school nursing cpd ·...

School Nursing CPD

Donna Mason – Principal Educator, CAMHS Maria Dale - Principal Educator, CAMHS

NHS Education for Scotland

• Brain development and adolescent development

• Measures – SDQ and YP-CORE

• Mental Health and Wellbeing

• ACEs and trauma, self harm, risk and resilience

• Case Conceptualisation

• Signposting

Plan for the Day

School Nursing CPD

Brain Development and Adolescent Development


• Harvard University Centre on the Developing Child – Brain Architecture

https://www.youtube.com/watch?v=VNNsN9IJkws

Brain Architecture




• Pre-frontal cortex described as the ‘social brain’

• Between 6 and 12 months there is a burst of synaptic connections being made

• Experiences as an infant create neural pathways – “What gets fired gets wired”

• Connections over time create functions

• Connections that are not used are “pruned” – Use it or loose it

Baby Brain Development (2)


• The way the adult responds can help develop pathways in the brain resulting in new skills

• Pre-frontal cortex development and connections to other areas in the brain is key to acquiring Executive Functioning skills

• Serve and Return interactions with caregivers are vital in developing these skills including emotion regulation

Serve and Return


https://www.youtube.com/watch?v=apzXGEbZht0

Still Face Experiment






• Prolonged periods of stress can have a detrimental impact on development and well-being of the child and on the way the brain is wired

• Sensitive periods in brain development, over production of cortisol in first 3 years impact brain architecture

• Not impossible to rectify at later stage but more difficult

Toxic Stress


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

Toxic Stress




• Managing attention and focusing

• Initiating and stopping actions

• Inhibiting first reactions - - putting the brakes on emotional and physical responses / Delaying short-term reward in favour of long-term goal

• Following rules

Executive Functioning and Self Regulation involves….


• Regulating emotions

• Understanding and considering the emotional needs of other people

• Planning and working towards a goal, prioritising

tasks, organising future behaviour

• Thinking flexibly & creatively – changing responses as the situation changes and reacting to unfolding events

Executive Functioning and Self Regulation involves….(2)


Executive Functioning Skills


• Examples of activities with children and young people that can enhance Executive Functioning skills can be found on the Centre on the Developing Child at Harvard University website

https://developingchild.harvard.edu/resources/activities-guide-enhancing-and-practicing-executive-function-skills-with-children-from-infancy-to-adolescence/

Enhancing and Practicing Executive Function Skills






























• Brain continues to make and prune connections through childhood

• Building on foundations laid down in the early years

Child Brain Development


• Adolescence from about 11 years old until early 20s

• Adolescence is a period of significant changes physically, cognitively, socially and emotionally

• Period of enormous potential, more adaptable to change and open to ideas

• Adolescence is the transition from childhood to adulthood

Adolescent Development


Physical / Biological development

• Puberty and growth, brain development

Social / Emotional development

• Developing autonomy, changing relationships with family and peers

Cognitive / Psychological development

• Abstract thinking, identity development, morality.

Developmental considerations of three main categories:


• Adolescence is the 2nd most prolific period of brain development

• Development is in regions of the brain that are key to regulation of behaviour and emotion and to the perception and evaluation of risk

• Most changes are in myelination and synaptic pruning in the pre-frontal cortex

• Resulting in improvements in aspects of executive functioning

• Just as in the early years adolescent’s experiences and environment influence how the brain is wired up



• Adolescents use the emotional part of their brain (the amygdala) to problem solve much more than adults do

• Changes in the chemical neurotransmitter dopamine may result in need for higher levels of uncertainty to stimulate dopamine

• Development of pre-frontal cortex and executive functioning (impulse control) still developing



• What risk taking behaviours do you associate with adolescence?

