Transcript for
Child mental health assessment and engagement strategies
Narrator (00:02): Welcome to the Emerging Minds Podcast.
Dan Moss (00:07): Hi everyone. My name is Dan Moss and today, we will be listening to some practice advice from three individuals who have been very influential in the development of the Emerging Minds e-learning course, Practice strategies for assessment and engagement. So if you are interested in this e-learning course or others, please visit our website at emergingminds.com.au. So for those of you who have followed our podcasts, you might remember psychologists, Penny Sih, sharing her thoughts about assessment and engagement and supporting the child to experiencing their best life, so I feel very privileged today to spend some time listening to three other significant contributors to our work in the assessment and engagement space, two of those individuals being Jess and Emi, Emerging Minds’ child and family partners, and the other being Ali Knight, a mental health social worker.
Dan Moss (01:04): Jess and Emi are two child and family partners who have made a significant contribution to Emerging Minds’ e-learning webinars and practice papers over a number of years. In this episode, they will be sharing their own lived experience of effective assessment and engagement and strategies with children and their families. Ali Knight is a social worker with 25 years experience who specialises in work with infants and children. Ali will be sharing some of her experiences in developing engagement strategies that help children and parents feel more confident and engaged in the therapeutic process. So when a child or parent first arrived to see a professional, we know that often, they feel anxiety or even reluctance. The child or even the parent might feel like they’re going to be told off or lectured or made to discuss subjects that make them feel uncomfortable, so firstly, I was interested in Ali’s experience as a social worker and what she does to overcome initial reluctance in children and/or parents.
Ali Knight (02:11): I always try to normalise the experience of coming to see a therapist because a lot of kids will come in with nerves and not really know what to expect, so it’s about trying to talk about other the children’s experience that they’ve come in and they felt like their tummy was just all swirling and that kind of thing, just let them know they’re not the only one that feels anxious about coming in or not knowing what to expect and setting some of the boundaries around as well so they know when they come, it’s a place where you can play, you can play about how you feel or you can talk or you don’t have to talk. So it’s just letting them know how things are and hopefully taking a bit of pressure off them.
(02:49): So I think it’s really important just to take your time with building the relationship, and you can imagine if you are to come and meet someone new as a young child, maybe if you may not be that happy about coming in, you need time, don’t you? Need time and you need an environment that feels supportive and welcoming, so I try to create that. And for young children, for babies, it’s about playing and for them being in a space where they can express themselves through play really, so trying to come up with ways that everyone feels comfortable and has a sense of safety is really important I think.
(03:22): So I think it’s really about being prepared to meet where that child and family are at, and some children will engage quite quickly with you and some will take a little bit longer to warm up to being with someone that they don’t know that well. So if it was an older child and they’re able to verbalise things, they may not want to talk and you might have to talk with the parent about things and get the parent to say what their child might be thinking. And then that sort of lets the child off the hook a little bit and they can just agree or disagree maybe, or they can show through play. You just have to get a little bit playful and sometimes, I might use toy animals and get them to show me or pick one to represent mum or dad or something like that. If they’re a bit older and they can get with that, that’s really interesting and can be a little bit of an icebreaker sometimes and mum would be like, “Oh, yeah. So you’ve chosen a line for me?”
Dan Moss (04:16): Through her lived experience, Emi described what was helpful for her and her children when working with a psychologist who helped them to feel more comfortable and positive in the initial engagement period.
Emi (04:29): When we came out of trauma and I wanted to get some help from my two youngest children, we went and saw a [cam 00:04:36] psychologist. And I went in there and I just wanted to say everything, all the issues that we had. That was my mindset back then, I really had to talk all my problems straight away. And so I think it was really good of the psychologist, she was able to turn that around a bit, put the focus back on the kids and who they were.
(04:54): So why that was good is that they didn’t become just their problems, so then their relationship with that psychologist wasn’t just about their problems, it was about them more as a whole and allowed them to talk about their life outside of their problems and to really set that scene and that environment in that room, which they were going to be going to use a fair bit because they had quite a bit of counselling. It set the scene for later counselling sessions because coming out of trauma, we’re still pretty raw and things were rough. They already knew all about their problems. Their life was so much about their problems so they just needed to start to build up the world again.
