as we use the term, is less about defining a specific organisational role, but it is more about focusing on //"Who, in the mind of the client, is currently key to finding help that is genuinely helpful?"// i.e. who in the network has the potential or a pre-existing relationship where there is some epistemic trust, and the capacity for learning __ , __from the perspective__ ''OF THE CLIENT''__
We think explicitly about who is in this position currently i.e. which relationship is 'key' in the clients' mind to getting help ( this may change and may be different to the relationship defined by the organisation as the 'primary' one)
!!We always join a pre-existing network of help
When we begin a new piece of client work, it can be tempting to believe that we have something 'more helpful' to offer the client, and to 'jump in' offering our particular skills. (this is not to say that we don't have something helpful to offer !)
However, in AMBIT we stress that there will already be a pre-existing network of help around the client when we join. There may of course be difficulties or factors that have prompted our involvement with the network. But, in joining there is always the potential to disrupt or undermine pre-existing help further, (hence increasing the burden on a client).
We believe it is therefore essential to recognise this risk and to place emphasis on considering:
* Where in the network are there pre-existing relationships that may offer support and learning?
* Who in the clients mind is most helpful within the network ?
*How might I as the new person position myself to scaffold and develop relationships that have the potential to be helpful?
*How might I position myself so as not to further overwhelm the clients' capacity to mentalize?
''We use some specific tools to help us with these questions. ''
The AMBIT [[Pro-gram|The AMBIT Pro-Gram]] can be used to map out relationships //with// the client and think about these questions directly with them.
We can also use the
[[ Dis-integration Grid|Dis-integration Grid]] and the [[Sculpt|Sculpting a Network]] as tools to address these question in our teams.
<a class="tc-float-right">[img width= 400 [Who has your rope pic.jpg]]</a>
!!What is it and what are the problems it aims to address?
AMBIT emphasises that for change and learning to happen, a helping-relationship is needed in which a client has the experience of being understood i.e. accurately [[mentalized|Mentalization]].
However when we are working therapeutically with clients, particularly those who are distressed or risky, this work can (//and should// at times) leave us feeling worried or anxious. So, it is inevitable that as a worker we will sometimes experience high stress and high emotion.
Theory and research on [[Mentalization]] tells us that
these experiences and feelings will constantly challenge the mentalizing capacity of the worker. However, in order for the worker to accurately mentalize their client, themselves, and encourage the clients' own mentalizing, the worker must be in a state in which they themselves can mentalize.
AMBIT stresses that the worker cannot regain their balance and mentalizing capacity alone. This is because mentalizing is a ''relational'' ability. It is something that we know develops in relationships, it is lost in relationships, and crucially, it is ''re-gained in relationships''.
So, AMBIT stresses that when working in therapeutic relationships, it is critical that this relationship is balanced with connections to trusted others, in order to restore or sustain the mentalizing of the worker. This is the theory that underpins the ''key worker well-connected to the wider team''.
!!Isolated workers
Within this area of complex practice, there is always a risk that we might un-intentionally become isolated in our work with clients. This brings with it a number of potentially serious problems, including:
*Burn-out
*Losing valuable perspectives and not seeing 'the whole picture'
*Becoming less able to plan in helpful ways
*Losing the capacity to think creatively about our practice
*Not seeing the clients' perspective
*Not spotting or evaluating risks
With this in mind we use a number of analogies to highlight the necessity of strong connections to team members (in mentalizing terms).
<a class="tc-float-right">[img width= 500 [https://lh4.googleusercontent.com/-WHgi7Bo5YOQ/US9d72FvokI/AAAAAAAAHEw/oqk3A0DWRac/s646/DiveBoatAnalogy.jpg]]</a>
Here the dive boat is an analogy to explain that [[Mentalization]] is hard to sustain in high-affect //"pressurised"// environments. Imagine the KeyWorker were a deep sea diver entering the pressurized and challenging world of the client; other team members (or a supervisor in a more formal sense) should see themselves acting (and we emphasise that these are often //pro-active// actions) as a //''support team''// on the dive boat above, pumping an "air supply" down to their colleague. In the case of AMBIT, that "air" is the capacity to mentalize.
Another metaphor, the mountaineer, is also frequently used - the worker needs to know some skills about what to do when she is out there, alone, but she also needs to know //who is holding her rope// and to feel confident that communications between her team member are reliable, trustworthy and secure.
!!! What does a '''Key worker well-connected to the wider team''' mean in practice?
We think it will look different in different contexts. However, in an AMBIT influenced team the intention is to make the process of seeking and offering help explicit and part of the 'every day routine' of work. i.e. for the team to become 'practiced' in holding an awarenesss of each others' minds (i.e. mentalizing colleagues). That this is recognised as an essential part of 'what we need to do this work'.
In order to do this we apply [[Mentalizing|Mentalization]] skills - but directed EXPLICITLY, towards one's colleagues within the team.
NB: this doesn't necessarily mean 'having lots of colleagues around'. It is possible to work in a busy environment and not experience strong helping connections. It is also possible to work without frequent close proximity to colleagues, but still have strong helpful connections to them.
We are also not talking about the nature of friendships or social relationships in the team (although of course this can be important in many other ways).
!![[Thinking Together]]
In AMBIT we have a tool that is designed specifically to support key-workers connections to their team. It is an explicit routine used to support help-seeking and help-offering between colleagues. It directly applies mentalization and focusses on actively helping the worker to regain their mentalizing capacity through connections with colleagues.
It is called [[Thinking Together]]. It is a set of structured "steps" that offer a deliberately ritualised way to talk about casework, so as to mark the fact that we are attending to mental states at that time - especially that of the worker asking for advice, support, or help.
Our experience is that this tool can be adapted and applied across different contexts to increase the chances that help is well attuned and experienced as 'helpful' for a worker when needed.
!!!How else can we work on our connectedness?
We encourage teams and services to talk and think together around the process of help seeking within their context.
For example:
*What kind of help do people need to do their work well?
*What kind of factors influence help seeking in the team?
*How do people already help each other, and what works well in our team?
We believe that this kind of dialogue is useful in encouraging teams to make more explicit what they do that works well, and continue to develop and practice new ideas in this area.
We encourage teams to [[Manualize|Manualization]] what they do well (and what they intend to do more of), in relation to this important area.
Video of Liz Cracknell teaching on this for a group of AMBIT Local Facilitators - this video goes on to describe the core activity that we use to help supported the "connectedness" that we are promoting, [[Thinking Together]]:
<html><iframe width="640" height="360" src="//www.youtube.com/embed/0e_kGvCtOEw" frameborder="0" allowfullscreen></iframe></html>
!!!Intervening when colleagues are not asking for help
We believe that another aspect of being 'well connected' is the capacity of team members to offer help or, at times, intervene when when people are not explicitly asking for help or have not recognised a problem. The ability to do this in helpful ways is a central part of team working and managing risk. For example, at times, a worker may notice something concerning in the practice or behaviour of a colleague in the team, which does not appear to have been recognised or acknowledged by them.
Please see here for theory and a framework around how workers of all levels can introduce challenge and inquiry to each other - regardless of relative seniority, etc.
<a class="tc-float-right">[img width= 300 [books pic 1.jpg]]</a>
!!Introduction
''This page is adapted from the core content of the AMBIT manual ''
Learning at Work is the principle of teams and workers becoming actively engaged in learning from their experiences at work. It is one of the Core Features of AMBIT practice. [[Manualization]] is one of the processes designed to help capture and support ongoing learning within teams.
AMBIT aims to support teams to learn in more ''explicit ways'' about their practice. We believe strongly that explicit learning in teams fosters crucial evaluation of ''what we do'', and ongoing development of ''how we do things''. Mentalization is closely associated with learning, and the development of new understandings. It emphasises holding an //inquisitive stance// towards our current practice and knowledge (rather than being certain that we know everything we need to know), which enables us to be //open to new learning//.
We believe that a mentalizing team is one which is able to ask itself questions such as..."What are our best shared ideas about how to do this work most effectively?"; "Why do we do this in this way?" "Are there other ways we could do this better?"; "Why do we do it like this and not like that?"
It is this kind of explicit and ongoing evaluation of our experience and practice, that we believe encourages genuine improvement.
!!A respectful balancing act
Learning at work requires a balancing between two elements of the AMBIT stance - Respect for EVIDENCE, and Respect for LOCAL PRACTICE & EXPERTISE:
|! |!Respect for Evidence|!Respect local practice and expertise|
|''What is it?'' |Published trials or meta-analyses, routine outcome monitoring and evaluations, service-user feedback and testimonies, etc |Respect for //existing// competencies & knowledge within team & across other agencies in the network that are attuned to local culture & service ecology |
|''Risk of Overemphasis'' |Teams that do "one size fits all" because they are rigidly applying evidence-based interventions, rather than practicing with attunement to the client and insufficient adaptation to the local service ecology |Team/worker that "makes it up as we go along", over-reliance on own preferred methods/ways of doing things (in the absence of evidence for these) |
<<list-links "[tag[Local Practice]]">>
List of pages about working with looked after children (LAC)
<<list-links "[tag[Looked after children]]">>
The list below are all the pages we have tagged with 'Managing Anger'. All of these pages are linked as they contain information and resources on how we as a team work to support children and young people to manage their anger. The theme of these pages is closely linked to working with behaviour problems.
<<list-links "[tag[Managing Anger]]">>
!!What do we mean by Risk?
#Risks for the client e.g. self injury, abuse, health problems...etc
#Risk for other people e.g. criminal acts, harm to pregnancy, violence...etc
#Risks for the worker e.g. burn-out, trauma, complaints, allegations etc
Managing Risk is one of the [[CORE features of AMBIT|Core Features of AMBIT]] and part of ''Working with your Client''.
!!Managing Risk, not Abolishing it
It is important to acknowledge that in this field we can never get rid of all risk. Working with impulsive clients, who have limited ability to plan, predict risk, and consider the consequences of actions, will always hold risks.
!!Risk and Mentalizing - an Assumption:
AMBIT takes the position that working with risk is (and should be at times) anxiety provoking and worrying (for all involved). We know that high levels of emotion impact on [[Mentalization]]. Therefore a key part of managing risk involves finding ways to regain and sustain mentalizing in these contexts.
Risk is highest at those times when [[Mentalization]] fails in:
#The client/family
#The worker
#The people (networks) around the client or worker
When any of these people lose the capacity to mentalize, it becomes harder to evaluate and respond to risk in thoughtful and effective ways.
At these times it is more likely that non-mentalizing interactions happen between people. For example Teleological thinking (i.e. 'quick fix'), often arises. Examples of this might be a violent act or using an intervention which has not been well planned or thought through. These kind of 'un-mentalized actions' can often lead to further unwanted effects - such as more relationship problems, increased vulnerability, side effects from medical interventions, increased dis-integration in a network etc
''With this in mind, we see managing risk as a process which relies heavily on the connections between colleagues and capacity of workers to support each other to think (or to mentalize) in conditions where risk (and hence, worry) is present.''
__Situations in which workers are attempting to manage risk without strong connections to colleagues would be highly concerning and, we believe, un-sustainable.__
The way in which the keyworker and team work to re-gain their balance and the ability to mentalize, through their ''connections with colleagues'', is therefore essential in order to carry out this work effectively.
Please see here for more explanation of this, particularly the notion of a [[key worker-well connected to the wider team |Keyworker well-connected to wider team]]
!!Managing Risk and the AMBIT stance features
Managing Risk is one half of two 'AMBIT stance points' (shown in the outer rim of the wheel in the [[Working with Your Client]] quadrant of AMBIT). The other half, is called [[Scaffolding Existing Relationships]]. We see the worker (and teams') role as attempting to hold a balance between these 2 points below.
{{Wheel with client highlighted.jpg}}
''Scaffolding relationships'' involves the essential work with clients in which we aim to help them build , strengthen and make use of relationships which are ''already present'' and which may serve an important (longer- term) role in their lives (long after we have gone!). This includes work with the clients' relationship with themselves (i.e. the capacity to mentalize themselves), as well as relationships with family, friends, the social world, employment and others with whom there is potential for ongoing support. Here the worker uses engagement, attunement, and builds understanding of the client and their network.
On the other side of this balance (sometimes in opposition, and pulling in the other direction) is ''Managing Risk''. At times within the work with clients and their networks risks will be present. When a risk is identified there is often a need for some kind of concrete action in order to better understand and reduce risk.
In many ways managing risk can be seen as a helpful use of ''teleological thinking''. There are actions, procedures and protocols that will be required in order to sufficiently reduce the risk (for example, with the disclosure of active abuse, the appropriate response will be clear, timely and decisive action in order to safeguard somebody). However, although clear actions are often essential, when these happen without mentalizing, there is a high risk that the relationships that the worker has been carefully scaffolding can be damaged (which in the longer-term, if the client or others dis-engage, can lead to greater risks).
This is the nature of the balance between these 2 stance features- both sides are critical and the worker attempts to balance between the stance points.
''Mentalizing supports the worker to hold this balance''
!!An example:
A worker has built a strong relationship with a parent and has begun to help the parent learn to manage some of their difficult experiences and strengthen some potentially supportive relationships in their life ''(scaffolding relationships)''. The worker then learns that a member of the network close to the parent and their child has a history of posing serious risks towards young people. At this point the worker is required to take clear steps to make sure that the well-being of the young person (and others) is appropriately safeguarded ''(managing risk)''.
Applying mentalizing to this situation might look something like the worker (supported by colleagues) to think through and plan points such as...
> //What might be the safest way to carry out these safeguarding steps? Who should we talk to first and how should we do it? who best to have these conversations? how might different people in the network experience this and respond? what does this tell us about how we should position ourselves to be most helpful and work safely? What steps can we take to try to limit any harm to protective relationships that have been built ? etc//
If we move in to action without this kind of thinking (mentalizing those involved) it is much more likely that relationships will be ruptured and it may become more difficult to manage these risks in the future.
!!Assessing and Managing Risk
It is critical that teams have clear ways of assessing risks and have shared explicit protocols for making plans to manage risks e.g. crisis contingency plans. These should be discussed regularly in the team.
AMBIT does not claim any originality in promoting this. However AMBIT does emphasise the need to develop and adapt these protocols and procedures in relation to new learning within teams' local contexts. We believe that teams making explicit, regularly rehearsing and adapting their approach to risks, in light of new experience, is essential here. We encourage teams to use [[Manualization]] as a tool for learning, recording and sharing their own protocols around risk.
!!Extended learning - <<tag [[Extended learning]]>>
Different teams will have different protocols and procedures around risk. below we have included some more general guidelines. Within the extended learning tag you can also find further reading around the process of challenge and support in managing risk.
''__Mentalizing our own feelings about ending __''
*sense of avoidance
*a sense of things feeling unfinished
*feel quite sad
*Frustrating if you have not achieved what you might have hoped
*thoughts that we may have disappointed
*feeling guilty
*feeling you are leaving them
*feeling you have to take on all the responsibility for them feeling good
*anxiety about their future
*hopeful/hopeless about their future
*proud of the work you have done and of them
*relief which might then make us feel guilt
*satisfaction
*failure (if we feel we haven't done a good job or that the client wishes to no longer continue)
We may be more inclined to feel certain ones due to our own experiences or the way that the work has been conducted/ the reasons and way is ending.
We cant take for granted how if might feel to end work as each ending will be different. need to acknowledge these feelings and communicate it to our team so they can support us,
''__Mentalizing our clients__''
* abandoning them
* leaving for other children
* feel the same types of feelings we might feel
*they might be feeling differently to how we feel about the ending.
''__What can we do to consider the states of mind during an ending__''
*need to consider the separateness of the clients mind, and keep curious. - we might feel anxious they might feel angry
* ask self how am i feeling about this ending have a space with a colleague to unpick this
* ask the client explicitly how they are feeling.
* Unpick how the client is feeling about this
* need to balance sharing own feelings about ending in a containing way without over-tipping the balance to just talking about yourself.
*be real with each other about how you both feel about the ending
''__What can we practically do?__''
* Talk to the client and family about endings before it happens
*preparation is key
*might need to have a few sessions which is focused on ending
* try to be explicit
*be clear about what you would like to achieve in the work before you end.
*be clear about what you might work towards to achieve a good ending:
** sustainability plan
**relapse plan
**safety plan
**what have you learnt? what would you like to continue working towards?
**what could you share with others? - could you make a document together so you can share it with others in your network
**unpick ways that they can share the work with the backup team. how could we share this? what could you say?
**bringing back in the back up team and how the client will continue to be supported
**Review the goals - what is there left to do? what else would you like to do? where would you like to get to?
**reminiscing about work
**reflect of big future goals
**like a mechanic- its ok it all of this work doesn't stick and you might need some maintenance later on down the line.
*ending sessions may take a few weeks
*how could we accurately sum up the story of the piece of work? - might not have had as much chance to practice things because of x,y,z but we could still make a plan of what you can do going forward (might be a summary of what we have done that helped or about what do we need to scaffold to support for the future.)
''__Troubleshooting__''
*we may not know when the ending is due to the current change in working- this can cause us uncertainty and the client.
**we could make sure we are clear about this in supervision.
*endings might be hard for many reasons such as: client needing more support, client not having a supportive back up team, client not being ready for the end.
*goals may not have been met as they were school based and have not be achievable during the current climate.
**create a realistic picture of the work that you have done together, acknowledge the goals that are still outstanding and plan what can be done to support this process.
*might be hard as you may only have just feel like you have been beginning to know each other or get down to the issues
*might be hard as you might be the 'only one they have to talk to'
** need to consider who else can check in, might have others who could that they are overlooking. really important they have found this helpful so its important that we find someone else who can do that. - could consider mapping networks
''Assessment Session''
__''Getting started / Broadcasting intentions''__
*Set boundaries in order to contain the conversation and make it secure
*So it would be great to talk about x, y and z
*Where would you like to start?
*Would be good to hear from everyone, and I'll do my best to make sure I do
*I might interrupt a bit, not to be rude, but just to make sure I’m getting what you’re telling me
*I want to just make sure I’m doing a good job of hearing from everyone, so I might interrupt a bit or bring in other people
*Who wants to start?
__''Getting multiple perspectives''__
*So I’ve heard from……what do other people think?
*Does anyone else have a different view?
*Do people see that in the same way or in a different way?
*What do you think about what your Mum/Dad/sister is saying?
*Is that how it seems for you too? Or is it different from your point of view?
*Is your Mum/Dad/family member right about that? Did they miss anything out? Is there anything you’d add to it?
*X, are you ok just listening or is there something that you want to add?
*X, I know you’ve been a bit quieter, how are you doing? Is this ok for you? I don’t mind if you just want to be a bit quieter, but don’t want to leave you out either.
*Look out for situational cues on how agreeable or not everyone is
__''Managing multiple perspectives''__
*People usually have different views and that’s ok – let’s just try and work out how everyone sees it
*You don’t have to tell me everything today, you’re just getting to know me
*This might be an easier conversation to have just with x, rather than everyone together
*It not about necessarily agreeing on one view of it for now, its just helpful for hear how different people see it
*So this is something you’ve all got quite different ideas about – you think this; while for you, its more like that
*Useful to hear how different people see it
''__Moving the topic on__''
*So I’ve heard a lot about…..what isn’t working; why it started; your ideas about what’s going on, but I was also wondering about
*That’s really helpful, so I’ve got a bit of an idea about x now, so could we move on to...
*Name the processes for them
''__Managing too many people talking at once__''
*Sorry I’m just going to interrupt as I don’t want to lose track of what people are saying! Let me just try and see if I’ve got it. Let me summarise.
*I can see you’re desperate to say something, I’ll come to you in a second – let me just finishing hearing from x
*Sorry I’ll have to slow you down a bit because I can’t keep up! So you were saying this; but then you were saying……?
*Can I just stop you for a second?
''__Managing conflict / raised emotions__''
*Is this usually how things get when you talk about this kind of stuff?
*It looks quite tricky/it kind of takes you into a bit of a disagreement/it gets a bit heated/you’re both trying to get your point of view across and feel like the other one’s not getting it?
*I obviously want to see a bit of how it is, but I don’t want it to feel like an unhelpful conversation either or let things get too heated/full on for today
*Shall we rewind a bit? Can I try to summarise? You think x, you think y – is that right?
*I’ll just try to help us keep on track if I can…
!!!What might make the transition hard?
!!!What may be some of the issues that CYP could face at the moment?
We discussed possible barriers or factors that may need to be considered that might influence the transition back
*Making the transition to a different school,
*Having new rules about Covid19
*Adapting to new routines re COVID,
*Worries around Covid19 and safety
*Loss and bereavement
*Difficulties separating from family re anxiety, closeness over lockdown, above worries
*Feeling behind in terms of academic work and feeling pressure to catch up
*Reconnecting with peers,
*Additional pressures for children with ASD,
* Children where higher risk to get excluded due to not following the Covid19 rules e.g. behaviour problems become amplified if harder to 'sit and follow rules',
*Parents' anxiety about health and school staff anxiety about how to plan the day while keeping the children safe
!!!We thought about how anxiety around the transition might show itself in CYP at different developmental stages
*Withdrawn and timid being around others
*An increase in challenging behaviours, testing boundaries,
*clinging to teachers needing proximity, separation anxiety with parents, the night before getting many worries about what is bad about school,
*school refusal,
*struggling to fall asleep the night before worrying about the next day,
*Feeling unwell unable to attend, physical symptoms such as headaches, stomach aches and dizyness, unable to eat,
*Friendship problems such as struggling to re-integrate into groups or pushing people away, resorting to social media and not physically connected to other children (quite withdrawn), sense of uncertainty and being on edge.
* When we try to share our understanding of behaviour of a child to a teacher: first, mentalize how is it like for them to be in the teacher's situation, have a sense of that such as so many guidelines they need to follow and feel stressed. September is overall a very stressful month where everything starts again, planning out everything, getting to know new class, etc.
* Research and evidence around the transition back to school (see Anna Freud Centre EBPU research bites )
Key points to consider:
* Being able to identify and have an idea of the young people who already are struggling with difficulties, they might be at risk. For example children with additional needs, children with pre-existing MH problems and who are already at social disadvantage
*Think about planning early particularly for these groups re what they might need to help support the transition (before they come in)
* Encourage schools to prioritise well being rather than only academic work: children need to be in a calm state to learn and do their work. Sometimes it can be difficult for parents and teachers to understand this as there are many external pressures to crack on with things.
* How the brain works - Links between the need for stability, calmness, well being-connections with adults- these are basis for learning. Could draw on theory about mentalizing and pre-frontal cortex to help explain
* The importance of recognising the well being of teachers is crucial too.
!!! We thought about how as EW's we might be able to play a helpful role
*First trying to understand the individual factors and context.
*Mentalizing the CYP and parents
*Can parents and teachers mentalize the child- what are their hypothesis and guesses of what may be going on for the child in transition? how might this guide what we do to support them? how can we find out of we are on the right track?
* Thinking together with the child-Getting to know them first, understanding more about what is going well too to start with e.g. their interests then explore what are their worries?
What are some of the ideas and tools we have to help explore worries and anxiety with younger children?
* Using different characters in a story to help play out situations to understand a CYP worries, expectations, ideas - using creative ways to bring characters to life...playing out 'transitions' stories...askig about what they think might happen, who would do/say what, how might the characters feel, what might help them in the story? Finding a creative way to explore it by linking it to what they are interested in. How we connect it to characters in Stars Wars for example? This could also detach a bit the problem from them, starting by being emotionally more distant and slowly figuring out a way to talk about them.
Story stems: You can start the story about the 'ninja who is starting to go to school this morning' and ask 'what do you think that happens next? What are they feeling?'
Using metaphors and scenarios that are slightly distanced from them which allows them to think about things.
*Making up vignettes about what the person would do if they were in that situation, the person not being them
* Keeping things visual by doing sentence completion: 'One thing I like best about school is: x'
'The thing most scary about going back to school: x' and 'What i like most in my school:x'
* How can we help? (Case example)
Research evidence says that having exposure and practice of going back to school should be a key part of the plan- rather than just talking about it.
i.e. It may not be enough to just talk about worries, but actually going to the school taking some steps there is key in the intervention (Not just in context of covid)
But to help with this exposure and steps back we need a plan !
* Graded steps back or faster move to re-integration?
P!!!Points to consider in planning
* What to do when things get difficult at school? Have a structured plan of this before going in
* Relationship Mapping who is important at school. How can we use their help?
*where might you go if it gets hard (a safe place in school?)
* Who will be the adult that meets the CYP on arrival if this is needed
* A child with social anxiety: Go before starting school to meet teachers. Also arranging with friends to meet before class starts.
*What info needs to be shared with staff and who with?
*Identified place to go if needed in school
*Do we need check in times with trusted adult?
* Mentalizing the staff first and then helping staff mentalizing the young person - sharing your understanding of the young person with staff- but first need to mentalize staff!
Staying in contact with CYP when the therapy sessions have to stop for a while e.g. during transition back to school and when therapy times have to be changed
What could we do in this situation?
*Message to CYP to show we have them in mind and tell them as much as we can about when sessions will start again, what our plan is, that they will not be lost
* Talk to parents and share ideas/plan, such as by sending emails or text messages or brief letters of what is happening at the moment
* Calling a parent to check how it has been going, ask to speak to CYP to update them and check in. Ask parent to let the child know you have called
Note: mentalizing how it might be like for you going back which can feel quite stressful, although it is hard to talk now the sessions are still there, for example 'I will be talking with your mum to see how to work best with you when things settle down'
[img width=100% [patrick-tomasso-Oaqk7qqNh_c-unsplash.jpg]]
!!''What is Manualization?''
'Manualization' is the process of recording what we do (in text or through video recording) in ways that would help others to do the same thing (and get the same results.) It is really another way of addressing the idea of ''team learning'' - and in this way it relates to ideas about developing learning organisations by Peter Senge.
Manualization is one of the [[Core Features of AMBIT]] - AMBIT workers don't just read their treatment manual, they are expected to //co-author// it.
Above all, Manualization is about promoting [[Learning at Work]] - particularly ''learning from mistakes'', or ''recognising a piece of local expertise''. Recording it (especially so in a public facing website) creates a kind of ''"ratchet effect"'' so that learning in a team is less likely to slip backwards and get lost (//because workers forget those team discussions when 'all came clear', or they leave the team to take up other posts, taking all their expertise with them... //).
!!! Using Wiki-Manualization in an AMBIT Team
<center><iframe width="640" height="360" src="//www.youtube.com/embed/tcE8k8REnzY" frameborder="0" allowfullscreen></iframe></center>
!!! Building a [[Community of Practice]] using the Wiki-Manuals
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!!Balancing Act
What you are reading now is a Wiki Manual, which is a different kind of manual from books or conventional websites. In keeping with two other [[Core Features of AMBIT]] ([[Respect for Evidence]] and to [[Respect Local Practice and Expertise]]) it is concerned with the difficult (but as we see it, crucial) task of balancing two potentially contradictory principles:
* ''Systematic Evidence-based Practice''
*''Locally-derived Practitioner-based Expertise''
...The approach to "manualizing" practice in a Wiki Manual allows for a marriage of 'top-down' evidence-based information and instruction, alongside 'bottom up' local expertise in ''//how we apply these techniques and methods here, with these particular young people...//'' or ''//what we learned from a recent near miss/mess/serious incident that would minimise the likelihood of this happening again//''.
!!''How to do it? ''
You will experience manualizing as part of your AMBIT training, one person will act as the 'scribe' recording the discussion and another person will act as the 'chair', making sure the team stays on topic. Below are some guidelines to getting started:
#Allocate some time in a team meeting for manualizing (some teams do this once a week, others once a month)
#Allocate two key roles: a chair & a scribe
#Make sure you are logged into your Manual
#Start by creating a list of topics that you as a team could manualize- a good place to start might be things that you as a team do well or topics which are live issues for you as a team
#Choose a topic to manualize first
#Break the topic down into smaller sections using the 'Slice & Dice Method'- ordering the sub headings before you begin
#You might discuss how individuals in the team have experienced this topic or why it has been chosen- you should then use an [[Active Planning]] approach whereby you make a plan about where you, as a team, want to get to, whilst recognising that things may change in the course of trying the agreed approach.
#You might revisit a topic if you do not complete it in one session - this is fine!!
#You might also revisit a topic if something hasn't worked or the situation has changed.
----
!!''Benefits of Manualization?''
There are a number of key benefits to having teams engage in manualizing their own practice:
!!!(a) Promoting Service Development
#Engaging in continual, small, iterative and incremental "tweaks" and changes to ensure that there is [[Learning at Work]]
!!!(b) Fostering a distinct LOCAL team culture
#A local team develops "our own unique manual" that is:
##//"Bespoke"// to our own local needs - attuned to the local population and geographical constraints (transport, culture, common clinical problems, etc)
##A record of the ongoing [[Mentalization]] efforts (the [[Learning at Work]]) of our team, //about our team// as a whole (why we behave in the ways we do)
##A powerful tool for inducting new team members
#We sustain a practice that is both //integrative// and //multimodal//, according to our [[Core Features of AMBIT]].
#It is hoped that the implicit sense that this method of working constantly tries to [[Respect Local Practice and Expertise]] will also support positive team morale.
!!!(c) Comparing and sharing our work with other teams
In AMBIT there are already multiple teams beginning to adapt their own local versions, which you can see from the dropdown list on the manuals signposting page (manuals.anafreud.org).
* An explanation of how the manual supports the development of AMBIT as a [[Community of Practice]]
* The ability to see what other teams have been writing about is a function that is still in development. You can, however, openly look in other teams manuals- an easy way to see what they have written is to click on the 'Recent Changes' tab (below the search engine) and then click 'Local'. Additionally, you can ask one of the ambit project team to point you towards other teams who manualize!
!!!(d) Research
There is as yet little research into the use of wikis in learning organisations, but a helpful paper exists for those who are interested: Cole, M (2009) Using Wiki technology to support student engagement: Lessons from the trenches
----
<center><<image-link "How to edit your teams manual" "luciano-de-sa-ObwMZBdEWdI-unsplash (1).jpg" "How to edit your teams manual" "250">>
Here are some topics that we would like to write some pages about:
[[How to use outcome measures in a collaborative way]]
[[How to work with young people who might feel ambivalent about including their network in the work|How to work with young people who might feel ambivalent about their network being included in the work]]
[[Exploring and understanding families' cultures]]
[[What's the best approach to planning our work?|Planning our work]]
Boundaries in our work
Using agendas
OARS - motivational interviewing skills
!What is Mapping?
<<list-links "[tag[Mapping]]">>
Mapping is a visual tool that can help us to gather, record and reflect on information that we are gathering from a person in a session.
A map is a spider diagram. In the centre of the diagram is the thing we are trying to understand. Round the edge, we gather the different points/ideas that relate to this.
We draw them out as we are talking to people. We can show them the map or refer to the map and summarise what is written on there, if we are not together or they can't read it (e.g. language/literacry barriers)
!What kinds of things might we map?
Mapping is a tool that can be used at any stage of our work.
!!Assessment stage - gathering information
*What are the problems/needs?
*What are the strengths?
*What is going well?
*Who is in the network? What are their roles?
*What are your desired outcomes? What help would you like?
*What does "helpful help" look like to you? What does "unhelpful help" look like to you?
!!Formulation - developing understanding
*What does [the problem] look like when it is happening?
*What do we know about what triggers [the problem]?
*What makes it better; what makes it worse?
*What do we know about *Why might x be happening? e.g.
**What might be making this YP feel angry?
**What is making it difficult to listen in class? **What is driving low mood? What's making you feel low?
**What might [x person] be thinking? What might be going on for them?
!!Developing interventions
*What has already been tried in the past?
*What seems to help at the moment?
*What makes it worse that we could avoid?
*What are your ideas about what could be tried?
*What could you do? What could other people do?
*If we were going to try [new approach/strategy], what would that look like?
!! Reviewing progress
*What's gone well this week?
*What improvements have you noticed towards [goal?]
* What have you/others been doing that's helped?
*What barriers came up when you tried to do [task]?
*What got in the way of you trying [task]?
*What else would you still like to work on in relation to [goal?]
!! Planning endings
*What's helped about the work we have done together?
*What progress have we made towards each goal?
*What needs to continue to maintain the progress?
*What barriers might come up? How could we overcome them?
*Who else can help to keep the progress going?
! How can maps help?
Maps help us to be thorough when we are gathering information. A map is a way of reflecting that there are lots of different ideas that might be relevant to a particular question, whatever that might be.
The process of jotting down notes in this way as we go is very visual and easy to read. It can help us to organise and keep track of the information we are gathering, without having to write in prose or long notes (or not at all!)
It helps with the pacing, as we can invite the other person to slow down to help us keep up with what they are saying. This can help them and us to move into a more reflective stance.
It helps us with reflecting back and summarising, which helps us to check out with the person whether we are understanding them accurately. Doing this frequently will help to build and strengthen the relationship.
We can draw out the maps we want to do in advance, to help remind us of the structure of the session. It can also help to prompt us (and the other person) to notice if the conversation is becoming unbalanced, i.e. if we are mainly focusing/being focused in on one particular area.
For example, sometimes we might notice that someone is very detailed with regards to problems and finding it harder to focus on strengths etc. Perhaps they are wanting to tell us what help is needed, without helping us to understand what the problem is. Mapping can help us build a picture of this more clearly and give us ways of bringing these reflections into the conversation we are having, both to validate the person's experience:
//"I'm just looking at our maps - you're feeling that there's a lot that's not working here; it's hard to see past all these needs; this sounds very tough going - things are hard in lots of areas"//
as well as to hold the balance in the conversations
//"We've talked a lot about the difficulties; would it be ok to hear a bit about the strengths? I know they might feel harder to reflect on when there's so much going on, but shall we see where we can get to with that?"//
! What is a network map?
A network map is a drawing, using concentric circles. The parent/YP are in the innermost circle. Invite parents to tell you about the other people they have in their life and plot these in the outer circles, according to how near/far the parent feels this person is to them.
! Why use a network map?
It's helpful to explore a parents' network with them. This is because we want to design sustainable forms of help, through [[scaffolding existing relationships. |Scaffolding Existing Relationships]]. This is an AMBIT principle which reminds us of the importance of using the relationships that already exist in a family's life to support them with the changes that they want to see. There may already been things that people around the family are doing to help. Understanding what these things are or drawing a parent's attention to this may be useful, so that these resources can be made use of in the intervention. It is not always the case that a new professional is needed to meet every need that is identified.
!!Introducing the map
Explain to the parent that it would be helpful for you to get a picture of who else is around and important in their life. It might be that some of these people already help in some way or could help with the things that are difficult. Genograms (family tree) can also be used for this, but they tend to privilege the exploration of family relationships. A network map can include anyone, regardless of the type of connection.
It is important to be mindful that some parents might not be feeling isolated. Do not make assumptions about people having partners, being in contact with extended family, having friends etc. Try to follow the parents lead by asking open questions such as "Who do you have around you?" and suggesting some categories, rather than specific people ("e.g. What about your parents?")
!! Who might feature on a parent's map?
* Their parents
* Their siblings
* Any other professionals
* Friends of theirs
* Friends with children of a similar age
* School professionals
* Aunts, Uncles, etc
* Their own workers (e.g. therapist)
* GP
* Community groups/supports
* Religious groups
* Neighbours
* Colleagues
!! Questions to explore:
* Where would you place this person on your map? How close or far away?
* What kind of things do you do with this person?
* How does this person help already?
*Is there anything this person could help with?
* Is there anyone from this map that you'd like to include in our work?
!! Using the network map in the work
The network map can be referred back to in subsequent sessions, as a way of thinking about how the network could be included. For example:
*Who could you ask for some ideas about x?
* Who could you talk to about y?
*Who from your network map could help?
* Who would notice this had got better?
* Do you think anyone from this map would have any ideas about why z might be happening?
!!What is it?
This is the first step in a four-step 'ritual' called [[Thinking Together]] that is designed to help improve the quality of //communication about our work//, and thus to improve the //quality// of that work.
It is the "short-term" version of one of the [[Core Features of AMBIT]] practice, which is [[Active Planning]].
!!Why do it?
