Life-changing mental health workshops empower parents to support their child
Meet advanced practitioner Alan Wilmott who, along with his team at Torbay and South Devon NHS Foundation Trust, devised intuitive and empowering parents’ workshops that won the RCNi Mental Health Practice Nurse Award 2017
‘Coming to this group and being given “permission” to play has led to quite a profound effect on our family as we have stepped back and thought about why we do things and how we can improve them.’
The parent quoted here has completed a ‘life changing’ workshop for parents whose child has been referred to child and adolescent mental health services (CAMHS). The workshop has improved the parent’s relationship with their child, and their understanding of their child’s and their own mental health.
The Torbay and South Devon NHS Foundation Trust team that devised and deliver the Understanding Your Child's Mental Health workshops this month won the Mental Health Practice category of the prestigious RCNi Nurse Awards.
Team leader, advanced practitioner Alan Wilmott says: ‘The workshops aim to help parents and carers to reflect on how their child or young person is currently experiencing life and help them develop resilience and a better understanding of what poor mental health might mean to their child or young person.
‘Topics covered include how brains develop and how external influences, actions and real-life events affect how people feel and the need to be able to feel safe sharing with the people we trust how we might be feeling.’
‘We encourage parents to try fun, creative activities to explore mental health and offer ideas about activities that help foster a positive, playful relationship with children’
Content has been influenced by a number of ‘parenting’ training programmes including Mellow, Incredible Years and Here’s Looking at You Baby.
Alan has brought ideas from the specialist clinical area of infant mental health around attunement, dyadic synchrony, brain development, developmental play and the importance of play, playfulness and being playful, as well as ideas around attachment thinking.
‘We have not really ‘devised’ anything new but brought these ideas and principles of practice together in a non-pathologising, non-judgemental programme,’ explains Alan.
The workshops (see box) are now offered to all parents whose child has received a CAMHS assessment.
Mental health nurse Clare Bird helps deliver the programme.
‘We encourage parents to try fun, creative activities to explore mental health and offer ideas about activities that help foster a positive, playful relationship with children,’ she says.
‘Parents’ own mental health, level of resilience, capacity to contain difficult emotions and or lifestyle choices can be an influencing factor. The workshops acknowledge this and create a framework for them to share experiences and create a support network as well as reflect, share ideas and challenge each other. It also gives them hope that things can get better.’
Like many excellent projects, the workshops were born out of service pressures. Alan explains: ‘We had increasing referral rates and extending waiting list times and wanted to bridge the gap between assessment and treatment, and reduce drop-out once in therapy by preparing the parents for the type of work we do.’
Alan had been considering a group-based intervention as an initial post-assessment offer to families. When a colleague was asked to develop a service improvement project for a course, he seized the opportunity.
Group therapy is a somewhat retro approach, but for Alan the obvious place to start. His pre-registration placements were undertaken in units using similar occupational therapy, psychodynamic and systemic therapy.
‘A fantastic tutor helped us experience and explore the vast terrain of mental health with the needs of the individual and the importance of the relationship at its heart. Self-awareness, insight, foresight, reflective capacity, compassion and human connectedness are the things that help to develop informed clinicians.
‘A fantastic tutor helped us experience and explore the vast terrain of mental health with the needs of the individual and the importance of the relationship at its heart’
‘With a strong focus today on outcome measures, randomised research data and dyadic cognitive interaction between patient/client/customer and therapist/practitioner there often feels that there is less time to consider the therapeutic relationship.
‘However, it is the capacity to model this experience to parents that in turn facilitates the development of insight into the experience of their young person’s mental health. The two are usually inter-connected in so many ways.’
Make sense of external world
He points out that poor or compromised mental health is rarely the starting point. ‘For many – and especially for children and young people – it is often the point reached when so much else has been missing, challenging or comprised, he says.
‘Early ante and postnatal experiences for baby and caregiver and the way in which those first relationships develop are crucial to the way in which all of us sees, experiences and makes sense of our external world.
‘By providing a structure in which parents/carers can feel sufficiently safe and emotionally contained so as to be able to begin to contain the emotional state of the young person, the workshops take parents and carers back in a sense to those early experiences.
‘It provides opportunity for reflection, but also re-assurance that ruptures in relationships are inevitable – what is important to the young person is to learn that ruptures are repairable. With this understanding, parents, carers and young people have an opportunity to understand their own mental health in a different way.’