Dan Moss (05:35): What effect could that have on them? To be asked about what’s important to them and what they value rather than just what the problem was?
Emi (05:42): I think it was a bit of a relief actually. Looking back, I think it was almost like a bit of a collective, oh, phew, we don’t have to really get into this territory. Because when you go through all the services and so on, because we’re in our refuges and everything, we came across a lot of services, we had to deal with a lot of services so that’s really about telling the story over and over again. And I know for me, it became really traumatic and for the kids, I can imagine, they’re so young, their lives are still developing. They haven’t got the experience or the life experience that I do.
(06:16): So it was a really negative effect on them to have to talk about their problems right up because if they’re like a cup, their problems are up here. The cup is three quarters full with their problems, but they’re so much more than that. And so it’s really about balancing that out and showing them how to find that balance too, because it’s pretty rough for kids. We were homeless, didn’t have friends and social networks, so quite easily, they could become just their problem and nothing else.
Dan Moss (06:43): Jess has been a wonderful resource for our work throughout the assessment and engagement e-learning course because not only does she have extensive professional experience, but also personal experience as a carer of infants and children. I asked Jess what helps parents and children to feel less anxious from the earliest possible point in the therapeutic process?
Jess (07:06): I think being upfront and honest is always a really good step, saying maybe we could talk about something different today than you are used to talking about, inviting them to either use the toys or whatever’s in the room. Maybe they have a tool that they use to find out the interest areas of a child. Those kinds of things would help the family feel like this is a different direction but it’s actually still going to be quite helpful. I think you still have to address why they’re in the room because the child normally understands the problem or the issue from the eyes of their adults in their life, the teachers or the parents at home or other adults they might have that are care taking for them. So I think the child then starts to get a bit nervous about, well, how come we’re not talking about the thing I know we’re here to talk about.
(07:56): So I think you have to address that with them so that they know that that’s just one part of who they are and we’re actually looking at who they are as a person, not just the problem or the issue. Because they’re not the problem, it’s actually something that’s going on that’s the problem, and it then externalises whatever it is that’s brought them into the room. And there might be things that the child wants to focus on that’s got nothing to do with what the adults think are important, and I think it’s important that the practitioner then addresses both of those. If the child has maybe some issues with friendship or with siblings or things that we see as menial child issues, by addressing those, that might actually help the bigger problem that’s going on as well.
Dan Moss (08:40): Okay. So as I’m sure you’re all observing now, one of the key messages that is standing out in all of these responses is the absolute importance of working with children and families from the earliest possible point to find out more about their preferences, relationships, and knowledge, rather than only about their problem stories. I wondered about whether the psychologist who worked with Emi maintained a focus on these things, and if so, how they did this.
Emi (09:09): Yeah, I think I wouldn’t have known it at the time but knowing what I do now, I can see that she was by much a strength based practitioner so she really allowed us to focus on our strengths. I can’t remember exactly the words that she used but I remember that we came out feeling really good and we were able to have really positive conversations after, because it would’ve been easy to just talk about all the negative stuff that had happened with so much had happened, but she was able to highlight the good things out of that.
(09:39): I wish I could remember some of the words she used but I just can’t, but I know that’s what she was doing. And if this was our journey of trauma, she was able to bring out the tracks that were really, really good and healthy for us to move forward. So yeah, it wasn’t like, oh, you’ve got to do this or you’re doing this wrong. It’s more like, this is what you’re doing right and this is really good and build on this. And I don’t think we would’ve really been thinking that ourselves if we hadn’t had someone to show us that or to highlight that for us because we’re so really stuck in stuff.
Dan Moss (10:13): Jess discussed her experiences of practitioners who use strategies which helps children describe themselves in holistic and positive ways.
Jess (10:23): I think visuals are a really good way of being able to do that. Getting out some big bits of paper, and writing or drawing or illustrating in some way, or using cutouts and sticking them on to see what the child likes in their life, what they’re really good at, what would their friends say they’re good at? What would their adults in their life say they’re good at? What would their siblings say that they’re good at? Because it then gets them thinking past themselves. I think sometimes, by the time they get to a practitioner, things aren’t always going well and it’s hard to see those good things in themselves, but they can put themselves in the feet of somebody else that’s looking at them and they’re very, very good at being able to empathise with their peers and knowing what their peers might say about them. So I think that’s definitely been one of the best techniques, doing something visual for them.