Most clinical discussions (we argue) start with [[Stating the Case]] and move straight into generating solutions ([[Return to Purpose]] in our language) - missing out two key elements (''Marking the Task'' and ''Mentalizing the Moment''). Investing some time in developing a plan - either for something as 'simple' as a conversation with my team-mate, or for something as complex as trying to help a young person, is associated with better outcomes than relying on chance, 'inspiration', or intuition on the part of the helper in determining what would really be helpful to her colleague.
More than this, Marking the Task involves a deliberate attempt to ''//kick start mentalizing in the worker//'' who is asking for help - emphasising that //in these conversations we ritually insist on mentalized explanations for behaviours - our own, as much as our clients'//.
!!Using chat usefully
As practitioners, we all talk about our clients in all kinds of ways and in all kinds of places. Stories are often what draws us into this work, and this is both a positive and potentially a negative, as we can get lost in the stories, especially if they are very compelling or anxiety provoking.
Marking the task is about making the best use of these conversations - that are generally happening anyway.
There is a risk that one practitioner's capacity to mentalize about what his or her colleague is //actually requesting// may not always be accurate. One team member may be keen to "pass the time of day" whilst the other is actually requesting a very serious discussion about important clinical material.
!!!KICK-STARTING MENTALIZING
As mentioned above, in insisting that my colleague stops and asks //their self// ([[mentalizes|Mentalization]] their self):<br><br> //''Why am I coming for help? What do I want out of this "help"? How would I know that I had been helped?''//<br><br>we are ''setting the tone'' in a conversation that insists quite explicitly on mentalized explanations by all participants. By insisting that our colleague does not rush headlong into [[Stating the Case]] we invite them into a mentalizing frame of mind - ''//"Help me understand what you think you need out of this conversation"//''
!!What is "Marking"?
We draw on the theory of Marked mirroring]] and Ostensive communication, that explains how mentalization develops through infancy, and which is also a helpful technique that practitioners can use in working with clients who are in distress. In "Marking" the KeyWorker takes responsibility for the clarity of his of her communication, and minimises the likelihood of misunderstanding about what is being asked for.
By explicitly MARKING a discussion we mean saying something that //explicitly// marks out what you want out of this conversation - that it is NOT just "passing the time of day" (although one could mark out that as the task, just as easily!):
>"I want to talk about THIS client, in THIS particular way, for THIS amount of time..."
A core team task in AMBIT is to foster and sustain [[Mentalizing|Mentalization]] in team members. By using language very explicitly in this way this function is supported.
!!''How to do it''
These are simple steps, and the key is for team members to find their way into using these as one of the rituals and disciplines that define the team's culture.
!!!''1. Ritualised language''
Some shared "marker" that all team members will recognise is required. We have called these disciplines "[[Thinking Together]]", or "Passed-outwards Discussions", and any of these phrases might be enough to signal that a very specific kind of communicating is being requested right here, right now. Teams may wish to agree in their //own// rituals to mark the introduction of this disciplined way of communicating - a simple form of words that carry a shared meaning as part of the team culture. What is important is that these Rituals are EXPLICITLY agreed, rather than IMPLICITLY //assumed// to be in place.
!!!''2. Set boundaries''
Agree ''how long we both have'', and ''what is the outcome we want''. This has been described as "turning the conversation upside down" and starting by defining what the ending might look like. The KeyWorker requesting this should have in mind:
>//"what would a satisfactory outcome of this discussion look like?"//
Is there a key issue that needs a decision?
Is there an area of confusion that needs a better framework for understanding it?
Is there a crisis that needs an emergency management plan to ensure safety for the next few hours?
Is there a wish for some "ventilation" of feelings?
Is the task... to work out what the task is?
Etc...
!!!''3. A contract''
By agreeing to take part in a ''Marked'' discussion of this particular type, the colleague is effectively "contracting" to maintain the boundaries in the next steps - to //keep the staff member on task// and to help keep to these particular boundaries.
Mentalization is one of the [[Core Features of AMBIT]] and underpins the AMBIT approach. This page describes Mentalization in general and ''Mentalization in AMBIT''.
!!''What is Mentalization ?''
''Mentalization is...''
>>//'The imaginative activity of making sense of the actions of oneself and others on the basis of intentional mental states such as desires feelings and beliefs'//
>>//'So, mentalizing is what we do when we are imagining what might be going on in the mind of someone, //underneath// the behaviour that we see on the outside'//
''We can mentalize ourselves...''
"Why do I keep getting into this same fix?..what am I thinking or feeling that means I keep ending up here?’’
''We can mentalize each other....'' “My mum doesn’t seem herself tonight…I wonder if it’s because she’s worrying about… or maybe she’s been thinking about…’’
''Mentalizing is a uniquely human process.'' It is something that we do automatically, often without conscious thought, in our every-day interactions. This is known as implicit mentalization.
Almost all aspects of social interaction involve the capacity to mentalize: //to understand the other person's behaviour in terms of the activity that has taken place inside their minds//…
//''Imagine if we never had any sense of other people’s feelings, beliefs or intentions..''//
We can also mentalize in a more conscious and verbal way. For example, in a therapeutic context with a client, we may try to understand with them, their mental states or the mental states of others, that underly certain actions. This is known as Explicit Mentalization.
Below are some video teaching sessions of varying length and detail explaining mentalization in slightly different ways.
For those who prefer to read, there is more explanation and links to related theory and concepts throughout this page too.
!!''Video teaching''
!!!Training videos
For most teams (short version - 10 mins):
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!!!''A brief conversation about Mentalizing ''
Wih Dr Jon Allen, Menninger Clinic, USA
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!!!''Prof Peter Fonagy - interview: What is Mentalization?''
Peter Fonagy here describes mentalizing and its applications in a 20 minute interview made at the Anna Freud Centre.
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!! Where does the theory come from and why does it matter?
Mentalization (or Mentalizing as many practitioners prefer), originates as a hybrid, and not essentially novel, idea from: Philosophy of Mind, Attachment studies, Systems Theory and Neuroscience.
It has been proposed by a group of psychologists working in the United States and Europe. It combines the framework of Psychoanalytic theory, Attachment theory and aspects of research on social-cognitive development.
It is proposed that mentalization is one of the core processes that effective therapies have in common. And in some ways the study of mentalization attempts to create a shared language between different therapeutic models. It explores how these shared factors play an important role in creating change.
''Mentalizing is central to understanding, regulating and communicating emotions,'' since emotions relate very directly to our beliefs, hopes and intentions, and whether they are being met, or frustrated or threatened.
Reflecting on one’s own beliefs, desires, and feelings is also important for maintaining a healthy inner life. For example, if we feel anxious but have no way of understanding this experience, or why it is happening, it might be pretty overwhelming !
''A broad range of psychopathology can be seen as involving one or another form of specific mentalizing dysfunction''.
See Specific diagnoses and their corresponding Mentalizing failures.
''Mentalizing is closely connected to the development of a particular type of trust, known as'' [[Epistemic trust|Epistemic Trust]]. Epistemic trust is thought to play a central role in creating the conditions for the learning of socially and culturally relevant information through relationships. The links between mentalizing and epistemic trust are highly relevant in AMBIT, particularly as AMBIT was developed for clients who often have a relationship to help in which it is difficult to trust in the value of information passed through relationships.
!!''What is Mentalizing, and why does it matter? ''
A 70 minute illustrated talk describing Mentalizing, its origins, its value and what happens when it goes "offline":
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!!Mentalizing and face to face work
Making sense of behaviour in this way is the cornerstone of clinical practice.
The [[Therapist's Mentalizing Stance|The Therapist's Mentalizing Stance]] is a core part of all of the growing family of mentalization-based approaches to therapeutic work.
Therefore, the ability of the clinician to mentalize (to make sense of the behaviour in mental state terms) is particularly important, especially when the behaviour of our clients does not make sense in obvious ways, or seems inexplicable.
Our Theory tells us that mentalizing is fragile, though – particularly in contexts of high emotion- and not just for clients, but for therapists too (in this sense it is a great "leveller" in the power dynamics of the patient-therapist relationship.) This explains the strong emphasis on Supervisory Structures in AMBIT - so that stimulating and sustaining our colleagues' mentalizing is as important as the work we do face to face with our clients.
!!''Pre-mentalistic stances:'' (or Non-mentalizing stances)
Three key concepts help to describe the states of mind (Pre-mentalistic stances) that are adopted when mentalizing becomes imbalanced. These are:
*Psychic equivalence
*Pretend mode
*Teleological thinking
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!!''Complexities in Mentalizing:''
''Mentalizing is a complex and uncertain process for a variety of reasons including:''
*A person can act according to a belief that is wrong.
*Beliefs arise through a complicated interaction between sensory perceptions, memory, and motivation and so may change for many reasons, perhaps because the environment has changed, or because some hidden mental process has occurred.
*Because beliefs are just representations of reality, people can have very different beliefs and feel very different emotions about apparently similar things.
*Mentalizing emphasises the uniqueness and specificity of the human's subjective experience. Therefore making sense of this in each other (or indeed at times within ourselves) is a complicated task at which we are only ever partially successful.
!!!''More videos''
See below a brief video of the famous scientist (and extraordinary communicator) Richard Feynman - describing how he came to understand that even the most basic mental functions (like counting, or reading) that we might take for granted as being the same for all of us, may in fact be conducted in extremely different ways:
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Another way of making sense of Mentalizing, courtesy of Pixar:
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!!A Developmental Concept:
The capacity to grasp mental states becomes evident in the second year of life. It continues to be refined over the whole course of our lives as the nature of mental states are understood with increasing sophistication.
!!''Further material:''
*There are many helpful Mentalizing Quotes that help to define this very old concept.
*There is a hierarchical series of Mentalizing Levels that can be observed, and which the therapist tries to build on.
*There are Features of Successful Mentalizing that can be useful 'checklists' for therapists (and clients!)
*There are Features of UNsuccessful Mentalizing that can be useful 'checklists' for therapists (and clients!)
*There is The Therapist's Mentalizing Stance which is how we translate //theory// into //practice//, and is a core feature of all the mentalizing practices.
!!''Powerpoint Slides''
You can access teaching slides about mentalization. Remember these slides are all released for sharing under a [[Creative Commons Licence]] - you just need to not pretend they are yours, and share them on similar non-commercial terms!
!!Reflections on the 8 team learning situations
* The team does not have an awareness of what works and what might need improvement - we have this in mind but we ideally would like more time to focus on this
* We are curious about our work and its impact - we take outcome measures - we reflect on our work and how interventions are going
* We need to reflect more to discover 'blind spots' or bias
* Busy doing sessions and meetings that we do not have time to plan and reflect
* Difficulty being evaluated - as a team we feel that we are quite happy to be evaluated, we do want to know
!!Two we would like to improve upon - what needs to happen to achieve the change?
1: The team are busy reacting, and not reflecting
* Have a learning space
* We feel like we don't have the time for the reflection
* Relationships with other people need to be comfortable and strong in order to be able to reflect with each other
2: The team considers different explanations and perspectives
* Would be good to learn more from Scotty's experience and knowledge within Brent - we do not utilise this enough
* We don't have a learning space - to learn from each other as a team
* Do more 'thinking together'
!!Reflections on the 8 team learning situations
*in light of COVID - we have had to be reactive both as a team and individually - did reflect but perhaps not as much as we would have liked
*we are very reflective as a team - we have had service development afternoon to discuss covid adaptions
*do have learning spaces but so much learning needs to be done as a new team - need to consider altering/ increasing these spaces
* evaluation of a new service- we have had to change to the requests made by commissioners - around the report time
*would like to be more curious - about the work and its impact - in a more live and continuous way not just around the report
*blind spots- had to adapt quickly due to covid so maybe didnt see all the 'blint spots' in hind sight- linked to being reactive
!!Two we would like to improve upon - what needs to happen to achieve the change?
1:Being less reactive and more reflective
*manualizing of reflections during the proposed new team reflective space
*having a helpful reflective space in team meeting about cases- taking the case allocation to a separate space to allow time for this
*need to ''continuously'' reflect and discuss adaptations as a team
2: Being curious/ evaluation
*bring outcome measures into our conversations so that we can continue to be curious about our impact.
*be continuously curious and reflecting about our outcomes/ impact/ feedback and 'data' and not just doing it for the report.
*weekly 'spotlight'? to create a space for some of the things that are going well as well somethings that haven't
!!Reflections on the 8 team learning situations
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!!A Special Interval
In a real sense the other three steps in <<tag [[Thinking Together]]>> (this being the third) are all designed deliberately to hold open this space - in which the worker who is [[Stating the Case]] is //steadied// enough by the mentalizing presence of their partner that they can mentalize more accurately. This is key to the value in [[Thinking Together]] - the FIRST task is ''to restore the mentalizing of the worker'', rather than to leap straight in to working out a plan for the young person or family.
!!Cabin Decompression!
It is like the advice in the safety message before a flight:
>//"In the event of a sudden loss of air pressure, oxygen masks will drop automatically from above your head. If you are with a child BE SURE TO PLACE YOUR OWN MASK FIRST, BEFORE ATTENDING TO THE CHILD."//
This is not about selfishness, it is about ensuring that our best intentions to help are supported by intact thinking!
''We can't support mentalizing in our clients if we are not first able to regain this state of mind as the worker!''
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The ritualised, marked, and boundaried "dance" that these steps provide gives //permission// to the worker to discuss their emotional reactions, and reflect on their thinking, alongside those reported by the young person or family.
The intention here is to allow and foster a more curious and exploratory kind of thinking; one that does not shut down real thinking (on the grounds that the professionals "already know the answer", or that further thinking would somehow be //indulgent// when //it is action that is now required// - this last version would be a good example of Teleological thinking.)
Too often, clinical discussion is //"un"//marked, and telling of the story (or rather purposeless and over-wordy "storytelling") leads straight into action.
Note the strong similarities between this and Mentalizing the Moment (in the Mentalizing Loop) that we use in mentalizing approaches to therapy/exploration with families and individuals. Effectively this is exactly the same process, but applied in a therapy case discussion.
!!Why do it?
This interval is an important space from which more accurate [[Mentalization]], and thus more accurate assessments of the changing risk assessment as well as therapeutic opportunities may emerge. Our hypothesis is that with more accurate mentalizing in the system, risks are reduced.
!!How to do it
1. The colleague who is offering help may firstly summarise back to the worker their understanding of the dilemma they have just heard. This gives the chance for the worker to hear their dilemma from a slightly different position, or from "closer to the bank" rather than being "right in the middle of the chaos"(if we use the Ripples in a Pond analogy).
2. Continuing this analogy, the helper here is momentarily trying to put themselves in the "middle of the pond", attempting to think about (and briefly communicate) what this dilemma may "//feel//" like for the worker. e.g.
>// "It seems like this is really tough for you at the moment with this young person..from what I understand, if I've got this right, it seems like the work has been going very well together over the last few months, and that this is a young person and family that you've got to know very well and really care about...This event seemed to come kind of out of the blue for you...I think if it were me I'd feel quite frustrated and a bit pushed away.."//
If successful the worker will be given a sense that their dilemma is understandable, that it makes sense to the helper.
3. The worker is then invited to join in acknowledging, clarifying and naming their ''own'' feeling states that may or may not be a reaction to the young person's dilemma - //but the keyworker will always try to MARK these as ''MINE'':// e.g.
>//"Thinking about it now, I guess my own emotional reaction is despair; I find myself thinking that giving up is the only option..."//
So although "feeling" in the present tense is a potential //barrier// to "thinking" ...in AWARENESS, it may also provide INFORMATION for the practitioner, and his or her [[Supervisory Structures]].
4. After this initial focus on the workers' state of mind it may be then helpful (and more possible) to mentalize the clients behaviour, looking for new understanding that might have been missed from being in the high emotion or chaos of the situation.e.g.
>// "Ok shall we just spend a minute trying to understand X's behaviour, because it does seem different and a bit unexpected..."//
!!And afterwards?
Only with the fourth and final step of [[Thinking Together]] ([[Return to Purpose]]) is this important "mentalizing hiatus" brought to a close.
!What might this time be like for families?
The outside world is rapidly changing in relation to coronavirus. This is an unprecedented situation for everyone and will be affecting people in a range of both similar and different ways.
Families who were already experiencing stressful circumstances may now be faced with additional challenges related to the current situation:
*family pressures (managing relationships and increased conflict that might be occurring through having to be at home together)
*financial pressures
*challenges accessing basic provisions (e.g. food)
*educational pressures (managing home-schooling; deciding whether to send CYP to school if they have been offered a place)
* lowered physical well-being (through illness)
*lowered mental well-being (feelings of anxiety, worry, uncertainty, boredom, frustration, hopelessness and helplessness, as well as many other feelings will be very common for many at these times)
* how to explain the situation to children
*how to ensure that family members follow government advice, where their may be different perspectives about the need to do so
People's emotional state is likely to be fluctuating as their own circumstances and the situation in the outside world continue to change.
! How might we best check in with families about this?
Families will vary in terms of how much they want to be in touch with the service at this time. If contact is being made with families, it will be important to check in with them about how they are doing as a starting point, rather than to assume that sessions will run according to their usual structure in the first instance.
* Ask family members how they are doing.
* Give space for letting them talk about their own situations and circumstances if this is helpful.
*Acknowledge and validate their thoughts and feelings.
* Acknowledge how much of a difficult time this is for many people and that everyone is having to adjust and find new ways of managing, without much time to have planned this out (NB. be sensitive in framing this - aim is to help normalise some of the experiences, rather than to appear to be dismissing or minimising them).
*Marking the task- helpful skill that our team would like to do more of in team meeting.
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[[Look at reflections!|Reflections on module 3]]
Below is our current to do list. Any pages tagged with 'ToDoList' will automatically be added to the list below.
!!Checklist
<$list filter="[!has[draft.of]tag[ToDoList]!tag[done]sort[created]]">
<$checkbox tag="done"> <$link to={{!!title}}><$view field="title"/></$link></$checkbox>
</$list>
!!Completed tasks
<$list filter="[!has[draft.of]tag[ToDoList]tag[done]sort[created]]">
<$checkbox tag="Completed"> ~~<$link to={{!!title}}><$view field="title"/></$link>~~</$checkbox>
</$list>
Possible ideas
*[[RCADS|https://www.corc.uk.net/outcome-experience-measures/revised-childrens-anxiety-and-depression-scale-and-subscales/]]
*[[Goal-based outcomes|https://www.corc.uk.net/outcome-experience-measures/goal-based-outcomes/]]
*[[Session Rating Scale|https://www.corc.uk.net/outcome-experience-measures/session-rating-scale/]]
* [[Current view|https://www.annafreud.org/media/3196/current-view-2015.pdf]]
Here is a list of all pages tagged with Outcome Measures
<<list-links "[tag[Outcome Measures]]">>
We would like to write a page about how to make sure we are balanced in the way that we make plans about our work.
*We think it will be important to use goals and follow manualized approaches
*But we also think it will be important to tune into what young people want, follow their lead and be collaborative - we liked the idea of the [[AIM Cards]] and can explore whether we adapt a version for our wellbeing offer
*If we focus too much on the manualized approach, we may lose the young person
*If we focus too much on the young person, we might lose the plan!
We agreed to come back to exporing this, as it relates to a concept called [[Active Planning]] in AMBIT.
!!!We would like to think about some dilemma's and questions around the following points:
1. We are called Well Being Practitioners but we have not carried out the formal qualification for this. In the formation of WEST the idea had been to train the WP's through practice 'on the job' rather than taking up a formal qualification as a WP before beginning the post
There are 2 qualifications for WP's
(a) Educational health and Wellbeing Practitioners - this is a post graduate cert and has an extra module more than...
(b) Child WP - for this you may not need a degree (check this)
The training is very similar/overlapping
Both are carried out by UCL and the AFNCCF-)
The WP's in WEST did not do this due to the above
2. The WP's in WEST have done a large amount of training and supervision with AFNCCF trainers/workers. Training has mapped onto the CWP/EHWP training curriculum (particularly in the early stages)
!!!The dilemmas for us are:
*How do we show and validate our experience and training?
*How do we show/prove our training to others (e.g. jobs sometimes ask for 'qualified well being practitioners)
*If there is a meaningful difference between what we do and what others WP's do should we have a different title?
The WP's have said that they would like to do have the formal qualification/accreditation.
We are wondering if it would be possible to do a conversion to the formal diploma? If so what would be needed?
If this is not possible, a recognition/validation of the amount of training that we have had in the role would be important (both for our sense of what we have achieved but also to show for future qualification/jobs)
!What is this page about?
We would like to include parents/carers in our work as much as possible. A common need can be to support parents and young people to reach a point of agreement with each other about things like rules, routines and how they will behave/communicate towards each other.
We wanted to put down some ideas about how we might approach these kinds of conversations.
!What's the problem?
It can be difficult to reach shared agreement between parents and young people, particularly for young people who are teenagers. There are lots of reasons for this, including the fact that the developmental stage of adolescence brings with it a lot of change, which might mean that rules, boundaries, routines and relationships start to look quite different from how they did when the young person was a child. Some parents and teens might be coming for help explicitly around their relationship, within which we might more naturally expect that collaborating on these matters will be hard. At other times, a point of difference/disagreement might come up as part of working on something else, which would benefit from some problem solving.
We tried to come up with an approach to structuring conversations around these types of difficulty. This framework could be used to approach any kind of point of disagreement/difference/issue. We are proposing that separate conversations take place between worker and parent and worker and YP before a joint conversation happens to bring these points of view together.
!Mentalizing the moment
What is it like when parents/YP are finding it difficult to agree with each other about how something should be? There can be a lot of strong feelings about, including frustration on both sides, feelings of not being listened to, being disrespected, different ideas about authority and whether it should be respected, feelings of powerlessness, helplessness and not wanting to be controlled etc. All of these could be being experienced on both sides, which might be making it difficult to think clearly about the best way forward or equally could be pushing parents/YP into very certain positions about what needs to happen, which could be leading to some inflexibility or a wish for a "quick-fix" (action) rather than a process of collaboration.
If parents/YP do not have very clear ideas in their head about what they think/what they want, having some time to work this through could also be helpful. Generally, if its hard to reach agreement, having a separate space where each person has an opportunity to work through their thoughts about what they might want and talk through any strong feelings, can be helpful before bringing people together. Doing so prematurely may mean that the differences and feelings play out in the session in a way that makes collaborative thinking much harder! It also leaves the worker in a position of having to think on their feet as they start to see the points of difference unfold in front of them, rather than being able to build an understanding of these prior to the session and coming with more of plan about what might help.
Giving people separate spaces could be thought of as having a ''mentalizing'' way of approaching the situation - giving each person a chance to have their own thoughts clarified and feelings validated before expecting them to get into a position of taking on the perspective of the other person. This separate opportunity to think things through with the worker gives each person the best chance to be in their thinking brain when the session to work out the "compromise" takes place. The worker may achieve this by supporting the parent or YP in any number of ways in order to achieve this (e.g. exploring their thoughts and feelings, offering the acknowledging/validating these, offering some scaffolding to help them think things through if they haven't done any thinking on the issue themselves or are finding it overwhelming to do this etc.)
!Introducing the rationale
Following an [[active planning|Active Planning]] stance, it's helpful for workers to broadcast their intentions about why they might be approaching the conversation like this - i.e.
//"The (e.g. bedtime/sleep routine) is important to you both, but you're got quite different ideas at the moment about what it should looks like. I know that agreeing on this has been hard, so I want to try to help you find something you can both agree on, but its probably going to involve a compromise! I'm happy to think with you both to see if we can work this out - we can do it separately to start with, so you've each got a chance to tell me what you think and what your ideas are, then we can bring those together and see where you agree, where you disagree and work out what the middle ground is".//
! What to include in the conversations
Some questions might include:
*Asking each person what they feel their ideal would look like, in terms of the (e.g.) sleep/bedtime routine?
*What would it best look like if they could design it?
*How close is that to what is happening at the moment?
*If its not close to what's happening at the moment, what would be realistic?
*Where would they be prepared to move to? What would their compromise be? (supposing the other person had a different view)
*What do they think the other person (their child/ their parent) would think about their ideas?
Can ask parent/carer to write down their ideas/routine/rules around (e.g.) sleep routine and then ask them to give each part a priority rating (low, medium, high) and a realism/achievability rating. This can help the parent to refine their expectations in line with what is achievable and developmentally appropriate, if needed.
Similarly, the young person could write down their ideas about what their ideal rules would look like or the worker could show them the parent/carers' ideas and ask them to rate them according to things they already do/could do/would be prepared to do (green), things that are a bit ok/achievable and things in red that they think are unreasonable and would be too hard.
When discussing rules with parents/carers and young people, it can be helpful to acknowledge the "purpose" of having rules - helps people to know what to expect from each other; most families do have some rules, even if they don't get called "rules" - like just how we do things/things we don't do. The purpose here is to make these a bit clearer, even though that might seem a bit formal, but with the aim that them being explicit and clearer helps people to know what to expect. For teenagers, mentalizing their experience of having to have rules might be helpful! Rules can feel annoying, but equally how does learn to deal with rules help prepare them for life?! Worker could acknowledge some rules that they have to follow as an adult that they would rather not!
!Increasing motivation/compliance with the proposed changes that parent might be suggesting
It can be helpful to address low motivation/ambivalence on part of YP to engage with parental wishes
*Explore what the pros and cons would be of trying it out
*Seeing if they would be willing to experiment with trying it and let you know how it was - then talk through if there were any pros and cons
* Would complying with it help in other ways (to get parents off their back; reduce arguments etc!)?
* Following the parents' expectation might be worthwhile - e.g. if you show you can go to bed at this time, maybe they will let you stay up a bit later - is there anything in it for them?
!Explore with parents how they will positively reinforce compliance with routine/rules
Share ideas with parent about how they do this already in general and therefore what might work here.
*What kinds of things do they feel might encourage the young person to stick to it?
*What works in general with this kind of thing? Do they like praise/encouragement? Would it be best verbally or sending a text or leaving a note?
*Who else might be able to help with supporting this to happen? Can other family members be involved in encouraging in a way that would be motivating?
**praise, positive feedback, encouragement
**reward system (e.g. earning something they don't already get; linking something they do already get to this new behaviour of following sleep routine)
**consequences for not following.
[[Rewards/consequence programmes]] need careful thought and planning.
__''What to include on the referral form''__
(CPFT example CAMHS referral form)
!Referrer details
*Self
*Parent
*Professional (details)
*Including phone number, email address
! Demographic information
*Name
*Address
*DOB
*Ethnicity
*Gender
*School year
*School
*GP
* Parent/carer (address, phone number, resident)
*Siblings and schools
* Other professionals (current)
*Tick box - CIN, CP, LAC, EHCP, SEN, Disability, Young Carer, known to CAMHS
! Reason for referral
*What are the well-being or mental health concerns?
*What's going well? (at home, school, other settings)
*What help is needed/wanted?
! Current risks/contextual factors?
Checklist - adapt inclusion form checklist
! Consent (if not self-referral)
Consent from young person
Consent from parent
__Being clear on the different spaces in our team__
*reflective space (separate space on a wed): reflecting on how we feel about the work
*service development space (at the end of the team meetings) : how our work is being implemented practically
*Using our time in a more structured way- team discussions
*really important to create these so that once we are back to face to face and things are busier we value these as a priority and treat them as such.
__How do we make use of manualizing __
* manualize during the last half an hour of team meetings during our discussion around practice development.
*we just need to do it!
*Allow us to be more focused in our conversations
*would someone be able to look at our wiki and learn what we do from it?
*to share the writing responsibility of writing in the manual during manualizing as a team
*learning to share our thoughts and manualize at the same time
*manualize the proposed reflective space
*manualizing pracitical non-identifiable points
*CH and JP to manualize conversations about the teams/ outcomes/ data/ reports etc.
*manualize how we write the report - to help us continuously evaluate our service in a transparent way
__What to hold in mind in the reflective space__
* changes/ adaptations that we have made and bring these back - example: changes we have made due to COVID and reflect on if these are working- what went well/ didn't
*points brought to the team meeting by members of the team that require more discussion rather than just 'business points' this might cross over from the team meeting service development space
* the thinking together tool - use it! using 'the chair' person
*how the work is effecting us, how are we feeling about the work
*how we communicate as a team
*how the current circumstances/ context may be impacting our work and how we are working as a team and individually - this may change once we go back to working face to face (currently may have more time/ easier to 'fit it in' and give it priority)
__How do we make use of local experts__
*We often wait until we have a relevant case - how can we preempt who the required experts are
*We have developed a directory- how we can use this to build relationships with these services.
*Could speak to services/ ask them to speak to the team on the phone/ teams to better understand what they do on a personal level.
*Could structure this by giving a member of the team a service to contact per month.
*when we have cases that we talk to external teams and services having a space to share this information- agenda on the team meeting
*using links/ connection made to services through case notes to ask about other wider services that are available
*reshuffling in Brent- could allow opportunity to make new connections
*need to make less assumptions that everyone in the team has the same knowledge of services as we do. - bring back to space in team meeting
*once back working in person this might be easier
*picking services that we will be working with often to start getting an in depth knowledge of what they do/ relationship build.
*connecting more with 'young champions'
*Brent induction- yet to receive this - could we spend some time understanding the Brent LA services.
*helpful structure for our team meetings and case discussions.
*Helps us have an expectation of what help seeking in our team might look like which might make us more likely to seek it.
*interrupting is ok! which is helpful to know for all members of our team as we will all know why we are doing it and it wont be misconstrued as rude
*help me be more aware to think about what i am looking for when i ask for help
*that help seeking is a two way process and you have to help them help you- being more specific about what you need/ want help with when help seeking
*The help seeking process can be awkward and make us feel vulnerable- this is how our families may feel and we need to keep this in mind when offering help
*having a space within the team to discuss help seeking that we can continue to consider and tap into this space in our work with families.
*might make us feel more contained knowing we have a team space that has had these discussions.
*Sculpting exercise helpful at point of referral to see if our support would be beneficial
*Sculpting in team meeting will help us inform our work with professionals and the next steps
*Sculpting exercise will help us to mould the TAC to be most helpful to the CYP
*Chair exercise - help us to 'team think' and use different minds to solve challenges that come up in our cases
*Chair exercise to use in team meeting and case discussions as well as consultations to help professionals think about the appropriateness of our involvement and what other professionals are already doing.
*adopting language from AMBIT in our practice when we are speaking with external agencies
*
* To be mindful of informing the client of your thoughts; sharing our plan and our thoughts, why we might be quieter some times
* To check in about what the client wants to bring and talk about how to make space for it in the session
* Leave time to reflect on the session together
* Thinking about each session as a "standalone" piece of work - what we might be wanting to achieve in each one.
* ensuring the client is also a participant; you're both hearing each other
* sharing the plan with the client and making sure you know what they think about it before you proceed
* remembering that the plan can be changed, as long as it happens in an agreed way - the plan can be dynamic, as long as you are both sharing your states of mind about it so that you can both be aware that the goal has changed so that you are still travelling in the same direction
* aware of how many people can influence the plans that we might have with YP. Are the plans that are generated always made on the basis of what the client and worker thinks or too heavily influenced by other people's thoughts and ideas?
__''Key reflections''__
We reflected together on key themes from today, in relation to the four different areas of our work. These were themes that arose from the discussion we have had.
__Client__
*Feel excited about making resources/portfolios for young people that are adapted to their needs
* Feel like we will need to balance being tuned into young people and following their lead, with ensuring we are doing the goal-focused work. We need to make sure we get shared ideas about what to focus on, so its not just about following their agenda vs. our agenda.
__Team__
* It was helpful to share experiences with each other - learned things about each other that we didn't know
* Feel like we will be working as a team and helping each other with our work and that this is important
*Feel that we will have a 'team behind us' when we are doing our work, even though we might be carrying out the work on our own
*Feels important to liaising with each other to share ideas about how to do the work - we can help each other out.
* Its good that we could talk to each other about what we are already good at, but also what we find hard and need to develop
__Network__
*How we can be thinking about involving the network around the young person from the beginning of our work? Its not something to leave until the end, but to be done throughout.
* We could think about creative ways to include people from the network - it's not just about bringing others in to focus only on problems, but also to share successes (this might feel like a more comfortable place for the young person to start)
__Learning__
Getting the balance right between:
* Learning from each other: It was reassuring to hear others sharing their experience about something that I didn't have much experience of (e.g. outcome measures) because it helped me get some ideas about it. I was less worried that I didn't know it, because I know there's others in the team who I can ask.
* Learning from evidence: its important to know the manualized approaches well (e.g. CWP manual), because it might be that we need to apply it creatively or adapt it to meet the needs of individual young people, which we will be better able to do if we have a good understanding of the material.
See [[LEARNING at work]]
* We can make templates of resources that we can share within the team
__What was helpful from today that we'd like to carry forward?__
*Having examples to make the ideas concrete
*Varying formats for activities/discussion
* Helpful to think about our general values about well-being and mental health
* Good to start thinking about this together
* Helpful to think about how we might adapt our explanations to fit with what they are bringing, rather than using a very fixed way each time
*
* Importance of highlighting that we are working together on your wellbeing and getting YOUR ideas about
* Helpful to think about the links between wellbeing and context
*Patchwork exercise helpful as a creative way to think about wellbeing
__''ACTIONS''__
*How would you introduce the idea of wellbeing
**To a younger child
**To an adolescent
**To a parent
*Think of analogies that might work that could link
*Get clear on your 3-5 bullet points that would help you describe what you mean by wellbeing in the context of being a wellbeing practitioner.
*Avoid jargon, being too long or doing a speech! Simple points are better - you can always elaborate if needed
#Introducing the cards - explaining the purpose of them seems ok; difference between saying "getting to know each other vs. getting to know you". These cards can help us work out what to work on together, so might feel like there are more cards in here that are to do with problems.
# Young person sorts the cards: helpful to comment a bit on the process when they are doing it
** You did that really quick!
** You were really thinking about that one
**That one seemed a bit harder to work out where it went
# Exploring strengths/what's going well:
Reflections:
YP - nice to speak about the good things that were written down. Liked being able to talk about the good stuff and how the worker linked the good things together; made me stop and think and work.
Workers - felt a bit more natural to gravitate towards the things that were a problem; important to go through these first. Hearing about the good things might help us out with some of the things that are going well.
Importance of asking OPEN QUESTIONS (vs.closed questions) to help explore and build an understanding of the strengths:
Examples of questions that could be asked about the card ''Getting on with my family'':
*What do you do with your family?
* Tell me a bit about why you picked that card?
*Who is in your family?
* Who do you get on with the most?
* What does getting on well with your family look like?
* What did you have in mind when you picked that card?
* Does everyone in the family get on with each other? vs. How does everyone else get on with each other? Who gets on with who?
''Exploring the the difficulties pile ''-
YP - nice that the worker asked things and also then gave bits back to me with her reflections to check she was understanding what was going on
//"So let me just check that what I've understood is correct..."//
Worker - felt easier to ask about the difficulties, felt as though there was more to explore. Trying to get the balance between YP express themselves and also helping out with that where it got hard. Was trying to normalise without being invalidating.
We watched the 4 videos below and reflected afterwards on what we liked/what was helpful about them
__''We all have mental health''__
https://www.youtube.com/watch?v=DxIDKZHW3-E
*Normalising - we can have good feelings, negative feelings and going through ups and downs is normal
**Feels important to be mindful of not invalidating how a CYP might be feeling by over-emphasising normalising)
*Could be a helpful video to take key points from to help us explain what we mean by wellbeing
*Different strategies were helpful for different people - e.g. distraction worked for one person, activities for another.
*"Emotions popping up and not going away" - helpful language
*Liked the emphasis on psycho-education - talking about it and learning about it together
*Seems more suited to younger children - could imagine showing it to a child to stimulate discussion
__''Talking mental health''__
https://www.youtube.com/watch?v=nCrjevx3-Js
* Good to hear the focus on the importance of CYP having people to talk to about how they are feeling - although they might be coming to see us, it will be important for us to help them to connect with the people in their existing networks to do this too
*Some of ideas might apply more in a group setting - i.e. 'how you could help someone else who is struggling?' could be a good question to ask in a group
**its also an example of a question that could be asked to help a young person come up with ideas for useful strategies that they could then apply to their own situation; sometimes this is an easier starting place than focusing "what might help me?", which might feel more difficult to think about
* Could be useful as a way of explaining some of the core ideas (e.g. showing a video in a school).