Retention levels are consistently high. More than 90% of people who start the series are still involved at its end.
Enjoy positive experiences
Feedback shows parents feel more confident in discussing mental health with their child and offering support, less isolated, and more able to create and enjoy positive experiences with their child.
Alan adds: ‘Some gain a greater insight into their own mental health and emotional well-being, which has a positive impact on how they support their young person.’
Comments include ‘I have learned to talk to my son at a better understanding level’ and ‘It was helpful to me in understanding my daughter more, what her moods really mean and how we can deal with it in a more helpful way’.
One parent stated: ‘Everything made total sense. It’s so obvious, but you just don’t get a chance to think about things in this way’ and another reported ‘The change in my reaction gave a new change in my child's response’.
What is the key to this success? Language is important – parents report the term ‘parenting programme’ implies their parenting is flawed and under scrutiny - as is the workshops’ non-judgemental approach.
Sense of connectedness
Alan adds: ‘Giving parents permission to share their story – often different, but at the same time also similar and familiar – facilitates a sense of connectedness among attendees. And the workshop is flexible and can be delivered in response to attendees’ needs.
‘The important component of our programme is not what we “do”, but in providing the opportunity for parents/carers to connect with what is important for them in their relationship with the young person in their care.’
‘Giving parents permission to share their story – often different, but at the same time also similar and familiar – facilitates a sense of connectedness among attendees’
The workshops formed the foundation of ‘train the trainers’ courses to staff in primary schools. Two schools now regularly deliver sessions for families who may not meet a CAMHS threshold but would benefit. Two more school train the trainer courses are planned this year.
Pennine Care NHS Foundation Trust associate director of acute and crisis cervices Clair Carson was on the Nurse Awards judging panel. She says: ‘It was refreshing to hear about a successful project that used the fundamental principles of mental health nursing in a manner that maximises the opportunities to support parents and carers and equips such people with resilience and tools to look after their own mental wellbeing while supporting and caring for others.
‘In a world of a barrage of new initiatives, to see a team take the essence of what being a mental health nurse is and turn it into a successful project such as this is admirable and I for one was bowled over.’
A maximum of 15 parents or carers attend the roughly two-hour workshops in a non-stigmatising setting.
The workshops are based on five themes:
- What is good mental health?
- How do we recognise when mental health goes wrong?
- Containing difficult feelings and emotions
- Managing risk and developing resilience
- Understanding our children’s mental health
A CAMHS clinician introduces topics with an informal discussion over refreshments.
Sessions are visual and interactive - film clips explore early brain development and the negative consequences of toxic stress. Creative activities complement the themes, for example masks, salt and chalk jars, creating collage, web of resilience, playful games – plus Lego and playdough.
Parents/carers provide feedback via recognised outcome measures as well as narrative feedback about the sessions’ effectivenes.
Mental Health Practice Awards finalists
Heather Meacham, NHS Forth Valley
Heather devised and introduced an evidence-based and cost-effective low intensity psychological interventions programme addressing both mental health and offending behaviour in prisons delivered by trained mental health nurses. Patients' behaviours and presentation have significantly improved and patients report less anxiety, reduced feelings of isolation and greater peer support.
Matty Caine, Integrated Nursing Team, HMP/YOI Low Newton
Women in prison can have experienced significant physical and psychological trauma, which can be exacerbated in the perinatal period. The team devised and delivered a perinatal mental health pathway, which ensures all women are listened to and their needs identified. Patients are treated promptly and feedback has been excellent.
Jessica Wilson, Elysium health care
Jessica was highly commended by the judges for her work introducing traditional oral storytelling to improve the relationship between staff and patients in forensic units. Jessica’s research shows storytelling creates a positive atmosphere and distracts patients from stressful situations or distressing thoughts and emotions, as well as engaging patients while in isolation.
Sarah Biggs and Helen Dudeney, Hertfordshire Partnership NHS Foundation Trust
Sarah and Helen used an airline industry approach to design patient safety hazards out of services. They successfully implemented two initiatives to address problems at transfer and discharge - a collaborative transfer and discharge system and a telephone follow-up for people assessed by the crisis team but cared for outside the trust.
The Mental Health Practice award is sponsored by Cygnet Health Care