Dan Moss (11:16): I asked Ali, from her professional experience, to describe what helps her as a social worker to focus on the important relationships and preferences for children and their families, rather than only a description of the problems or the deficits.
Ali Knight (11:32): What I really try to do is sit back on the relationship, establishing a really good relationship with that parent from the outset and try to connect up with their experience, whatever that is, and be empathic around the struggles they might have had for example. The other thing I was just thinking about is really important is to highlight what’s going well in terms of what they’re doing with their child and the strengths that I see in the relationship, and that’s a really good initial thing to do. I think before you start looking at what some of the difficulties are, because people can be really sensitive to that as you can imagine, so if you started to build a bit of a relationship and give them maybe a bit of a sense of confidence by highlighting what they’re doing well, which has to be you from a genuine place because you would be giving them specifics around what you’ve noticed, that can really help for them to be able to hear some of the stuff that maybe is a bit more challenging to talk through.
(12:22): And even just looking at what’s happening in the actual relationship and breaking that down into little moments that you might see, like, “I saw when your baby looked at you and you were able to respond in a really warm way,” just talking that through a bit and just looking at the really small moments. I think that’s a really important part of the work because it’s all the small moments that build up into the repetition and the consistency is what those young children really need for their healthy foundation.
Dan Moss (12:49): I asked Jess whether, from her personal or professional experience, she has observed how children over a period of time throughout the therapeutic process have become more confident or descriptive in the skills or the knowledges or even the values that they have.
Jess (13:06): I think so, especially after that trust has been built. Sometimes, that’s a couple of sessions, sometimes, it takes them a little bit longer. To be able to have that practitioner reflect back and be able to highlight where those strengths might be or what they’re seeing is their real interest areas, they start to then take that on board and they try that on, a little bit like trying a hat on, to see if it fits for them and when they can trust that adult and what they’re putting on works for them. They start to say, “Oh yeah, this is a part of my identity and who I am.” I think that takes a long time to get to the point where they’re willing to accept those things, but they start to try them out, especially if they’ve got that relationship there.
Dan Moss (13:46): So as you’re beginning to hear from talking with Jess, Emi and Ali, it has become apparent how important these holistic understanding of children are, tells us as practitioners that to work effectively through the engagement and assessment process, we have to have a thorough understanding of the whole child. Given this, I asked Ali how a holistic understanding of the whole child and their parents help her to support them to move past only their problem and to experience positive mental health.
Ali Knight (14:20): I think I really want to be able to fully understand the child in the context of their relationships and their world. I really want to support that child with where they’re at in their life and around their mental health and being able to move forward, so it’s really important to really fully appreciate the context and what’s impacting on or getting in the way of their life, some of the issues they’re facing. That’s a really great way to move towards some of the work that needs to happen, which might be a bit more challenging for the parent. It’s about seeing that you can see the whole picture, it’s not just about focusing on some of the challenging things but for them to feel that they can be seen as a parent who does have capabilities to do some things for their child in a way that is going to support their child.
Dan Moss (15:03): I asked Emi about how her psychologist was able to help her and her children think about themselves and their relationships and the positive aspects they were able to contribute to those relationships. I wondered how the psychologist drew attention to the children and to her so that they could notice what they were doing well, and to take a far more strength based perspective to their own lives and relationships.
Emi (15:29): Yeah, well, asking lots of questions and she really got down to their level physically, but also emotionally. Just in her mannerisms, she was smiling, very smiling and had a really expressive face and looked directly at them and talked directly to them, and was really gentle. So with the questions, it wasn’t like bang, bang, bang. She’d ask a question and then wait a bit, so there was just a relaxed air in the room, I guess, through that gentleness. And it’s probably to do with silences as well, with allowing the kid space to talk, things like that.