Risk Taking Behaviour


• Adolescents are likely to engage in risk taking behaviours

– Using drugs, binge drinking, smoking, causal/unprotected sex, engage in violent and criminal behaviour, drive dangerously and have more car accidents

(Steinberg, 2004)



• Adolescents have been found to be just as competent as adults at estimating risk and logical thinking

• Developing brain and chemical changes in the brain may explain why they engage in risky behaviours

• May also be influences by social / emotional factors



• Facial recognition study (Yurgelun-Todd, 2006) • 100% of adults identified fear correctly • The area of the brain activated was the pre-frontal

region (used for thinking, reasoning, organising, planning and goal directed behaviour)

• Adolescents identified fear correctly 50% of the time

• Less activation in pre-frontal area and more in amygdala (emotional/gut reaction part of the brain)

• May explain some ‘gut-reaction’ responses in adolescents

• Adolescents may misperceive feelings of others

Emotion Recognition


• Changes in sleep cycles occur in adolescence and are linked to puberty and changes in hormones

• The sleep hormone Melatonin is released around 1am in adolescents compared to 10pm in adults

• Adolescents need about 9 hours sleep per night

Changes in Sleep


• Many adolescents are not getting sufficient sleep due to these changes in biology as well a: – environmental influences – lifestyle/social factors – jobs / extra curricular activities

• Insufficient sleep can lead to a number of vulnerabilities

– Impairment in: mood, behavioural control, attention, memory and executive functioning

– Can impact negatively on: academic performance, school absences, motivation to learn

• Studies into delayed school start times have found an increase in %

of pupils getting 8 hours or more sleep a night as well as a number of other benefits

Insufficient Sleep


• In groups of 8-10 create a developmental wall • Write down what the needs of a normally developing child

are at each age range; – 0 - 1 year – 1 – 3 years – 3 – 5 years – 5 – 9 years – 9 – 13 years – 13 – 18 years

• Write each need down on a post-it note (brick) and place against the age range to create your wall

• Some needs will continue to be relevant in each age range, these only need to be recorded once so that the wall is highlighting the changing needs of the child as they develop

Developmental Wall Task (1)


• Once you have finished your wall think about the events Billy experienced and whether the needs you have highlighted may have been met, not met, partially met or met in an inappropriate way

• If needs:

– Not met – remove post-it

– Partially met – rip in half

– Met in an inappropriate way – turn upside down



In his first 6 months Billy’s mother experienced Post natal depression, this continued into Billy’s early years. During this period there was also domestic violence in the home. Billy’s mother felt isolated from family and friends, receiving little support. When Billy was 4 years old his parents separated and he and his mother were made homeless. In his pre-school years Billy and his mother moved home a number of times and Billy had to change nurseries often. Billy’s mother continued to experience low mood into Billy’s primary school years. When Billy went to Primary School he struggled to regulate his emotions and as a result could lose his temper and get excluded from school. He struggled to develop relationships and was often in conflict with his peers. Despite his parent’s earlier separation Billy’s father was known to periodically be present in the family home. When Billy was 10 years old his mother developed a chronic illness and Billy often took on a caring role for her. Around this time his maternal grandad died and his mother’s mental health was significantly affected by this loss. Billy found the transition to Secondary School difficult and he would often not attend. His appearance at this time deteriorated and he became more isolated from his peers.



Developmental Wall

Measures

SDQ and YP-CORE

School Nursing CPD


• Brief behavioural screening tool for children aged 2-17

– P2 -4 year olds, completed by parent/carer

– T2-4 year olds, completed by educator

– P4-17 year olds, completed by parent/carer

– T4-17 years old, completed by teacher

– S11-17 years old, completed by young person

• Follow-up questionnaires available for all

Strengths and Difficulties Questionnaire (SDQ)


• 25 item questionnaire regarding child's attributes, including strengths and difficulties

• 25 items dived into 5 scales – Emotional symptoms – Conduct problems – Hyperactivity / inattention – Peer relationship problems

– Prosocial behaviour

• Total score and score in 5 scales • Scored by hand using scoring tool

Strengths and Difficulties Questionnaire (SDQ)

