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picture1_Cbt Pdf 108327 | The Bridge April 20 Cbt


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File: Cbt Pdf 108327 | The Bridge April 20 Cbt
april 2020 cbt edition can transdiagnostic cbt improve outcomes in children with asd does online cbt work for treating adolescent anxiety plus research digests from acamh jcpp and thejcpp camh ...

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      April 2020
      CBT  
      Edition
      Can transdiagnostic 
      CBT improve outcomes 
      in children with ASD?
      Does online CBT work 
      for treating adolescent 
      anxiety?
           Plus
          Research 
         digests from                                            @acamh
          JCPP and                                              @TheJCPP
           CAMH                                                @TheCAMH 
                                                                acamh.org
          Dr Juliette Kennedy                                               Contents:
          The Bridge Editor                                                 p3         A day in the life of a CWP
          I am Dr. Juliette Kennedy, Editor of The                          p5 A thinner c        ortex predicts a better 
          Bridge, and a Consultant Child and Adolescent                               response to CBT
          Psychiatrist working clinically in a North                        p6 CYP -IAPT – Where next?
          Yorkshire CAMHS team. I am Associate Director 
          of Medical Education in the trust I work in, also                 p9         Online CBT is ineffective for treating 
          Training Program director for CAMHS higher                                  adolescent anxiety
          training in Yorkshire.
          The Bridge presents the most clinically-relevant                  p10        Can transdiagnostic CBT improve 
          research from our two peer-reviewed journals:                               outcomes in children with ASD?
          Child and Adolescent Mental Health and The                        p11        CBT and sertraline are effective 
          Journal of Child Psychology and Psychiatry, as                              treatments for paediatric anxiety, 
          well as interesting and important studies from                              but how do they work?
          the wider literature. Please let us know what 
          you'd like to see in upcoming editions by sending 
          an email to me at: researchdigests@acamh.org
          Dr Jessica K. Edwards
          Research highlights in this edition are prepared 
          by Dr Jessica K. Edwards. Jessica is a freelance 
          editor and science writer, and started writing 
          for ‘The Bridge’ in December 2017.
          2
           A day in the life of a CWP
           By Susan Moore
           A children’s wellbeing practitioner (CWP) is a highly         Typical day as a CWP
           specialist role in a CAMHS team. CWPs deliver                 Following the initial assessment we will meet with 
           low-intensity psychological interventions for mild            the young person to complete a collaborative 5 areas 
           to moderate low mood and anxiety disorders. We                formulation. During this session we also review the 
           treat children and young people using a variety of            RCADS and start the joint decision-making approach 
           interventions such as:                                        to decide which intervention we are going to use.
           • Behavioural Activation                                      A typical day for a CWP will always include a number 
           • Graded Exposure                                             of 30 minute intervention slots. We usually see our 
           • Worry management                                            patients weekly or fortnightly. Preparation is needed 
           • Parent-led CBT                                              for these appointments as they often rely on the use 
                                                                         of worksheets for homework/tasks. We see the young 
           Initial Assessments                                           person for around 30 minutes which allows for us to 
                                                                         provide feedback to the parents/carers. Once we have 
           A psychological wellbeing practitioner (PWP) will             done this feedback we have a brief window to add a 
           start the therapeutic process by offering an initial          case note and make any other changes.
           assessment, in order to gather more information 
           about the presenting problem. This is an important            Summary of a typical intervention – BA for 
           part of the process as it allows the PWP to develop a         depression
           CWP formulation, which helps with moving onto the             • Treatment Session 1 (with parents): Young person
           intervention stage (Curry, Dunsmuir & Fuggle’s, 2012).          and parents (1 hour). The CWP provides psycho-
           A CWP’s initial assessment is different to a generic            education about depression. We will also discuss
           CAMHS clinician. It has a tight structure and a short           the treatment rationale with a brief personalised
           time slot. The initial assessment can be broken down            exploration of the model (Homework-Activity
           into 3 sections: information gathering, information             monitoring form). We will complete RCADS.
           giving and shared decision making (Reach Out).                • Treatment Session 2 (30 minutes): A review of
           The information gathering section of the assessment             the daily monitoring form with a treatment
           can be broken down into four key elements: 4 W's, 5             rationale review. During this session we will look
           areas formulation, impact and risk. The 4 W’s explore           at what activities provide positive and negative
           the presenting problems in terms of; what is the                reinforcement and consider the balance of activities.
           problem? where does it happen? with who is the                  (Homework is continued activity monitoring and
           problem better or worse and when does this happen?              balancing of activities).
           These four brief questions allow for the practitioner  to     • Treatment Session 3 (30 Minutes): A review of daily
           be time efficient in this area of the assessment                monitoring forms and activity targets. We will then
           (Richards & Whytes, 2011). Following the 4 W’s we               complete a values-based assessment task where we
           complete a 5 areas formulation, identify impact and             look at different areas in the young person’s life such
           complete a risk assessment.                                     as family, friends, hobbies, self-care, future plans and
           According to the “Reach Out” document, the next                 physical health. We will then generate one activity
           steps after completing the information gathering                to try. (Homework is to review the diary exercise
           section are to complete a problem statement, create             and introduce one activity target).
           patient-centred goals and give treatment information          • Treatment Session 4 (30 minutes): A review of the
           (Richards & Whytes, 2011). A problem statement draws            values-based activity task. Then, the generation of