(16:08): I guess the other thing is that I know as a parent, I was carrying away a lot of shame, and now, I’m able to realise too that my children probably were as well, carrying around a lot of shame and so it would’ve been really easy to fall back into that pit of shame. And so I think it was really important for the counsellor to focus on the bits that allowed us to feel pride, because I know now that there were a lot of things that we could feel pride about, even though it was a really ugly situation. We did some of it really well and that counsellor was able to bring that out so that we could come out of there and feel good about ourselves, instead of feeling like we were really trashy.
(16:49): Because when we were homeless, we’d gone into so many real estate agents and they wouldn’t show us a list, and you just felt just like trash to be honest. And we’d only just… Oh, I don’t know how long we’ve been housed for. Anyway, we had been housed but it was still pretty new so we still felt pretty trashy. And I guess maybe looking back, that counsellor was part of that turning point of allowing us to step away from that a bit.
Dan Moss (17:16): Some of what our three interviewees have described is important throughout the engagement process, is this idea of understanding thoroughly where the child is at and using the context of the whole child to help negotiate what it is that will be talked about within the therapeutic process or the activities that will be embarked upon during therapy. Ali Knight described how she does this in her own practise with infants and children and their parents.
Ali Knight (17:45): Yeah. So I think it’s about spending time to really understand that child’s world, and I’d be focusing on trying to get a sense of what’s happening around them and what’s going on in the family, if they’re at school or outside of that. It’s almost like you trying to put yourself in their… What it would be like in their world. A sense of how their parents are responding to them and is it in a way that’s going to support that child or not? That may be where the work needs to happen so getting a good sense of that.
Dan Moss (18:17): I asked Jess if she has seen practitioners pick up on cues that the child might be exhibiting in the session to help them negotiate the pace or the activities within a session.
Jess (18:29): Definitely. I think one of the biggest concerns, especially from the child’s point of view, is what is going to happen today? What’s going to happen in this appointment? And so when they come in and they realise there might be a little bit of freedom, maybe to play with toys or to do some colouring in, they’ll want to push that a little bit further if they can. The best one I’ve seen is the child stuck their head under the couch and didn’t want to look at the practitioner at all and was playing with the toy under there. And the practitioner, instead of reprimanding her or trying to coax her out, she actually got down next to the child at their level and asked if they could put their head under the couch with them. And they just talked about the toy that she was holding and what they were doing with it to make her feel a little bit more comfortable about that adult, that strange adult she’s never met before trying to talk to her about things.
(19:25): I think you have to be willing to be a little bit flexible and I think using the things you’ve got and the tools you’ve got will definitely help the child feel more comfortable about the whole experience.
Dan Moss (19:37): Oh, great. Thanks. That’s such a great example.
Jess (19:39): It was very, very powerful to watch it happen.
Dan Moss (19:42): What was the effect on the child in that situation?
Jess (19:45): She was quite comfortable, so she stayed there as long as she needed to and eventually come back out from under the couch. But I think for her, she’d never experienced adults in her life being that silly, that curious to see what was under there, making her wanting to be away from everything else but just accepting her where she’s at. And if hiding under the couch was what she needed, then that was okay.
Dan Moss (20:12): I asked Emi what helped her practitioner to work with her and her children to help to understand and to react to the cues that the psychologist observed, and in this way, helping the children to be able to be active and negotiating the activities and the discussions during therapy.
Emi (20:30): Talking, definitely talking, but building up that relationship first. Nothing would’ve happened without that trust being built first, so those first sessions of finding that balance, setting the scene that this is going to be okay, and then just going slowly. So it was just a long term thing, just talking, talking to all of us in the room, picking out something when it came. Picking out the positives and then repeating it back so that we could hear somebody else say to us from what we’d said, “Oh, well that’s really good. You told me you did this and wow, that would’ve been fantastic. What made you think of doing this?” Do you know what I mean? So picking the positives out of complexity and then having conversation around that positive and drawing that positive out.
Dan Moss (21:21): So a lot of the engagement and assessment strategies that we’ve talked about today have involved working holistically with the child and understanding the context of the parent or the caregiver to assist engagement in the therapeutic process. So I asked Ali specifically about her intention to include the parent or caregiver wherever possible throughout the engagement process so that they can be present in the conversation with the child. In this way, I asked Ali whether it was important to prioritise the importance of the parent or caregiver/child relationship as even more crucial or important than the relationship between the therapist and the child.