Added together to

generate total

difficulties score


• Scoring Parent 4 – 17

Scale Normal Borderline Abnormal

Total Difficulties 0 - 13 14 -16 17 - 40

Emotional Symptoms

0 – 3 4 5 - 10

Conduct Problems

0 - 2 3 4 - 10

Hyperactivity 0 -5 6 7 - 10

Peer Problems 0 – 2 3 4 - 10

Prosocial Behaviour

10 - 6 5 4 - 0


SDQ Website

• Questionnaires

• Scoring Instructions / Template

• Record Sheet

www.sdqinfo.org

http://www.sdqinfo.org/


• Self report measure of psychological distress for young people 11 – 16 years old

• Can be used as an initial screening tool and outcome measure

• 10 items • One flag item regarding self harm which should trigger

more discussion and/or further assessment if scored over 0

• Scored on 5 point scale 0 – 4 • Total score calculated by adding response values of all 10

items • Total clinical Score calculated by dividing the total score

by the number of completed item responses and multiplying by 10

Young Person - Clinical Outcomes in Routine Evaluation (YP CORE)

Mental Health and Wellbeing

NES Psychology

School Nursing CPD


Session plan

• Anxiety in children and young people • Low mood and depression • Neurodevelopmental disorders • ACES and thinking about trauma • Self harm

• risk factors and assessment • Case vignette exercise


GIRFEC & the National Practice Model

• Appropriate, proportionate and timely planning Single planning process Single child’s plan with regular review Inter- and Intra- agency

• Observe and record information based on SHANARRI wellbeing indicators

- a common language for talking about wellbeing

- a focus on operationalising needs

• Gather, structure and analyse information My World Triangle Resilience Matrix


https://www.google.co.uk/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=0ahUKEwjAmY3-9LnRAhXdd1AKHVbpDHkQjRwIBw&url=https://www.argyll-bute.gov.uk/girfec&psig=AFQjCNHNi9gqsD0f2hBH7E5ruWQjJ0QzNw&ust=1484217976686213


Prevalence

• At least 20% of young people will experience mental health difficulties such as depression, eating disorders and substance misuse, with suicide being the second leading cause of death.

• Problems in social and emotional development can present in different ways.

(adapted from Minded © Copyright Royal College of Paediatrics and Child Health 2014)

http://www.rcpch.ac.uk/


ANXIETY


Anxiety

Anxiety is a normal reaction. Everyone will feel anxious at some stage.

Designed to keep us safe by preparing us to deal with challenges or situations that are dangerous or threatening.

•Cognitive – able to spot and avoid danger by appraising events and situations for risk •Physiological – prepares the body for action (fight or flight) •Behavioural – helps us learn to anticipate and avoid future danger


Anxiety can be helpful

Anxiety is triggered when we are confronted with a situation or challenge that is perceived to be threatening. This could be a situation that poses a real threat to our physical safety e.g.

• Crossing a road when a car suddenly comes round the corner very fast

• The fire alarm sounding • Someone grabbing hold of you


When we perceive a threat our body prepares to deal with it. This is often called the fight, flight or freeze response. This prepares us to run away (flight) or to confront and face the threat (fight) or become immobilised in the face of a threat (freeze)

You will need to jump out of the way of the car to avoid being hit (flight)

You will need to quickly leave the building when the fire alarm sounds (flight)

You may need to fight off the attacker (fight)

In some situations, individuals may freeze, like a deer in the headlights when faced with a threatening situation.


Fears and worry are common

Worry and fears are very common. Approximately 70% of adolescents report having at least one worry per month and children as young as 3 have been found to worry. Children’s worries are often about their physical security e.g. fear of scary creatures, being hurt, others harming them Adolescent worries are more abstract and relate to negative outcomes e.g. worrying about school performance, social and friendship issues and well-being Most worry is normal and usually doesn’t require any intervention


Types of anxiety

There are 5 major types, differ in terms of the focus of the fear. Separation anxiety - fear of being separated from attachment figures

Specific phobias - fear of specific things e.g. animals (dogs) or places (dentist)

Generalised anxiety disorder - fear of the unknown or uncertainty

Social anxiety - fear of social situations

Panic – fear of disaster or being out of control In all instances the fear results in some form of avoidance


When does anxiety become a problem?