* Wellbeing work being preventative - when the problem has just started. Feels like this language/framing would work well for this aspect of our work
__''What does wellbeing mean to you?'' - Nuffield__
https://www.youtube.com/watch?v=oSIWo5nxF2A
* Helpful to have the adolescents' ideas
*More focused on physical health and less on emotional health explicitly, but physical health is an important contributor to good emotional health
* Liked the terms that were used "taking care of yourself"; being healthy outside and in.
__''Mental health: In Our Own Words''__
https://www.youtube.com/watch?v=_y97VF5UJcc
*Although older young people with more significant difficulties, there was a sense of hopefulness: people talking about how they have coped
* Emphasis on how talking and sharing it had helped - importance of networks and relationships
* Becoming aware - of how the problem started, what they can do to cope, a sense of knowing how they are now. Having an understanding of these things seemed helpful?
* How different the experience can be for everybody - people defined and described different experiences that had contributed to poor mental health
* Did describe how difficult the hardest moments can be - not trying to gloss over these with an idea that everything can be made better. Helpful to be able to sit with this
* Some of the things that they described as helpful were still some of the 'everyday' things about how they looked after themselves, their relationships, doing activities, as well as things like having therapy/seeking professional help - important to remember the balance between these
__Other videos that you could watch and comment on:__
*''Five ways to wellbeing'' - a video made in collaboration with adolescents
https://www.youtube.com/watch?v=yF7Ou43Vj6c
!!Key points of theory
* AMBIT is an approach which emphasises //the importance of relationships in promoting positive change//, so engagement is a primary task for the worker (and the young person!)
* It makes use of attachment theory (especially the idea of internal working models) and [[Mentalization]] (especially the related topic of [[Epistemic Trust]]) to provide the theoretical basis for this; help-seeking behaviour lies at the heart of attachment theory and research.
* There is also a fit here with ideas about hidden, private or implicit theory drawn from the implicit psychoanalytic model]] that can be seen as contributing to the [[Mentalization]]-based approaches.
!!How this fits with AMBIT
* Within this general framework, there is also interest in the specific processes and experiences of people seeking professional help for their difficulties:
** One of the assumptions of the AMBIT model is that many of the young people will have had negative previous experiences with professional helping systems and/or will have negative beliefs and feelings about such help.
** Many AMBIT practices are designed to find ways of working with clients who may have many reasons for not wanting to work with professional services.
!!!A universal 'Primary Outcome' for ~AMBIT-influenced teams?
* There are few if any generalisable treatment Aims and Goals in AMBIT-influenced teams - but ''"developing a more adaptive relationship to help" is probably one of them''.
!!Mentalizing the relationship to help
There are many ways that clients might //perceive// the help that we offer, and these may be influenced by early experiences for an Attachment-based explanation of this.)
Our perception of what help is will trigger emotional reactions to this, and these will influence our behaviour. AMBIT takes a view that there are many different ways in which our clients might experience our help (however authentically //we// might feel we are offering it). The point is that ''understanding how young people see our help'' might in itself help us with [[broadcasting our intentions|Broadcasting Intentions]] in a clearer way //for this young person// - to enable them to accept (or "enter") help, despite their concerns or objections. In this way we are offering opportunities for them to develop new perspectives on help.
!!Diagram
<<image [[RelatToHelpDiagram]] width:600 height:480>>
This diagram (animated below) is ''not an attempt to define reality'' (which would be Psychic equivalence on our part!) but is more a "thought experiment" that tries to describe some of the commonest barriers to help that may be worth considering.
A young person may (mis)perceive help in different ways at different times. Getting to be helped requires a "Therapeutic Bargain" - in which the client "takes a chance" and "enters anyway". Although she may enter through many different "doors", she may leave understanding rather more accurately the perspectives of a helper that may have been misunderstood from "outside the door". There may commonly be "comings and goings" in and out of relationship with help, rather than a "coming to stay".
*Consider ''"//different kinds of Help//"'' as being available "inside" the diagrammatic "house".
* There are four doors in and out of this house (though in reality of course there are many more)
* The three "Blocks" that stand in each doorway are as follows (from the outside going in):
#The ''Response to Help'' in terms of the ''//affective/behavioural response//'' to what they "see" standing between them and real help ...e.g. hopeless, fearful, denying, angry.
# The ''Response to Help'' in terms of the young person’s own ''//perception/construction/imagination//'' of the ''state of mind of the worker'' who stands between them and help ...e.g. helpless, useless, refusing, accusing.
#The ''Offer of Help'': A selection of potential ''states of mind that the worker might actually offer the young person'' e.g. interested and committed, holding hope that things will change over time even though ways forwards now are difficult to see, authentic and truthful (expressing confidence in the young person's self-agency, unafraid to "tell it as it is" in terms of diagnoses or reflections.
If the worker can properly mentalize the young person's authentic feelings and beliefs, right here, right now, and can //show// (in her eyes, and her manner of speech, etc) that this has been sensitively understood, then [[Epistemic Trust]] may be established, and help or learning may quite suddenly be accessible - like a door opening. There may be learning, that //"help may look unhelpful sometimes, and this can be explored..."//
The point of this thought experiment is that ''if we, as workers can more accurately mentalize our clients' experience of (or relationship to) this "Help" we are offering, then we may be more successful at __adapting the way that we are offering it__'', in order to make it less indigestible than unfortunately our well-intentioned offers of help too often appear. Of course, the shift towards greater mutual understanding is the work of engagement, and a key skill is how the worker can find ways of [[Broadcasting Intentions]].
!!!Animation:
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!!Welcome the Coming and Speed the Going
(With thanks to Dr Paul Caviston for this quote)
Note that the end point is not the young person "__taking up residence__" in the help centre, but taking what is on offer there to set off on the next stage of her journey. This echoes the ancient "code of conduct" described in Homer's //Odyssey// which all dwellers in the Greek islands held:
>''"Welcome the coming, speed the going"''
This code dictated how islanders were obliged to behave towards sailors who were shipwrecked on their shores (which must have been a pretty commonplace event back then.) The duty was to provide hospitality, repairs, and to stock the ship for the onwards journey.
__Reports__
* Report on the specific KPI’s directly
* Excel spreadsheet – how we are achieving the specified targets – all KPI’s at a glance
* Borough priority to provide services to boys of Black Caribbean heritage- need to include how many are involved in the service
* Within each ethnic group – need to be specific about gender and age too i.e. the number of boys of black Caribbean heritage that are aged 14 involved with our service
* Be specific about how many CYP’s have an EHCP, how many are at risk of exclusion etc.
* Also breakdown according to the vulnerable groups – children on CP, edge of care, gang affiliation
* Template to be shared of report and state what key characteristics need to be reported on specifically
* Spreadsheet of those cases that are too complex or severe for our service – add these in to signposting section rather than rejected referrals
__Reporting__
Reports to be sent out two working days prior to contract management meeting
Next meeting dates:
* Q2 - Thursday 23rd April
* Q3 - Thursday 23rd July
* Q4 - Thursday 22nd October
- SDQ shows level of need rather than improvement
- The question is whether we have reduced the impact of the MH problem – not whether we have cured the MH problem – the problem might be less
- Reduce the chronicity or intensity of the distress rather than cure
- Improved functioning
o Engagement in education
o Achievement of goals
o Improved sense of agency – feel like they can do something about their problems
- How much do we target more vulnerable groups?
- How does the demographic of our service compare to the demographic of Brent overall? E.g. ethnicity of the CYP seen in the service compared ot the ethnicity mix in the borough – are we seeing a presentative population?
- Is our service helpful to our population? Organise our report around this question?
- How much recovery happens independently of therapy?
Look at our service spec – page 12 – outcomes
JP - Look at Helen and Emma’s original outcomes plan – logic diagram – does this till fit? Organise the report around this?
<<list-links "[tag[Resources for work]]">>
Here are some websites that may have useful resources that could be adapted for families, or if used, their source fully acknowledged. Please discuss the appropriateness of the resources with your supervisor before sharing with families. Get familiar yourself with any of the resources that you share and be able to offer a rationale for why you are sharing them, so that you are able to answer families' questions about them.
''A wide range of CAMHS resources''
[[CAMHS Resources- Downloads|https://www.camhs-resources.co.uk/other-links]] contains their list of helpful booklets and resources for children, young people and parents which may be particularly relevant during the COVID-19 lock-down.
Managing COIVD-19 related anxiety [[resource|https://www.christie.nhs.uk/media/8758/1386-managing-anxiety-about-covid-19.pdf]]
[[Health Young Minds|https://healthyyoungmindspennine.nhs.uk/resource-centre/guides/ ]] contains resources un specific to COVID-19 but that cover MH concerns that might arise during home isolation
[[NHS Lothian website|https://services.nhslothian.scot/camhs/Resources/Pages/ResourcePacks.aspx?fbclid=IwAR0lN_o4l3r0Omib6daX43Ji2XlX51W4x5ra9MrggqHM6VqUuQceVhvFONs ]] contains a plethora of resources regarding COIVD-19 for parents and children and young people. It also contains specific supporting resources for people with neurodevelopmental disorders, as well as activities, social stories and visual aids.
''A range of additional resources in a open access dropbox''
https://www.dropbox.com/sh/x7p6mqpknblwgbe/AAC8yjkvj4PpmrnsXda1M9DXa?dl=0
''Self-care ideas''
The Anna Freud Centre have developed a variety of [[self care ideas|https://www.annafreud.org/on-my-mind/self-care/]] on their website
''CBT App for 10-18 year olds''
[[An app|https://www.healios.org.uk/services/thinkninja1]]
that has added a lot of Cognitive Behavioural Therapy resources that has been opened up to be ''free'' for 10-18 year olds
''Supporting CYP with autism''
[[The National Autistic Society|https://www.autism.org.uk/services/helplines/coronavirus/resources/helpful-resources.aspx ]] have collated a series of useful resources that autistic people and their families can use during this time of changes
''Bereavement support for CYP''
[[Winston's Wish|https://www.winstonswish.org/coronavirus/ ]], are a bereavement support service. Our Freephone National Helpline, along with our ASK email, Crisis Messenger and online chat services remain available to support bereaved families and professionals caring for them.
[[They are the Future|https://theyarethefuture.co.uk/ ]] - Loss and Grief in children and adolescents related to Coronavirus and Worry and Anxiety about Coronavirus.
''Online counselling service for CYP''
[[Kooth|https://www.kooth.com/]]
are a counselling service that run their services online
''Peer support (online) for CYP with MH needs''
[[Hearts and Minds|https://heartsandminds.org.uk/]]
''Talking to children about Coronavirus''
Story book for young children who are worried about conronavirus:
<<link-doc "Dave the Dog is worried about Coronavirus" "https://drive.google.com/file/d/1D7pN6gHSfVT-tRL2REzkdgPVZOTLKEqZ/view?usp=sharing">>
A fantastic book by Elizabeth Jenner, Kate Wilson & Nia Roberts Consultant: Professor Graham Medley Professor of Infectious Disease Modelling, London School of Hygiene & Tropical Medicine and Illustrated by Axel Scheffler
<<link-doc "Coronavirus: a book for children" "https://drive.google.com/file/d/1-EdhVyWeXrd0Dvc5OYS3KPQa3PlXaRjG/view?usp=sharing">>
Another lovely book called 'There's Something in the Air' Written by Anjali Bhat. About a bee trying to cope with lockdown due to the pandemic.
<<link-doc "There's Something in the Air" "https://drive.google.com/file/d/1lo1yIHR1PLWDhQWN7sHT6um40Ta47BvB/view?usp=sharing">>
''Talking to children about illness''
<<link-doc "Talking to Children about illness" "https://www.bps.org.uk/sites/www.bps.org.uk/files/Policy/Policy%20%20Files/Talking%20to%20children%20about%20illness.pdf">>
Children's Commissioner's have developed a helpful guide for children regarding coronavirus. The have also got a plethora of [[resources and support for school staff and parents|https://www.childrenscommissioner.gov.uk/coronavirus/]]
<<link-doc "Childrens guide to coronavirus" "https://drive.google.com/file/d/1k4QQUgnC3SVRLlcPUVSs_BqG0u2hD77i/view?usp=sharing">>
''Supporting parents/ carers''
School closures:
<<link-doc "Support regarding school closures" "https://www.bps.org.uk/sites/www.bps.org.uk/files/Policy/Policy%20%20Files/Coronavirus%20and%20UK%20schools%20closures%20-%20support%20and%20advice.pdf ">>
WHO have developed [[Parenting Tips|https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/healthy-parenting]]
''Supporting children and young people with worries about COVID-19''
A handout called Supporting children and young people with worries about COVID-19 from Emerging Minds.
<<link-doc "Supporting children and young people with worries about COVID-19" "https://drive.google.com/file/d/1qzuSSCz0NNwvDGayqHoFoV7VRbQgo11N/view?usp=sharing">>
''Other helpful websites''
A great website [[Safe hands thinking minds|http://www.safehandsthinkingminds.co.uk/covid-anxiety-stress-resources-links/]] containing Covid, Anxiety, Stress- Some resources to support children and adults around anxiety, worry, stress, and fears; including specific Covid (this page will be updated on a very regular basis.
Mind – [[Coronavirus and wellbeing|https://www.mind.org.uk/information-support/coronavirus/coronavirus-and-your-wellbeing/ ]]
AFC – [[Advice for young people, parents and carers and schools and colleges and self- care ideas|https://www.annafreud.org/what-we-do/anna-freud-learning-network/coronavirus/]]
''Self-care ideas''
The AFC have produced tiles for Self-care on their [[website|https://www.annafreud.org/on-my-mind/self-care/]] these can be used by staff or shared with Young people and families.
[["It's okay not to be okay"|https://www.ics.ac.uk/ICS/Education/Wellbeing/ICS/Wellbeing.aspx?hkey=92348f51-a875-4d87-8ae4-245707878a5c]] A page of resources from the Intensive Care Society about supporting staff wellbeing.
''Talking to children about Coronavirus''
The BPS have developed some advice for pracititoners on how to talk to children about coronavirus.
<<link-doc "BPS advice: how to talk to children about Coronavirus" "https://drive.google.com/file/d/1mbO1aNp2kgg9AfojVUMrTpuCcW8RfNtX/view?usp=sharing
">>
''Talking to People about Dying during the Pandemic:''
<<link-doc "Talking to People about Dying during the Pandemic" "https://drive.google.com/file/d/13_pSm_4UrsNj3sC3EdBY57XJ5OOCnw68/view?usp=sharing">>
''Supporting children and young people with worries about COVID-19''
A handout called Supporting children and young people with worries about COVID-19 from Emerging Minds.
<<link-doc "Supporting children and young people with worries about COVID-19" "https://drive.google.com/file/d/1qzuSSCz0NNwvDGayqHoFoV7VRbQgo11N/view?usp=sharing">>
A policy document from the UN's IASC summarizing key mental health and psychosocial support (MHPSS) considerations in relation to the 2019 novel coronavirus.
<<link-doc "ADDRESSING
MENTAL HEALTH AND
PSYCHOSOCIAL
ASPECTS OF
COVID-19 OUTBREAK" "https://drive.google.com/file/d/1LZZlc4Lqy64obof8XbEoJ95q1MR_v8ce/view?usp=sharing">>
A brilliant blog post from an psychological wellbeing practitioner in the UK with a wealth of practical advice about how to conduct psychological work effectively over the telephone.
A short fact sheet of guidance from the Oxford CADAT about how to conduct effective memory work in cognitive therapy for PTSD remotely.
A stance of respect for local practice and expertise is one of the [[Core Features of AMBIT]], and there are [[Training Exercises for Respect local practice and expertise]] in this manual.
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Consistent with a [[Mentalizing]] stance, AMBIT adopts an explicit sensitivity and respect towards the local service ecology; for instance, local Social Work departments, Youth Offending Services, Medical services, Education, Housing departments, etc.
The aim is to build on strengths and existing local expertise ([[Scaffolding existing relationships]] as it were) and this is reflected in the process of [[Manualization]], which asserts the value which existing local expertise in a team will add value in terms of //how to implement// other evidence-based ways of working, or AMBIT-influenced practices //here, in this specific locality, amongst these specific organisational constraints//.
Much of what a successful team is already deploying locally with success will be expertise that offers value for other teams working in similar settings, or with similar target groups. This explains to some extent the high value that AMBIT places on its [[Community of Practice]]. AMBIT's TiddlyManual format allows for a "__co-construction__" of evidence-based practice and practice-based evidence, and moves away from the monolithic 'one-size-fits-all' approach that has characterised many manualized approaches before.
What this means is that AMBIT workers deploy their [[mentalizing|Mentalization]] skills ''not only'' towards:
* Young people and families
* Their team colleagues (the [[Keyworker well-connected to wider team]] is another of the [[Core Features of AMBIT]])
''But also'' in relation to:
* The local service ecology (other agencies and professionals working with the same client group.)
This means making a positive and explicit efforts (adopting this as a deliberate staff culture) to avoid 'polemic positions' (//"Social workers are ALWAYS doing this to my clients...!"//, or //"Typical GP!"//), instead [[Addressing Dis-integration]], for instance by using the [[Dis-integration grid]] to clarify one's own ('mentalized') understandings of local practitioners' positions.
!!AMBIT is never a stick to beat other practices with...
A huge amount of investment goes into training and developing models of practice, and developing the outcomes evidence that supports these. For a new model or approach to arrive in a locality and unintentionally (or, worse, intentionally) undermine or damage an existing model of practice that is working well, would be a serious "side-effect" of the training intervention.
AMBIT is expressly designed to //avoid// such unintended consequences. Indeed, any active attempt to use AMBIT as a "stick" to beat other methods and practices in a kind of "treatment models turf war" would be an extremely non-mentalizing use of these materials and theories.
!!Training
The training of [[AMBIT]] increasingly tries to recruit LOCAL specialists to deliver training on specific interventions during team trainings, or to deliver AMBIT training. There are [[Training Exercises for Respect local practice and expertise]] in this manual which we encourage [[AMBIT Lead]]s and others to practice.
!!Experts by Experience
Another area of Local Expertise, is of course that of the Service users - who are "experts by experience". The constant harvesting, learning from, and adaptation of a service in relation to service user feedback is thus a key part of the practice that flows from this principled stance.
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One of the [[Core Features of AMBIT]] is ''respect for the fact that //there is such a thing as __evidence__//'', on the basis that to ignore this would be to show great disrespect towards those whose future may depend upon the outcomes of our decisions.
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As the phrase suggests, AMBIT strives to orient itself to reality, and to facts that are proven, rather than a particular clinician's opinions or wishes. This is entirely consonant with [[Mentalizing|Mentalization]] practice, which promotes a curious inquisitive //tentative// stance - open to learning and avoiding the assumption of knowledge without evidence (Pretend mode functioning.)
Evidence can take a variety of forms; different pieces of evidence are different not only in how much respect they command, but also in their applicability to a specific situation at a specific time. This work is an inexact science, but [[Evaluating outcomes|Outcome Measures]] lays out the rationale for integrating the day-to-day therapeutic tasks with regular, robust outcomes measurement. Of course, in the hierarchy of evidence applicable to the developing content of the AMBIT manual, properly conducted trials and systematic reviews are at the top. Outcomes evaluations from teams working in the field constitute a valid and important step towards developing and conducting such trials.
Respect for evidence is applied in AMBIT in three ways:
!!(a) Manualization
Firstly, the approach takes seriously the need for [[Manualization]]. The AMBIT approach is manualized, using highly innovative web-based documentation (see [[User Guide]]), in recognition of the fact that evidence points to improved outcomes for interventions that are manualized, as opposed to 'reactive' or eclectic approaches (Huey et al, 2000), and where fidelity to the model is high.
!!(b) Evidence-based interventions
Wherever possible we use [[Working in Multiple Domains]] to deliver interventions which are ''evidence-based'', or adaptations of these to fit them for the non-standard settings they are delivered in. The AIM Formembedded in this manual will generate a range of AIM suggested interventions from the scorings you enter into it about a particular young person, and there is advice on how to think about Which Intervention When (please note this function of the manual is currently under development).
It is accepted that in some such settings (home-based, street-level), there is not yet sufficient trial evidence to assert effectiveness, so that the phrase 'evidence-oriented' is rather more fitting at this early stage than the rather over-used 'evidence-based'.
As regards the evidence for home-based, multimodal, assertive models of practice, we acknowledge the huge role played by MST (Multisystemic Therapy) in developing a rich literature on this area of work. It is helpful to consider some of the differences between MST and AMBIT.
!!(c) Regular, systematic Outcomes measurement
See [[Evaluating outcomes|Outcome Measures]].
!!And finally...
Making sense of evidence is helped by an understanding of the skills of critical appraisal - how to read a scientific paper, so as to understand its reliability and validity, and in particular its relevance to one's own clinical practice. We don't explain these skills here, but why not sing about it... with thanks to James ~McCormack (and Prof Peter Fonagy who pointed this little gem out):
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At the end of the [[Thinking Together]] exercise, there must be a return to the overarching Task...
!!START Boundaries.
In this respect is is helpful to remember the ''START boundaries'' of around any task (these are described at keeping your bearings).
*Space
*Time
*Authority
*Responsibility
*Task
!!The Task in Thinking Together
All Thinking Together has a task that relates back to the search for some kind of product (a ''decision'', an ''intervention'', an ''understanding'', etc) that ''offers promise as help'' for the client/family.
!!The previous stages are a DELIBERATE SUSPENSION of this task-focus..
To enable what we refer to as //"the curious exploratory play of ideas..."//. So to end the exercise there must be a return to this purpose.
!!If no progress is made...
If a decision cannot be made, or an understanding is not reached, etc, then the practitioners will decide if the risk assessment is at a level that leaves them "quorate" (see reflective quorum) to make decisions about postponing this decision, or if widening the Quorum is required right now, and who else might be required to advance the management of this problem. They may need to resort to formal [[Supervisory Structures]] and/or emergency procedures, or they may be able to agree a process to carry forwards their thinking to, say, one of the next team meetings.
!! Things to consider –
* Hygiene procedures/different procedures across different schools
* What type of mask to wear
* Travelling to Brent
* Our own anxieties around returning to work
!!! Hygiene procedures –
* Each school has a different risk assessment and different procedures
* Our AFC risk assessment will ask whether each school has considered different risks
* If we bring our own equipment/resources we should bring wipes to sanitise afterwards
!!! Different types of mask to wear –
* Visors might be better to create a rapport with the child
* Face masks with a clear mouthpiece to show our mouth expressions
!!! Travelling to Brent –
* Best to take cars if possible
* Possibility of taking a bike on the tube to get to Brent and then cycling around Brent
* We can type our notes on our phone in between sessions and it links with our notes on our emails
* Possibility of getting screen protectors so that public cannot see our laptops whilst working in public place such as café
* We may need to rearrange our schedules to fit in a whole day or Brent work to avoid having to go in on two days
<center>{{Stance-Scaffolding.JPG}}</center>
''Pictured above:'' the repair of the famous Mostar bridge that was all but destroyed in the war that accompanied the break-up of former Yugoslavia.
Scaffolding existing relationships is one of the [[Core Features of AMBIT]].
There is constant effort to support, or add scaffolding to, key //existing relationships//:
* The young person's relationship to him or herself
* Relationships within the family
* Relationships between the family and other professionals in the network
* Relationships with key professionals in the network that may be of significant value, or likely to be longer lasting than ours
...rather than a drive necessarily to //replace// these. Other ways of looking at this include:
* The necessity of identifying any (rudimentary, or frail) Strengths Resiliencies that might easily be overlooked, and building on these
* The need for a practitioner to hold in mind the risk that out of good intentions (to become an important, helpful figure in a young person's life) I might inadvertently undermine a relationship that - although fragile, and perhaps even apparently //unhelpful//, actually holds a greater ambit for influencing positive change over the coming year(s) than I - or my team - do.
Wherever possible, security in existing attachment relationships is supported as being in the long term interests of the young person’s psychological development, even in settings that may conventionally be seen as high risk.
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AMBIT stresses the importance of Social Ecology, and Systems Theory, and supports an unwillingness to be drawn into Teleological thinking that attempts automatically to //replace// existing supportive structures. The focus in AMBIT is always on //scaffolding what is there//, so that fundamental structures (relationship to self, to family, close friends, School, Social Services, a Youth worker, etc) can be strengthened in ways more likely to sustain the task of maintaining an integrative context.
>>"Scaffolding is a major word we use - as in intensive treatment service, our CPNs see themselves as a temporary part of a young persons life and talk of scaffolding other workers in the network."
>>>Ambit-influenced team, 2014
!!But...
This is unless, of course, the level of Safeguarding or Child Protection concerns make this option inevitable - and it is not at all uncommon that a high degree of uncertainty surrounds such questions.
!!Keeping a Balance
Of course scaffolding relationships //that may be far from ideal// requires attention to [[Managing Risk]]... It is important to work with what is //there//, but not to lose sight of the need for careful governance so that risks are managed and client, worker, and others are protected as much as possible.
...this is why [[Managing Risk]] is the stance item in the [[Core Features of AMBIT]] that is paired with ''Scaffolding existing relationships''. See the AMBIT Wheel.
At times we overbalance into too-rigid protocol-driven (Teleological thinking) risk management interventions that in the long term threaten our relationship with a young person, or their relationship with others who might actually still be in their lives long after we have left the scene. At other times, a diligent worker's compassion and empathy may lead them to over-identify with the young person, or "up-regulate" their tolerance of risk (//"maybe it's just me being too much of a worrier, or getting old and not understanding how young people live these days - who am I to wade in and tell people they are wrong?"//)
!!What to do?
* An approach to assessing what is there: the Multi-Domain Assessment and in particular the narrative history and Strengths Resiliencies are key.
* Social-Ecological Work for building resiliencies in a young person's life
* Mentalization Based Work for work on a young person's relationship to themself and others
* Family Work for work on family relationships that might be improved
We will include here information on separation anxiety where this overlaps, as school refusal can be closely related to separation anxiety (particularly in younger children) however they are not always related. Sometimes difficulty in separating from parents/carers is a key underlying factor in school refusal.
In teenagers it is less prevalent , but still may be part of the school refusal e.g. when a young person has concerns about leaving their parent at home alone and worries about what may happen if they are away from them at school.
There are a number of factors that can underlie and lead to school refusal (it is a term which captures many difficulties).
For both separation anxiety and school refusal the starting point for any successful intervention would be to develop a good understanding of the different factors which are influencing and maintaining the difficulty (i.e. a formulation of vulnerabilities and risks, maintaining factors and protective factors as well as any specific triggers).
!!!School refusal:
* Separation anxiety in younger children might look like being unable to settle in school, or crying when separating from parents and being unable to. There may also often be stomach aches/ physical symptoms of illness due to separation anxiety that
* Separation anxiety may come from parents concerns about their children, particularly at the moment and in the current context of coronavirus. Some parents may not be agreeing with school policies or that CYPs should be in school, making it more difficult
* Difficulty of not wanting to reassure parents too much, as we don't know if there is something wrong with their child
!!!Building a formulation of school refusal...
Child/young person factors
Family system factors
Network factors
School factors
!!!Formulation (try one in pairs)
Which are vulnerability factors?
Which may be maintaining factors?
What might be some triggers
What are strengths we can build on?
!!!Intervention
Some key points to include in your thinking:
*Where might you be able to intervene in the maintaining factors?
*What is realistic? What is within your AMBIT?
*Including the network- reducing dis-integration and coordinating network
*Sharing an understanding with family young person and network, of what may be underlying the refusal (how could you do this?) see [[Egg and Triangle|Broadcasting Intentions]] as one simple tool to share our understanding of simple formulation
*Individual work- finding ways to help the child/young person express difficulties/anxiety around school/separation
*CBT for anxiety (including family)
e.g Cathy Cresswell's book in this manual
*Building a plan for return- Break down into steps and rewards for each step
*Not too much time between steps- better to build up quickly if you can
*involving the family and the network to implement this...how could we do this?
We would want to consider....
Who are secure relationship in school?
who will meet them? where will they go when they arrive? where will they go when they are upset or distressed
!CBT approach
!!What might we do?
*Psychoeducation about anxiety - normalising, providing language and thinking about symptoms. Making sense of their experiences
*Developing a '''TOOL KIT'' to cope
* understanding the anxious thoughts/ thinking traps
*Cognitive restructuring
*Working with parents about their worries
!!How might we do this?
__Psychoeducation__
*drawing selves and their symptoms
*cartoon strips - fight of flight
*talking about the psychical symptom changes
*NORMALIZE - through vignettes/ stories/ cartoons/ videos
*Get parents to map out how they feel their anxiety
* Draw an outline around the child and draw where the symptoms are (better with a parent present)
*step by step approach to facing fears
__Tool kit ideas__
*Breathing/ relaxation - bring parents into the work so they can practice it at home (Belly breathing, candle, feathers, bubbles)
*tensing muscles
*shake up snow-globe and then practicing breathing whilst it settles
*5-4-3-2-1 method recognising via senses (alternatives to this to draw them)
__Anxious thoughts__
*''Thinking traps ''
*Putting the anxious lens/ glasses on, we can take these glasses off and ask for help taking them off. when are you most likely to put your glasses on?
*Name traps as people 'catastrophising Cathy' etc.
*''Thought detective'' - spot when your falling into a thinking trap and is the person who is getting the facts from the thoughts- whats factual, how do you know, whats not and what can I do to help
*''Traffic light thoughts'' - red- unhelpful, amber- neutral, green- helpful
__Cognitive restructuring__
*speaking to the worry as separate from the YP taking them out reshaping them and then putting them back in our heads
*using a machine the thought goes in one end and then goes through the machine and out the other end
__How to encourage at home___
*statements/ reminders around the house
*reassurances
*achievements - memories
*reminders that the feelings of anxiety will pass/ its always worse in our head
*Coping statements - linked to characters they connect with (Ninjago)
__What if the parents are also anxious?__
*Utilising our team to support parents
*do a similar CBT structure with parents
__Facing fears __
*Fear ladder- using this to rate how scary these things feel
*use achievable steps
*utilize the tool box
*rewards! stickers, praise form mum and dad, their favorite meal, more time on laptop
*drawing the steps out in a nice way
*using a graph to map where they are each week.
[[The Schools Outreach service's wiki|https://manuals.annafreud.org/schools-outreach-service/]]
!!Introduction
This is a "low impact" form of roleplay - minimal dramatic skills are required. A paper based version of the exercise is the [[The AMBIT Pro-Gram]], and a more directly clinical tool that addresses the same topic of [[Dis-integration|Addressing Dis-integration]] is the [[Dis-integration Grid]].
A Sculpt is one of the training exercises AMBIT uses, and is designed to help teams to:
* Visualise the large and complex networks around young people
* Take multiple perspectives from the positions of various protagonists (note positioning theory)
* Map out ''Dis-integration'' in physical space that might otherwise be mapped via the [[Dis-integration Grid]]
!!What you need
* Space to move people around, chairs
!!Example
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!!Activity
* Invite one person (or a small group) to describe a clinical scenario from their experience
** Brief history of the case
* Start with the index client, and arrange other figures in ways that reflect their relationship with each other
** Close relationship - sit them close together, looking at each other
** Distant relationship - sit them far apart
** Consider whether you want them seated in a "face-off", or turned away from each other, etc, etc
* Add all members of the immediate family first
** Then extended family, peers, friends
** Then significant others (Pastor, Imam, Coach, etc..)
* Then complete the Professional network
** with each professional, consider the 3 levels of dis-integration that the [[Dis-integration Grid]] uses
*** What is their EXPLANATION for why they are involved: "What's the problem?"
*** What is their intended INTERVENTION: "What to do?"
*** What is their understanding of systemic RESPONSIBILITIES: "Who does what?"
* Once the network is sculpted "as it is", ask key "players" to talk about how it might feel for their character to be in this Positioning Theory.
* Try to ''re-organise the network''
** Re-arrange characters in ways that the main protagonists might start to experience them as more accessible, helpful, etc.
** What are the barriers to such systemic change?
** What are the most glaring ''Dis-integrations'' in the network?
<<list-links "[tag[Self-Esteem]]">>
Where does low self-esteem come from?
*Things out of their control, e.g. safeguarding
*Negative thoughts, e.g. thinking traps
Strategies we could use:
*Worry time
*Thought challenging: pros and cons, identifying thinking traps
* Role model activities and my strengths activities.
Thinking about self-esteem:
* Self esteem is not separate from other experiences and emotions. It is linked to anxiety and making sense in ourselves. You build self-esteem by how you are perceived by other people and how you interact with other people.
* Social interaction plays a big part in self-esteem. Have you experienced high level of judgement.
* For children to make sense of self esteem is important. For instance the hot cross bun can be helpful to understand thoughts, behaviour and feelings better. Gives more confidence to control your thoughts.
* Strategies:
* Role models: who do you aspire to be and look up to and why. This creates different explicit conversations, like drawing attention to the people the child sees important and what he really values. There is a connection between what the child thinks it is important in people and how to link that to the child.
* Balance thinking: asking yourself questions to thoughts you might have.
* The importance of talking with the child about what can be shared with the network. 'How would it feel to share this with your parents? What bits you do not want me to share?' Suggest parents and teachers to praise their child.
* Do a strengths list and make family members and friends contribute to that list and validate those strengths, achievements, skills and hobbies.
* A visual representation of who I am to think different aspects of life, think what are you good at in each of the areas, Eg. How is school important and how do you contribute to that. Have areas to prompt them with. Try to stimulate who am I, what is important and what I do in my life. You can have visual prompts to scaffold the conversation.
* Have different values and the young person has to say whether it is important for them or not. It opens up interesting conversations about 'why' they see themselves in certain ways. This also helps to work and construct on their identity.
* Emphasize their negative thoughts is a belief and an opinion, is not a fact. These thoughts may be due to experiences you had but may not be true. Have a shared understanding about why they have certain thoughts.
* Self-compassion: Talk to yourself with kind comments, the same way you would talk towards a friend. This is for young people who are very critical and harsh to themselves.
* Making sense and name it when thinking styles are dominating, what is actually happening through their mind. There can be an internal bully that is very critical and explore how can you respond to that.
* Comic book with different characters.
* Name the internal bully as a different name, like 'starving gremlin' and talk about what makes it take over, makes it bigger and smaller. In a way you separate it.
* How do you get a teenager who was low self esteem? With teenagers it may be more related to the thoughts and thinking patterns. It is important to acknowledge the down talk and understanding it better. In some cases, when you work with other areas alongside self-esteem things can become better. Being lead by the young person and what is important to them.
* Being able to control the negative thinking and feeling empowered makes a big difference for their self-esteem. They can view situations differently this way. By the time sessions have finished, they may be able to quiet that voice or have tools to manage it better.
#Self-Help Videos
#Self-Help Apps
#Self-Help Books
#Self-Help Websites
We looked at the self-care ideas that had been generated as part of the On My Mind project at the Anna Freud Centre
https://www.annafreud.org/on-my-mind/self-care/
__''Ideas''__
To make some card based resources to look through with young people
Questions that could be asked to explore these:
* Which of these have you tried before?
* Which do you regularly use?
* Which are the most helpful?
* Which haven't you tried, but might like to give a go?
* Are there any that were helpful in the past that it might be worth trying again?
__''ACTION''__
These might be more suitable for an adolescent - are there cards you could make for younger children or an adapted version? Doesn't necessarily have to be called "self-care"; could be "things that make me feel good"
Some key themes for the following 4/5 sessions will include
* Making sense of self-harm.
* What is it like being a practitioner working with self harm?
* What does the evidence tell us about self harm?
* How to set up a context that feels ok to talk about self harm. Explore pros and cons of self harm and ways of talking about self harm with CYP and parents
* Motivational interviewing review
* Making safety plans, assessing risks and involving parents/carers
* DBT and MBT: core ideas that we can apply in our work with CYP
!!!What is self harm and its behaviour?
* Formal definition of self harm is where there is an intention to harm yourself e.g. self injury or self poisoning, for example injury using something sharp, self- poisoning, self burning.