Ali Knight (21:59): Yeah, that’s right, and I think sometimes, that comes up as a surprise for families so I think it’s really good to be upfront about that and if you get a sense that the parent’s really not very confident about the role they’ve got in their life, to try and sort of lift that up a bit as you begin to work with the family. It’s really important.
(22:17): A lot of the work I’ve done with parents is that there is a lot going on for them in their lives and they’ve had lots of issues, whether it’s their own experience of trauma or some struggles around drug abuse or their relationships might have been violent. So they’re really big issues but you really need to attend to where that parent’s at because they’re not going to be able to really support their child very well if they’re struggling with all those issues and they’re getting in the way. So it’s good to be able to spend time with the parent on their own and really be able to support them with where they’re at with that, but also to have the parent and child together. So if you can mix, do a bit of a mix of different things, I think that can often work well when you’re working with really young children.
Dan Moss (22:56): I asked Jess, as a caregiver and as a professional, how important it is to work with both the parents or caregiver and child to develop strategies and solutions that both best fit for the child, but also those strategies that can be replicated at home after the therapy session has concluded?
Jess (23:16): I think it is important to include the child and talk to them about what’s going on, because they are the experts of their lives. The school and the parents or the caregivers at home, they’ve only got a piece of the puzzle or a piece of the picture and they’re looking at it through their own lens, their own eyes and I think when you look at the child, they’ve got the bigger picture. They’ve experienced whatever this problem is within themselves, so I think it’s important to include them and make sure that you’ve got a full picture from them. Because those adults might be missing something and if you don’t include the child, you’re kind of missing the point. You need to have them on board to be able to make those changes. If they’re not on board and they don’t want to make them, then it’s not going to actually happen.
Dan Moss (24:00): I asked Emi about some of the useful strategies that her psychologist used to help her to understand the history of Emi’s relationships with her children and how these relationships could be nurtured and sustained, and how the strengths that both Emi brought to the relationship, but also the strengths of her children could be replicated and used and prioritised when things were tough.
Emi (24:23): Start off on the whiteboard, I think that was really good. I’m really into mind mapping because I think it really gets your thoughts out of your head and onto something external, so just by starting off with doing a family tree, because with a family tree, you’re building it so you don’t really focus on one element. That allowed us to be able to explain our family situation, but because we were building the tree, we couldn’t get stuck on one particular part. Because if I was just talking about what led us to where we were, which is basically my ex and all the stuff around that, I just would’ve got stuck talking about that forever, but doing that family tree allowed us to be able to move on. And it also allowed the counsellor to get a sense of our family, where we fit in all that and the people who weren’t in the room as well, like my two older children.
(25:15): It always broke the ice as well because if it had just been about fun, then it would’ve been like, what are we doing here? So I guess it was about finding that balance, so the family tree allowed us to be able to talk about, a little bit, some of the situations while we were there, where the kids fitted in with that and where I fitted in with that, but also then doing the fine side of things was about getting that balance and not all difficult territory and not all fun as well.
Dan Moss (25:43): Great. So I’m sure you’ll all agree that the input of our three guests, Emi and Jess, our child and family partners, and Ali Knight have been fantastic and insightful. To Emi and Jess, thank you once again for your contribution, not only to this podcast, but over the course of the Emerging Minds Webinar Practise Strategies for Engagement and Assessment. Similarly, Ali, throughout this process, thank you so much for sharing the benefits of your 25 years experience as a social worker.
(26:15): I’d just also like to take this opportunity to thank the lived experience of our child and family partners, which is so integral to the work that we do here at Emerging Minds. And I’d just like to send a special thanks, not only to Emi and Jess who have been so wonderful, but to all of our partners who work so generously with us to share their wisdom and experience.
(26:36): So that ends our podcast today. Thank you all for joining us, but once again, if you are interested in our practice strategies e-learning courses or any of the resources which exist on our website, please visit us on www.emergingminds.com.au.
Narrator (26:55): Visit our website at www.emergingminds.com.au to access a range of resources to assist your practise. Brought to you by the National Workforce Centre for Child Mental Health, led by Emerging Minds. The National Workforce Centre for Child Mental Health is funded by the Australian Government Department of Health under the National Support for Child and Youth Mental Health Program.