We all feel anxious for short periods of time or in certain situations. In these cases, a period of a few weeks of watchful waiting is appropriate. For some people this is insufficient and anxiety takes over. Anxiety becomes a problem when it • is persistent – the child may constantly feel anxious and always seem to be worrying

• is severe – the child may experience significant and distressing anxiety symptoms

• interferes with everyday life – the child may avoid going to places or doing things that make them anxious.

When anxiety takes over the child may benefit from some help.


LOW MOOD & DEPRESSION


Low mood

Children and young people experience the same emotions as adults It is entirely normal and to be expected that children and young people will feel sad, lonely or tearful at times when they are growing up.


Life events, stresses and losses cause big/small upsets: - disagreements with friends or family - not being picked for a team - marks in school tests/exams - family break up or conflict - bereavement


Look fed up Down in the dumps Tearful Isolating self Look pre-occupied Under confident in their own abilities

Low mood – what does it look like?


Only 3-4% teenagers and 1% 7-12 yr olds per year develop clinical depression. Strict set of criteria must be met for a diagnosis of clinical depression

When does low mood become clinical depression?


• Irritable, tetchy

• Isolated from friends, activities and family

• Excessive boredom

• Decreasing school performance • poor concentration • losing track in class • not picking up information as well as before • can’t make decisions

• Acting out of character • ‘walking on eggshells’ • ‘flying off the handle’

Signs and symptoms of depression Behaviours


Signs and symptoms of depression Thoughts (cognitions)

• Slowed up thinking

• Difficulty concentrating or staying focussed • Ideas of worthlessness

• Low self-esteem

• Ideas of harming self or ending life

• Hearing voices

• Strange thoughts • (can be seen in severe depression or signs of psychosis)


Signs and symptoms of depression Feelings

- low - sad - depressed - irritable


Signs and symptoms of depression Physiological

- loss of interest or pleasure in things

- loss of energy or drive (get up and go)

- changes in appetite (eating more or less than before with weight change)

- changes in sleep (sleeping more or less than before with early morning wakening)

- mood changes during the day, usually waking up feeling very low and getting better as the day progresses.


Additional risk factors

- Biological/genetic factors - strong family history of mental health

difficulties

- Early relationship factors - loss of primary caregiver in early childhood

- Environmental factors - bullying in school

- Cultural factors - feelings are not spoken about in the family


Diagnostic criteria for depression?

- Young people must have at least 4 symptoms

- Symptoms should be present 50% of the time

- Present for 2 weeks in a row

- Should get in the way of young people’s ability to live their life well – ‘impairment of functioning’

Hard to categorise normal fluctuations in mood and periods of low mood as clinical depression

Young people who have been clinically depressed are at higher risk of mental health difficulties in adult life.


When intervention is required?

Mild difficulties: watchful waiting is appropriate for 4-6 weeks.

Moderate difficulties: more than 5 symptoms and some impairment in functioning or any additional risk factors such as self harm, suicidal thoughts or unusual symptoms onward referral to GP and/or local CAMHS services is recommended.

In crisis: Immediate support is required for YP due to risk of self harm or risk to others.