*Although the above definition is more narrow, we need to recognise that there are a very wide range of behaviours which could be understood as 'self harm' or harmful to ourselves. These may also be used in ways to help cope with feelings/situations/experiences e.g. restricting food, drug abuse, very high levels of exercise or work also putting yourself in a risky position, putting yourself around people that can cause high level of risk.
!!!What feelings does self harm it evoke in us as workers?
* It can evoke a feeling in practitioners that we need to stop this behaviour immediately, feeling responsible for this happening, feeling helpless, feeling that we have to get them to stop.
* It can bring up a lots of powerful feelings in workers, such as sadness and feeling panic, feeling the need for action and wanting a quick fix
* We might feel revulsion
* We might feel 'cut off from it'
These feelings may influence how the worker reacts, for example trying to stop it and moving into 'quick fix' before really understanding well what is 'underneath' the self harm for this CYP and what might be maintaining it for this person
!!! There are some Myths about self harm
(see youtube video from Pooky Knightsmith on self harm myths)
It can be useful to discuss these myths with CYP and parents carers...Could show video and discuss afterwards e.g.
which of these myths have they heard? this can begin conversations about new ways of understanding self harm and curiosity about what may be going on underneath for the CYP.
!!!Some common Myths:
*The more someone cuts the more severe is their problem
*Just teenagers that self harm
*It's 'fashionable'
*Self harm is about getting attention
!!! Some responses to myths
* Re-framing/challenging idea of attention seeking....Self harm can be related to attachment needs, seeking care/support, seeking something which is not present at the moment or that they need more of... what kind of attention would they most need? have missed out on?
* Shifting people to try to think about What else might be going underneath for this young person instead of focusing only in self-harm? What might influence this behaviour? when does it happen, in which contexts?
* Rephrase/reframe if they use words such as 'naughty' or attention seeking or other labelling terms...how could you re-frame this....e.g. showing need for care? showing distress...showing pain? punishing self....
Sometimes it might be appropriate to explain more generally about what we know about some of the varied reasons for self harm... That it can be very different for different people....it is usually helping someone to manage something (even though that may be hard to understand)
e.g. managing intense emotions, needing to feel real, needing to feel present, using it to block out other very painful experiences or memories/thoughts, using it to punish self, using it to express anger or stuck ness...can be a way of bringing people closer...
Sometimes more general psycho-ed about 'other young people' who self harm and 'some of the reasons i've learned through my work with other CYP' can allow people to think more about their own family/children with a bit more freedom..
This links with....
!!!Talking to parents carers about self harm:
See also youtube video by Pooky Knightsmith on 'what not to do for parents, and can be helpful and not helpful'
* Pooky video: look together with parents and ask what they make of that. It is not telling them what to do, you are proposing to think and evaluate the video together. This shifts you out of the expert position
Some key points and principles to try to help parents/carers to hold in mind:
*Listening and being curious about feelings rather than trying to stop self harm/move to quick fix (this is a completely understandable reaction but may inadvertently cause more upset, feelings of being coerced/intruded upon etc which can increase difficulties
*Caring response, e.g. offer to tend wounds, offer to check in on self harm, need for physical care of these
*balance between managing risks e.g. removing risk items and keeping an eye out/checking in vs becoming overly intrusive and punitive- discuss this balance with parents/carers- it is difficult to get this right, will constantly need to re-adjust !
*Showing concern and worry but trying to control feelings of anxiety, frustration helplessness , panic etc (Mentalize the parent- they may well feel this !)
*Opportunities and showing openness to talk and listen but not pressure to talk
*An important goal would be to help contain parents' emotions (i.e. mentalize them) so that they are in a better position to mentalize the CYP rather than respond in lots of non MZ ways e.g. who else is supporting parents/carers? who has their rope? who is in 'their back up team?'
* Self harm can and does improve when we can better understand what is underlying it for a CYP and when we can help change those underlying difficulties
*Challenging myths/certainty about self harm (e.g. myths above)
!!!Creating a context in which the young person may feel able to talk about Self Harm
*For some this may happen quickly and feel ok once they see that you the worker are open to talking/thinking about this. For others, even saying that they have intentionally hurt themself may be a huge step and take time (see more on this below around ''warming the context'')
!!Evidence base and treatment approaches
* NICE Guidelines are clear that building a good understanding of the young person's individual context and life - what might be the range if factors for them that relate to the self harm- is central to helping
''This means an individual understanding/formulation of the different factors in someones' life that might contribute- then using this to help guide what might need to change/what is possible and realistic to change/what does the CYP want to be different ?''
!!!What causes self harm?
*explore the many aspects of a YP's life that might cause a YP to show their distress through self harm (our hypotheses):
**''societal'' pressures
**''cultural'' expectations not being met
**parental/ cultural pressures regarding academic achievement leading to linking this with self-worth - GCSE's, Alevels etc.
**access to help/ support-
**wider societal stresses - global climate change, BLM
**socially acceptable way to show distress due to the culture and time era
**parental conflict - causing anger or a need to bring people closer to them and care for them.
**''family'' -rejection, trauma, neglect
**learnt behaviour from family - expressing emotions/ help seeking/receiving
**''peers'': bullying, relationship breakdown, isolation, others distress causing distress, competitiveness between peers
**identity formation - based on the feedback from others determine our self worth - this can be negative or 'positive' but may cause a link to thing aspect of life to their self worth that is unachievable
*Low self worth/ not liking self
*using self harm to 'bringing yourself back' from disassociation caused by trauma or distress
*the 'alien self'/ the internal bully - can be developed from a mismatch between personal experience and external response from caregivers
!!!What do we know about what works/ doesnt work when working with YP who self harm
*''Focusing on the whole person rather than focusing on the self harm'' - it is often better to focus on the things that are happening that feel hard for the YP in their life and understand them. Often this can then reduce self harm in the longer term.
*Can we model how the whole family seek help and talk about their emotions
*there is no 'one treatment' that is the best way to work - indicates we need to look at this concern holistically
*we need to consider risk - although it may not necessarily mean suicidal but this needs to be checked
*NICE guidance: person needs consistent support for 3 months
!!!how can we set up a conversation about self harm during an assessment?
*if its in the referral form then its a good opportunity to talk about it explicitly
*would it be alright if i ask you a bit about that?
*''warming the context''- how can we make the person feel more comfortable and safe to talk about difficult things
**broadcasting intentions
**explicitly stating that the topic might feel a bit uncomfortable.
**invite them to help you understand
**general talk about 'other young people' finding it a bit awkward to talk about self harm etc. there are some people that are a it worried about it so it feels a bit important but that i know lots of people find it a bit difficult.
**how you you feel if I were to ask you about it? i wonder if there is anything that could make it easier? would it feel ok for you to tell me a bit about it.
**talking about it is reducing the stigma- it would be more unhelpful to not talk about it or avoid it as this can increase the stigma.
**using psychoeducation - i know there are lots of myths and stigmas around self harm - i have a video about it if we aren't quite ready to talk about it.
**there is something i have been thinking about but m not sure how you might feel about it but i really wanted to have a think with you about ... do you think it would be ok to talk to you about this?
**if it did become too difficult/ too much how would you let me know? what could we do in the session if it did become too much?
**what might make you fell most safe if we talk about this?
**Ensure that confidentiality and sharing information is covered at the beginning again.
''Interventions for self-harm''
* Build on what you've already learned together about when self-harm has been avoided? What helped? How can we make this part of the plan?
* Grounding - using any sense to bring you back to the hear and now. May be dissociated, in a memory that's very traumatic.
Can use to test in sessions and see what smells they find.
'Feet to floor; bum to chair'
Breathing exercises - relaxation (e.g. breathing in through mouth and out through nose)
Belly-breathing or getting them to trace round their fingers slowly (up and down)
Using a candle - aim to make it 'dance' rather than blow out , or making a feather move on the out breath
Imagery - dampen down fight/ flight. Imagine a safe-space
* Alternative strategies: behind the self-harm; e.g. its role is soothing = hugging instead, or pain = ice instead
* Emotion regulation - using thermometer (what do you notice (thoughts, feelings actions) when you're at each level). You can try and use that in conversations regularly and then use different strategies at different temperature levels
<<list-links "[tag[Separation Anxiety]]">>
''Exploring sequences with parents''
__Broadcasting Intentions__
* Would it be okay to go through in a bit more detail exactly what happened? Just to help me understand it and then it might give us some better ideas about what to try
__Get the detail, like a movie script of who did what when.__
*So how did it start? Take me back to the beginning bit, when everyone was calm
*What happened next?
*At what point did it start becoming difficult
*Can you remember exactly what he/you said?
__Speak in the present tense to help recall__
*So imagine I'm there, what would it have looked like?
*So you're here, he's there...you're getting pretty angry - what happens next?
*How does it end up going from// x // to// y//?
__Get specific__
*When you say he was being disrespectful, what was he doing?
__Get internal processes as well as behaviour__
*"It just shows that he can't just rule the roost" - so was that something you remember thinking at the time? How did it make you feel when you thought that?
''Reviewing sequences with parents''
*Let’s look back through and work out where did it start getting difficult?
*What were you thinking and feeling at that point? What do you think the other person might have been thinking or feeling?
*Where did the emotional temperature start getting high for you both?
*Which are the points at which it could have gone a bit differently? What could your options have been at that point?
*Is there anything in here that you would have ideally preferred not to have done/said?
*How would you have wanted this to end? What would you have liked to have seen go differently? Let’s work out how we could have got that to happen.
*What could have happened differently that might have prevented this situation from happening all together?
*How could this situation have been exited more quickly?
__Broadcasting Intentions__
*Emphasise how helpful it is to have heard the detail – really grateful for the explanation.
*Clearly its much easier to do this in hindsight; we are slowing this down a lot.
*There’s things we would want him to do differently too, but we are just going to focus on you here because we’re in this conversation now! I will do the same process with him etc.
''Intervention areas to hold in mind when reviewing sequences with parents''
*''Re-stating the rules/expectations'' - being clear about what you want to see right now
*Pre-empting difficulties by giving ''reminders/warnings'' - e.g. in 10 minutes it will be time to finish on the Playstation or go to bed
*Reminders about ''rewards/consequences -'' //Remember if you do x [desired behaviour], you will get [reward]". / "Remember if you continue to do x [undesired behaviour], then y will happen [consequence]."//
*Modelling ''staying regulated'' - exit the situation when you need to //We'll come back to this when you're calm"//
''Practising new skills/strategies with parents''
*Getting ''specific'' about what they might actually say or do
*Some parent will be okay with the idea of roleplay, others less so. (//How do you think you would actually say that? Pretend I'm the YP - how would you put it? Give an example of the kind of thing the parent might say and then ask them to put in their own words//)
*''Re-run the sequence'' with the new part built in - "//So let's go back to the beginning, you come in and see YP doing x - you say your new bit and then I'll be the YP//
*Use you ''MI skills'' to build motivation to change! //How do you think it might pan out if you're able to try that? It's so much easier with hindsight but what would have gone differently last time if you’d been able to take the approach that we’re just talking about? What do you think it might be like to try it for the first few times? What do you think will happen after they’ve seen you do this a few times?//
''Reviewing sequences with YP''
*''Establish that “a difficult thing happened that we would want to avoid happening again” – these things are usually not nice for everyone in some way''
*Link to their goal?
*Link to something psychoeducational about family life? //All families have disagreements sometimes; helpful to talk about ways to manage at those times so that they don’t get out of control; important that people show each other respect in families through their words and behaviour; of course people have disagreements, but we want to work out ways to have these as safely and calmly as possible.//
*''Broadcast your intentions'': want to hear from them about how it went and then work out what people in the situation could have done differently to change the outcome.
''Get their story''
*Ask the young person for the sequence
*“Take me through it step by step. I want all the detail! I might slow you down to ask more questions so that I can check I’m getting it all”
*Consider if you need to address any feelings of shame that the YP might have about telling you the details
*Use your OARS - empathise and summarise. This is tough – wow, this really did get a bit out of hand! etc.
''Explore motivation to change''
*Try to establish a ''shared understanding'' of whether or not the young person wants to avoid a similar situation happening again and if not, why not. //How did that situation leave you feeling?, How would you have ideally liked it to end?, If these kind of situations were happening a bit less, would that make a difference to you, How would you prefer it to be?''
__Service development: Day 1 __
What does telephone/online support/therapy mean for us, our children young people and their families and the professional networks around them?
''Things to consider ''
*The technology requirements and the pros and cons of online contact
*Establishing a safe space
*Safeguarding issues
*Boundaries and time management (forms of contact and frequency)
*Non- verbal communication when working online
''What we need to keep in mind for this type of provision: ''
*We are experiencing this uncertainty too.
*It is a novel and stressful time for everyone
''The technology requirements and the pros and cons of online contact''
Pros:
*We can still do our work
*Some CYP may prefer phone support and may be more comfortable being in their home. They might like to show you their rooms, which can help support alliance and they have access to all their things.
*The CYP does not have to explain to their peers where they go for an hour a week
*Being online gives them a bit more control over their sessions – whether they want to attend or not in contrast to feeling like they have to attend in school.
*Not seeing us could make them feel more open to talk - could be beneficial for some CYP
*Saving time on travel – are we able to support more people/do we have more time to plan?
*Lockdown is something that everyone is experiencing – this might make our YP feel closer to us and improve therapeutic relationship.
Cons:
*It is challenging to build a relationship with someone you have not met in person
*For some CYP it could make us seem more intimidating
*There is a lack of body language which can make it difficult to read how they are feeling and how engaged the person is at the other end of the phone.
*We discuss difficult things, and this can be hard when you can't see the person or know how they are reacting.
*People may only feel comfortable with phone only- no video is trick due to lack of body language
*It is easier to miss/cancel a phone call - so CYP more likely to disengage/sporadically engage
*Technology issues like wifi connections
*Financial deprivation may cause issues with access to support
*Anxiety around not being able to see colleagues and how this affects us being able to engage with CYP and families
*Not being able to use resources to support engagement – like the AIM cards
*It can be harder to maintain boundaries- we seem like a 'friend' FaceTiming them.
*It can feel invasive/ intrusive on both sides - we are in their room and they are in ours- are they expecting our call?
*Collecting outcomes is more difficult as it can feel 'clunky' and not inviting to read out measures over the phone, which can break up the flow.
''This raises the question - Could we think of a better way to do this? Could we use the Aim card online space? Could YP log in to POD? ''
*There is a lack of sensory experience - not getting this information.
*Being in same room that you offer support to other and relax/ need to try to create separateness and boundaries
*The journey allows thinking time
*We are now in contact with more people around the child- takes up spare time
''Establishing a safe space ''
__Our own safe space - __
*We may not have confidential space in our own homes
*Where we are working and what can CYP and families see in the background
*Where we are having particular conversations (perhaps distressing) and what impact our professional conversations have on our personal spaces
__For CYP__
*Some CYP may not have a space away from their family to talk like they would in school
*We usually automatically offer a safe space by just being in a room with them- no longer able to do this
*The home can be a safe space for some CYP, but for others it will be a place that is not safe.
__How can we help to establish a safe space within the home?__
*CYP using earphones so that the therapist is not heard. Other family members putting on headphones so that they cannot hear
*Make contact when the person exercises outside of the family home
*It is helpful when parents are encouraging of the space and support the CYP to have a space on their own to do their work
''Safeguarding issues ''
*How are we communicating effectively as professionals whilst we are working remotely – and who holds the safeguarding risk (Social Care)
*We are holding more risk - school aren't seeing them, SC might not be visiting- CYP may be more vulnerable and we may be the only ones in contact.
*Most CYP are not getting school contact which makes them harder to reach by professionals - causing worry from schools and other professionals
*It is harder to identify neglect, self-harm etc. when working online. Seeing them in schools gives a better sense of the person – seeing what they are like in school – low mood, lethargic, behavioural issues etc.
*Can young people disclose more easily when we are on the telephone? Is it helpful that it is more impersonal?
*CYP more or less likely to disclose things depending on if they feel their parents can hear them
*The risk might be from their parents - domestic violence has gone up so likelihood or risk is higher.
*Protecting ourselves in situations where we feel the YP is at risk - managing our anxiety and stress.
''Boundaries and time management (forms of contact and frequency) ''
*We need to remember to protect ourselves in situations where we feel the YP is at risk.
*Boundaries harder to hold – we are working in our personal space and could lose some control of the space
*We are easier to contact as phone working, finding ourselves calling more people more often - school, parents etc. to manage risk
*Being in higher level of contact could put us in a place of holding more risk.
*Power balance of maintaining boundaries- This requires us to be stricter/firmer with boundaries and how we communicate this to the families we support in a clear way.
*CYP can ignore calls or put the phone down, which might feel easier than not physically turning up or leaving
*Emotional boundaries- we are all experiencing the lock-down and this will affect us all. We are trying to support others when we are trying to support ourselves and loved ones as well.
__For CYP__
*WhatsApp has made the work easier and more accessible. Facetime is only compatible with apple devices. Using the platforms that our young people use is helpful
*We must maintain professionalism when working via WhatsApp and WhatsApp video to make sure it does not feel too informal/social
__For us as a team__
*We must consider how we dress when we are working from home compared to when we are at work. Do we look like professionals going in to school? How might CYP view us?
*Receiving messages outside of our working days/hours and holding a boundary around only responding during our working hours – who should they contact when we are not working?
*How can we maintain a boundary around our work when we are working at home? Doing things such as shutting all our work things away and not checking our phone and laptop outside of working hours.
*Where we are working and what can CYP and families see in the background
*Where we are having particular conversations and what impact our professional conversations have on our personal spaces
__Non-verbal communication when working online __
*A lack of body language makes it difficult to read how CYP are feeling and how engaged the person is at the other end of the phone
*The option of not having to give eye contact or think about the non-verbal communication might be a positive for some CYP, but could also be a negative as some CYP have never had good eye contact from family etc.
*Silence in the therapy room is often more possible, but silence over the phone is less possible as you need to make sure they are still there and visa-versa. The silence might feel more awkward.
*We discuss difficult things, and this can be hard when you can't see the person or know how they are reacting
*Physical interventions (breathing techniques etc.) could help to break down barriers of online working, making people feel more connected.
*CYP will have to describe how they were feeling in their body which may be a challenge if they do not have this language.
__Main points to consider after discussion - __
*Contracting’ at the beginning how the work will happen – safe space, boundaries, room in the house what the child needs and what the family needs at the same time
*Risk assessment during COVID-19 requires another level of thinking. Family background and issues of family, such as who might drop into sessions
*Ensuring we look after and protect ourselves first before thinking about your children and families in order to provide an effective service
__Service Development Day 2__
Our service when we return to work- what will the CYP and families that we work with want help with once life returns to ‘normal’ following the lock-down? Issues such as loss, trauma, fear and transition to be considered...
__Overall issues - __
*We might feel uncomfortable about going back to work (commuting, getting into contact with so many others etc.)
*We hadn't been able to do that much work within schools before the lock-down - may bring about challenges for us
*It will be another adjustment
*There could be a spike in referrals
*How to be emotionally present as professionals when we may be experiencing the same things at the same time as our children and families
''What concerns might arise for CYP and families from lock-down? ''
__CYP__
*Exacerbation of existing fears - germs, social anxiety, school/home behaviours, agoraphobia
*Children may be more aware if family members have experienced the virus – hyper aware of the symptoms
*Original difficulties (e.g. low mood, challenging behaviour, anxiety) may be highlighted or exacerbated during this period of lock-down - potentially development of coping methods that might be unhelpful to CYP
*Conflicting ideas from family about returning to normal life/ school
*Some CYP may be enjoying lockdown without the pressure of the school environment. Teenagers could enjoy that they can sleep later and they are still quite able to keep in contact with all of their friends
*Some CYP may have got very behind on academic work and will therefore struggle to catch-up to peers if they were already struggling at school
*CYP and families have become used to technology – will this present more risk for YP in post lockdown because of the communication on technology – differentiation between freedom and not being free and their exposure world – over reliance on technology exacerbating risk
*May have become quite isolated
__Schools__
*What will social distancing look like in schools?
*There may be a reluctance to go back to school/normal routine from CYP and parents
*School reluctance could influence parental/school relationships – their age may make a difference to CYP's readiness to go back to school
*Many of our referrals come from school for school related behaviours- these may not be relevant anymore, but there may also be a surge in these referrals when going back to school (particularly as CYP may be very out of routine or used to individual attention, not having to do schoolwork etc.)
*Many may have missed milestones at school (GCSE, leaving year six etc.) - loss; dealing with this
*School staff may need our support more with the transition back- school may not be as confident at managing the behaviours we often get referred into help with - we may get more referrals or need to increase the support offered to school staff
*School staff themselves may have experienced difficulties during this time and their return to work may be difficult
*We will be dealing more with bereavement and might need to offer some more systemic support
*Support schools to support CYP with 'core issues' that we might be able to predict for when others go back - e.g. relationship breakdown, germ phobia etc.
*School stress over managing CYP all being at the same academic level; there will be an impact of being behind in terms of academic work
*The new academic year will bring new teachers who may be less able to support CYP who may have previously had lots of understanding and strong relationships with their teachers
__Friendships __
*Friendships may have been affected/changed during lockdown
*There may be tensions due to technology reliance during lock-down - CYP may have differing access to technology to communicate
*Some may have less access to technology so less access to friends, or may not like communicating in this way
*Potential of cyber-related issues (e.g. cyber-bullying; access to inappropriate content if lack of parental supervision)
*Separation anxiety, reliance on family instead of friends, and fear of things happening to family or self may cause CYP or even parents to have lots of anxiety about CYP returning to school
__Parents__
*Parental mental health may be affected, which could have a knock-on effect on CYP and their ability to partake in interventions
*Potential violence in the home exacerbated
*Potential job loss and economic strain
__Family life __
*Home may have a different meaning to lots of families now, as lots of things from the outside (e.g. work) have now been brought into the home
*There will be very differing experiences of lock-down for different children and families, such as sharing bedrooms and having a lack of personal space
*Being ‘stuck’ with your parents – without input and support from school and seeing their friends
*Losing loved ones suddenly and not being able to conduct family, cultural, religious rituals
''What will the new normal be? ''
For schools? For professionals?
*There is a lot of uncertainty around the future
*Questions over whether children should be sent to school, with parents perhaps feeling ambivalent towards governmental guidance
*Potentially lots of parents being out of work resulting in economic difficulties within families
*Safeguarding and risk – will there be increase substance misuse in families and in CYP?
*Social distancing will mean unfamiliar settings for CYP even when things return to ‘normal’
*It will be a slow return, learning as we go along; it is hard to plan and prepare for it
*Will it be a staggered return to school/work? How long will that last?
''How will our service respond to these needs? ''
*Will we have to be more flexible in terms of eligibility criteria?
*Will our service model still fit once lockdown is over?
*How do we support our children and families to re-engage with their local communities? Such as extended families, sports communities, religious communities, music communities
*How do we make the Brent community more aware of what is available in relation to emotional wellbeing both in relation to WEST and other services
*Will we see an increase in self-harm?
*Should we be publicising self-referrals more?
*We could offer some summer training, pre-empting some of the effects that CV19 may have had on CYP - or we could create resources about this and how we might be able to best respond.
*We might be positioned to offer groups in schools around these specific issues– so that we can reach a wider number
*There will be an impact on the whole generation
*We may have to do more work with social care as they might be overwhelmed once schools return
*It might be helpful to think about some of the questions around what things will be like when we go back with the CYP we work with now to help involve them and bring the 'external world' back into their 'internal world'
*Normalising the difficulties/ challenges in balancing wanting to be at home and returning to normal
*We will need to be more aware of safeguarding issues - problems at home may have been exacerbated during this home, which could have an impact on CYP's own safety/ safety of others at home
*People may get used to feeling isolated, stressed, anxious – will people therefore be less able to seek help, or will stigma around their mental health reduce and access to services increase?
Topics to think about in this space:
# What happens when risk escalates
# 8-10 session model
# participation group (may need two weeks)
#Data and record keeping - how to make our case notes more concise
#how can we have conversations with school around providing us a space virtually
# consultations - what we need to gather and what the team needs to know
#When to close cases if there is lack of engagement?
#how to write a supporting report - proformas etc.
# working with different cultures engagement etc.
# Outcomes focus (Monthly - last Wednesday once every month)
# discussion once report has been finished (half an hour after commissioning meeting)
#how we can better connect to Brent and Brent services now we are working from home - consider service directory
# how we can work from home effectively and promoting staff well-being - considering physical space, practical management, team connectedness etc.
#how we can use the AMBIT framework as a team
''Good news story at the end of each week ''
---
!11/11/2020
!!What is this space?
* Service development: we have discussed outcomes, consultations, participation, POD, referral pathway, good practice and what isn't working.
* We discuss waiting lists and certain cases that need discussion with whole team
*
!!Do we need this space?
* Thinking together and Service development can feel very similar - need to be clearer in how we use this space.
* What separates this space from the 'Thinking Together' space?
* We need to have an agenda for each week
!!How often do we need this space?
* Weekly OR monthly?
* Feels weekly needed as there are things that the team doesn't get time to consider and discuss elsewhere.
!__''Sharing our experience and skills''__
''Purpose'': to work in pairs to reflect on our individual experience and skills in relation to the below areas. It is helpful to develop an explicit awareness of the experience and skills that we each bring, so that we can draw on these in our own practice, but also so that we can skill-share within the team. We want to get a good balance between ''learning from evidence'', as well as ''learning from our experience'' (key to [[Learning at Work in AMBIT]])
''Method'': to map this out in a visual and creative way, as a way of practicing a method that we might be using when working and thinking with CYP (colours, stickers and post-its!)
!__''Areas we reflected on''__
What have we done between us?
__With CYP/settings__
*Working in a school for children with ASC
*Young people affected by CSE
*Enabling Service - working with a YP to support them to access resources in the community e.g. after school clubs; holiday clubs (e.g. young people with additional needs; socially disadvantaged)
* CAMHS work - outreach team, intensive home treatment team
* Adolescent inpatient unit
* Home based support for families where a young person has ASC
__With parents/families__
* Thinking with parents about their relationship with the child to promote his independence and be more socially involved with peers
* Mentalizing with parents to help them understand why their child's behaviour - help them think about what could be driving behaviour.
* Home-based support for a YP with ASC - helping parents to develop a shared approach to parenting her.
*Exploring the impact of culture/religion on parenting, their expectations for their child/adolescent, the way that they understand child's needs (i.e. cultural differences in understanding ASC) and how this influences what they think might be helpful to try.
*How to think with parents about child development
We reflected on the importance on working through parents and seeing them as a resource who can help with the work. Its less helpful to work with CYP in isolation, as it may limit the sustainability of the work.
__What needs have you helped with?__
*Supporting a young person with an individualised timetable and helping the teachers to individualise the curriculum to suit his needs, build a relationship with him and adapt their approach
* Working with a young person who is withdrawn and showing behaviour problems
* Young people who self-harm - supporting alternative ways of coping
*Child Sexual Exploitation - exploring healthy relationships and relationship skills
__What approaches have you used?__
*Some CBT work
*Parenting work
* Coping skills for self-harm (e.g. soothing boxes, sensory ideas, safe people/places)
* Understanding healthy relationships and reviewing current relationships to see how safe/healthy they are
* Healthy living skills
*Supporting the system around the young person
**Adapting the school environment for a young person with ASC
**Adapting the home environment for a young person with ASC
*Psycho-education
**to help parents to understand what ASC is
** to help parents understand eating disorders
__Using outcome measures__
* Using outcome measures at the beginning and throughout the work to monitor the impact of the work
* Supporting teams to use outcome measures in their practice e.g. focusing on the importance of using outcome measures in a way that promotes learning (i.e. how can the scores inform the work with the young person; how can they help a young people understand themselves better; how can it help the team learn about the impact of it's practice - (e.g. not just seeing them as something that we do because the commissioners want them or using them to prove our impact - rather, we should use them to //better understand// what our impact is
* We have some awareness of what the barriers might be to using outcome measures, which will be helpful in working out ways of using them sustainably in our practice
!__What was it like to do this together?__
*Useful to learn from others -found out some things that I didn't know
* Good practice to share experience in this way - will be important for our work going forward
* Useful to reflect on own experience - struggled at first, but gradually realised I had done more than I had at first thought
* Useful to keep adding to these - learning is constant!
* It is a way to do an assessment with young people and families.
* It is to think about how to carry a child intervention in our work. The application of the approach and a range of tools.
* Working relationships are fundamental: disintegration in networks is kept in mind, keeping links with professionals.
* Keeping in mind the relationships that are maintained by different perspectives of professionals.
* Sometimes when we think about families, we can hypothesise many different things instead of actually thinking what is going on and what we actually need from them.
* It is based on 4 key questions:
1. What is working well for the family from your perspective? Identify strengths. (Eg. the resources does the family hold in the community, family networks). This helps us think what are we actually worried about.
2. Identify what are we worried about? (Draw a house of worries with the child: house of worries, house of hopes, house about what we need help for. These houses encourages the child to think what would their relationships with parents/foster carers be if they were good, visualise them and express the wishes of the child.) This is a simplistic tool to use for assessment with children. Shows the protective factors too.
3. How safe is the child and possible risks (eg. self-harming, exploitation, vulnerability).
4. What needs to happen next? This will inform how the intervention is planned and how professionals will work.
* Make sure we are using a consistent framework when we speak to social care in Brent
It is important for the practitioner to clarify in his or her mind what are the ''SIMPLE BONES'' of the story or problem that they wish for help in thinking about. In conversation with a colleague about this problem I must ask myself:
>//what information does my colleague need in order to help me decide on actions that will address my concerns?//
There is never time to tell the //whole// story, so the KeyWorker must act as a faithful editor, trying to represent to the best of his ability the account that has been given, but in an abbreviated form. Over-long "STORYTELLING" is in fact a version of Pretend mode thinking.
There is a balance to be struck between:
#Providing sufficient data and information to convey the richness and complexity of the story, and...
#Applying sufficient discernment to provide practical knowledge rather than an overwhelming "sea of facts."
!!''Adding links''
We do this to create narrative coherence. At times, in telling the stories of our clients, we are drawn into //adding// detail - that connects facts and which adds to the overall //coherence// of the narrative. This is tempting, and to some extent inevitable if we are to help our colleagues form "three dimensional" pictures of young people. It is important that if we do find ourselves doing this we MARK the fact explicitly: //"Now this is my assumption, rather than anything Jane has directly said to me, but it seems that after her difficult experience with her father she went on to suffer a series of other difficult relationships with older men..."//
!!''The listener is contracted''
The colleague who has //agreed// to hold a conversation that is //''Marked''// as 'Thinking Together' has effectively //contracted// to hold the speaker to these boundaries - of task, time etc. It may be necessary to point out:
>//"Hey, we need to keep the SIMPLE BONES here... is this is getting into story-telling?//
...Equally the worker giving the account needs to hold onto this shared understanding of the task, so that such prompts are not taken as //criticisms//. [[Thinking Together]] requires a degree of trust, and allows for conversations that might be seen as blunt, or fast outside of this environment. (Remember that the theory of [[Mentalization]] places //error// right at the centre of communication; rather than it being something that is a surprising disappointment, it is to be //expected//.)
''In our work with families:''
__General__
*Creating POD logins for YP to complete outcome measures virtually
*Using online Aim cards/our adapted young child AIM cards in our assessment/ to help us get to know what the CYP would like help with
*To try and create as confidential a space as possible for the client and ourselves- preferably in a room with the door shut
*Making work much more visual by creating worksheets / tasks for the session on a visual sheet that you can visually show them.
*Stories / comic strips that describe the concept you’re trying to target, encourage the child and parent to have an active part in writing these. Ensuring they incorporate a special interest.
*Start / end the session with a game -helps to break down a bit of awkwardness with talking over the phone
*Get them to show you something they’ve been doing
*Football kick-up competition. When getting to know a child, each write down 10 questions you want to know about eachother. Then however many kick-ups you do, depends on the number question you ask the other person / answer.
__Getting feedback__
*Our administrator calls CYP/ families and professionals after we have had a session or conversation to collect an SRS.
*The SRS can be collected over a phone call or over ~WhatApps/ Text
*Please see below for the document on how we are collecting SRS's over ~WhatsApp/ Text
<<link-doc "Obtaining Feedback via ~WhatsApp (WEST)" "https://drive.google.com/file/d/1p9Vzq9xTGS6fVmraNbm-xbo0L1FBF02t/view?usp=sharing">>
<<link-doc "How to complete an SRS via ~WhatsApp" "https://drive.google.com/file/d/1tqs-nFc1stROGqQysCMwsf3c3GNNh8cP/view?usp=sharing">>
__General phone use__
*For all contact with families to take place via work phones
*sending resources ahead of time over email or ~WhatsApp
*Sending text/~WhatsApp reminders of tasks and session appointments
__Using ~WhatsApp__
*Whatsapp pictures- for our pictures on our work whats app to be a picture of our work badge.
__Video calls__
*to ensure that our background is either blurred out or a 'plain'
*To encourage the use of video calls and explain to the client the importance of being able to see each other in helping to communicate better.
__Audio calls__
*To use constant verbal cues such as 'hums' and 'yes' so that we reassure the person we are still on the other end of the phone.
*keep checking the young person can still hear us to ensure connection hasn't dropped.
''To manage our work/ home-life balance:''
*To store our work equipment away from sight when not working
*Having a separate space to work from than you sleep (if possible) and keeping this space organised and tidy
*Having a schedule for each day
*Ensure other people in the house know when your sessions are so you can’t be disturbed
*trying to do distracting things in your evening such as getting outside.
*Ensuring you still allow yourself breaks in the day
*Keeping in contact with colleagues throughout the day as you would if you were 'in the office' together.
*Checking in with colleagues
*Reaching out to our team if we are struggling with something
*Being honest with our team if we are feeling overwhelmed (if this feels comfortable)
*schedule in a structured time slot with our loved ones in which we can talk about work and any struggles and then 'putting it to bed' for the day
* Connecting the network together in the absence of the young person's engagement.
* Not overstepping your role and keep boundaries.
* Really thinking what would be helpful and what will make a difference, learning what is going on and learning what we take from each experience and learning.
* The goals you start with does not mean that they will be achieved but you can still make positive changes, as well as creating relationships in the network, feeling helped and validated makes a big difference.
* What really changes at the end despite goals, if the families feel helped that is still a difference. Acknowledge people's experiences about what happened.
* Engage children virtually online via games to develop a therapeutic relationship.
* Develop shared language, name feelings and helping young people to express themselves.
*
!!What is this?
This page introduces readers to the the use of ~Peer-to-Peer Supervisory Structures, which is critical for [[Working with Your Team]], one of the [[Core Features of AMBIT]] practice, and in particular this relates to the AMBIT Stance of [[Keyworker well-connected to wider team]].
A key point is that //this is work that involves all the protagonists (our clients, and ourselves as workers) in anxious worrying situations.//
AMBIT trainings spend some time emphasising that ''if this work does NOT make you worried at times, then you are probably in the wrong job'', as you are out of touch with the reality of what is at stake.
[[Mentalization]], and its fragility in situations of anxiety, is something that underpins __not only__ much of the therapeutic work with //clients//, __but also__ the //relationships between members of an AMBIT team//. AMBIT-influenced teams place as high a priority on attending to the mentalizing of their professional peers as they do upon stimulating and sustaining mentalizing in their clients.
!!AMBIT Training
The AMBIT training includes a section on learning about Supervisory Structures.
!!Implications
It is important to note that the kind of peer-to-peer supervision described in AMBIT is not //instead of// ordinary clinical formal supervision arrangements (that governance arrangements in the wider system will determine) but are an //additional feature//; defining the //particular culture// of [[Working with Your Team]] that is deliberately and explicitly developed in an AMBIT-influenced service.
!!Live, responsive, accessible supervision
The team is expected to use appropriate technology to support this (mobile phones, telephone conferencing, mobile email, etc), enabling team members to form a reflective Quorum, flexibly, and at short notice. Seeing this as //part of the daily work// rather than an 'occasional extra' is central to the AMBIT model.
This core feature is adopted because of the considerable potential for individual practitioners to end up working in isolation in a community setting with high risk and potentially adversarial clients. In our view, apart from impact on staff morale that such isolation can cause, clinical effectiveness and decision-making also become compromised as practitioners struggle to ‘think’ ([[Mentalize|Mentlization]]) in such high stress contexts.