           a conclusion to the initial assessment. I try to encourage      a list of activities to inform activity scheduling.
           the young person to write their own problem statement           We will commence activity planning and scheduling
           with some verbal help from myself. Once a problem               using ACE logs and activity scheduling sheets.
           statement is completed we can then think about                  (Homework is 3 activity targets).
           setting goals and the intervention we are going to use.       • Treatment Session 5: A review of the daily
                                                                           monitoring form. We continue activity planning and
                                                                           scheduling using ACE logs and activity scheduling
                                                                           sheets. (Homework is 3 activity targets).
           3
          • Treatment Session 6 (with parents 1 hour): A review         Formulation and team working
            of progress and continued activity planning and             As a CWP we have weekly formulation slots in our  
            scheduling, using ACE logs and activity scheduling          diary. Clinicians can book a half hour slot to discuss  
            sheets, with some problem solving. (Homework is to          a young person that they would like to refer to us 
            add or remove or adjust activities based on learning).      for low intensity work. During this discussion a CWP 
          • Treatment Session 7: Continue activity planning and         will think about previous work undertaken, risk and 
            scheduling using ACE logs and activity scheduling           complexity. A CWP will work with children and young 
            sheets. Problem solving and thinking about any areas        people who need further work, after completing a tier 
            left to work on. (Homework is to add or remove or           3 CAMHS intervention. 
            adjust activities based on learning).                       Once a young person has completed a low intensity 
          • Session 8 and beyond (with parents). We complete a          intervention such as BA, the CWP can then think about 
            relapse prevention exercise. A review of learning and       other interventions that the young person may benefit 
            accomplishments. CWP will provide advice:                   from such as Graded Exposure. 
            including top tips for staying well.
          • Discharge - planning for the end of treatment (with         If a CWP is worried about a child, and thinks they may 
            parents). Complete progress review and finalise             need higher intensity work, we can discuss this with  
            relapse prevention plan. Complete RCADS again.              the tier 3 team through supervision, formulation or  
                                                                        case discussion.
          A Typical CWP’s Diary is below:                               Attending complex case discussion
                                                                        As part of working in a generic CAMHS team, a CWP 
                                                                        will attend a weekly complex case discussion. The form 
                                                                        of the complex case discussion depends on what the 
                                                                        clinician who is presenting wants from the meeting.  
                                                                        One aim may be to think about a plan/future work 
                                                                        for the young person. A CWP can also take a case to 
                                                                        discuss. They may discuss a case that has gone well  
                                                                        or a case that they feel they need support with. 
                                                                        I think it’s important for CWPs to take cases that 
                                                                        have gone well, to help other clinicians in the team 
                                                                        understand the structured role of the CWP. A CWP  
                                                                        may also contribute with ideas about how a low 
                                                                        intensity intervention may benefit the young person 
                                                                        under discussion.
                                                                        Working with complex cases as a low intensity 
                                                                        worker
          Providing supervision                                         As discussed, a CWP will work with young people  
          Another part of our role as a qualified CWP is to             with mild to moderate (current or historical) risk to  
          provide clinical and caseload management to trainee           do a specific piece of work to help meet the goals of  
          CWPs. This supervision is weekly as trainees have a set       the young person. The lead professional continues to 
          number of hours of required supervision for their course.     hold the case and manage risk whilst the CWP offers 
          Supervision is to ensure that trainees have access to         their intervention.
          suitable cases and to check that they are able to stick to 
          their evidenced-based model of treatment.                       Referring to:
          Working alongside Single Point of Access to CAMHS               Curry, V. Dunsmuir, S. Fuggle, P. (2013). CBT with 
          As CWPs we work very closely with the Single Point of           Children, Young People and Families. London:  
          Access Team to ensure that our initial assessment are           S. 63-64.
          selected to be mild to moderate in risk. This ensures           Richards, D. Whyte, M.. (2008). Reach Out. 
          that chosen cases benefit from our specific structured          Available: https://cedar.exeter.ac.uk/media/
          model. A CWP model may not be appropriate if there              universityofexeter/schoolofpsychology/cedar/
          is complexity or risk or if there are neurodevelopmental        documents/Reach_Out_3rd_edition.pdf. Last 
          concerns that need to be assessed.                              accessed 06/03/20.
          4
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...April cbt edition can transdiagnostic improve outcomes in children with asd does online work for treating adolescent anxiety plus research digests from acamh jcpp and thejcpp camh thecamh org dr juliette kennedy contents the bridge editor p a day life of cwp i am thinner c ortex predicts better consultant child response to psychiatrist working clinically north cyp iapt where next yorkshire camhs team associate director medical education trust also is ineffective training program higher presents most relevant our two peer reviewed journals mental health sertraline are effective journal psychology psychiatry as treatments paediatric well interesting important studies but how do they wider literature please let us know what you d like see upcoming editions by sending an email me at researchdigests jessica k edwards highlights this prepared freelance science writer started writing december susan moore s wellbeing practitioner highly typical specialist role cwps deliver following initial as...

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