An Investigation into the Implementation of CYP-IAPT Routine Outcome Measures in their First Year of Integration into Child Psychotherapy Practice

This thesis examines the impact on child and adolescent psychotherapists within CAMHS of the introduction of routine outcome measures (ROMs) associated with the Children and Young People’s Improving access to Psychological Therapies programme (CYP-IAPT). All CAMHS therapists working within a particular NHS mental health Trust1 were required to trial CYP-IAPT ROMs as part of their everyday clinical practice from October 2013-September 2014. During this period considerable freedom was allowed as to which of the measures each therapist used and at what frequency. In order to assess the impact of CYP-IAPT ROMs on child psychotherapy, I conducted semi-structured interviews with eight psychotherapists within a particular CAMHS partnership within one NHS Trust. Each statement was coded and grouped according to whether it related to initial (generic) assessment, goal setting / monitoring, monitoring on-going progress, therapeutic alliance, or to issues concerning how data might be used or interpreted by managers and commissioners. Analysis of interviews revealed greatest concern about session-by session ROMs, as these are felt to impact most significantly on psychotherapy; therapists felt that session-by-session ROMs do not take account of negative transference relationships, they are overly repetitive and used to reward / punish the therapist. Measures used at assessment and review were viewed as most compatible with psychotherapy, although often experienced as excessively time consuming. The Goal Based Outcome Measure was generally experienced as compatible with psychotherapy so long as goals are formed collaboratively between therapist and young person. There was considerable anxiety about how data may be (mis)used and (mis)interpreted by managers and commissioners, for example to end treatment prematurely, trigger change of therapist in the face of negative ROMs data, or to damage psychotherapy. Use of ROMs for short term and generic work was experienced as less intrusive and contentious.

Childrens experiences of domestic violence and abuse: Siblings accounts of relational coping

This article explores how children see their relationships, particularly their sibling relationships, in families affected by domestic violence (DV) and how relationality emerges in their accounts as a resource to build an agentic sense of self. The ‘voice’ of children is largely absent from the DV literature, which typically portrays them as passive, damaged and relationally incompetent. Children’s own understandings of their relational worlds are often overlooked, and consequently, existing models of children’s social interactions give inadequate accounts of their meaning-making-in-context. Drawn from a larger study of children’s experiences of DV and abuse, this article uses two case studies of sibling relationships to explore young people’s use of relational resources, for coping with violence in the home. The article explores how relationality and coping intertwine in young people’s accounts and disrupts the taken-for-granted assumption that children’s ‘premature caring’ or ‘parentification’ is (only) pathological in children’s responses to DV. This has implications for understanding young people’s experiences in the present and supporting their capacity for relationship building in the future.

Are mental health staff getting better at asking about abuse and neglect?

This study ascertained the extent to which abuse and neglect are identified and recorded by mental health services. A comprehensive audit of 250 randomly selected files from four community mental health centres in Auckland, New Zealand was conducted, using similar methodology to that of a 1997 audit in the same city so as to permit comparisons. Significant increases, compared to the 1997 audit, were found in the rates of child sexual and physical abuse, and adulthood sexual assault (but not adulthood physical assault) identified in the files. Identification of physical and emotional neglect, however, was poor. Male service users were asked less often than females; and male staff enquired less often than female staff. People with a diagnosis indicative of psychosis, such as ‘schizophrenia’, tended to be asked less often and had significantly lower rates of abuse/neglect identified. Despite the overall improvement, mental health services are still missing significant amounts of childhood and adulthood adversities, especially neglect. All services need clear policies that all service users be asked about both abuse and neglect, whatever their gender or diagnosis, and that staff receive training that address the barriers to asking and to responding therapeutically to disclosures.