NEURODEVELOPMENTAL DISORDERS


Neurodevelopmental disorders

• Attention Deficit Disorder (ADD) • Attention Deficit Hyperactivity Disorder (ADHD) • Autism Spectrum Condition (ASC)/Disorder (ASD) • Developmental Co-ordination Disorder (DCD) • Specific Language Impairment (SLI) • Specific Learning Difficulties – Dyslexia Dyscalculia • Tics (motor or verbal) • Tourette’s Syndrome (TS)


Overlap in neurodevelopmental disorders


ESSENCE

• Term coined by Christopher Gillberg (2010)

Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examination


ESSENCE

• Parents or professionals may express concern about:

- general development - communication and language - social inter-connectedness - motor co-ordination - attention or activity - mood or behaviour - sleep

Children who have experienced maltreatment are nearly 10x more likely to have 3 or more neurodevelopmental problems


https://www.youtube.com/watch?v=7JdCY-cdgkI




ACEs and trauma,

self harm, risk and resilience

NES Psychology

School Nursing CPD


Take Care of yourself

• Traumatic experiences are common

• It is difficult to think about children and young people experiencing trauma.

• This may trigger strong thoughts or feelings for some of you today

• It can be harder to manage your feelings in training than in clinical work

• Be aware of your own reactions and do what you need to manage these

• Supervision is really important


Setting the scene

• What are ACEs?

ACEs, or Adverse Childhood Experiences, are events that can have long-lasting negative impacts on health and wellbeing.

http://www.aces.me.uk/in-wales/





• Five are personal – physical abuse

– verbal abuse

– sexual abuse

– physical neglect

– emotional neglect

• Five are related to other family members – parent who’s an alcoholic

– a mother who’s a victim of domestic violence

– a family member in jail

– a family member diagnosed with a mental illness

– the disappearance of a parent through divorce, death or abandonment.

ACEs: Ten areas of adverse experiences


Types of trauma

Single Event Trauma

A. Exposure to Trauma

B. Re-experiencing

C. Avoidance

D. Changes in Thinking & Mood

E. Changes in Arousal

Complex Trauma

– Attachment

– Biology

– Emotional Regulation

– Dissociation

– Behavioural Regulation

– Cognition

– Self-Concept

– Family Context


Transforming Psychological Trauma: NES National Knowledge & Skills Framework


Long Term Complex Trauma Outcomes (Briere & Lanktree 2013, p.9)

• Anxiety, depression &/or anger

• Cognitive distortions

• Post-traumatic stress

• Dissociation

• Identity disturbance

• Interpersonal problems

• Suicidality

• Grief reactions

• Substance abuse

• Self-mutilation

• Binging & purging (bulimia)

• Unsafe or dysfunctional sexual behaviour

• Somatisation

• Aggression

• Personality Disorder


Resilience

• Good relationships • Positive experiences

– School – Leisure – Community

• Ways to make sense of what is happening – Assessment, Formulation

& Psycho-education about trauma

• Trauma informed care


GROUP ACTIVITY

In small groups think about some of the common protective factors and risk factors that may be important to note for the young people with whom you work.


Self harm

• Self harm is a broad term that can be used to describe the various things that young people do to hurt themselves in an intentional way

• Self Poisoning or over dose

• Self Injury: A physical injury intentionally inflicted as a means to manage an extreme emotional state

• The term suicidal behaviour is used to mean a deliberate act that is intended to end one’s life


Risk Factors

• History of self harm

• Substance abuse or misuse

• Mental health disorder

• Physical illness causing pain or distress to young person

• Family history of suicide

• Family history of mental health problems or substance misuse


• Method used

• Availability

• Likelihood of discovery

• Suicidal communications (notes/texts/calls)

• Motives

• Precipitants

• Previous suicidal ideation/acts/self harm/ attempted suicide

Risk Assessment


• A way of dealing with distressing experiences / complex trauma and difficult or overwhelming emotions

• To feel real – a young person can feel numb and disconnected from reality and their

self harm awakens them and makes them feel alive and helps them to cope in the short term

• To enlist help, a way of expressing distress – NOT attention seeking

• To keep people at bay by making themselves unattractive

Reasons Why


Reasons why

• Cause physical pain - some young people self harm because the physical pain seems more real than emotional pain and so is perceived to be easier to deal with

• For some young people the sight of blood and bleeding represents a release of emotions

• Brings calm - neurochemicals that are released when the body experiences injury lead some young people to experience a sense of calm and well being


Safety planning

What you need to do to reduce the risk of acting on thoughts of self harm:

• Know and recognise triggers or warning signs

• What helps?