!!A Team around the Worker
We know that [[Mentalization]] is restored in secure relationships. Access to immediate phone or face-to-face supervision needs to be positively supported by a whole team approach, which recognises the need for such back-up as essential to such services. ''Doing this work for each other is seen as a CORE part of a worker's role, not an "added (optional) extra"''!
This is something of a shift from the traditional notion of the "team around a child" (which may still have great value, but can drive dis-integrated interventions), towards an arrangement that is about the ''"TEAM AROUND THE WORKER"''
[img[https://lh6.googleusercontent.com/-Q--oDenShgU/UcD32HjdpVI/AAAAAAAAIlk/tGuG_Ps4QbE/s512/AMBITSpokes_B%252BW.JPG]]
!!Implementing and Sustaining this peer-to-peer supervision
Rituals and disciplines within the team define this culture of mutual support, and an important example is the way in which such consultations are marked out and structured (see [[Thinking Together]] and Passed-outwards Discussion.)
The critical component of this process is to enable a conversation to take place between a front line practitioner who is exposed to the full multi-dimensional aspects of the young person’s difficulties and a member of the clinical team who will know the case but who is not emotionally engaged with the family members. The Ripples in a Pond analogy is used to explain this aspect of the practice. Another metaphor that we routinely use to describe this relationship is to describe the front line practitioner as a deep sea diver in which the meta-team is likened to those in the Dive Boat.
!!Transparency
Such supervisory input is provided in a transparent way with the family and young person so that they are aware that the front line practitioner is supported by a wider team (note one of the [[Core Features of AMBIT]] is the principle of [[Keyworker well-connected to wider team]].
!!Team Meetings
The availability of this live supervision needs to be complemented by team meetings which provide weekly group-based formal supervision of the clinical team. Such group supervision could be likened to an in-patient ward round in which the weekly treatment goals are reviewed, risks reassessed etc, but with particular attention to ensuring that the meeting addresses the needs of the workers who attend - which is helped by structuring case discussion along the lines of [[Thinking Together]] conversations.
!!Line Management
[[KeyWorker]]s are under the line-management of a lead clinician who is responsible for ensuring that appropriate supervision is provided for each activity that he or she undertakes. A psychiatrist provides medical assessments, and is responsible for the prescribing of medication and any other physical treatment.
!!The Meta Team
The Meta-team may in some situations be those [[KeyWorker]]s who are not working directly with a particular young person, but who make themselves available to the Keyworker who is "in the thick of it" via a Reflective Quorum. More formally, the Meta Team refers to the team of specialist professionals who may not sit directly //within// the team, as keyworkers with caseloads themselves, but who have given consent to an agreed level of consultation to the team about areas requiring more specific expertise.
!!Experts By Experience
The team should aim to recruit over time a panel of experts by experience, who can be consulted on problems of managing the difficulties of young people and their families.
Always remain mindful of how difficult the situation is.
Consider drawing on wider networks
Consider structuring the day. (see [[Supporting families to create routine/structure]]
! What is this page about?
We are writing this page to help us think about how we can support families to create routine and structure, particularly at the current time where people are being asked to stay at home to prevent the spread of coronavirus. Some of these ideas may also apply beyond this period of time.
! What might this situation be like for families?
We have written a page to summarise our thinking on this - see [[Mentalizing the impact of coronavirus on families]]
We should be mindful of checking out with families how they are doing before approaching any specific pieces of intervention work.
! What do we mean by routine and structure?
Routine and structure can be generally helpful for children and young people, for a range of reasons. Having a regular routine helps children and young people to know what to expect, which can help them to feel settled and secure. Having a routine which balances attention to the range needs that CYP have, in an age-appropriate way, is important for their well-being.
Routine and structure does not have to be rigid; some parts of the day might be more similar from one day to the next (e.g. morning routine, mealtimes, bedtime routine etc), but other parts might be more flexible and varied in terms of what happens during them (e.g. what happens during play time, family time, hobbies/activities, exercise, social events on any particular day).
Some children may enjoy being involved in setting parts of their routine (e.g. what to play, who to spend time with), whereas parents/carers may want to have more ownership over other parts (e.g. getting up routine/bedtimes/mealtimes etc). Naturally, as children get older, the amount of autonomy that they have over parts of their routine may shift in line with their development. This can require an adjustment for parents/carers too, to help ensure that they are retaining appropriate authority alongside this.
! How might focusing on routine/structure help?
At the current time, it might be helpful to think with parents about what the routines/structure look like for their children at the moment. They are likely to be developing and adjusting to new routines and families will have different ideas about what would work for them in their situation.
If parents are reporting ''struggles to manage children's behaviour'' at this time, routine and structure could be a helpful area to focus on, in order to help create some clear rules and expectations about what the child should be doing at different points during the day and what the rules are within each of those activities. If conflict is occurring between siblings, it could be useful to work out what their respective days look like, in order to try to work out how they can have time apart/time together in a way that is likely to be the most manageable - perhaps working out which parts of the day they are managing well and where points of conflict might be arising.
If parents are noticing that their ''children are struggling with their emotions'' (e.g. feeling anxious, feeling low, withdrawing), exploring routine and structure could also be a helpful area to explore. For example, it might be relevant because it helps children feel that there is some predictability within their day; to help take their minds off things that might be troubling them; to help encourage them to do activities that might help their mood; to maintain their connections with other people who may be a source of comfort, enjoyment, safety, support or distraction etc.
This is not exhaustive!
! Exploring routine and structure with families
''Active Planning alert!'' Remember to broadcast your intentions - why are you going to think about this with the family? If it hasn't been raised by them, you will need to introduce the idea, share why you think it could be helpful to do so and check out whether this is ok with them, before launching into anything!
A helpful starting place is to ''explore'' how things are at the moment in terms of structure/routine:
* What does a typical day look like at the moment?
* Talk me through the day for x (and for other CYP in the house), from when they wake up to when they go to bed?
* What has x been doing during the morning, afternoon, evening?
* What's the arrangements with x's schooling?
*How is that working?
* Which parts of the day feel like they are working well?
* What's helping it to go well?
* Which parts of the day are feeling more difficult?
* What's making it challenging?
* Are there some things that are not happening at the moment that you would like to be seeing more of?
* Are there other things that you'd like to build in?
! Ideas for families to try out
* Creating a 'Timetable' (potentially together with the CYP that they could decorate and they could display somewhere visible (on wall/ whiteboard) at home. May want to break up the different parts of the day:
** Getting up
** Meal times
** School/work time
** Family time (quality time)
**Individual time (free time)
* Having specific times for daily activities that are consistent each day might be helpful.
* Having conversations about what you're going to do the next time
! Specific parts of the day
''The getting up routine:''
It might be helpful to talk through what this part of the day looks like. Are parents wanting the CYP to be up at a certain time or are they happy for them to lie in until they wake (either might be preferable depending on the families' circumstances and the CYP's ages).
For those that want to keep a regular routine
* Waking up at the same time everyday (a time that is reasonable)
* keep an alarm,
* if a child is waking up earlier than the parent would want, are there age appropriate rules they could put in place about staying in their room until a certain time? What could they do to occupy themselves? Pick from a box of toys, read a book etc.
* Teenagers sleep routines might be affected by the lack of school structure to the day. It might be that its ok for them to sleep in a bit more in the mornings than they might usually (although beware shifting the sleep pattern too far i.e. very late nights and waking up in the afternoon for example)
''School time''
See this page on [[education at home|Education at home]]
''Family Time''
*Being sensitive to the difficult situation and mindful of what is realistic.
*Parents may already feel overwhelmed
*Avoid phrases like quality time or 'should be doing..'
*encourage YP to ask everyone how they would like to spend time together.
*encouraging YP to problem solve how they would like to interact with parents. - Yp may want some space- need to be considerate of this but also encourage YP to consider mindfulness and problem solving.
*Try not to give the answers/ ideas for activities but rather encourage the person to come up with other options/ solutions.
*Have a set time
*what is realistic as activities
*Who will be involved
*Take it in turns to pick an activity
''Free time''
* Think with parents/CYP about ideas of leisure/free time activities that they could do. Again, they could make a poster with ideas on there
* Look on websites for ideas or look out for free streaming activities on social media. Check out local council websites
*Having social media/ Netflix/ TV time
''Boundaries in the house''
Additional consideration might need to be given to helping CYP understand some of the rules/boundaries associated with the new routine
*when x is doing their work, we shouldn't disturb him. This is when you're play time with him is.
* How can we work together? I can help you out with this; you could help me out with that
*Everyone has their own skills to bring
*Encouraging a family ethos - we are going to help each other out; this is a different situation. What kind of things do all the kids think would be helpful for people to do for each other at this time?
''How to help older siblings to help out with younger ones''
*Mentalizing their perspective (e.g. this isn't ideal for anyone; if you do spend a bit of time with younger sib, then it night mean they hassle you less; i know they can be a bit annoying; it would really help me out as a parent). Making an agreement with the child (if someone plays with him, then it will last this long).
! Reviewing the routine with families
*How is the routine looking, what's going well? Is there anything not going to well?
*What problem-solving around this could be helpful See resources for problem solving here
https://www.talkplus.org.uk/downloads_folder/Problem_Solving.pdf
* Make sure to click save every time to write a contact.
* Every referral should go on PSS, despite being closed or on hold.
* When we end our interventions, we need to end contact involvement.
* See the 'walk through' that Eleanor sent, written by Nancy.
* Notes have to be brief, such as 'telephonne session with Harry, main themes discussed were his anger in relation to school. Next session is on Friday.'
* If there is a safeguarding issue, you have to put a whole entry of what happened and in detail.
* Be aware that other people in other teams have access to the notes, but the people that have access are people who are involved in the case.
* The notes are reviewed by Ofsted, so be clear when contacts have been made.
* Every session and contact done has to be on Synergy.
* As soon as you do a session or you have a meeting regarding the young person, you put it directly on Synergy and our record keeping.
* When you signpost a young person, it also has to go on Synergy.
* If text messages is the only contact, then write that text messages is the only type of contact done with the young person.
<a class="tc-float-right">[img width= 400 [complexity pic.jpg]]</a>
!!Networks around clients who have multiple needs
Often, the clients we see are experiencing
multiple problems, in multiple areas of their lives. Mental health problems, histories of abuse & neglect,
substance use, CSE, gang involvement, school
exclusion, physical health problems, poverty, housing
problems, offending behaviour…
These problems interact in multiple directions which makes it difficult to know how best to intervene and in what order.
At times (although not always), the more complex the difficulties, the greater the number of services and professionals that are brought in over time, offering help in different areas of the clients' life.
Sometimes this can work well. However, this is often not the case. Clients can experience the number of people involved as overwhelming, hard to navigate and make sense of.
''In AMBIT we make the assumption that there will almost always be some kind of helping system in place already in a clients' life. Therefore there is a real risk that when we (and other services) become involved, this further disrupts or undermines existing forms of help.''
!!!Mutiple interventions
An additional level of compexity is added because the various interventions that might be offered to address different areas of life are often drawn from different theories, they may represent different treatment //models// (pharmacological, individual work, family work, cognitive behavioural, psychodynamic, etc etc...), and may be delivered by //different workers// or different //agencies//.
As professionals, we are then faced with the challenge of working together in these networks, being clear on our roles, and building shared ideas about what we are trying to do, and where we are headed.
However, clinical experience suggests that this ‘team around the client’ may experience difficulties in working together.
!!!Why?
!!!We work in systems where there are:
* separate minds
* different organisational constraints
* different organisational goals
* different theoretical models
* different practical interventions
* different levels of training and different professional groups
* the possibility of misunderstandings...
!!!There may be many different underlying processes at play...
*Conflict (implicit, unrecognised)
*Rivalry
*Policy contradictions
*False beliefs: These are the kinds of 'mythologies' or 'stories' about other agencies in a network that can arise
So ...it is easy for tasks and arrangements ''that are developed out of the best of intentions'' to pull in opposite directions, or inadvertently to undermine each other.
This can be experienced as overwhelming or simply confusing and aversive for clients. It also can raise strong feelings in members of the network all who are trying their best to help.
''In AMBIT we have a way of making sense of this that we call....''
!!Dis-integration
We take the position that no service intends to deliver dis-integrated interventions. But, it is not the job of the client to integrate the various services involved in their lives. We see this as the role that services should take on.
''In AMBIT we believe that each member of the network has a role to play in this. ''
This is called.......
''Taking Responsibility for Integration''.
//Seeing it as my business to do something helpful about Dis-integration in my professional networks is central to work in an an AMBIT-influenced team//
Here Liz Cracknell talks about network complexity and Dis-integration
!!! A video on Complexity & Dis-integration
<html><iframe width="640" height="360" src="//www.youtube.com/embed/lRoOYlPwzWo" frameborder="0" allowfullscreen></iframe></html>
!!!What do we do about this?
!!Working in Multiple Domains
When working with complex difficulties it is rarely sufficient to intervene in one area of a clients' life. There are often things happening in multiple parts (domains) of life that contribute to the overall situation. e.g. being out of work, ongoing family conflict, falling out with friends, drug use, thinking style, past trauma etc. We know that for change to happen we need to do more than focus intervention on, for example, thoughts and feelings alone (i.e. one domain).
''We propose there may be more to gain from offering different interventions through a single practitioner who has a good therapeutic relationship (where there is the potential for [[Epistemic Trust|Epistemic Trust]] and learning), rather than a number of professionals offering help simultaneously, increasing the potential for dis-integration and puts emphasis on clients to manage multiple relationships.''
So the AMBIT worker takes a"wide-angled" approach aiming to support or intervene in different areas of someones life.
''We call this........'' [[Working in Multiple Domains]]
At the same time, the AMBIT worker tries to help the client (and network) in integrating the interventions that are offered.
''We call this.....''
''Worker Taking Responsibility for Integration''
Exactly how the worker does this will vary and should depend on what is most useful for the client. For example, it may be the role of the worker is to support, and work through helpful relationships which already exist for the client in their network, rather than attempting to build a new relationship with them.
Please see [[Addressing Dis-integration|Addressing Dis-integration]]
This gathers together the tools and practices that AMBIT uses to help workers promote integration and manage dis-integration in their networks.
!!!Workers Taking Responsibility for Integration....
!!!How does it look in practice?
Integration is in the doing as well as the thinking - integration happens between worker and client, and in conversations that take place between worker and teacher, police officer, social worker, etc, etc.
''Below are some examples''
* Developing a shared understanding with a client of the difficulties. Then with their agreement, communicating this understanding with the wider professional network, to help others think about how to approach the work.
*Organising a meeting between key members of the network to find out more about each others roles and understandings of the client.
* A worker helping ''interpret'' to a client information about other parts of the system, what they do and why they are there.
*Leading on from the above, the key worker may physically map out with a client the professional network, helping the client to make sense of the various relationships, how they connect with each other, and their own relationships to each. Please see the [[AMBIT program|The AMBIT Pro-Gram]] which provides a practical tool to do this.
''Note that the worker attempts to hold and model a mentalizing stance towards other network members at all times.'' We take particular care not to increase dis-integration that may already exist or feed into pre-existing negative experiences the client may have about what can happen between people around them in their life.
----
If you would like to read more on the theory and ideas around the '''Domains and levels of dis-integration''' and dis-integrative processes, please see the tag <<tag [[Extended learning]]>>.
Team around the Worker provides an explanation of how AMBIT influenced teams may support and work through a key therapeutic relationship in order to increase the chance that the help offered is useful
!!! What are some of the questions or worries that CYP might have about the pandemic and issues related to it?
...............................
* What is it like as a worker when we are with CYP who are struggling with these issues?
................................
* Mentalizing CYP in the current context during the pandemic
.................................
*What principles are helpful to hold in mind as a worker in these situations?
1. Active Listening and practising a curious mz stance- trying to really understand the worry (what tools do you have that might help them express these things?)
2. Asking about what the CYP already knows, what things they have learned/been told/heard
3. Asking about whether they have had experiences of these things happening in their lives e.g. do they know of people who have died or been ill...what was this like for them? what did they understand about it?
3. Being honest and as open as we can in answering and when sharing information whilst also balancing this with consideration of the CYP developmental level (what can they make sense of, what would be too much to understand?).
4. Be senisitive to how much they are curious about and what they want to know...what is it that they are asking?
5. Being honest about the things we don't know or the questions we are trying to find out (rather than pretending there is an answer)
6. Doesn't have to be part of a series 'sit down' conversation- could be alongside play/activity, part of a drawing/creative exercise
7. Holding awareness of messages that might promote fear and alarm and protecting children from these
!!!How would you tailor sharing information/talking about these issues in relation to different developmental stages? what tools could you use?
ages 3-6 years?
6-10 years?
11-13 years?
Adolescents?
Focus – Successes/challenges/opportunities
* What do we want to feed back to the commissioner?
* What do we want to learn as a team?
! What has gone well?
!! AMBIT Training
* Learning to think together and apply this in supervision
* Taking in mind the professional network
* Using our own team spaces better
* Has made us think about the different ways that we work
* We have learnt to mentalize the network better (e.g. social care frustrations)
* Developing a common language
* Doing more manualising – keep track of our discussions and what we agree and keeps in a consistent place
* AIM cards
!! Supervision
* Important to reflect and figure out how to move forward
* We have discussed supervision and what we want to get out of it and we have changed the way we look at supervision and how it is conducted
!! Resilience
* Covid-19 (adjusting to working from home)
* Guy leaving
* Adapted well to the changes
* One team member had only just started before lockdown and we have managed to work well as a team and integrate that team member
* Adaptability
* We adapt our practice with each case and do not stick to the model strictly
!! Connectivity as a team
* Despite having different working days/working from home we are a strong and capable team
!! Laura’s training
* Big success
* Even though we are not doing the work we thought we would, we have adapted the skills we have learnt to work for our team/situation
!! Groups
* A success and a challenge
!! Known within other services
* Our service has become known to other members of Brent
* Achieving our aim as a service
* We have managed to do what we set out to do as a service
* We have managed to engage and give our families a positive experience
* The complexity Of our cases have been much higher than we thought yet we still have managed to engage most of them
* A lot of families have not engaged well with services in the past but our feedback has shown that families feel that we listen to them, respect them as parents and take their thoughts seriously
* Covid-19 has allowed for some more flexibility and might allow for more sessions to build up the trust if they are not engaging.
* JP thinks that we would do this anyway even if covid-19 hadn’t happened; we persevere and we do not have such a strict model like CAMHS does
* We put the family and young person at the centre of the intervention rather than the needs/way the service works – we are flexible and we model the intervention around the child and family
* We are connecting with their networks so they might feel that we are taking care of them
!! Joint working
* When working on a case together the practitioner has felt supported by the senior practitioner
!! Schools Forum
* Connecting with schools outreach team and having training on trauma
* Something we found helpful and would like to do again
! Challenges
!! COVID-19
* Working from home has not been an ideal environment for most of us
* Hard to engage the CYP
* Harder to work on referral goals/needs – a lot of them work school based
* CYP being at home has at times increased their risk
* It has taken us longer to get through cases
* We have not been accessed by so many people because CYP haven’t been at school
* Work on something not on referral form and then put on hold so that we can do go back to the problems on the referral form when CYP are back at school
* It will bring about more difficulties for school and children
* It will continue to bring about new challenges / we will keep re-adapting
* Schools are more anxious now that they have returned
* There will be more exclusions/behaviour is going to be monitored differently/behaviour policies changing (e.g. leaving your school bubble/coughing on other children)
* Parents will have heightened anxiety about their kids being sent home again (either because of school closure or exclusions)
* We have not got to understand the geography of Brent as we are working from home, do not have such a good understanding of the different areas/schools
* Motivating ourselves to work at home
* Can be hard to engage children online, sometimes we have intense periods of work and sometimes little work and hard to motivate
* Back to back meetings online are very difficult to sit through in one place all day online
!! Everyone having different working days
* We do not cross over with each other often
* Not having the whole week to talk to other professionals
* Playing ‘catch up’ for the days we do not work
* Difficult when discussions happen when one person not there
* Have to squeeze everything in on one day, very mentally draining and exhausting
* When we do go back to working together we need to think about how we manage having meetings together on different days in different buildings – will probably need to move things around
!! Groups
* It has been a big worry, we have had the referrals for some of the groups since February and it was incredibly difficult to organise them considering the lockdown
!! Complexity of cases
* Most of our cases are not what we would expect
* Difficult to do standardised work with the types of referrals we get
* We cannot do the 8 week model when it takes 5 weeks to engage services
!! A lot of record keeping systems
* Lots of administrative procedures around each case/session
* Lots of different systems – PSS/POD/own record keeping
!! IT systems
* Difficulties with IT systems and doing all this work from home
* Two different emails/calendars – hard to keep track of all of our systems
!! Working for two different organisations
* Two different approaches to returning to work
* Where do we sit between employer/commissioner
* We are not managed from Brent – who is our manager at Brent? To help with the new starters with their equipment etc
* Jyoti needs someone to report to within Brent
* Because we have not been managed by Brent we feel quite disconnected, there should be more support for us to connect with other services that sit under our umbrella of services
!! The current situation of the world/marches/BLM
* We need to be more aware of the culture of our borough and how recent world events are affecting our clients and work
! Opportunities
!! Outcome measures and report
* We should look at the report together as a team once it is in
* We should look at our outcome measures and their improvement
!! Relationship with CAMHS/Social Care/other services
* To develop relationships with services as service to service not just with individuals
* Aim to have more consultations rather than just being referred straight to us
* We need to get to know our partner agencies better and know when to refer on to a better suited service
* Publicise ourselves more within Early Help services, children centres etc
!! Relationships with schools
* Using the resources from within the schools team with the schools we have relationships with
* Creating stronger relationships with schools
* We could do more preventative work/early identification
!! AFC Schools Team Resources
* There are so many resources from AFC that we do not share enough with schools
* If we shared our resources/leaflets/training/materials to more groups (Inclusion/schools)
!! Discuss diversity and differences in cultures and bring this into our work more
* Boys of black Caribbean heritage are one of our target groups but how are we actually helping this group.
!! More group interventions
* 8 session model might be easier to stick to with a group
* Brent want us to run more groups as part of our enhanced contract
* A lot of parents/cyp feel alone in their difficulties and would benefit from talking to others in the same position (perhaps James can help with the training of this)
* Social skills groups
* Would need to know what young people want
!! Involving CYP in the development of our service
* How can we engage with our CYP more?
* Increase our self-referrals
* Young Champions in Brent?
* Promote ourselves through schools (newsletters etc)
* If we had an Instagram/website
* Youth programmes/religious communities
* Workshops within schools (e.g. during exam time) – commissioner doesn’t want us to do bespoke trainings in schools
!! Group training
* Trauma training
* Reflective fostering training
* Connecting with Schools Outreach Team
!! Scaffolding healthy relationships so families can have smooth transition into other services
!!A tool for mapping the professional network around a client
This is a paper version of [[Sculpting a Network]]. It is helpful to identify opportunities for [[Scaffolding Existing Relationships]]. [[The AMBIT Pro-Gram: an example]] is an example of the use of the tool.
!!Video introduction by Peter Fuggle
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The AMBIT Pro- gram is the equivalent of a genogram, but for the professional network. The technique is intended to be as simple as possible and can be adapted by a worker to their own style of working.
The basic idea is to make a drawing or map with the young person in the //centre //of the piece of paper and then to position professionals in the network in relation to the young person. It is the equivalent of a [[sculpt exercise|Sculpting a Network]] on paper. Those positioned closer to the young person have a stronger relationship than those positioned further away.
The aim is to be as inclusive as possible, to include teachers at school, and those who may appear at first sight to be peripheral practitioners.
The diagram can also be used in a developmental sense in that it may highlight previous relationships with professionals which are no longer active. For example, a relationship with a previous social worker that was felt to be helpful may want to be included. A simple method of doing this is to discriminate between live and past relationships by using two different colours to mark these names on the chart.
The quality of relationships can be indicated - straight lines for positive (thick for more significant ones) and zig-zag lines for negative/conflicted relationships.
!!AMBIT pro-gram, described live by Peter Fuggle during a training for AMBIT Local Facilitators in 2014
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!!(Fictional) example:
<center>[img width=600 [Pro-gram picture]]</center>
Joe is a talented footballer who has stopped playing for his local side since getting into Cannabis use and low level running and dealing to pay for this. He has been convicted of shoplifting, and has an Order with the Youth Offending Team (YOT) - which he has started to see quite positively because he gets on well with his YOT worker (also a keen footballer). His low mood had led him to start self injuring (cutting) and he has started to see a therapist about this. His treatment is overseen by a psychiatrist because of serious threats to kill himself or others by setting fires that were made around the time of his initial arrest.
Although he initially got on quite well with his therapist, and was positive about this, he has recently been missing appointments, and appears to be drifting away from her. During the creation of the Pro-gram he reveals that he thinks that the Therapist and YOT worker "don't get on at all well" - though it is unclear how he has decided this, and whether they even actually know each other at all.
He has remained on good terms with his old football coach, but is still not going back to football.
A family support worker is dismissed as "working for my Mum" by Joe, and he denies ay connection between this man and anyone else in his network - describing him in neutral, disconnected terms.
He is annoyed at the fact that his Social Worker has changed recently - his previous one had been "funny" and he had felt that she "really got on with me". He compares his present one negatively with this.
He is entrenched in his aggressively negative views about the Police who he sees as "out to get me" and (perhaps because he first met her in a Police cell) he is equally negative about his psychiatrist, who he sees as "working for the Police".
It is extremely important to feedback to children, young people and parents what you have learnt form the questionnaires that they have filled in. ''No client should be asked to complete a questionnaire that is not fed back to them.'' Feeding back results from questionnaires will need to be practiced as part of the skills sessions.
A number of principles need to be borne in mind.
#recognise the effort that has gone in to doing the questionnaire (//e.g. 'Thanks for doing this. People often find doing these forms a bit of a faff.'//)
#scores form questionnaires are not 'facts' but are a helpful way of making sense of complicated matters.
#clients should be encouraged to give their views about what you have understood from the questionnaire ('//e.g. it seems that you get most anxious meeting people and less anxious about things like travel or homework. Does this seem right to you?//)
#balance feedback between strengths and difficulties. (//e.g. some people get really bothered about going to bed but this seems to be no problem for you. However, I can see that getting ready for school is a real struggle for you.//)
#be clear(and empathic!) when there is understandable room for concern.(//e.g.'I can see that when you get low, this is not just being a bit miserable but is much more than that. This seems ot be something that i really impacting on your life.'//)
#always check at the end of your feedback if they have questions about what you have discussed with them.
!!RATIONALE for a "Mentalizing Stance"
During the assessment and intervention stages of Mentalization-based therapies, specific Mentalizing Therapy Techniques are the primary skills that the therapist needs:
*To flesh out their understanding of the mentalizing capabilities within ones self, or their family
*To assist the client or family members in improving their understanding of mentalizing and the role it plays in all relationships - with family members, with friends, with the self.
*To improve the family members' capacity to mentalize about each other.
However, ''there is also a "way-of-being-with" our clients'', that is referred to as the ''Mentalizing Stance'', that represents maintaining Mind-mindedness, and which characterises the mentalizing therapist.
There is one of our training exercises to help teams learn about this, at the bottom of the page.
!!The heart of good mentalizing
>//Is not so much the capacity to always accurately read one’s own or another’s inner states, but rather a way of approaching relationships that reflects ''an expectation that one’s own thinking and feeling may be enlightened, enriched, and changed by learning about the mental states of other people.'' In this respect, ''mentalizing is as much an attitude as it is a skill'', an attitude which is inquiring and respectful of other people’s mental states, aware of the limits of one’s knowledge of others and reflects a view that understanding the feelings of others is important for maintaining healthy and mutually rewarding relationships.//
This stance is the ultimate foundation of the approach that the therapist tries to demonstrate and thereby encourage. Remember that [[Mentalization]] is one of the [[Core Features of AMBIT]], which includes it as the first aspect of its own stance.
!!GENERAL FEATURES of the Mentalizing Stance
A series of general features of a "Mentalizing Stance" have been described, which give a broad flavour of the "way-of-being-with" that the stance represents.
In addition there are four more specific and practical aspects of worker behaviour that make up the...
!!FOUR "LEGS" OF A MENTALIZING STANCE:
<<image [[Ment_Table_Stance_pic]] width:480 height:320>>
|''1. ''|The Inquisitive Stance|Consistently modelling the value of mentalizing|
|''2. ''|Holding the Balance|Emphasising //mobile// or //adaptive// qualities|
|''3. ''|Terminating non-mentalizing interactions|Diverse (often playful) methods apply|
|''4. ''|Highlighting and reinforcing Positive Mentalizing|Encouragement of the desired behaviour|
!!Video
The therapist's mentalizing stance - by Liz Cracknell and Dickon Bevington at a training for AMBIT Local Facilitators
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!!Video - see the first five minutes
A narration to a slide show about the Mentalizing Stance and [[Active Planning]] - the mentalizing stance is covered briefly in the first 5 minutes:
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!!Exercise 1: Spot elements of the stance
Client's part played by actor.
Watch the clip and then in pairs or as a group try to spot the elements of the stance that you notice in this clip.
Feel free to criticise the therapist, too - the therapist's mentalizing stance has been likened to flying as it is described by the character Buzz Lightyear in the film //Toy Story//: //"it's just falling... with attitude"//. The critical elements of maintaining inquisitiveness, are to retain awareness of the extent of one's not-knowing, readiness to take responsibility for getting it wrong, and commitment not to get it wrong again in the same way.
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!!Exercise 2: Real time practice
Client's part played by a volunteer.
''Exercise instructions:'' Watch this video, press PAUSE whenever you are directed, and consider these two questions:
#What's the therapist trying to do?
#What would you try next?
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!!Thinking Together in Your Team
[img[https://lh3.googleusercontent.com/-J5GW0cjH2CI/Ubjka0EsxgI/AAAAAAAAIb4/UpMrGfUpVm8/w721-h541-no/ThinkingTogether.jpg]]
This is a key practice relating to the peer-supervision that flows from having a [[Keyworker well-connected to wider team]] and applying [[Active Planning]] in all that we do (both of these are [[Core Features of AMBIT]]).
In terms of [[Active Planning]], Thinking Together is the very shortest-term version of this practice - making a plan (and [[Broadcasting Intentions]] about this) for how to use //this next ten minutes// 'around the water-cooler', or on the phone, in my colleague's car, or in Team Meetings, etc., (see below for "When and Where").
!!''Analogies''
Drawing on the Ripples in a Pond analogy, ''Thinking Together'' is a set of rituals and disciplines that are designed to maximise the amount of ''useful'' information that can be 'Passed-outwards Discussion' from places of greater disturbance towards calmer places or people, where //attuned// and //productive// thinking together (a.k.a. [[Mentalization]]) is more possible.
Mountaineers have worked out over time that having a strictly disciplined approach to the kinds of ritualised call-and-response required to use a rope safely (making absolutely sure you are holding my rope and are tied on when I start to climb) is critical to ensuring safety - especially when they are stressed and tired. ''Thinking Together'' is a very similar attempt to "get things lined up" in preparation for what is a very common, but often critical operation in the risky word of trying to help very vulnerable young people.
!!''A Video on Thinking Together''
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The more that ''accurate'' and ''relevant'' information can be passed-outwards from a very chaotic and overwhelming focus the more it can be digested and acted upon in a timely, effective and therapeutic way.
!!''A "good pass"? Four steps to Thinking Together''
''1.'' ''[[Marking the Task]]'' <br>''2.'' ''[[Stating the Case]]'' <br>''3.'' ''[[Mentalizing the Moment (in Thinking Together)]]'' <br>''4.'' ''[[Return to Purpose]]'' <br><br>What is absolutely critical is that in a team there is a ''shared understanding'' of WHAT these 4 steps are (please have a look at the separate pages for each step) and WHY we choose to use this disciplined way of setting up dialogues to seek help from each other .
!!''When and Where to use it?''
This is for teams to work out as part of the development of their local team culture, but certainly existing AMBIT-influenced teams have reported finding this useful in:
!!!(a) ''1:1 staff conversations''
Here we are trying to replace the "water cooler/kettle chat" or enhancing telephone consultations with workers in the field.
In these situations, if appropriate, the exercise can be done //in front of the young person// with the mobile phone switched to "loudspeaker" - this is very similar to the systemic practice of the "reflecting team", but in addition, we would argue that it is a great way to be [[Broadcasting Intentions]] and to be modelling help-seeking behaviour to the young person. By showing a young person that //"My own ability to think clearly and make the best decisions is affected by my circumstances, and 'phoning a friend' is a helpful thing I do"// I am modelling healthy help-seeking, and there is an implicit invitation for worker and young person to explore later, which is: //"You've seen how I have a bit of a back-up team who help me keep my balance. Who is in __your__ back-up team, that you could lean on at these kinds of times? How could we go about getting a few people in place that you could use?"//. This is a nice way to introduce [[Scaffolding Existing Relationships]].
!!!(b) ''Team Meetings''
There is video of some role-plays in team meetings that shows how this can have a significant impact on how these critical working spaces can be enhanced by a team adopting this approach.
!!''What if my colleague doesn't recognise the concern? Graded assertiveness.''
Thinking together is helpful if a concern (even if poorly defined) is //acknowledged// between parties. //What about the situation when a worker notices something of concern in their colleague's situation or practice, which they, however, do not seem to recognise?//.
>''Here there is a requirement for'' graded assertiveness in challenging a team member.
This may be necessary to create awareness of the concern, and is certainly a critical aspect of a team's duty to pay attention to [[Managing Risk]] (one of the [[Core Features of AMBIT]].)
!!Role play videos on Thinking Together
* Below are two videos - "thinking apart" and thinking together, that give a simple demonstration of how the technique might be helpful.
* There are also role-played examples of doing it, and not-doing it in team meetings, where the technique can have a helpful impact on the effectiveness and sustainability of meetings that involve case discussion, group supervision, etc.
!!''How not to do it: Thinking Apart''
Here we offer two examples of what might be called ''"Thinking Apart"'' - well-meaning but un-marked and un-boundaried (and ultimately, not very well [[mentalized|Mentalization]]) discussion, that can inadvertently serve to amplify anxiety or shame in the worker:
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!!''Thinking Together (OK, it is idealised!)''
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!!''Exercises''
These steps can be put to work in a more formal exercise - the Passed-outwards Discussion introduces the rationale for making space for mentalizing in discussing high affect situations, and the Thinking Together training exercise helps to practice the day to day routine.
!!''Feedback from AMBIT-influenced teams (2014)''
>>"We are now using thinking together regularly"
>>"Thinking together is used in our peer supervision"
>>"We talk about 'having an AMBIT moment' - meaning thinking together time"
>>"Utilising thinking together in our case discussions has helped team stay more focused and achieve more from team discussions. Shared team language and people feel more supported and cohesive."
>>"The "thinking together" concept has been very influential when used appropriately. It is very clear in meetings when we have an "AMBIT facilitator" and mark our task compared to meetings that try to follow an agenda, but we miss the mark."
>>"Outside of meeting the team use 'thinking together' frequently and speak v positively of it at review."
* We can bring a referral issue or think about something that has been going on in the team.
* When we are not able to engage young people, think about how much do we keep trying until we decide an end point.
* Consultations: think about how to offer them in this space.
* Checking in on how groups are going and face to face work is going.
* How we support each other and promote help seeking within the team.
* A safe space to expose our vulnerabilities and ask for help from each other in an open way. Create a culture within the team to challenge each other.
* Non judgemental, listening to each other and validate each other's feelings even if we do not understand the other. Validate how each other sees things, and how they see the world.
* Bring ourselves together in the work.
* Think about our cultural differences within the team and also how our team is viewed by the population that we work with. How we acknowledge those differences within the team and the way we work. Think about race, gender and ethnicity. How do we enable ourselves to be accessible to communities.
* Fostering a sense of containment in this space: conversations that we need to in our team. For example, what may not be working well in our team dynamics.
* We will use the AMBIT frame in terms of mentalizing each other, thinking together, etc.
* Cyra's role as the facilitator.
* Signs and safety and wellbeing: language that social workers use for child protection work and cases. One tool that is used when working with young people is the 3 houses: house of worries, good house and future house. This is helpful to get the child's point of view. We can adopt that model to see as a team what is working well and what we hope for the future. Also to explore what we are worried about in the team, what is working well and what needs to happen and how the future can look like.
* How do we know each other better in a more personal level and bring more of ourselves in the work? For example, at the beginning of our meetings have a catch up, also attend lunch breaks to relate to each other as people. Have a space to manage this ongoing working from home situation.
* Sharing our vulnerabilities more and asking each other for help.
* Catch up with each other 15 minutes before the meeting, we can join at 9:15 am.
* The possibility to do the team meeting together face to face monthly.
* Once a month have an hour to do a fun activity, like a quizz night after work or watching the same movies at the same time.
* Cyra can check with each individual in the team what they are worried about.
* Bring for next thinking together meeting what has been going well and what changes we want to do. Adapt these ideas to the house if we can. Each one to share something with the team that we are worried about and what we need to work on. It can be visual or talk about it. Then we can think about common themes.
We looked at this document, which outlines the Thrive Framework
https://www.annafreud.org/media/9254/thrive-framework-for-system-change-2019.pdf
We discussed in more detail the differences between Thriving, Getting Advice and Getting Help.
The team is set up to see CYP for Getting Advice and Getting Help. We reflected that this might be in the context of a problem with a recent onset, that is mild in nature or it might be that a CYP has an existing difficulty, but currently feels that some Advice or Help that is more focused/specific would help (e.g. a young person who has ongoing struggles with low mood, but wants help specifically to manage the exam period).
It was helpful to think about understanding this as the purpose of what we are doing. Other members of the team might be more familiar with work that might fall within the Getting More Help or Getting Risk Support.
A description of the Thrive model can be found here
https://www.annafreud.org/media/9254/thrive-framework-for-system-change-2019.pdf
The Targeted Wellbeing Service is listed in a local document as offering services that fit between the Getting Advice and Getting Help quadrants.
However, some of the wellbeing work undertaken with adolescents may draw on aspects of Risk Support.
Videos on the Thrive model:
http://implementingthrive.org/implemented/toolkit/toolkit-phase-1/stakeholder-engagement/7-minute-briefings/
!!!Westminster Drug Project
*Two branches to this service, a mental health and wellbeing branch and a drug misuse branch.
* Work with young people on relationships, drug misuse
* offer a wellbeing service- been running the branch of the service for
*unlikely to turn people away- often try to find other services to support them.
*Will support young people who are using around risk reduction
* Work with YP with a diagnosis but look to bring in other services
*1-2 months waiting list- but priority is made based on level of need.
*3 practitioners- psychotherapist, keyworker(goal based, social, health needs), and a practitioners who works with building up the network.
*offers a weekly session mostly over video calls now but usually in the community.
''*to send referral form and check with her if they need to be a user. ''
!!!Early Help
*Family wellbeing centre have taken over from the children's centres
*up to 18 or 25 with SEND
*9 sites
__The support is grouped into 4 sections__
*0-5
*6-11
*12-18
*parents which specific service for dads.
__the different types of support__
*health offer - school nursing, sight and hearing clinics, health visiting etc.
*parenting programme offer
*housing officers
*young carers
*speech and language - currently only under five
*Brent start
*school admissions
*lots of voluntary sector
*fun fit families - healthy lifestyle
__Roles at the centres__
*Centre manager - case manging and centre management, developing steering groups,
*early years officer
*triage officer- identifying families needs
*family support assistant - may run a group based on need.
__How can we support each other to support families?__
*book rooms s and when you need.
*can we offer group work to enhance their
*to plan a meeting with our team and the centre managers for me to email JP with NC and ST cc'd
*for Nicky to send across the core offer
*''There was significant discussion during the training and afterward regarding our ability to book rooms in these centres (particularly over the summer). This needs further exploration within the team as it was suggested that to use this space it would be helpful for us to provide them with running groups etc. This is to be discussed with JP and brought back to the team.''
!!Kooth
*Online anonymous platform providing mental health support for 11-15yr olds
* three main types of support: professional online support, peer support and wellbeing tools/ resources
*www.kooth.com
*no referral needed and no waiting list
*working with lots of
*NHS commissioned
*across the whole of London
*online counselling support
*young people
*they can text and receive a reply within 24 hours
*Kooth early intervention
*anonymous service- although some demographic information needed
* able to Journal their mood/ symptoms
* everything is pre-moderated and confidential- nothing goes live if it is triggering or offensive
* trained counselors
* can speak about face to face services they could access.
*Kooth podcast
*utilise outcome measures - RCADS, Goals etc.
*CBT resources- apps etc.
*case notes
*contains other services that the practitioner can signpost to.
*meet the team section - user can request new counsellors
* duty of care - disclosures: Each client was given a ‘traffic light’ tier relating to their level of risk and if the practitioners were concerned for the child’s safety they can ask the child for their personal information/ investigate who they are based on their conversations, location and age and share this information with police/ ambulance services etc.
[img width=100% [alexis-brown-omeaHbEFlN4-unsplash.jpg]]
!!What's here?
This page is a tag for all the pages that either describe or sort the many training exercises developed for teams to practice skills in relation to AMBIT.
!!Training Exercises Contents
The below contents table categorises the exercises from training. Click on the arrows to view the dropdown lists.
<div class="tc-table-of-contents">
<<toc-selective-expandable 'Training exercises'>>
</div>
!!What training do you or your team actually //need//?
Consider using the [[AMBIT Practice Audit Tool (APrAT)]] to help your team decide what to practice or work on.<br>There is an [[APrAT exercise in, or across, teams]] to structure this.
!!Additional Training Exercises
*''Advice on planning'' a //local// training event: [[Planning a training event in your team]]
*''Pre-formed'' suggested team sessions: <<tag [[Suggested Team Training Sessions]]>>
*List ''Locally-developed sessions:'' <<tag [[Local AMBIT training session plans]]>>
[img width=100% [ian-dooley-3NCA3tbaE5I-unsplash.jpg
]]
!!The Manual
* Each team who trains in AMBIT gets their own online manual. A list of all the current manuals can be found on the signposting site. The online manual provides teams with all of the core AMBIT content, i.e. everything you need to know to be able to use the AMBIT approach in your work, as well as a space for teams to capture their own practice and what they are continuously learning from their practice.
!!Training Slides
* Teams who train in AMBIT are provided with the training slides from each day of training through the [[Downloadable Resources from Training]] page. The training slides are accessed through the manuals and are added to a teams manual following the training- the links to each day can be found on your homepage and are freely available to download from Google Docs.
!!Training Exercises
* Descriptions of all training exercises can also be found on the manual.
* Additionally, you can access a list of all the Downloadable Resources from Training, through which you can download the tools in pdf format.
!!Videos
* There are a vast amount of videos on AMBIT, which can be found on the manual. Using the tag <<tag [[Videos]]>> users can access these videos. Any page tagged with 'Videos' will have a video explanation or role play to explain the theory or tool being described. You can also access all videos from YouTube on [[AMBIT.tv|https://www.youtube.com/user/ambitafc/videos]]
//N.B All AMBIT Training Resources are freely available under the [[Creative Commons License|Licensed]].//
Below is a list of training themes that is linked to the types of difficulties that they are supporting children, young people and their families with. We can tag pages we create in training with one or more of these 'themes' so that they are easier to find when we want to remind ourselves of the things we have learnt or how we work with specific difficulties. All training pages can be found under the tag 'Wellbeing Training'
<<list-links "[tag[Training Themes]]">>
See [[Training ideas]] for previously discussed ideas and [[Understanding our training needs]] for an overview of our training needs
Possible ideas for work with adolescents?
* Teaching the [[AIM cards|AIM Cards]] as an assessment method with adolescents
* Building a toolkit around how to use this and how to link interventions with particular cards.
* Session plans based on commonly chosen cards
!!!Training ideas developed for CWPs/ EMHPs
Carolyn Edwards and colleagues at Kings College London have developed some extremely useful activities that supervisors could do with their EMHP/CWP trainees.
<<link-pdf "Training Ideas for CWPs/EMHPs" "https://drive.google.com/file/d/1agO7x_uZD6nNvd28y1CKk1yW1Y6aGFyy/view?usp=sharing">>
!!!Training topics 29.04.2020
*Review last week's topic to see what we implemented
*[[Troubleshooting|Troubleshooting]] interventions with parents
*Working with parents to support CYP's emotion regulation
!!!Topics for today 08.04.2020
__Queries__
*''how to respond when YP don't seem bought into the strategies we are suggesting'' - we added our thoughts about this to this page where we are collecting our ideas about how we are applying [[active planning|Active planning stance and collaborative working]] in our work
*''ideas for having more exploratory/getting to know you sessions'' - we added more ideas to the [[engagement during remote working|Engagement in remote working]] page
*''working with looked after children and balancing priorities of different people in the network in relation to the focus of the work, including balancing exploratory and change work''. We started this page about [[working with looked after children|Working with Looked After Children]] and will have some further dialogue within the team.
*Dilemmas related to [[working with parents |Dilemmas when working with parents]]were also discussed:
**''how to best respond when parents are expressing difficult feelings/thoughts about their children'' (e.g. showing understanding whilst not 'colluding')
**''how to respond when parents are asking you to pass on a message to their child''
!!!Topics for today's training 22.04.20
*Improving self-esteem and confidence
*[[Addressing sleep|Working with sleep difficulties]] (especially with adolescents)
*Support parents to manage challenging behaviour at home (younger children)
6th December 2019
!!Next week ideas
* Understanding the context: What is our stance on wellbeing in this team and what are our core values/ ideas? Describing the difference between mental health conditions and wellbeing. How does this all link into us explaining ourselves.
* Setting up a helping process: How we work within a school context.
* Wider networks: Building rapport with outside networks and how this relates to the referral form. How do we work out who is best to include (e.g. not taking referral form as absolute fact to make assumptions about involved people).
* Monitoring your work: How do we balance working with goals and outcome measures with ensuring the sessions flow and can be also guided by what the young person/ parents may bring and they want to engage with.
!!Other training needs
* Behaviour manual training- feels quite complex and feel the need to get specific training in this.
* Sessions with parents- how to have difficult conversations with parents when we are young and don't have children ourselves.
We met together for our first session of Well-being Practitioner training with LT.
''Today's Purpose'':
*to reach a shared understanding of what we want to learn about that will help us in our role as Well-being Practitioners
* to share our experience with each other
* to begin working on some of our learning needs
Here is a summary of what we covered.
[[Introductions exercise|Introductions exercise]]
[[Understanding our training needs|Understanding our training needs]]
[[Sharing our existing strengths and experience|Sharing our existing experience and skills]]
[[Creating resources for young people]]
Started a [[Manualizing list]]
[[Reflections on the first training]]
We covered the following in today's workshop
[[What is the difference between wellbeing and mental health?|What do we think the difference is between well-being and mental health?]]
[[Videos on CYP wellbeing - our reflections|Reflections on wellbeing videos]]
[[On my mind - self-care ideas for CYP|Self-care: On My Mind]]
[[Thrive framework - where is our service positioned?|Thrive framework]]
[[Wellbeing patchwork activity|Wellbeing patchwork]]
[[Reflections on today's workshop|Reflections on training workshop 2]]
{{Open book pic (2).jpg}}
!! Core AMBIT Training Content
These pages cover the CORE aspects of the AMBIT approach and form the basis of the AMBIT manual.
Each of the pages tagged with 'TrainingCore' covers the content to support the topics covered within the [[AMBIT Training|AMBIT Basic Five Day Training]].
All of these pages are tagged here
<<tag TrainingCore>>
''The AMBIT manual contains many pages in addition to the Core Training pages. These include further explanation of related theory, therapeutic approaches and interventions, evidence and research. These pages are not integral to using or applying the AMBIT approach but are intended to be a resource and a learning aid for workers who would like to read in further depth.''
!!Links to the Core Training pages
!!!Overview
*[[Mentalization]]
*[[Core Features of AMBIT]]
*[[AMBIT: an overview]]
!!!Client
*[[Working with your CLIENT]]
*[[Scaffolding existing relationships]]
* [[Managing Risk]]
*[[Active Planning]]
* [[AIM Cards]]
* [[Broadcasting Intentions]]
* [[Epistemic Trust]]
* [[Relationship to help]]
* [[The Therapist's Mentalizing Stance]]
!!! Team
* [[Working with your TEAM]]
* [[KeyWorker]]
* [[Keyworker well-connected to wider team]]
* [[SupervisoryStructures]]
* [[Thinking Together]]
* [[Marking the Task]]
* [[Stating the Case]]
* [[Mentalizing the Moment (in Thinking Together)]]
* [[Return to Purpose]]
!!!Network
* [[Working with your NETWORKS]]
* [[Working in multiple domains]]
* [[Taking Responsibility for integration]]
* [[Addressing Dis-integration]]
* [[Dis-integration grid]]
* [[Sculpting a network]]
* [[The AMBIT Pro-Gram]]
!!!Learning
* [[LEARNING at work]]
* [[Respect for Evidence]]
* [[Respect local practice and expertise]]
* [[Manualization]]
* [[Community of Practice]]
* [[Evaluating outcomes]]
* [[Developing learning organisations]]
* [[TiddlyManual]]
* [[Training Resources]]
* [[Training exercises]]
!What do we want to cover?
* Differences between primary and secondary school
* Common worries about going to secondary
* Changes in routine for going to secondary school
* Meeting new people and making new friendships
* Ending primary school
* Moving on from network of support at primary school
* Developmental stage transition -from childhood to adolescence
*What might help to prepare children for transition in current circumstances?
* Motivation to carry on with education when there is a change to routine ("What's the point, I'm not going back?")
*Including parents in transitions planning
*Including schools in transitions planning
! Exploring children's perspectives on primary and secondary school
Important to be aware that children will have a range of perspective about going to secondary and we would want to "hold the balance". This means that we want to think about these issues from as many different perspectives as possible - what are the worries, what are the hopes, what will be different, what will be the same; what will they miss, what will they look forward to etc.
!Differences between primary and secondary school
* A new building to get used to
*Different rules
* They will go from being the oldest to being the youngest
*Being around much older children/YP
* New teachers, new subjects
*Increased demands and expectations
*Having to get used to being around different classes and different children.
* Being put in 'sets' according to ability; so more awareness of ability relevant to peers.
*Maybe less acceptance of difference and more emphasis on "fitting in". Perhaps less tolerance of difference or different needs, a wish not to stand out.
*More adolescent environment - might be different peer pressures e.g. to respond a certain way to authority; aspirations.
*Breaktime/playtime might feel different (different ways of spending the time, e.g. games/activities less common and more 'hanging out')
*Might be less dialogue/relationship between home and school
*Might be less awareness of home context at school, because might be less regular contact with parents (e.g. not being picked up from school).
*Might be more difficult to form relationship/seek out help/have people know what is going on with you because of all the different teachers - might be overwhelming for some.
*More responsibility on CYP to remember to do things
*Harder to develop individualised approaches to support that are consistent across a large number of teachers
!Things that might be positive/opportunities that come from going to secondary school
*Chance to make new friends
*Wider range of subjects or more facilities around some subjects (e.g. music, art, technology)
* More independence (new journey, being able to travel on their own)
*Getting a new phone or more pocket money!
* More clubs, activities, teams to join - more extra-curricular activities.
*More opportunities to develop existing hobbies - e.g. orchestra, band, sports competitions with other schools
* Some children might want to have a fresh start after primary school
* More choices of what club you go to - more autonomy
*Library!
*Different options in PE
*More trips/projects that are offered
__What might be the same about secondary school?__
Remembering to think with CYP about what won't change; what will feel the same, to help them feel that there is some continuity or sense of familiarity or mastery that they might already have.
! What worries might children have?
* Being a new place
* Not knowing people
* Making new friends
* Not being able to fit in
* Finding the work hard or not being able to keep up
* Who you will be in a class with
* Will the teachers be nice? Will I like them? Will they like me?
* Puberty and physical differences between peers
* Missing siblings that you might have been at primary school with
* Getting lost in a new building, being late
* Getting detentions
*Forgetting the timetable, forgetting equipment
*Remembering all the equipment and carrying it around!
* Getting bullied
*Nervous about new subjects or having to do new subjects that they don't like
* Worries about specific subjects (e.g. PE - new activities, more competition, ability)
* Worrying about what other people think of you
* Having 'cool' uniform, shoes, bag etc
*Hearing specific rumours or stories about what happens at secondary school
* Worries about gangs, seeing police at school
! Where might children's worries come from?
*Their own worries
* Worries that their friends might have
* Worries that their parents might have
! Methods for exploring this
* Through questions
*Designing worksheets or a workbook
*Draw a picture of what you think your first day of secondary would look like - can then ask them to tell you the story
! Talking about friendships
*Practical ideas:
* How to make new friends
**Conversation starters
**Finding common interests
**Doing activities together
**Inviting people to do things out of school
**Joining clubs together
**Travelling to and from school with
**Who could they link up with from primary school
**Asking people to hang out at breaktime
**Asking to sit next to people in lessons
*Exploring with CYP "What makes a good friend?"; "What do your friends like about you?"; "What are your strengths and interests - all about me"
*Exploring what CYP would look for in a friend; draw their ideal friend - what would they talk about, what would they do together etc.
* Friendly/unfriendly behaviours - what might these look like? What impact might the unfriendly behaviours have? What might alternatives to those things be?
* Bullying - what is it, what does it look like, what can CYP do if they see bullying or experience bullying?
* How to repair friendships/arguments
** exploring different scenarios
** exploring their perspective about what happened
** helping them to take other people's perspectives
''ADD THE OTHER IDEAS HERE''
* How to keep in touch with friends from primary school
! Ideas
*Helping people in the network to understand them better - through making a booklet or document with a young person to help other people understand them more - i.e. an "all about me" book or "when I'm feeling this way, this is what I find helpful". How can we help the teachers better understand you? How would you like them to react to you? How would you explain it to them if you are feeling more calm?
Could be useful generally as well as for transition
* exploring friendship difficulties through play (e.g. acting out a story with lego figures and making each one have a superpower or strategy that they could talk about that might help in the situation).
''Children and YP''
*Consider health anxiety, and a place for psychoeducation. Could this present itself in differing ways, e.g. irritability, anger, separation anxiety
*Sessions with children: 'What do you think will be different about school when you go back'
*Practice skills you need for school at home
''Parents''
*Encourage conversation in the home with families about coronavirus, we could prompt
''School''
*How can we consider our support to school teams at this time
*Individual schools and children resources
*Encourage information sharing
*Risk assessments of school, can we help create activities that minimise risk and teach skills
*Share managing transitions AFC booklet
Once agreed an intervention to try out (e.g. a behavioural parenting technique), can be useful to check out some thoughts on what implementing this might be like:
*How manageable does this feel?
*Is there anything you could see that might go wrong?
*How easy/hard do you imagine it will be to stick to this each day?
*What might get in the way?
*What could we do about that?
Setting an expectation that its helpful to try things out, see what happens and refine them is a helpful frame, so support the parent to have a balance of realism and hope about what it might be like to make some changes
We looked at the suggested list of topics together prepared by LT and discussed which felt like priorities, as well as adding new ideas.
!__''Suggested topics:''__
@@.bubbles-triangle-border.bubbles-left
''Understanding the context:''
What factors influence wellbeing in children and young people? What are the risk and protective factors? What is our stance on wellbeing in this team? What are our core values/ideas? (e.g. about role of family in the work etc)
@@
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''Setting up a helping process: ''engagement and relationship building; confidentiality and risk; who to include in the work; using mapping to understand needs; balancing strengths and needs
@@
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'' Helping with specific needs:'' working with anxiety, low mood and behaviour
@@
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'' Monitoring your work'': using goals, using routine outcome measures
@@
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'' Team working:'' What team working skills are important in this work?; Asking for help;
What is supervision and why is it important?
@@
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'' Network skills:'' Who else might be involved with the young people we see?;
What do we know about these workers and what their job might be like?
@@
!__''Our additional ideas''__
<<<.bubbles-oval-thought
''NETWORKS''
How do I find my place in the network of helpers?
How do I work out what other people are helping with?
How do I make sure everyone is on the same page?
<<<
<<<.bubbles-oval-thought
''TEAM''
How do I introduce the service?
How do I introduce myself?
What's group supervision?
What's the difference between line management and supervision?
<<<
<<<.bubbles-oval-thought
''CLIENT''
How do I personalise the work to suit each young person?
How can I be helpful within an 8 session timeframe?
How do I involve the young person's network in the work?
<<<
<<<.bubbles-oval-thought
''LEARNING''
What should I do if the plans I make don't fit the context I'm applying them in?
What's the best way to manage working in lots of different contexts and environments?
<<<
<center> [img width=100% [NAV.PNG]] </center>
!!How to use the manual
This page covers how to navigate this manual and how to get started with developing and editing your teams manual. Navigating the manual is recognised as something that people who are new to it can find difficult: 20 minutes spent exploring and understanding this page will be time well spent!
!!!''[[Wellbeing Service Index]]''
The index lists all of the pages which have been added to the Wellbeing Service manual.
!!!Keeping track of Recent Changes to your manual
*You can find your most recently edited pages under the 'Recent Changes' tab in the right hand side panel.
!!!What pages have I got opened?
Browsing and opening pages is the best way to explore the manual content but this means you can end up with quite a lot of pages open on your desktop!
* You can see a list of all the pages you currently have open by clicking on the ''Open Pages'' tab on the right hand side panel.
* You can //skip from open page to open page// by clicking their titles in this list (quicker than scrolling if you are on a laptop or PC).
* If you've got too many pages open to skip around easily, you can //close pages directly from this list// by clicking the little X beside the titles (marked in the picture above.)
!!!''The Search bar''
Use the search bar to find pages that have been added to the manual.
!!!Tags and links
The software used to support this on-line manual is called tiddlywiki. It has similarities to other wiki software, most notably for Wikipedia. This has enormous flexibility so that material can be linked together in very creative ways. However, for some users, they experience the manual as being hard to find things and to know what is available in the manual.
A ''[[tag |Tags]]'' (a pill-shaped button usually found above the page title) joins together pages to do with a particular topic. You can think of tags as "chapter headings", so there is a tag for Mentalization that links together all the pages related this concept. This is a big topic so it has lots of pages connected together under this tag. Within this big topic, there are tags with a smaller number of pages such as Attachment. Other than thinking of tags as topic/chapter headings, you can think of them as being like a washing line (remember these?) where all the clothes (pages) on the line are strung together - whether or not the line is stretched out or jumbled up, the clothes will stay connected in order. The line is doing what a tag does for pages.
[[Links]] make a specific connection between two individual pages, so that someone can easily explore more detailed content related to the page that they are reading. Using the metaphor of the washing line, a link would connect just //two pieces// of clothing, like a pair of socks! If you click a link, this page will open below the page you were just on.
!!!Printing stuff
*You can print pages from the manual, which is easy (right click on your mouse and select print), and allowed under the terms of the [[Creative Commons License|Licensed]]. Don't expect to be able to just "print the whole thing out", though!
!!!Sharing stuff with colleagues
Create an instant address link ("URL") that you can email or text to colleagues - that will open a copy of the manual //with specific chosen page(s) pre-opened for them to look at//.
* Get the page(s) you want to share opened in your manual.
* Use the crazy looking hashtag just above the search bar to copy the URL of all the current pages you have open to your clipboard:
{{ht.JPG}}
{{URL.JPG}}
* Open your text or email programme, and 'paste' the URL address in, press send and share the link with your colleagues.
* This function means that you can direct your colleagues to specific pages, so if you wanted to share the page that was created at the last team meeting for everyone to review, or something that came up in supervision , etc, you can link them directly to that single page.
* ''This function effectively turns the whole manual into a big filing cabinet of individual shareable worksheets!''
---
!!You may also be interested in:
<<image-link "How to edit your teams manual" "luciano-de-sa-ObwMZBdEWdI-unsplash (1).jpg" "How to edit your teams manual" "200">>
!!!The purpose of this page is to describe the development of the WEST approach to consultation
Firstly, we need to recognise that:
*Consultation can mean different things and be different in different contexts and for different professional groups
* There are overlaps between the terms 'assessment' and 'consultation' e.g. In a consultation we will need to be gathering information and helping to make sense' of the situation. This crosses over with what we do in an assessment
*There are also differences between assessment and consultation that we can define, (although these are not always clear-cut)
The WEST team define the first contact with a client or network member contact as an 'initial assessment' rather than 'consultation' to help clarify some of the differences set out below
Some of the differences that we define in the WEST team between assessment and consultation are:
1. In consultation we are contracting with another professional to use our knowledge/specialism to help them with an issue and to find ways forward ''together'' in a defined/one off piece of contact. This is a bit different to the ongoing gathering of information/iterative approach to assessment where we are responding to new information and building an evolving picture over time...
2. The picture we gain from assessments changes and develops as we learn more over time and this should happen- it is expected. The initial idea/plan from a consultation might change once the assessment develops further
3. We frame consultation as a more discreet piece of contact with another professional (although this could include a number of 'consultation sessions')
4. In a consultation there is more emphasis on how we can work indirectly with a client by supporting the professional that we are consulting to in order to help their work with their client
*It is important to note that both in assessment and consultation we will be thinking about ways forward and resources/strengths of the client/network. This is an area of overlap
*Consultation is different to supervision in that we don't have accountability or power to direct the work of the consultee, where as in supervision, the supervisor will hold some of the responsibility for the work of the supervisee
!!!What are the different scenario's where we might use consultation in WEST?
1.Working with network members to help them use their pre-existing relationship to carry out a piece of intervention work with a client but being guided/supported by us e.g.....
* helping a social worker to plan and carry out conversations with a CYP around loss or bereavement when the SW best placed to carry this out using the existing trust they have in the relationship
*Supporting a teacher to develop and carry out strategies for managing a difficult/challenging behaviour in their classroom
*Supporting another network member to have conversations with a parent about parenting strategies e.g how to use praise and rewards with their child...
2. When a network member/professional approaches the team with a request for help/support , ''or often with a request to take on a referral''...
here we would carry out a consultation to help the professional think about their case, the options, what might be the most helpful ways forward by providing a different perspective from 'the edge of the pond'.
This does not always mean taking on the case. We recognise that this situation can be difficult when a professional comes with lots of 'certainty' about what is needed, (and when the certainty is that WEST should work with this young person). It can feel challenging ion this context when we decide that taking the referral is not appropriate for WEST.
!!!Key aspects to the WEST model of consultation
(this is not set in stone and can continue to develop over time)
!!!First steps
*We need to 'broadcast' and make explicit our intentions as the person who is setting up the consultation...before starting/when arranging, we would explain how we see the purpose of the consultation, set a time frame and explain our service context (if appropriate)
We can use analogies to help us explain how we see the role of consultation e.g. the ripples in the pond analogy...e.g. where the consultee may be 'in the middle' with the client and the consultant is here to help bring another perspective, to help think through the issues/ think together about next steps as someone who is 'on the bank'.
We may want to explain some ideas around why we don't automatically see young people individually, especially when there are complex networks involved and the difficulties that can happen with lots of workers and low trust( which can result in a CYP or family being overwhelmed, unable to make use of help)
Again, explaining the above can be hard if a referrer is very certain about what they think is needed. It can take confidence to re-position ourselves as being there to help think through options rather than to 'take on the case')
One way to help with the above dilemma is to enquire about what different people in the network think about what the problem is, what should happen and who should do what. In particular it is important to enquire about what the child/family may want. This is a way to help introduce multiple perspectives and open new conversations about the similarities and differences between views about what should happen. We can use the [[Dis-integration Grid|Dis-integration Grid]] to help us structure this conversation and we could share this with the consultee to highlight differences and develop curiosity around these areas.
!!!What is our general stance in a consultation?
*Open and transparent stance
*make an effort to validate and connect with the professionals dilemma (mentalize them)
*Model a curious stance to behaviour
*Enquire about strengths and difficulties
* Actively enquire about the network around the client, in particular who else is involved and their relationship to the client/family (we can map this using mapping exercise such as the [[PRO-GRAM|The AMBIT Pro-Gram]] from the professionals perspective. Using this kind of mapping exercise we can enquire about where trust may exist between client/family and network members and then begin to think about how we can we use this relationship in the most helpful ways? This includes considering whether there are existing relationships in the network that we can strengthen?
* The consultation is like a 'filtering down of information process'
* Scotty draws on the Signs of Safety and Wellbeing model - strength and solution focussed questioning
* Begin to establish from the above who any future work will best involve?
*Establish any practical next steps
* summarise back and set out plans
[[Thinking Together|Thinking Together]] provides a framework that we can apply to consultation conversations
It is important to help the consultee 'mark their task' first. Consultee's might feel the need to 'jump into story telling' or sharing details of the problem before having any defined idea of what they need help with. We can explain that in order for us to know how to be helpful it is important first to spend some time understanding what they would like from the conversation... what kind of help they might need (they might not know this at the start without thinking about it)
*We recognise that it can be really hard to 'mark a task' with a consultee who comes with certainty that what they need is for WEST to take the referral on. In this context it is important to spend time first explaining how we see consultation, what we do as a service, how we work, why we don't automatically take referrals, and how the consultation process is designed to help think about what may be the most helpful steps for the client.
!!! Initial assessments
(note the difference between 'consultation in WEST and initial assessment as explained above)
!!!Wat to do when the ideas/plan change after the initial assessment
Sometimes after the initial assessment the ideas or goals suggested at this stage change or develop. This can be because we learn more, the context changes or because the CYP wants something different to the request from others in the network.
''How do we manage this?''
*We should expect/predict this (its normal)
*share the changes of plan with the network and explain why/explain thinking behind this
*Discuss with team if we need help in making new plans
*Put CYP view and needs at the centre e.g. when members of the network may be feeling anxious and seem 'certain' about what is needed, shift to focus on what the CYP may want, think, be hoping for...
*We can use [[Active planning|Active Planning]] as out basic stance to balance our ideas/intentions (and those of network) whilst trying also to attune to the CYP
''What makes a helpful link/handover between initial assessment and beginning the EWs work with a case?''
1. Scotty/Jyoti carry out the initial assessment then connect with the EW about what has been learned after the case has been allocated.
After allocation EW's will send a message to Scotty/Jyoti to arrange a brief talk re the below points.
EW's can also join the weekly referral meeting after they have been allocated a new case to learn more about the case.
In this brief handover meeting it is helpful to discuss:
* What referrers original concern was, what was their expectation (referrer). Any additional information about network
that is important
*Who to contact first from network (being put in contact with them if possible to 'bridge' and make introductions)
*The current formulation- any parts of the formulation that are particularly relevant to beginning the work
*Risk assessment
*How people have presented in the assessment- and helpful points around how the EW may best position themselves to build relationships and not undermine existing network strengths
*Having a joint handover meeting with Jyoti/Scotty, the EW and the referrer when possible can bridge the relationship and start of work by the EW. This may not be realistic always but it is easier to do this when we are working with people within the organisations in our local network (this is also a helpful way of building relationships in our networks)
* Hearing the young person's voice- what do they want from the work?- we recognise that in many instances young people are not consulted during the initial assessment process. For teenagers who are able to give consent/have capacity we would consider this but we are also aware that beginning an assessment with a YP then handing over to another team member to do their assessment may not be helpful for the CYP
*Sometimes tensions then arise when the CYP has very different ideas to what they want compared to the initial referral question/request/idea from initial assessment
!!!How do we manage this dilemma?
*Broadcast our intentions to the CYP and be open about ideas that others have in the network (see Dis-integration grid as a way to help this). Think with the CYP about what they make of others' ideas for help...what fits? what doesn't? what is similar/different to their ideas/hopes?
*Share the CYP perspectives/hopes with the network
*Hold in mind the [[Active planning stance |Active Planning]]
!!!27.01.2021
* To focus more heavily on goals in the report- % of YP who show improvement over 2.45
* To think with team why collecting time 2 of SDQ/RCADS is more challenging
* To consider shorter outcomes such as ORS and CORS
!!! Discussion with team 03.02.2021
What are the difficulties around collecting outcome measures? -
* Covid has impacted the ability to collect SDQs and RCADS
* SDQ and RCADS are really long measures
* It feels like we are collecting them for our benefit not theirs
* SDQs are hard to collect when working virtually (in particular from parents and teachers as we are not seeing them - they are being sent out but not returned). The language barrier for some parents may be relevant to this.
* The CYP do not enjoy completing these measures
* Sometimes the young person will stop engaging after completing only one measure (so no time 2 measures are collected for this reason)
* There are a lot of measures to go through in the first session when you are trying to build a relationship with CYP
Other points to consider -
* The goals help to keep sessions on track and remind CYP of their goals
* We are getting good scores of improvement for GBOs
* SRS feedback - how can we phrase the questions better and in a way that makes it seem helpful to them?
* Could we use one subscale (which is shorter) as the second time point for RCADS?
* RCADS is a useful tool to help pull apart difficulties for anxious and low mood CYPs. It is the only symptom measure that we collect.
* CAMHS services give questionnaires to complete with the referral form.
* We would probably get a lower response rate if we sent to them separately.
!!! 17.02.2021
JP had conversation with Peter F about this -
* Given that we are collecting goals frequently we are getting good amount of goals
* SDQ score - we usually work around one goal (e.g. emotion) so the score on one domain may have changed, even though the rest of the domains may not change
* SDQs in lots of different languages
* Could collect for assessment not as part of outcome measures
Discussion -
* Different cut off ages - RCADS 8+; SDQ 11+
* Social workers use SDQs once a year for LAC children (for LAC reviews)
* LAC with high SDQ scores is one of our vulnerability factors on service spec - if we get a LAC child we should collect the SDQ
* We will be re-commissioned based on who we see and what outcome measures we collect
* Could ask social worker to complete SDQ if a LAC referral has been made (send word doc)
Going forward -
* ''Should be collecting SDQs for //ALL// LAC children and at two time points''
* Should use SDQ/RCADS as an ''//assessment tool//'' for non-LAC CYP
* Should be collecting parent AND teacher SDQ (and self if applicable)
* We can use SDQ scoring tool (via EJ)
* We need to record when/why we are not collecting them
* EJ will send out SDQ when we receive a LAC referral
!!! 03/03/2021
Elly created skeleton of report based on previous reports
__CH and Elly came together to discuss the parts they would be working on (25.06.2020):__
*Elly to do the demographic info and complexity factors (for main report and virtual school)
*CH to do POD export and analysis (for main and VS)
*both using the caseload analysis spreadsheet on the shared drive.
*EJ to complete tabs: demographic info, total complexity factors and the demographic info section of the virtual school tab.
*CH to complete tabs: session overview, directindirect sessions, consultation, supervision and the session information on the virtual school tab.
CH and Elly to revisit written feedback on the 2nd of June - agree on what should be included in this report - JP SUGGESTS: including as much as possible.
__Questions that have come up:__
*when doing case demographics should they be done for all cases seen this term or only new referrals? - all cases seen this term.
__points that have come up__
*need to count WBR as a separate category like direct/ indirect ect. and need to separate this data from the direct and indirect work.
*complexity factors taken form record keeping not referral forms
__ideas to make the next report smoother__
*For EJ to check over the spreadsheet at the end of the deadline for anomalies and errors.
!!!Q4 2020
*include BBCH break down (and in annual report)
!! New target group reporting - annual report 2020
*The target groups we need to report on are as follows:
**child protection plans
**LAC and post LAC or care leavers
**EHCP where Social emotional mental health is identified as a primary need
**at risk of exclusion
**edge of care (clarify with JP if multiple vulnerabilities i.e. CSE, gang affiliation needs to be reported separately or only as part of those who are at edge of care.
**young carers
**those excluded from mainstream education or in PRU
* Need a graph showing the break down of referral sources
* then separate graph for each of the main referral sources and the number of children within each target group for each of these sources - e.g. we had 5 referrals from schools and 3 were on the edge of care 2 were at risk of CSE.
*if a child falls into more than one target group they will be counted 'twice' and this will be stated below the graphs. i.e. 5 out of the 10 referrals received from schools had more than one presenting need/ target group and 5 had 3 or more.
*for each referral source target group reporting explain what/how long we see them for, if we refer on and where to.
* include a table in KPI spreadsheet that has a full break down of the number of children in each target group.