• What doesn't help?

• What will I do to calm and soothe myself?

• What thoughts will I tell myself?


Safety Planning

• What would I say to a friend that was feeling this way?

• What could others do that would help?

• Who can I tell? Make a list with names and contact numbers

• What safe place can I go to?

• If I still feel suicidal or out of control I will go to A&E or call 999

• http://www.handsonscotland.co.uk/topics/troubling_behaviours_topic_frameset.htm


Useful references

• Brent, D, A., McMakin, D, L., Kennard, B, D., Goldstein, T, R., Mayes, T, L., & Douaihy, A, B. (2013) Protecting Adolescents From Self-Harm: A Critical Review of Interventions Studies, 52:12, 1260-1271

• Kokkevi, A., Rotsika, V., Arapeki, A., & Richardson, C. (2012) Adolescents’self-reported

suicide attempts, self-harm thoughts and their correlates across 17 European countries. Journal of Child Psychology and Psychiatry, 53:4, 381-389.

• Mental Health Division Scottish Government (2010) Consultation on Responding to Self-Harm in Scotland

• NES Transforming Psychological Trauma A knowledge and Skills Framework For The

Scottish Workforce 2017 • www.chooselife.net • Chooselife. The art of conversation: A guide to talking, listening and reducing stigma

surrounding suicide: http://www.healthscotland.com/uploads/documents/19417-TheArtOfConversation.pdf

http://www.chooselife.net/


Case Vignette Exercise

- Get into groups of 8 -10 people - Read the case vignette about Billy - Discuss the factors that may be impacting on Billy’s presentation - Complete the ‘How did the problem develop?’

NES Teaching and Training

School Nursing CPD


Signposting NES: Early Intervention workstream http://www.nes.scot.nhs.uk/ - Psychology Directorate

NES: Essential CAMHS http://www.nes.scot.nhs.uk/

MindEd modules https://www.minded.org.uk/

Hands on Scotland website https://www.handsonscotland.co.uk/

Local CAMHS services

http://www.nes.scot.nhs.uk/



https://www.minded.org.uk/

https://www.handsonscotland.co.uk/


TIPS-EIC (Training in Psychological Skills-Early Intervention Children)

• To enhance capacity at the tier 2 level, relieve pressure on Tier 3 and establish care pathways across the service tiers

• Implementation Science principles are employed to select, train and coach individuals across various professional groups to deliver evidence-based / informed psychological interventions to children and young people who may not otherwise be able to access such support

• Funding for Clinical Psychology sessions across 11 Health Board areas


• Training in Psychological Skills • Derived from NES Paediatric Psychology resources

• Comprising basic skills modules in; Communication Skills, Enhanced Communication Skills, Motivational Interviewing, Managing Distress, Promoting Positive Behaviour, Grief & Loss. These modules are broadly applicable across the child workforce.

• Ten HBs have signed up for this package and a train the trainer event for Clinical Psychologists was delivered on 20th Nov 17

• Connecting with Parents Motivations • Training for primary 1 & 2 teachers to assist them to encourage

parents to engage with NES PoPP parenting groups which are now available to the parents of 5 and 6 year old children who meet criteria for significant levels of behavioural difficulty.

• Seven HB areas are planning to progress this package

Programme of Training & Coaching


• Training in trauma-informed practice

– Mapped to the NES Transforming Psychological Trauma: Knowledge and Skills Framework for the Scottish Workforce, which will be relevant for all members of the child workforce

– will be delivered to all 11 HB areas

• Low Intensity Anxiety Management

– Based on CBT principles

– A tiered training offer to be targeted dependent on the level of intervention to be undertaken by the workforce member

– Nine of the eleven HB areas have Clinical Psychologists trained to deliver this training and coaching package

– Training for school nurses has begun in NHS Lothian and in NHS Lanarkshire

Programme of Training & Coaching


• Essential CAMHS is an online educational training resource designed to support staff through the transition into working in a Specialist CAMHS environment. The materials are designed to support the development of a range of knowledge, skills and attitudes which will promote collaborative, safe and effective work with the children, young people and families who attend services.