*need to include CWP criteria, and harrow horizons (Banardos) and compare to how many we are seeing- why they can't be referred on.
''CH and EJ need to develop a simple way to capture this information for next year and for the annual report.''
''Need to consider direct meetings with everyone to go through data''
!Commissioning report meeting 9th Dec 2020 (JP,EJ,CH)
*training info and feedback - in annual report
!!Termly reports:
*No KPI report in excel - Word document with table, and case study, and some feedback.
*Separate report for VS
*term 1 + Christmas holidays, term2 +Easter, 3 term+summer
*''Friday the 8th January'' - Next data deadline?
!!!Proposed reporting periods:
[img[Reporting deadlines.PNG]]
!!!Term 1 2020-2021
*Deadline Friday 8th January - all data, POD, case studies, feedback and session information
*RS to write case study and use feedback from cases
*VS report - Theresa to write up ''one'' of the groups.
!!AFC request
*CH to write email to practitioners, when did you start going back to face to face, how may kids support, how many sessions roughly. Breif bullet points about how they have adapted going back to face to face- deadline for Monday. cc elly and JP
* CH will write up without number for EJ to fill in the numbers.
Protocols were developed for a waiting list on the 19th of August due to the team reaching capacity and practitioners having CYP on hold which are being reviewed in Sept to evaluate the teams capacity.
We need to make contact and offer a consultation to each case before putting them on the waiting list.
This ensures everyone has had contact within three weeks and that the family know they have been accepted and we are clearer on the aim of the referral.
Elly to make a template for a letter after a consultation has been given stating the date of the consultation what was discussed and when the family will be seen.
We need to consider risk level and evaluate this during the initial consultation.
We will ''prioritise based on risk'' rather than date of referral.
!!!Background to this discussion
During the second lockdown (winter) we have been thinking about the ongoing stresses and difficulties in working at home and in isolation.
In addition there have been ongoing uncertainties about how we will work going forward (face to face or remote) and this may remain uncertain over time.
As well as this we are at a stage in our teams development when we are developing our approach and model and there can often be questions and dilemmas about the most helpful ways to work within the parameters of our service.
In this context we thought about how we stay connected and how we seek and offer help to each other when we are feeling anxious or uncertain (this also includes, of course, when we need to talk about our case work)
* in AMBIT we try to recognise explicitly that anxiety or high emotion , stress, worry are an inevitable part of the work we are in.
*The team already use the AMBIT [[Thinking Together|Thinking Together]] model as a structure for offering and seeking help in team meetings and in supervision. Some team members are beginning to use this in more informal situations with each other too.
We talked about how in this current context there are more stressors and changes happening that can impact on us and our ability to mentalize.
''We described situations that can happen in the team where it can feel like we 'end up jumping in the middle of the pond together'....this is a bit like someone having a worry or a dilemma, and others around them join them in the worry or discussion about the concern. The sense is that this can lead to people leaving a conversation feeling more uncertain or sometimes more anxious''
In AMBIT we use the idea of ''ripples in a pond'' to highlight how we can be at different positions in relation to 'the intensity' or the dilemma. That the aim is that for the person who is in the 'middle of the pond' in the 'intensity' that they need to be able to use help (to regain the capacity to mentalize) through connections with others who are stepped further back 'on the bank' 'or at the edge of the ripples'
We discussed ideas today about how we might try to stay on the bank and help people who are in the middle of the pond, particularly if this is challenging and there is a pull to also 'jump in the middle'
!!''Some ideas were:''
*Before having conversations with team mates about potentially emotive issues, checking with them how they would feel about discussing this particular issue...do they feel like they could take a 'position on the bank' if we talk about this or are they in an ok headspace to help me think this through? are they too close to the middle to be able to help me think at the moment without also 'jumping in'
*having the above conversation together kick starts mentalizing in both colleagues i.e. 'how do i feel about this? can i be helpful right now...where am i in relation to this issue?'
*Being honest with each other about this and if it would be difficult , thinking, who else might be closer to the bank on this one that could help me to think it through
*When we do end up in the pond all together naming that this is ok ! this can happen as part of this work. Just naming it has happened is helpful for getting back out !
*Using the thinking together structure explicitly in more informal help seeking conversations as this helps to 'stay om the bank' if you have a defined role as being the helper (so its harder to 'jump in')
Add more ideas as they develop...........
This is the core tag for the Brent Wellbeing Service. Below is a list of all pages tagged with 'Wellbeing Service':
<div class="tc-table-of-contents">
<<toc-selective-expandable 'Wellbeing Service'>>
</div>
<<list-links "[!is[system]!is[image]sort[]]">>
Two main types of helping roles within the team are:
#Wellbeing practitioners
#Outreach therapists
*''Wellbeing work'' - ie. because the team has been commissioned to provide a Tier 2 service, positioned in the Thrive model as between Getting advice and Getting Help.
*''Targeted work ''- i.e. with children and young people who fit into the vulnerable groups that have been identified. They may have a range of needs, which may include difficulties with their emotional wellbeing and mental health. They may not be accepted by CAMHS, perhaps because their difficulties are seen as being related to their context or because they do not easily engage in structured forms of help.
!!Wellbeing Practitioners
will be using evidence-based early interventions using a brief guided self-help model. To aid this work the below guided self help [[Intervention Manuals]] can be used. These have been divided into 4 key area with which children/young people and families are likely to be referred:
# Child Anxiety
# Adolescent Anxiety
# Adolescent Low Mood
# Behaviour Problems
!!Outreach therapists
We adapted this exercise and thought about what a wellbeing patchwork might look like. We worked in pairs to make some patchworks using post-its and stickers.
http://www.safehandsthinkingminds.co.uk/wp-content/uploads/2016/03/Parenting-Patchwork-exercise-worksheet.pdf
We brainstormed ideas about what we think contributes to children and young people's wellbeing
Create a page to summarise your key ideas:
* Sense of belonging in the community
* Being connected to people who share your culture and interests
* Stability in family
* Friends
* Religion
* Accessing education and getting on ok there
* Being part of clubs/groups
* Freedom and choice - having options and ability to make choices
* Feeling valued and important - a sense of self-esteem
* Being able to enjoy things - having fun!
* Feeling loved and supported
* Having people you can trust and depend on
* Having a voice
* Being able to develop healthy
* Good physical health
* Good personal hygiene
* Opportunities to develop cognitively
* Being active
* Having interests
* Having hobbies
* Safe environment
* Good living conditions
* Having future goals and aspirations - feeling like you have aims and a purpose and a drive.
* People valuing you for your skills, characteristics and ideas
* Being around other people
* Being able to use other people for help
* Regular structure and routine
* Rules and boundaries
* Being able to spend time with your parent/family member
Maslow's Hierarchy of Needs
* We need to consider the context for which we know them. And consider how we respond on a case by case basis.
* Some of our team live and work in brent for a long time and so may know many people but might not know them closely.
''Case discussion''
* If they are closely linked to us i.e we know the family or child very well then the practitioner would have to leave the room/ conversation when the case is being discussed.
''Supervision''
*if the supervisee is working with a case that the supervisor knows then the supervisee would have be reallocated a different supervisor
These are our ideas from the beginning of the session about what the difference might be between well-being and mental health
* Well-being – you might do things like self-help to improve your wellbeing.
* Mental health – diagnoses such as depression, anxiety. More medicalized?
* Could be a thin line between them – young people might interchangeably use these terms or confuse the two – might think that feeling low occasionally means they are depressed.
* Everyone has mental health – but people can equate this term with meaning that someone has a mental health condition/disorder.
* Well-being - Everyday decisions that you make to keep yourself well vs. being unwell and needing to act on it.
* Physical health analogies – e.g. being diabetic vs. pre-diabetic.
* Can be stigma around mental health; its less visible, maybe seen as a less legitimate need than physical health?
* Might be differences around how mental health and seeking help is viewed between individuals/groups/cultures/societies – some families might feel shame if a family member is experiencing a difficulty with their mental health.
* Good communication
* Containment
*feeling safe, secure and supported
* Knowledge
* Time
* Trust in eachother
* Understanding from senior management what it is like to be in the frontline of what it is like dealing with complicated factors: referral forms / new processes
* Clear ethos of team, and how we come across to others
To do our job well we need -
* Supervision (making proper use of supervision)
* Good communication within/between the team
* Voicing when someone is unsure about something
* respect each others different ways of working
* if we are struggling, to be able/feel able to communicate to our team
* active planning (ensuring we have a task, plan and implement)
* what we are offering is appropriate for who we are working with
* listening to the what the clients want
* Supportive, encouraging and cohesive team around them
* Non-judgemental approach within the team
* Everyone in the team is approachable - always someone to talk to
* Trust and confidence in one another and our abilities - we can also recognise our own limitations and vulnerabilities and be able to seek help
* Honesty and the ability to disagree
* Ability to acknowledge one another's perspectives even if we don't agree
* Variety of skills, knowledge and expertise etc.
* Clear systems, processes and protocols in order to feel confident that we're doing what we should be doing in the right way - particularly when the work feels difficult - this was harder at the start but should ease anxieties
* Good communication skills and listening with each other, as well as families and other professionals in the network
* Representing peoples voice- managing to capture YP and families voices that we support so we can represent this to the wider network
*Ability to work independently, being able to think on your feet when you might not have immediate support from your team due to nature of the work (outreach work).
* The ability to reach out to team members when needed.
How do we learn from evidence? What evidence do we make use of in our work
*CBT based interventions around well-being
** The CWP-IAPT and EMHP manuals have been used and have involved adapting them to our context
* We use evidence gathered from outcome measures to guide our intervention
* Positive, rewarding feelings (both with children, and own knowledge)
* Feelings of hope
* Making a difference
* Safe
* Overwhelming
* Frustrations
* Resentment (wanting to do work, barriers in the network)
* Lose hope
* Holding other peoples stress
Positive -
* Fulfilling to see when a CYP is improving, making progress and achieving their goals
* Feeling very contained and have space to think about different aspects of work and rely on others in the team
* Seeing of the progression of our service, how we are improving, expanding and adapting, brings pride
Negative -
* Not knowing how to proceed or feeling stuck with a case, it can bring about negative feelings, but this is the nature of the work
POSITIVES
* Empowering to empower someone else
* Satisfying to be able to engage YP/ families who are hard to engage
* Achievement
NEGATIVES
* Anxious about amount of work, how to manage workload and clinical cases, complexity of cases, risk and safeguarding
* Frustration with other professionals in the network, with ourselves and parents/ YP
''-''
*Frustration
*Helplessness
*Despair
*Concern
*Sadness
*Anxiety
*Worry
''+''
*Hopefulness
*Joy
*Connected/ relatedness / closeness
*Satisfaction
!! Things to consider
* What happens when the risk increases so that it is not suitable for a practitioner to hold?
* What risk are we identifying? Risk to the young person from external factors or risk of their mental health declining?
* The referrer filling out the referral form - cases of them filling out too much/not enough
!!! In initial consultation stages -
* Which professionals hold the risk?
!!! Social care involvement
* It is easier to hold a higher risk case when there is a good and involved social worker involved
* Are there protective factors?
* Social care can withdraw when we start intervention as they feel we are holding the risk
!!! What things do we need to feel that we are managing the risk
* Social worker/mentor that is also involved in the family to feed back to/communicating work to someone regularly
* Support from the team (e.g. Scott) to discuss the risk
* Having a key professional who has a ''long term ''relationship to the family as they will need to practice and continue the techniques/methods once our work has finished.
!!! How can we look after the risk once we end
* Involve the family more
* Speak to others in the network (//raise anxiety// within the network)
!!! Moving forward
* Speak to members of our own team more
* Use the network better
* Brent Family Front Door (Safeguarding)
* If risk to mental health escalates higher than mild to moderate then referral to CAMHS need to be made (CAMHS on duty worker)
* If risk is from external factors they must be escalated via social care
!!! Still to consider -
* Specific avenues to go down depending on the risk (look at different scenarios)
* Clarify which professionals we need to contact when
* How to have conversations between wellbeing practitioner and someone senior about risk (using AMBIT techniques? Ensuring that the anxiety is recognised)
__''What have we taken from the Wellbeing Practitioner Training?''__
__Feedback 1__
* I have a look in the manual before my sessions and usually find something very helpful I can use from what we've covered
* Sessions have helped me to communicate better with my clients, using the OARS
* Has helped me with technique as well as giving me ways to express my ideas more clearly
* Being more practical in my work
* How to make sense of things with people
* How to have meetings with parents and schools
* Being mindful of pre-contemplation and contemplation stages – rather than trying to persuade or force people. It doesn’t help their ambivalence to do that! Keeping those stages in mind, rather than jumping to quick-fix has been usefful.
* Working with low mood – has been useful to use the resources.
* Having ideas of what to say – how to phrase things
__Feedback 2__
* How to run an assessment session, how to structure it in a collaborative way. Using spider diagrams – going well, not going well, what they would like help with. Planning out the questions within those to cover all areas of life.
* Using AIM cards to generate an initial assessment and overview – found it really helpful with teenagers, especially doing it online, if they can do it on their phone
* “More than one person in a session” – how to structure it with the agenda, so you can interrupt as you need! Being able to broadcast at the beginning how you might approach it, so that people know what to expect.
*Having some sentence starters and prompts so that we have ways to say/do things - e.g. for how to draw people into conversations who are quieter; how to manage the louder people!
* Motivational Interviewing – stages of change were really helpful to work out what stage is the person actually at. Helps to make sense of when I’m stuck – usually I realise I’m trying to do something that’s not matched to their stage.
** Pros and cons of change tool has been helpful
** OARS – was worried when starting out that I wouldn’t know what to say or respond. Helpful that you don’t have to come up with pearls of wisdom – using reflections and summaries can help keep the conversation going
** Restructuring the sentence – saying the “change talk” bit last when you hear ambivalence - helps to elicit more change talk.
** Taking up the opposite side of the argument, not just arguing for the change, which doesn’t leave the client with space to do that
** Rolling with resistance – don’t panic! Explore it a bit more
* Practising in roleplays
* Active Planning – being transparent about what I am hoping to get out of the session. In my agenda setting before, might not say WHY and remember to ask them what they wanted to cover. Both your ideas and their ideas. Considering the context of what has happened that week
* Rules – how to come to a shared agreement between parents and teenagers. How to do it in a way that feels ok for the young person – how to help them accept rules by combining psycheducation on rules in a young person friendly way, with inviting their input into designing them.
* Brain swapping – helping people to mz each other. How about we swap brains and try to work out what the other person might be thinking/feeling?
* How to make it creative and visual – the art of play even in remote work! How to make it interesting to CYP and adapting how many words you use depending on the age.
* Roleplays – helpful because makes me feel I can do it when we've practised it.
* Creative and collaborative
__Feedback 3__
* Reminding each other of the things we have covered when we help each other out in our work each week
* Behaviour interventions – being able to work with parents to manage a range of behaviour difficulties.
* Holding the balance – e.g. through the AIM cards, nice to draw out the strengths and positives to then build on them, not just to focus on problems.
* Brain House – making the characters, writing stories with younger children to help them develop their emotion regulation skills, printing it out as a story book, sharing it with the network "How you can help me and how I can be encouraged to help myself".
**Helps the consistency between the two environments.
* Mapping out the team around the young person – making sure we focus on involving the network from the beginning of the work. This is especially important when we might be worried (or it might be the case) that they don’t have many people around - we might have been more reluctant to do it.
* Remembering the importance of holding in mind from the outset that we won’t be there forever – part of the task is to find other people in the network to carry on the bits that they found helpful in the work.
* Traffic lights – how to help parents help the children move between the different zones of regulation
* Self-esteem – using the team around the YP to help him become more aware of his strengths and skills by setting him a homework task to ask different people.
* CBT hot cross bun – still trying to draw it out on the computer (rather than on paper in person!) to link thoughts, feelings and behaviours together.
* Helpful balance of theory and how to put it into practice
*Being given feedback about what we are doing well which builds our confidence and also constructive feedback about what we can improve on.
*Being able to share examples of work and hear examples of work, in terms of getting ideas about what to say or ideas about how to approach things.
''A wellbeing review is a direct session that takes place instead of a direct intervention''
* We created these as a result of Covid-19, as a way to stay connected with the families that could not complete their work/goals working virtually
*We need to record them on our record keeping
* we need to distinguish the difference on our record keeping/ report writing-on a session by session basis
!!!What is the purpose?
*Helps to maintain/develop therapeutic relationships
*Showing to families that we are holding them in mind
*Keeps the context there to ease the transition back into therapeutic work
*To assess/ review if the family are able to access therapeutic work online
*To review/ check with the family what feels right for them in terms of sessions
!!!When would we use these?
*When the child/ family are not able to engage in online working
*If the child attention span is sort/ easily distracted
*If the family are not invested in the online working/ willingness to help facilitate this
* If the child doesn't have access to the internet/ technology
*If the family living situation makes online sessions difficult
*If it is a school based problem- this may not be affecting them now, goals cannot be worked towards
*The age of the child is too young to engage in online sessions
*If the difficulties are not acute/ time sensitive
*If they have a very intense school day online
*If the child chooses not to have sessions
!!Have we used these outside of the COIVD-19 lockdown?
*Check ins over exam seasons
*Life situations causing breaks in sessions
!!How are they different from an adapted online session?
*does not focus on goals but we might check in about these
*does not set an agenda
*No set time/ usually shorter
*do not think about problem solving with families
*It does not have a structure like an intervention
*It is an organic conversation to catch up with the CYP/parent to check in with them and see how they are
*adapted online session for some children may still not be very long or always very focused - this makes it feel blurred
*they may blur together/ overlap which causes issues when recording what they are.
* if the conversation moved towards a therapeutic conversation around goals/ progress we may record this afterwards as a session
* Difficult relationships with families
* Anxiety
* Networks misunderstanding what we do, not being able to link up networks
* Do we know what we do? Are we specific enough? We may get referrals from people who may be unsure of what they want from us
* Overthinking things / talking over things before they are properly investigated
* Sometimes CYP do not want to engage
* Hard to proceed with cases we are working with
* Negative feelings that a CYP can provoke in us
* Different points of view within the team (maybe specific to one case or more generally with how we work)
* Not being able to physically be together as a team
* complex cases
* Ambivalence and resistance in YP and families
* Lack of communication between professionals
* Big workload and lack of time
* Can sometimes feel isolated - due to the nature of the work (outreach)
*containing the lives and struggles of the families we see to a working day and then move on with our own lives.
*we might not always have the answer we are expected to have by others- this can be hard to sit with
*We can't always change things immediately the way families and professionals might like us to
*There is no magic solution! Which is sometimes what people want. Hard to help people realise this.
What does wellbing mean to us?
#emotional and social health and how we can look after this
#Can be affected by environment, social context (our networks) and OUR ACTIONS
Difference to MH?
#spectrum of effect of emotions
#intensity of this effect
#diagnosis
What you are reading is a WIki Manual. It is a way of manualizing complex interventions that offers multiple additional functions over paper "how-to-do-it" guides, and a lot more than other web-based treatment manuals that do not use the highly innovative opensource software called Tiddly Wiki (hence the name.)
The use of wiki manuals has increased enormously over the past years at the [[AFNCCF|Anna Freud National Centre for Children and Families]] and AMBIT is proud to have been the beginning of this. Here is a brief introduction to how wiki manuals are being used across the centre, and below this is more detail on what they are and how they work.
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!!Brief narration and animation to explain "Why use Wikis?"
By Dickon Bevington
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Tiddlymanuals take much inspiration from the 'OpenSource' movement in computer software development. They are freely available (though released under a [[Creative Commons License]]), as the notion of closely guarded, and expensively-marketed, intellectual property in respect of best psychotherapeutic practice seems contradictory in the helping professions. We acknowledge the support of the [[AFNCCF|Anna Freud National Centre for Children and Families]] and our sponsors in allowing this development.
''Practitioners using Tiddlymanuals remain responsible for their own professional practice.''
~TiddlyManuals take the form of [[Wiki]]s, but they function as completely self-contained and easily editable documents, too; they can be downloaded, saved locally, and run from a USB stick, or a local computer without any access to the internet.
See the [[User Guide]] for more details, and go to @tiddlymanuals to see other versions of tiddlymanuals that are available.
A list of topics that we need to consider when working remotely.
For all pages about this topic please see the tag
!!<center><<tag [[Working Remotely (COVID-19)]]>></center>
'' What online methods will we be using?''
* Try to use a software that allows you to see the YPs face if possible. W can use FaceTime, Whatsapp, Teams.
* Most YP will have a computer to complete school work.
''How do we use resources working remotely.''
* Especially if we were planning play based support.
*How to make sure YP have enough help to complete them,
*What are the best resources to send
*Need to consider: wifi, printing, IT access
*we could send pictures or screen shots of resources
''How to practically support younger children online.''
''Working with Adolescents''- confidentiality, managing what can we share, what is being shared due to overhearing.
''Helping families share a space and the conflict this might bring''
''What is an appropriate intervention when working remotely.''
''How do we do an initial assessment, what can we use instead of aim cards''
''Conducting risk assessments remotely''
*The use of questionnaires can be helpful to instigate conversations
''Topic ideas to support families during lock-down''
*Helping children understand the current situation: Why can't I leave the house?
*Keeping a routine
*Living with worry and anxiety for children of any age.
*Supporting parents with behaviour management
*Managing conflict in the family
*Supporting YP to look after their mental health and well-being.
''What to offer if the agreed goals are no longer relevant due to the current situation.''
*parents may want to 'pause' cases if family do not feel the support is helpful now but might become helpful
*Need to keep in mind that preset goals may or may not have changed but that we need to ensure we avoid certainty
*Don't assume that they would like to continue receiving support. People may have different priorities at this time.
<center>[img[Stance-Domains.jfif]]</center>
!!Why intervene in multiple domains?
Making deliberate attempts to work in multiple domains is one of the [[Core Features of AMBIT]]. This element of the AMBIT stance is increasingly recognised in policies that encourage a broader set of core skills.
We recognise the complex and 'multifactorial' causes of many of the problems faced by young people - it is rare that problems have a single cause. Practitioners are trained to work across a range of intervention modalities. Intervening in a single domain (such as the domain of individual psychology - beliefs and motivations, etc) ALONE is not AMBIT, unless there are explicit efforts to work in at least one //other domain//.
!!Multiple interventions
The kind of interventions a worker might use will often have been developed in, or may be seen traditionally as the province of separate professional groupings. Having a wider range of "barefoot" skills, equips the KeyWorker for active, flexible, "light-footed", non-clinic-based, “frontline” or “street-level” work, allowing the person of the worker him or herself to act in an integrative role (see [[Taking Responsibility for integration]], one of the [[Core Features of AMBIT]]), rather than exposing the young person to multiple professionals at a time when developing a therapeutic attachment to just one individual may be hard enough. One of the purposes of this approach is precisely to //reduce// the need for a young person to be seen by different specialists and, through a willingness to work across different domains of functioning, to invest in the development of a helping relationship with the AMBIT keyworker.
There is a strong focus on effective practice (see [[Respect for Evidence]]) – using manualized evidence-based treatment modalities as far as possible, albeit in settings that have previously not been seen as ideal for these to be delivered within.
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!!What are "domains"?
''1. Biological''
*Workers have an understanding not of psychopharmacology (which remains the province of the prescriber) but of:
# Key physical signs that would indicate a need for closer medical assessment,
# The rationale for using medication
#Tools for developing and sustaining adherence to pharmacological treatment regimes, both addressing the individual and the systemic context (engaging family-members in the task of supporting adherence to a prescription, for instance.)
''2. Individual psychological''
Workers have skills in:
# Mentalization-based approaches to therapy
# Basic CBT
# Motivational approaches
# Psychoeducational techniques
''3. Family/care network''
*The basic approach is ~Mentalization-Based Family therapy, which emphasises the value in improving the capacity to mentalize within and between family members, but includes, also, structural interventions addressing power hierarchies, boundaries, and the promotion of developmentally appropriate responsibilities.
''4. Social-ecological''
*A range of interventions are included, aimed at shifting a young person’s social ecology towards more mainstream and pro-social networks and positive recreational activity.
''5. Education/Vocational/Employment''
*Interventions within this domain are designed to promote the development of links to sustainable, mainstream institutions or employers (which may be referred to as “mainstreaming”) if at all possible. An overarching goal is to establish networks beyond Mental Health or Social Care institutions if at all possible.
''6. Inter-professional network''
*There is a strong emphasis on how to identify and avoid Dis-integratedInterventions amongst the ProfessionalNetworkMembers that tend to collect around young people with complex needs.
!!Mentalization as an organising principle
In [[AMBIT]], the 'oil' which lubricates these different types of intervention together is a pervasive use of mentalization as an organising principle.
!What is school like for CYP?
*Might be a safe space/unsafe space – home might feel unsafe, so school is safe or vice versa
* Different for every child – have their own experiences at home, states of mind, relationships with parents
* Could be a place where there is pressure to conform/perform/fit in
* Rules might be quite different between home and school – might be some aspects of school life might be quite unfamiliar. They might have to switch between “how I do things at home”, “how I do things at school.
* Could feel scary school – expectations change as you get older. Having to take on more responsibility to remember things, look after yourself, be independent.
* How manageable school feels might depend on how your parents are – do they take an interest in school, do they remind you about things you need etc.
* Peer pressure – could be more pressure to fit in – might involve feeling that you have to change how you are to fit in
* Are you cool? Are you not cool? What’s your identity? What group are you in?
* Could be exciting also – fun, developing etc. An opportunity to explore different identities
* More choice over forming relationships/friendships – lots of children.
* Children relate according to their interests
* Might really enjoy learning about new things
* Enjoying getting positive feedback from teachers for doing things well
* Being successful at school can be really validating
* Opposite also true – not doing well at school/in subjects can make CYP feel stressed/bad about themselves
* Can feel under a lot of pressure – comparison to peers
* Different schools have different expectations – goal-posts can feel that they are always moving.
* Have to respect authority
!! The announcement of a second lockdown has raised further questions about how we work in a face to face way in schools.
!!! Things to consider -
* Schools are in a bubble, if we went to visit multiple schools in one day we would be going into multiple bubbles
*We must tell schools that we might be going in to another 2 or 3 schools in one day, to see if they are comfortable with that
* If we have multiple cases from one school we should consider the possibility of allocating all cases from one school to one practitioner (if feasible). This could reduce the number of schools that you need to visit.
* Now that we have these extra restrictions, CYP networks must really justify the need for working face2face.
A 1 hour webinar is available on the Future NHS Platform. this webinar covered how to work remotely with children and young people with anxiety and low mood. It has short presentations from different people on working with adolescents with anxiety and low mood (low and high intensity), working with parents of younger children with anxiety, using ROMS remotely, and some feedback from young people on remote working.
It had good feedback from those who attended (there were 650 of them!).
If you follow this link on the platform, you can access all of the recordings, resources and slides.
https://future.nhs.uk/connect.ti/MHLDAcovid19/view?objectId=19345904
''Questions we want to find out:''
* What are problem behaviours happening at home/ school/ community? Can be easier to approach by domain…
* With each behaviour; onset, frequency and duration?
Getting really specific is helpful:
**What are the behaviours?
**Helpful to spend some time on why you think the problem is happening?
* What’s the parents sense of why this happens or why it’s difficult for the YP/ child?
** Could you give me an example of how it tends to happen? Can you talk me through a recent example; how did it start? (can give some ideas)
** What are the triggers?
** What sets it off?
** What helps?
** What makes it worse?
** How does the parent usually respond when behaviour happens?
** What kind of thing have they tried? (can give some ideas of what’s absent and present and where you might be able to start work)
** What has worked/ what does tend to help (even if there’s only a little improvement)
''ROUTINE'' is important – one way of managing behaviour is to make sure as many things are happening as possible – makes problematic behaviour much less likely as child will be reasonably happy, regulated – if something does happen it’s a bit of a frustration rather than building up and becoming overwhelming – can be ‘nipped in the bud’
# What is the routine? How does it look?
** Tell me how the day works?
** What do you tend to do in the evenings? What time do you get ready for bed; dinner etc.?
** What time is the behaviour most problematic – sometimes just directing parent towards putting activity in can help
# How clear are RULES AND EXPECTATIONS on what they’re supposed to be doing
** Are there house rules? In school? (e.g. listening etc.) – does the child know what’s expected of them; do they get reminded about it? Is it clear?
** Can explore directly with children:
** What are important things for children to do?
** How do we make a happy house?
** Thinking with the parent about what they do, do when they see what’s expected – do they praise? Are they just so relieved they don’t comment as to ‘rock the boat’? What are the child’s views on praise? Does this work?
** Can help to form picture of how much reinforcement is happening
** When they do, do something wrong, what happens? What’s discipline? Consequences? (‘all parents have different ways of doing things and this isn’t me telling you what to do, I just want to get a better understanding and through using some ideas of things that other parents do’)
** Do you take things away? Ground them? Punish them?
** Are there no punishments, or lots and lots of punishments (then child thinks I’ve got nothing to lose or 'I’m so angry and cross and hopeless that there’s no point in behaving anyway')
** Do they follow through with punishments?
''What is the general state of the quality of the relationship? ''
** Looking at warmth; play; stimulation
** How do you spend time together?
** Do they have a preference for attention they get?
** Do they like positive attention or do they seem to prefer getting attention through misbehaving etc.
** Focus on the NEED rather than the attention (e.g. ‘sounds really hard that they’re always wanting to spend time with you)
** Parents should be able to generate type of things they enjoy doing with their child and what the state of the relationship
** Language –age-dependent (e.g. much younger child may do ‘play’ whilst older children wouldn’t)
Is there warmth and reciprocity?
''Where is the parent at in terms of own regulation?''
* e.g. modelling – is the parent themselves reacting by losing their temper quickly, shouting, hitting etc., this is an important part of the picture as reward program is going to be difficult if they can’t keep their cool.
''Behaviour charts''
* Behaviour programs – e.g. is there a particular behaviour they want to focus on with the child?
E.g. listening: every time you do good listening, you’ll earn a token. We can count them up at the end of the week and if you get x amounts of tokens, we can do y. Parent can do by reviewing by day or by every time they see the nice things happening
* Every time might be more motivating as other misbehaviour in the morning may make the day feel hopeless and difficult
''Rules''
* Might be several rules – tick on chart how well child has done them – full tick if done great, half tick if not – green, amber and red (e.g. amber = problem with 1 of more behaviour). Each colour corresponded to certain amount of time on the PlayStation etc. (individual reward).
* Need to work out desirable behaviour and see if child is more likely to do them if they’re encouraged by a reward and worried about the consequence (which can be not getting the reward or use consequence of losing PlayStation for day for e.g. or going to bed early – withdrawing a privilege).
* Important to make sure child is only losing something for a shorter period of time (e.g. day) – children don’t tend to learn from longer lessons but more from short, sharp consequences – quick cycles are best)
''Individual skills for parents''
* What is praise and what it looks like
* How to give instructions – be calm and direct; try and talk about behaviour you want to see rather than what you don’t want to see
* Setting house rules
* Ignoring is also an option – can be implicit or explicit (tell them you’re going to ignore a certain type of behaviour ‘e.g. I’ll listen to you when you can be respectful again) - this can be for more low-level behaviour
* Walking away; taking a breather
* Working out how to detach rather than persist in these moments (e.g. ‘I’m going to come back and speak to you when we’re both calm’)
''Repair conversations''
* Template of how we’ll sort things out afterwards can be very helpful (goal: have your say, get it off your chest and move one).
* Could use this template to introduce talking about feelings
** E.g. I wasn’t very happy when you did this … I’m going to think of something I could have done differently and you’re going to think about one thing you’ve done differently and we can both say sorry and move on.
* Has it ever worked? What can go well?
* Do you ever have conversations about child’s worries/ feelings?
* What worries might the child have?
* What feelings do they think their child has?
* Can make a chart with child – check-in with them at the end of the day and use faces
''Working with goals''
* Want one quite specific goal of what the undesired behaviour is and what the desirable behaviour if – do they have skills and if not, how can we as a unit develop them together?
* Problems with respecting parental authority – if so, can try behaviour chat and consequences
* What skills are you going to focus on?
* What are you motivated and interested to hear about?
Could use card or quiz on their strengths and what they’d like to improve on in terms of parenting strengths and difficulties – might help to reduce the extent to which they feel judged. Not about not being a good parent, but that for lots of different reasons it gets tough sometimes.. It’s helpful if we can prioritise in your mind and respect the fact that you’ve tried a lot already and you know you’re child best.
All Looked After Children have different circumstances and needs, which we will need to be held in mind and used to guide the best way of helping them and their networks. This page is not intended to replace this process, but instead to list some general principles that are helpful to consider when thinking about offering a helping intervention.
All Looked After Children will have a social worker and the majority of Looked After Children will be living in a foster placement, supported by one or two foster carers (nb. some children will live in alternative residential settings).
Following the principle of [[scaffolding existing relationships|Scaffolding Existing Relationships]], we would want to be thinking very carefully about how our work supports, strengthens and makes best use of these relationships, as they are most likely to endure long beyond our involvement.
This group of young people may also find it more challenging than others to build trusting relationships with people, because they are likely to have had experiences that have left them finding others hard to trust. This means that we may need to allow longer for engagement and building a relationship.
Looked After Children can also have needs in a number of different areas, meaning that they can attract quite large networks of professionals. They may be faced with a large number of adults trying to form relationships with them, all trying to help with different things. This might be quite overwhelming for the young person, particularly if they do not share ideas with the workers about what their needs are.
Considering how best to respond to referrals for Looked After Children needs particular care and attention to ensure that the response is helpful to the young person. Very often, referrals may be based on things that other people think would be helpful for the young person and are not always coming from the young person themselves. At other times, the young person might have made an explicit request for help with an issue, which we would want to make sure is responded to.
It is helpful to think carefully with social workers and foster carers about where the request for help is coming from and if the young person is in agreement with this, whether there is anyone in the existing network who might be able to provide this, before setting up a new form of help. If something is offered, it is useful to think about whether this might be best done through or with the social worker and/or foster carer/s, in order to support their relationship with the young person and ability to sustain any benefits of the work. At other times, more thinking may be required with the network about the best way to proceed, if something is being asked for that the young person has not requested themselves.
It is not very helpful for a young person to be introduced to a new worker, who has been given a task to complete by another worker, without the young person having any say about whether this is wanted, needed or how it might best happen.
What can also be inadvertently overlooked are existing relationships of trust that the young person already has. There may be someone in their existing network (both personal or professional) who might be better placed (in the young person's eyes) to be helpful to them. We should be considering what role these people could play in helping before assuming that this task should be assigned to a new person who the young person does not know and would need to build a trusting relationship with.
We should be mindful that whilst some short-term, goal-focused wellbeing work might be useful for some young people who are Looked After (particularly if they are help-seeking), work on their underlying difficulties or exploring/unpicking events related to their life story (which is likely to include relational and developmental trauma) is long-term work that is beyond the scope of the intervention length offered by WEST and needs careful planning, in order to ensure that there is sufficient stability and support available to the young person in order to make best use of this.
We may want to consider offering consultations to social workers and network meetings before agreeing to meet with young people to carry out a piece of wellbeing work, in order to give full consideration to the above.
!!!Short-term goal focussed work with looked after children:
*How do we approach this?
*what will be important to consider when we have a referral that asks for this?
*What might be indicators of short term work being possible with a looked after child?
*What might be indicators that it could be less helpful/not possible to start short term work?
*what happens when we agree to short term work at the initial consultation but then further complexity factors arise which suggest short-term work may not be helpful? how do we manage this as a service?
*How can we feel confident in explaining our rational for not starting direct work with a CYP when there seems to be other helpful ways of approaching the work (e.g. supporting a social worker, working instead with a foster carer or helping support the network etc)
Key theory to hold in mind: Attachment theory- how can we promote in our stance the principles of promoting a 'safe base', consistency, trust, predictability for the CYP (particularly when there may be a large network around them)
Holding attachment theory in mind, it is likely that the CYP may have had adverse experiences of attachment relationships and hence there is a genuine risk of overwhelming the CYP with demands to create too many new attachments
Note: review learning from AFC around effective work in this area and case studies done with looked after children that can be beneficial. See what the evidence tells us.
[[Attachment Theory|Attachment Theory]] see here for re-capp on key features of
!!What do we do when we get a referral for a LAC
*Scotty conducts consultation/ assessment (note we aim to include Scotty and Jyoti in some future training sessions to learn about how they carry out consultations)
**Does Scott speak to the YP who are old enough about what they want from the support?
*Referral accepted
*Allocated to WP
*WP reads record keeping from AS about consultation ( it may be helpful to speak with Scotty in person about what he has found out about the CYP at an early stage)
*Make contact with the network
** explain what we do/how our service works, invite them to help us in understanding the young person's needs, what do they see as the problem:
!!!Key early questions to ask when talking to referrer/members of network:
Whose idea was the referral? what were they hoping for? what does the CYP think about this? does the CYP agree? What has been discussed with the CYP? Do they know about you being involved? What is the CYP understanding of you being involved?
Next steps in the process:
**Do we start with the network or do we start by speaking with Scott? Clarify this - this could be a hindering or time consuming thing, but might feel helpful to get a sense of the network
**then contact SW, referrer then foster carer then YP/child
*Contacting the Social worker
**History, context, what are the main strengths and difficulties, begin by using the [[Dis-integration Grid]] to map different members of the network and their ideas about the problem, the intervention and their ideas about who should do it
*Contacting the carer/foster carer
**what are their concerns, goals, what is their relationship like, what is their family set up and how does the young person slot in, how long has the YP been in their care, do they spend time together or are they in their room, what are the next steps- will they be there for a long time.
*school
** what is their behaviour like at school, peer relationships, relationships with teachers, learning etc.
*YP/Child
**Do you know who i am and why i am calling you? was it a surprise/ did you know? Broadcast who I am what I do...clear about our intentions. What were they told?
**What is their understanding of why they are there,
**What is their reaction to you calling? (their understanding/ experience of helping professionals/ attachment styles)
**Their understanding of their living situation
**Use network mapping ([[PRO-GRAM|The AMBIT Pro-Gram]] - is it more helpful to support the network in an aspect of their work? how does the CYP see their network and who is helpful/has trust from their perspective?
**have conversation with YP about helping relationships and whether they would feel ok with someone coming in for a short time
**What is contact/ relationship like with biological family
**Relationship to help- what is their experience of help in the past - how have they found this, what have they had previously?
!!Can we help?
!!!What are some indicators that short term direct work is possible with LAC?
*If the CYP agrees and can themselves identify something specific/ have a clear (ish) idea of what they want help with - low mood/ exam stress etc.
*If the network are in agreement for the type of support needed
* The CYP can make use of remote work (in lockdown)
*There are not barriers to forming a relationship in a relatively short period
*The CYP has had some positive experiences of helping relationships
!!!What are some indicators that short-term goal focussed direct work may not be helpful/ possible
*when they cant think about what they would like help with in the first few sessions
*When the requests for help come from others and the CYP does not agree, or when there are lots of conflicting views in the network about what is needed and the CYP doesn't agree either
*When we see that it may take a number of sessions to form a relationship with the CYP in order for them to access any support from us
*There are others in the network who already seem to be doing something similar with the CYP to the request for us to do. It may make more sense that another member of the network who has pre-existing trust/relationship is supported to do this work rather than add another worker to a large system
*There are other key issues that need to be prioritised first in order that they are safe and contained e.g. somewhere to live, some stability, safety
''Note: It can feel challenging for WP to change suggest that appropriate support is not provision of 1:1 with child as this may have been agreed during the assessment phase. This can arise when we have agreed to the referral at the initial consultation but further complexity factors arise when we begin work''
!!!How might we manage these situations as a team?
*
*
!!What is the evidence base for supporting LAC
*Foster carers - attachment, attuning
*Attachment styles
*How do consultations happen (with LAC)
How best to input/connect about these?
See here for
[[Ideas for supporting foster carers/members of a network around a LAC|Working with carers of LAC children and trauma]]
Particularly in the context of challenging behaviours that may be related to trauma in a CYP's history
<<list-links "[tag[Working with Peer Difficulties]]">>
''What do we mean by peer difficulties?''
* Not having friends
* Poor social skills or understanding around friendships
* Arguments/fall outs with friends
* Antisocial peer group (worries about gang involvement; older peers; child sexual exploitation; county lines)
* Bullying or being bullied
* Problems on social media, cyberbullying
** Online friends
''Our previous experiences of working with these difficulties:''
* Teaching friendship/social skills
* Exploring “what is a friend?”
* How to respond appropriately in a social situation
* Managing emotions when with peers
* Self-esteem work around bullying
* Keeping safe in relationships – healthy/unhealthy relationships psychoeducation
* Managing conflict in friendships
* Evaluating friendships – increasing interactions with positive peers; decreasing interactions with negative peers
* Working with parents around online safety
* Thinking with parents about supervision and monitoring
''Why might children struggle with their peers?''
* Not fitting in
* Not valuing themselves; low self-esteem which might lead them to seek out acceptance/value from others
* Disruptions to friendships – e.g. moving house; moving schools
* Lack of opportunities to practice making and sustaining friends
* Hard to manage emotions
* Temperamental factors- being more outgoing vs. more shy
* Not being able to read people well – inappropriate responses
* Behaving in ways that other YP might find aversive
* Friendship/social skills not modelled at home
* Individual needs- ADHD; ASD might impact on friendships
* Poor peer relationship at school/performance at school might lead you to seek achievement and connection elsewhere e.g. outside of the home, negative peers
* Not being able to invite friends over- can’t hang out in family home;
* Cultural/family factors – different views in the family about appropriate friendships and what its ok to do
* Lack of appropriate boundaries around friendships – e.g. permissive parenting style
* Push and pull factors
''Exploring peer relationships''
* Exploring peer strengths and needs
** What’s going well with their friendships?
** What are the challenges?
** Parents – who do you know?
* Peer mapping
** Who are their peers?
** Closer relationships; more distant
** What’s good/helpful about each person?
** What do they do together?
** Any challenges in that friendship?
''Bullying''
* Getting a picture of the bullying
** What does it look like?
** How does it start?
** What helps?
** What makes it worse?
* What’s the impact?
** How does it make me feel?
** What kinds of things does it make me think?
** What kinds of things does it make me do?
* What to do
** What have I tried?
** What could I try?
** How do other people help?
** How else could other people help?
!!Introduction
One of the [[Core Features of AMBIT]] is using [[Mentalization]] in face to face work with your clients. In focusing on what goes on between between client and worker, AMBIT is like pretty much any other therapeutic approach (it is AMBIT's emphasis on the //other three quadrants// of the AMBIT Wheel that makes AMBIT a bit different.)
Aside from [[The Therapist's Mentalizing Stance]], it is [[Active Planning]] (the way mentalizing informs our ''planning'' in work so as to allow for sensitive //adaptation// without a loss of //purposeful direction//) that most centrally captures this, but there are a wide range of other aspects of face to face working that are also gathered under this heading, as sub-topics.
!!Aspects of Working with your Client
The main subtopics to Working with your Client are listed below, click on the tags to see a drop down list of the pages under each sub-topic.
*<<tag [[Active Planning]]>> - AMBIT's [[Mentalization]]-based approach to co-producing rationally-sequenced & effective action plans
*<<tag [[Relationship to help]]>> - How different clients respond differently to offers of help, and how to adapt the offer
----
*<<tag [[Phases of AMBIT work]]>> - Orienting yourself to what should be happening, and when
*<<tag [[Manage CLIENT RELATIONSHIP]]>> - Making sense of and managing the therapeutic relationship between worker & client.
*<<tag [[Managing Risk]]>> - Managing risk in general (& its pitfalls) and in relation to specific situations
*<<tag [[Manage CLINICAL PROBLEM]]>> - Lists specific situations in direct face-to-face work (problems, scenarios, etc; not necessarily "clinical" in the technical sense) with suggested responses
*<<tag [[I'm stuck: what next?]]>> - Other material, useful if your efforts to keep the work moving have stalled.
-----
*<<tag [[Interventions (by target group)]]>> - Lists range of "manualized" interventions that might help, organised by the domain you want to work in (individual, family, etc)
*<<tag [[Specific interventions]]>> - Lists links to specific guides ("how to do it" manuals) on a range of simple evidence-based interventions
*<<tag [[Monitoring Outcomes]]>> - Links to activities and resources directed at assessing whether the work of the team is effective.
!!Introduction
Here we address working with the common problems that arise in working with the professional networks that gather around a young person and their family - particularly if you are keeping to one of [[Core Features of AMBIT]] which is to ensure that you are [[Addressing Dis-integration]].
!!Aspects of Working with your Networks
The yellow (& green) tags below provide you with the key themes which fall under working with your networks. Click on the tags to see a drop down list of the pages under each topic.
*<<tag [[Working with your NETWORKS]]>>Key topics, and local additions to how we work with large complex networks of professionals, families, and social contacts
*<<tag [[Addressing Dis-integration]]>> - The central theme of AMBIT practice with networks
*<<tag [[Working with other professionals]]>> - A collection of activities and advice for working effectively across agencies
*<<tag [[Taking Responsibility for integration]]>> - The AMBIT stance element that underpins this work
*<<tag [[Working with the Social Ecology]]>> - Addresses work with the INFORMAL networks around a young person
!!Reframing expectations - a core feature
In AMBIT we try not to be //surprised// or //disappointed// by ''Dis-integration'' in practice across complicated networks; instead, we ''//expect it//''!
Indeed, working with these //imperfect associations, affiliations and collaborations// (which requires consistent effort by workers in [[Addressing Dis-integration]]) is one of the [[Core Features of AMBIT]].
This answers the AMBIT stance element that promotes [[Taking Responsibility for Integration]].
!!Note on definition
Although the Family is often the most important part of a young person's network, we locate many of the face to face working issues to do with the family under manage Clinical problems - this is because the '~Family-As-A-Whole' can in many respects be seen as the client, rather than just the young person (and the "family" is however the young person defines this, which may refer to carers who are not strictly family members).
!!Introduction
Working with your TEAM is one of the [[Core Features of AMBIT]], both as a core practice, and as stance principle [[Keyworker well-connected to wider team]]. This page provides you with a brief introduction and links to ideas about AMBIT-Team working, and how you can use these in your local team.
!!Team working in AMBIT - the "well-connected team"
AMBIT is a method of working that involves the team as a whole - and in particular how we try to use [[Mentalization]] to structure and support team working, and in particular to help the team support the individual KeyWorker.
Indeed, in earlier versions of AMBIT the [[Supervisory Structures]] in teams were given as the "[[core feature|Core Features of AMBIT]]" of AMBIT, rather than //"Working with your team"// in more general terms.
AMBIT promotes the development of principles and specific practices that support team practice that are underpinned by the use of [[Mentalization]]. These principles and practices (the [[Core Features of AMBIT]]) can be adapted for a wide range of different service structures. AMBIT does not specify the managerial or organisational arrangements for teams which use this approach.
The AMBIT approach aims to enable local expertise to work more effectively by explicitly finding ways to:
* Support practitioners to remain [[well connected|Keyworker well-connected to wider team]] to other team members
* Support practitioners to take responsibility for stimulating and sustaining //each others'// [[Mentalization]]
This particularly happens through a key process which we call [[Thinking Together]].
!!Video on AMBIT and Team Working
By Liz Cracknell, one of the senior AMBIT Trainers - here she is addressing a Training for AMBIT Local Facilitators:
<html><iframe width="640" height="360" src="https://www.youtube.com/embed/0e_kGvCtOEw" frameborder="0" allowfullscreen></iframe></html>
!! Aspects of Working with your Team
The tags below (yellow pill shapes) provide you with the key themes within working with your team. Click on the tags to see a drop down list of the pages under each topic.
!!<<tag AMBIT-Teamworking>>
*Material specific to AMBIT's approach to team working
!!<<tag [[SUSTAIN best practice]]>>
*Supporting teams to work in sustainable ways (beyond mere heroism) is a primary aim
!!<<tag SupervisoryStructures>>
*Includes boundaries & local rituals/disciplines such as [[Thinking Together]]
!!<<tag [[Rituals and Disciplines]]>>
* Local rituals and disciplines that define a team culture are what AMBIT training helps teams start to choose
!!<<tag [[Problems in teams]]>>
*Problems occur in every team & are opportunities to learn
!!<<tag [[Boundaries]]>>
*Clear, well-marked boundaries help reduce risks and problems in teams
---
!!<<tag [[AMBIT training]]>>
*Training in AMBIT is exclusively team-based for good reasons
!!<<tag [[Core Features of AMBIT]]>>
*This covers all parts of the AMBIT Wheel
!!<<tag [[Roles and Responsibilities in an AMBIT team]]>>
*Clarifying roles and responsibilities is a critical (and recurring) conversation
!!<<tag [[Developing learning organisations]]>>
*AMBIT is about explicitly attending to developing a team culture
!!<<tag [[OUR Team]]
*Developing [[OUR Team]] rather than //"making our team into an AMBIT team"// is the point!
!!<<tag [[Monitoring OUTCOMES]]>>
*Monitoring outcomes (and //evaluating// these) indicates learning from your experts by experience.
----
!!Diversity, with common core features
Another of the [[Core Features of AMBIT]], is to start with the assumption of respect for local expertise ([[Respect Local Practice and Expertise]]) both in the team, in wider networks, and in the [[KeyWorker]]. Thus, developing your LOCAL Team working is key!
As part of the development of a local team culture, local teams should record their own expertise and protocols in their local version of the manual.
BOOK for carers and workers: [[Attachment in Common Sense and Doodles|https://www.amazon.co.uk/Attachment-Common-Sense-Doodles-Practical/dp/1849053146]] Miriam Silver
!!Ideas for supporting foster carers/members of a network around a LAC
We talked about some of the dilemmas faced by foster carers within this field and in particular situations where they may see/experience behaviours from a Child/young person that are hard to make sense of, distressing or at times overwhelming. Sometimes these behaviours can feel as if they 'come out of the blue' or are 'incongruent' with a given situation.
*An overall aim of work with foster carers is to help support them to find ways to re-generate mentalizing (of the CYP and of themselves) when it is inevitably lost in situations where there is high emotion or confusing/distressing behaviours.
*Carers will need to have close relationships to the CYP they look after in order to support them well, but this will mean they are likely to be 'in the middle of the pond' with them at challenging times too
*Helping a foster carer hold on to or regain mentalizing is likely to allow more attuned responses to the CYP, more thoughtful and reflective ways of responding and will likely decrease the chances of responding in ways that might escalate the behaviours or develop further challenges in relationships
*It is also more likely to allow space for the carer to help the CYP to learn to regulate their emotional state- a key developmental challenge particularly for many LAC- i.e. if the CYP can experience //being// mentalized by the carer
!!Time Holes
This is a tool/ idea which relates to the above challenges and is grounded in trauma theory
Some key relevant points from trauma theory
!!!Memory storage and Trauma
*Non-traumatic memories are stored in a autobiographical way so they are stored with a sense of time and place/context. They can be expressed verbally or are 'verbally accessible'
*Traumatic memories or memories that are stored when you feel in danger/ threat (this can be to your sense of self) are often stored in a non verbal way, without sequence, time or narrative meaning they are often held as feelings in the body or visual/ sensory ways e.g. images/sensations
*Children and young people will be much less likely to have a verbal narrative about events because of the way that the memory has been stored in the brain
*These kind of memories are called 'situationally accessible memories' as they are unstable and easily triggered, often without warning but in situations that might somehow relate to the memory
*This might look like a young person reacting strongly with a fear/threat/fight/flight/freeze response to something which seems hard to understand or recognise
!!!Dissociation
*shutting off/ distancing from the real world
*may happen if the danger continues over a long time
*may look calm or not really there/cut off
*An adaptive response to prolonged threat
*a way of psychologically distancing from the distress
*Can have very severe psychological consequences if prolonger re self of self, emotion regulation, capacity to mentalize
*Dissociation is associated with developmental trauma or 'relational trauma' where source of trauma may be in a key relationship/attachment figure
*Stress Physiology and hence responses to stress may change/ adapt when exposed to the danger/ threat for a long time.
Goal of using the Time hole work (see above book by Miriam Silver for further explanation)
*Explaining in simple ways the potential link between past trauma and current behaviour- linking this to the nature of sensory/image based memories in trauma, ways in which the body may still be 'moving quickly into fight/flight/freeze in relation to sensory/image based memories which are unstable...'pop' back in relation to triggers
Can we (the foster carer and worker) piece together what the triggers might be that lead a CYP to fall back down their 'time hole'? what do we know about their history...exploring the current challenging situations in detail..(as you might in a good behavioural analysis) see here for more on this [[Behaviour problems|Working with Behaviour Problems]]
*Helping the foster carer consider what they might do/adapt/test out with some new ideas about a 'time hole' if they have been able to identify one...
*How might they talk to the CYP about what they have noticed ? is this possible appropriate? (it may not be at this stage)
*Are more sensory/physiological/somatosensory ways to help sooth/calm more appropriate? e.g. if trauma was at very early developmental stage? Trying to do 'talking work' may not be helpful now if trauma happened at pre-verbal stage
Discovering the triggers that lead us down the 'time hole' by getting curious about what these triggers might be and how the child may react.
<<list-links "[tag[Working with co-morbidity]]">>
It can be hard to know where best to focus when there are several different problems that a young person is facing
Some YP might be struggling with lots of different emotions (e.g. anger, anxiety, sadness etc). How do we prioritise between those?
*Could ask the YP which they might want to focus on. Would they prioritise one of these?
* Could do some general work on emotion regulation and work out which skills/approaches might be relevant that might help with all of these
<<list-links "[tag[Working with low mood]]">>
!How to do behavioural activation when CYP have to stay at home more?
Some of the activities that CYP might have been able to do as part of BA might now feel more limited
*Want to schedule activities that bring a sense of ''Achievement, Connection and Enjoyment''
These will look different for all YP but some examples might include
''Achievement'': getting up/out of bed by a certain time; doing some school work; making bed; cleaning/tidying room; showering; getting dressed; brushing teeth; reading a chapter; cooking a meal; doing a workout/hobby
''Enjoyment'': watching favourite show/film; walk; cycle; looking after a pet; something that's relaxing (e.g. having a bath); face mask; playing an instrument; listening to music; reading; doing your hobby; drawing; watching a video of someone doing your hobby!; how to adapt your hobby for doing it at home!
''Connection:'' doing something with parent; doing something with a sibling; playing computer games online/in person with family members; chatting to friends; going on social media; Houseparty app; watch a movie on Netflix party;
These might be things that are built up gradually (trying it once, then scheduling it more regularly)
Could look through the self-care tiles (put link)
They could ask others for ideas if they are struggling to come up with things themselves
Could also think with YP about how to generally try to maintain their routine and structure, which might help them to look after themselves.
! How can do the values activity remotely
* You could show the values cards over the screen
* They could google "values" and work out what for homework what some of their values are and make a poster/drawing/list to represent these
* Could use the letters of their name to pick values that they think they have e.g. "C for caring; H for helpful; A for achieving; D for dynamic". Then explore how they are living those values at the moment - what activities they could do that relate to those
* They could ask their family members to name some values they think they have to get some ideas or about their positive qualities and repeat same question of how this links to activities that they could do
* What do they value in a friend? Which of those qualities do they have? What activities could they do at the moment that relate to those?
! How to help keep motivation/positivity up when not in the room with a YP who might be low/not talkative
* Could name this and check in with the young person - is it relevant/helpful?
* How could we do it in a way that feels the most interesting
* Could you use more writing/drawing to show them rather than just talking
*Asking the YP if its easier for you to offer more options/asked more closed questions that they can just say yes or no to, rather than open questions which might be a bit harder to think about
*Sending resources in advance so that they can look through and tell you what they think during the session (E.g. a list of activities - which would they want to try etc)
*Encouraging them to keep a diary/list of things they might want to talk about between sessions
! How the restrictions might be making low mood worse
! Keeping up motivation to do 'homework' tasks
*Not calling it homework! Find a name that might be more acceptable to them e.g. something for you to do before we next meet an idea to try out; things to try; actions etc;
* Remembering to explain the purpose of it, how it could help, do they think its realistic - make it SMART
* Remember to check in on it
*If can't do a full diary (for example) what could be a smaller way of doing it - a drawing ,a picture, a note on their phone
*Send a reminder/summary text - thanks for talking to me today; look forward to hearing about how you get on with your diary entry etc. I'll have a think about.....before next time too.
*Make it reciprocal - what is your homework going to be? Can they set you a task? Is there something you can offer to do?
! Harder to pick up on cues of the YP who is low in mood when on the phone if they are not very talkative
For all pages about this topic please see the tag
<<list-links "[tag[Working with parents]]">>
''What have we each done when working with parents?''
* Worked with parents in an inpatient unit, updating them on what was going on with their child.
* ASD assessments, screening for neurodevelopmental disorders.
* Eating disorder service: family therapy and supporting and guiding parents in helping their children recover from eating disorders.
*In hospital- atopic dermatitis- moderate the dysfunctional caregiver-child relationship through mentalizing in a group with other psychologists and professionals- encouraging parents to reflect on their childhood. often resulted in intergroup relationship building
*observed multi-familygroup with adult children and their parents
*learning mentor- liaised with parents on development, behaviour, engagement with school, independence of child - at home strategies
*TA discussed strategies and progress of child
* Mother-infant observation for 18 months
* Worked as support worker - liasing with parent's about their child's care and new behavioural problems/ health concerns during day - used communication books for non-verbal children
* Dissertation - interviewing parents of non-verbal children with ASD. Supported by linking parents with other services
* TA - similar liasing with parent's about needs of child and development
* Support worker in home with parent, yp and sister - liased about child's development and what I could offer to support
''What works well when working with parents? What are important things to hold in mind?''
*acknowledging the difficulties of being a parent, validate struggles and feelings, normalise, positivity around that they are help seeking, non-blaming approach.
*Giving them control, allowing them to choose what areas to work on
*Instilling hope – important to motivate parents to see small changes and keep goals in mind
*Language; normalising, non-blaming, not patronising
*Remembering parents are an expert in their own child
*Trying to show them you’re on their side
''What dilemmas have come up and how have we addressed these previously?''
*mother who wanted a diagnosis of schizophrenia as behaviour of child was 'difficult'- exploring family history in a sensitive way, uncovered the child's lack of autonomy was coming from mothers need to protect and 'do things for him'
*child having anxious attachment concerns- talking through parents experiences and own concerns from childhood and how this was being repeated with their own children. practitioner also explored with child how they felt about their parents- uncovered the parents separation was causing the child to feel detached from one of the parents.
*Stigma around diagnoses; parents seeking an answer/ cure to symptoms rather than understanding and exploring the function of these behaviours/ symptoms
**ADDRESSED by psychoeducation, parent training workshops
*Being set in their ways and seeing problem as child’s as opposed to need for family change
**ADDRESSED by explaining/ psychoeducation and keeping a realistic view of what can be changed within the family and work with that
*Feeling judged – parents feeling in a position of blame for their child struggling and not wanting to accept conversations around difficult issues
**ADDRESSED through being transparent, presenting in a non-blaming way, normalising and acknowledging that everyone has/ is doing the best they can – emphasising that it isn’t about blame but ultimately helping the child
*Limited contact; restricted by wants of the child/ adolescent
*Parents focussing on negatives rather than positives –struggling to see the small changes their child is making
**ADDRESSED by recording small changes, demonstrating small progress through memories and reinforcing positive things. Explaining that the task ahead might be quite big and not simple but small steps is the only way – being realistic and open about expectations from the beginning
''What specific barriers could we imagine coming up when working with parents in this work?''
*Parent expectations
*Other children
*Previous experience with services
*Child and parent being on different pages
*Parental tension; different parenting styles
*Complex families
*Different cultures
*Stigma around mental health/ wellbeing
*seeking external reasons for the child's distress and the problems they face (diagnosis's for conditions) instead of mentalizing the reason for the behaviour
*reluctance to take some responsibility
*taking too much responsibility and feel high level of guilt, don't feel empowered to make change
*negative labels of child being 'difficult'- barrier to understanding why the behaviour is occurring. Self fulfilling prophecy
*non-collaborative- that it is the child's issues and they need to change
* they cant see the benefit/ link of what the change could do
*feel stuck in ways doing things
*change may cause things to get worse/ not going to make things better- whats the point?
*unaware of their impact on the child.
*Disbelieving/ distrust of therapeutic intervention - perhaps due to previous experiences/ cultural reasons/ expectations
! What do we want to cover?
* How to apply some of the strategies we have already learned to parent sessions (e.g. the brain house)
*How do we approach supporting parents to talk to children about their feelings?
*How to introduce some of the things that parents could try in a way that doesn't lead to them feeling blamed
* Thinking with parents about how to regulate their own emotions when they are trying to support a child who is emotionally dysregulated
*Addressing barriers that come up when supporting parents to mentalize the child's perspective
!Exploring feelings with parents and children
* What feelings do children know? Which ones come to visit them (at home, at school, with friends etc)?
* Using feelings cards – which one is this? How do people show this? What does someone look like when they feel this? What kinds of things might make someone feel this? Can you think of a time when you felt like this? Someone you know felt like this?
* Feelings charades – acting out what the feelings look like and having to guess
* Using scenarios – give a picture/scenario and asking what the people involved might be feeling and why. Again using questions to link back to their experiences (have you felt like this?)
* Feelings backpack – which ones do they carry around, which ones weigh them down?
* How we manage different feelings:
* Understanding what might trigger them – what kinds of things make you feel x?
* What helps – what do you do, what do other people do that helps when you’re feeling x?
* Ideas of what might help – which have they tried, could they try, which have/haven’t previously helped
* Using hot cross bun to explore the experience of a feeling in detail, in terms of accompanying thoughts, behaviours and body sessions
* Metaphors like anger thermometer, volcano, racing car etc to explore the experience of the onset of the feeling – gradual, sudden, how can we spot the signs its coming and what could we do at different points before it boils over, gets too hot etc etc.
* Acting out strories/scenarios with the Lego people or toys to help explore situations, feelings, perspectives, behavior and different endings – how people could have helped each other to make a different ending
* When you’re like this, let’s pretend this one is your parent/carer, what can they do to help you? What doesn’t help etc
<<list-links "[tag[Working with schools]]">>
<<list-links "[tag[Working with sleep difficulties]]">>
!Topics to cover
*What might sleep difficulties look like?
*Exploring sleep routine
*Relationship between sleep and mood - how anxiety and depression can affect sleep
*Sleep hygiene ideas
*Addressing low motivation to address sleep difficulties
*Reaching agreement between parents and YP about sleep routine
__What might sleep difficulties look like?__
* Staying up late
*Waking up late
*Reversed sleep pattern (i.e. awake at night, asleep in the day)
*Disturbed sleep - waking up a lot; poor quality of sleep
*Nightmares
*Difficulties getting to sleep
*Difficulties waking up
__Questions to ask to explore current sleep routine__
*What time do you get up?
*What time do you go to bed?
*How do you get yourself ready for bed?
*What do you do before you go to bed?
*What's your screen time like in the evenings?
*What are you doing during the day (particularly at the moment during lockdown?)
*Where are they spending time during the day (e.g. on/in their bed all day?)
*What's their physical activity daily?
*What's the room like in the day/night? (e.g. open/closing curtains, making the bed etc)
*What do you do when you wake up? (get up straight away, make your bed, do you use an alarm?)
*What's everyone else in your house's sleep routine look like?
*Are you tired during the day? Do you nap?
*Tell me about when you are trying to fall asleep - what's it like? Are there lots of things you are thinking about? Is it hard to switch your mind off?
*Are you sleeping all the way through or waking up a lot?
*What do you eat/drink/snack on during the evening? (sugary things, caffeine, big meals late at night).
*Do you use any drugs (e.g. smoking, substances, alcohol?) - when?
*Noise - from outside/inside the house
*Do you share a room? Who do you share with? How does this affect your sleep?
*What are your friends' sleep habits like? Do you stay up late chatting to your friends? Either messaging or in a phone/video call.
__Exploring what YP know/feel about sleep and sleep hygiene__
//Exploring motivation//
*Do you feel that your sleep or any aspect of your routine is a problem?
* Are you able to get things done that you want to during the day? Are you able to concentrate (i.e. at school etc)? Is it interfering with other things that you do?
*Would you like to be able to sleep earlier, get more sleep, wake up earlier or make any other changes to your sleep pattern?
*What do other people think about your sleep pattern?
*What would be different if you could get more sleep?
* Using [[scaling questions|Scaling questions]] to explore importance, confidence ratings
*What does a really good night's sleep look like?
*What's does a bad night's sleep look like?
*In an ideal world, what would you like your sleep to look like?
//Exploring existing knowledge//
*Why do we need sleep?
*What do you know already about what helps and what doesn't help with sleep?
*What do you know already about tips for a good night's sleep?
*What do you know about the effects of e.g. having caffeine/sugar before bed?
*What do you know about how sleep and mood affect each other?
*How important do you think sleep is?
*Do you know what kinds of things happen to people when they don't get enough sleep?
*Do you know that sleeps well/struggles with sleep? What does that look like?
*What do you know about how many hours of sleep you (i.e. CYP your age) need?
*What do you know about why sleep is important for (their age)?
__Psycho-education about sleep specific to age__
We could make a psycho-education sheet about sleep. Could include some of the below, plus anything else that might specifically motivate a young person (e.g. being better at a particular hobby for example, or linking it to another goal that's important)
*Supports your brain development and do its maintenance (e.g. consolidating memories etc)
*To get rest!
*Our body needs a time to regenerate and repair
*Effects of sleep deprivation - negative
*Need sleep to help us make decisions, take in new information, be able to concentrate
*Different sleep stages (e.g. REM, non-REM) - they have different jobs etc.
*To have enough energy to do things during the day (school, things we enjoy)
*Helps to regulate other important functions - appetite, hormones, mood etc.
*Reasons why different age groups need different amounts of sleep - evolutionary perspective - needed different people to be awake at different times of the day!! Older people waking earlier, teenagers on a later shift! Anthropological theory.
*Sleeping tablets - some people might raise this.
__Supporting parents and teenagers to reach shared agreement about the sleep routine__
It can be difficult to [[reach shared agreement|Reaching shared agreement between parents and young people]] on things like this! This framework could be used to approach any kind of point of disagreement (doesn't have to just be about sleep!). There can be a lot of strong feelings about, which might be making it difficult to think, but also people may not have very clear ideas in their head about what they think/what they want, so having some time to work this through could also be helpful. Generally, if its hard to reach agreement, having a separate space where each person has an opportunity to work through their thoughts about what they might want and talk through any strong feelings, can be helpful before bringing people together, where what might happen is that the differences and feelings play out in the session in a way that makes collaborative thinking much harder!
This is a ''mentalizing'' way of approaching the situation - giving each person the best chance to be in their thinking brain, by supporting them in whatever way is required to achieve this (e.g. chance to have their feelings validated, their perspective acknowledged, or help to work out what they think/feel if they haven't already done any thinking or are finding it overwhelming to work it out on their own, or need some more motivational work to increase their interest in thinking about the topic).
Rather than having a joint conversation first off, could have a separate conversation with each person (i.e. parent, carer and YP)
Following an active planning stance, it's helpful for workers to broadcast their intentions about why they might be approaching the conversation like this - i.e. "The bedtime/sleep routine is important to you both, but you're got quite different ideas at the moment about what it should looks like. I know that agreeing on this has been hard, so I want to try to help you find something you can both agree on, but its probably going to involve a compromise! I'm happy to think with you both to see if we can work this out - we can do it separately to start with, so you've each got a chance to tell me what you think and what your ideas are, then we can bring those together and see where you agree, where you disagree and work out what hte middle ground is".
Some questions might include:
*Asking each person what they feel their ideal would look like, in terms of the sleep/bedtime routine?
*What would it best look like if they could design it?
*How close is that to what is happening at the moment?
*If its not close to what's happening at the moment, what would be realistic?
*Where would they be prepared to move to? What would their compromise be? (supposing the other person had a different view)
*What do they think the other person (their child/ their parent) would think about their ideas?
Can ask parent/carer to write down their ideas/routine/rules around sleep and then ask them to give each part a priority rating (low, medium, high) and a realism/achievability rating. This can help them to refine their expectations in line with what is achievable and developmentally appropriate.
Similarly, could show the parent/carers' ideas with the young person and ask them to rate them according to things they already do/could do/would be prepared to do (green), things that are a bit ok/achievable and things in red that they think are unreasonable and would be too hard. Acknowledge that can't get rid of rules/expectations all together as they are important to life (given examples).
Increasing motivation/compliance with the proposed routine
*Explore what the pros and cons would be of trying it
*Seeing if they would be willing to experiment with trying it and let you know how it was - were there any pros and cons
* Would complying with it help in other ways (to get parents off their back; reduce arguments etc!)
* Following the parents' expectation might be worthwhile - e.g. if you show you can go to bed at this time, maybe they will let you stay up a bit later.
*Explore with parents how they will positively reinforce compliance with routine
**praise, positive feedback, encouragement
**reward system (e.g. earning something they don't already get; linking something they do already get to this new behaviour of following sleep routine)
! Why are we writing this page?
We want to capture some of the ideas that we have about how we are involving parents in our work, particularly during this time of remote working
! How can we think with parents about why it might be helpful for them to be involved?
*
! How can we think with CYP about why it might be useful for their parents to be involved in the work?
We want to try to find a way of keeping parents' in the loop about the work. They often have an important role.
* Explaining why its useful to you to be able to check in with them, in a way that the YP might be able to connect with
* Can be useful to share with parents about what you and the young person about what you are learning together, so that they understand them better/feel more understood or less misunderstood
* Can be useful to think with the YP about how the parent could help with any of the strategies
*Are their bits of the work that they thnk it would be useful for the parents to know about?
!Reflection Time
We came up with the idea of ''Reflection Time'' that some families could try- a time to sit down and talk together as a family to talk about how the day has been.
__Why might this be helpful?__
* To help build/strengthen the relationship between parents and children
* To have a way to check in emotionally with children about how they are feeling
*Could be an activity that can fill some structured time! Could send a well-being resource for the family to look through together (e.g. The Brain House)
! Sharing wellbeing resources with parents
Could send worksheets/booklets to families and then the worker could go through the sheets virtually with them so that they have an understanding of them and a way of talking about it with their CYP. (15 min sessions)
!Sharing a summary of the session with parent/carer
*Suggesting to the YP "(What shall we)Shall we share with your Mum/Dad what we have been doing today and what you're going to try this week?"
* Could include praise/positive feedback about how the CYP has managed the session
*Check with the YP about if they want to give the feedback, if they want you to do it, if they want to do it together
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IN NO EVENT SHALL THE COPYRIGHT HOLDER OR CONTRIBUTORS BE LIABLE\nFOR ANY DIRECT, INDIRECT, INCIDENTAL, SPECIAL, EXEMPLARY, OR CONSEQUENTIAL\nDAMAGES (INCLUDING, BUT NOT LIMITED TO, PROCUREMENT OF SUBSTITUTE GOODS OR\nSERVICES; LOSS OF USE, DATA, OR PROFITS; OR BUSINESS INTERRUPTION) HOWEVER\nCAUSED AND ON ANY THEORY OF LIABILITY, WHETHER IN CONTRACT, STRICT LIABILITY,\nOR TORT (INCLUDING NEGLIGENCE OR OTHERWISE) ARISING IN ANY WAY OUT OF THE USE\nOF THIS SOFTWARE, EVEN IF ADVISED OF THE POSSIBILITY OF SUCH DAMAGE."},"$:/core/icon":{"title":"$:/core/icon","tags":"$:/tags/Image","text":"\\parameters (size:\"22pt\")\n<svg width=<<size>> height=<<size>> viewBox=\"0 0 128 128\"><path d=\"M64 0l54.56 32v64L64 128 9.44 96V32L64 0zm21.127 95.408c-3.578-.103-5.15-.094-6.974-3.152l-1.42.042c-1.653-.075-.964-.04-2.067-.097-1.844-.07-1.548-1.86-1.873-2.8-.52-3.202.687-6.43.65-9.632-.014-1.14-1.593-5.17-2.157-6.61-1.768.34-3.546.406-5.34.497-4.134-.01-8.24-.527-12.317-1.183-.8 3.35-3.16 8.036-1.21 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