Essential CAMHS


• The Essential CAMHS training resource consists of five modules:

• The resource consists of five modules which should allow any member of staff, who is new to child and adolescent work, to make sense of the experience of working with children, young people and families.

• Module 1 Child and Adolescent Development and the

Development of the Family • Module 2 Engaging with Children and young People • Module 3 Mental Health of Children and Young People • Module 4 Assessment and Formulation • Module 5 Therapeutic Interventions

Essential CAMHS (cont)


Psychology of Parenting Project: aims and progress

• Improve outcomes for 3-6 year old children with significant levels of early-onset disruptive behaviour problems

•Increase workforce capacity around evidence-based parenting interventions for such children and their families

•Implementation of PoPP is a named commitment in the current Mental Health Strategy

Number of Community Planning Partnerships that have adopted the PoPP model

20

Number of multi sector practitioners trained in either Level 4 Group Triple P or the Preschool Basic Incredible Years programmes

593

Number of groups delivered (or currently being delivered) 570

Number of families enrolled in groups 3553

Number of children for whom pre and post group SDQs have been gathered 1849

%of children in the clinical range at the start of groups who had moved out of this high risk range when their parents finished attending a group

61%


Other initiatives within the Parenting Workstream

• Connecting with Parents Motivations (CWPM) Cascade Scheme

• Strength based communication skills training, designed to enhance the abilities of the Early Years workforce to have effective conversations with parents to increase their participation in PoPP groups

• Since 2015 over 650 practitioners have participated in one of the 53 CWPM Cascade trainings

• Solihull Approach Cascade Scheme (SACS)

• Since January 2014, NES have delivered, and will continue to deliver this basic Infant Mental Health (IMH) training, in keeping with commitments in both the previous and current Mental Health Strategies

• Over 870 practitioners and 78 trainers have been trained via this scheme

• New IMH training initiatives are currently being planned

• These aim to extend the IMH training opportunities available to the multi-sector early years workforce by offering a systematic training pathway that aligns with a stepped-care delivery model

• This new, extended IMH training pathway will involve self-directed online training, standardised and authorised face-to-face training in a minimum of 2 IMH interventions with promising levels of evidence of efficacy and implementation support around the delivery of these interventions

• NES Psychology are also leading on work to update the Perinatal Mental Health Curricular Framework and contributing to the work of the Perinatal Mental Health Managed Clinical Network


NES Paediatric Psychology Training in Psychological Skills (TIPS-PH) Training in Psychological Skills Paediatric Healthcare Staff on: • Communication Skills (half day workshop) • Motivational Interviewing Approaches (half day workshop) • Reducing Distress (half day workshop) • Promoting Positive Behaviour (half day workshop) • Managing Paediatric Pain (half day workshop • Hospital Passport (30 minute presentation) • Life Limiting Conditions and Palliative Care (2 day workshop) • Supporting Adherence(2 day workshop) Online resources to support training at http://www.knowledge.scot.nhs.uk/child-

services/education/psychology-education-specialist-children's-services-(paediatric-psychology).aspx) Psychosocial Interventions for Neonatal Healthcare Staff on: • Identifying and Managing Distress in a Neonatal Unit – recognising and managing parental distress in a

neonatal unit. • Communication Skills – communicating and problem solving skill. E-learning resources (available on LearnPro) • Chronic Fatigue (e-learning resource)- 2 modules • Communication and Managing Distress in Neonatal Healthcare Staff – 2 modules • Procedural Distress (e-learning resource)- 1 module (available shortly)

http://www.knowledge.scot.nhs.uk/child-services/education/psychology-education-specialist-children's-services-(paediatric-psychology).aspx)
















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