Transcript for
Professional roles in child mental health support

Narrator (00:02):

Welcome to the Emerging Minds podcast.

Joss Marsland (00:07):

Hi everyone, welcome to the Emerging Minds podcast. I’m Joss Marsland, and today I’m chatting with mental health professionals about their work with children and families, and how they collaborate and work together often as a team to support families. Each of them comes from a different discipline and professional background. We’ll be hearing from Gabrielle Hart, an infant child and adolescent psychiatrist in private practice. Marnie Winterford, a clinical psychologist with a specialty in supporting young children and adolescents. Gill Munro, who comes with many years of experience managing a large drug and alcohol rehab service in South Australia. Ali Chisholm, an occupational therapist who works in an early childhood and family team and community health. As well as Fiona Bottroff, a speech pathologist, also from an early childhood and family team.

Joss Marsland (00:57):

Each of these practitioners share their experience of collaborating with parents, children and other professionals to support child mental health, each bringing a different lens and expertise. So let’s get started. First up as Gill. Thanks for joining us today, Gill. We’re going to be chatting about your role as a social worker in the community. And I’m interested to know more about the types of social work roles in that space.

Gill Munro (01:21):

So social workers might work in government organisations, not for profit organisations in services that work with families. And that can be all sorts of things, such as drug and alcohol services and homelessness, and family violence, and family counselling, and child protection, out of home care. They also might work in schools and hospitals. So quite a lot of different settings, really.

Joss Marsland (01:45):

And in these roles, when working with parents who have concerns about their child’s mental health, what are the common issues that they might raise with you?

Gill Munro (01:53):

Parents will be concerned about lots of things with their children from time to time. And they often won’t describe that obviously as the child’s mental health. But it will be things like behaviours, tantrums acting out. It might also be sleep issues, eating issues, making friends, and how many social supports the children have. It can also, as children, get older and even from quite young, I guess, be about the technology, their use of technology and the amounts of time they want to be on the phone, or on the screen, playing games. And parents can often not be sure what children are doing then. So that can be a concern as well.

Joss Marsland (02:31):

Thanks, Gill. Can you tell us a little bit about how you might approach working with families in the community?

Gill Munro (02:37):

Social work’s a very collaborative. We take a team approach, and it’s all about this walking alongside parents and carers to ensure that they get all of the supports that they need. So often families will turn up and they may have multiple issues, such as housing issues, financial problems, loss of job, or violence in the family. All sorts of things may be impacting a family. And social workers will take that really holistic view of trying to chip away at some of these various issues, whilst also continuing to work with the parent and child themselves. So yeah, it’s that really holistic approach. And then I think with children, we know that their mental health exists within an ecology basically. And the most important thing of their ecology is their parents and family.

Gill Munro (03:25):

So it’s about strengthening the parent child relationship, but it’s also about looking at other things such as schooling, and health issues, and social issues, and all sorts of other things, neighbourhood issues, maybe that may be impacting upon the child.

Joss Marsland (03:39):

Thanks so much. That’s great. So I’m also going to be talking with Marnie, a clinical psychologist. And we’ll hear about her role in supporting children and families. Thanks for joining us today, Marnie.

Marnie Winterford (03:50):

My pleasure.

Joss Marsland (03:51):

Marnie, you have experience in both public and private mental health. Can you describe a bit about your role in an early childhood and family team?

Marnie Winterford (03:59):

Yes. So I work with other health professionals, so speech pathology, occupational therapy, and paediatric registrar. We also have a creche coordinator, who helps run our children who need care attending groups. So my role is really around behaviour management, parents needing support with that, children with developmental delays, assisting diagnoses and getting further assessments completed, seeing clients individually and also running developmental groups. So our clients are zero to six years of age with delays in developments.

Joss Marsland (04:38):

So I’m also curious about why toddlers in preschoolers might come in to see you, and what are their common presentations?

Marnie Winterford (04:46):

The main concerns that parents have around toddling sleeping, eating issues, or big meltdowns and tantrums, not being able to handle them. They’re just overwhelming for the family. Might be a developmental concern about, “How do you think my child’s going in this area?” To possibly look at what their concerns might be with their child’s development and to see whether we need to refer on to formal assessment for autism or global delay, or that kind of thing.

Joss Marsland (05:16):

Thanks, Marnie. Can you describe what that first session might look like?

Marnie Winterford (05:21):

So definitely see parent and child together. We wouldn’t never see the little one on their own. We look a lot at the parent child relationship and their attachment, and how the development occurs within that relationship. If there’s any struggles or history around postnatal depression or for dad’s trouble adjusting, that kind of thing. So we would just have a play-based session with a child. Typically in my early childhood role, I’ve got another clinician with me. So that will be either I speak to your OT. And we’ll do a tag team about finding out from the parents what their concerns are, why they’ve come along. Generally, they’ve been referred from a GP or CAFS nurse, or a children’s centre, or that kind of thing.

Marnie Winterford (06:06):

So we’ll just see what their concerns are, if the parents are as concerned as their referrer in that time. We’ll have a look at the child, how they’re engaging with us, how they’re relating to the parent in the room, what they’re playing with, what their development’s like, how much they’re talking, and jumping, and running, and that kind of thing. So we get a fair understanding about where we might go after the first session together.

Joss Marsland (06:31):

Sounds like a really valuable service where families can get some support with their young ones. And you mentioned you were also work privately with older children. Can you describe how this differs and what presentations you often see in children in this role?

Marnie Winterford (06:44):

Yeah. So that’s with children three to 18 years of age, so a broader age range. So my role there is really seeing children with a range of different concerns from the littlest with with behaviour management issues, supporting parents in their role. A lot of anxiety and depression with the older age ranges, a lot of self harm with teenagers, peer issues, school concerns, trauma and abuse backgrounds, that kind of thing. So yeah, supporting people in therapy and counselling in that role. Anxiety would be the biggest presenting issue. And that can show up quite obviously in separation issues or phobias or fears about specific things. But also lots of sleep problems, lots of school refusal, separated families, anxiety around going to access returning to and from depression, probably with the older age range of teenagers, working out identity and sexuality.

Joss Marsland (07:52):

And if children want to access psychology, what’s the referral process for them?

Marnie Winterford (07:56):

Generally, kids and teens get a mental health care plan from the GP. In fact, they have to have that as the gateway in. So parents or carers will present to the GP with their concerns. And then the GP will have a chat with them and write a mental health care plan for typically six sessions to start with. And then we start from there. Children or young people can go on to need further sessions. And then we go back to the GP, talk about the work we’ve done so far. And if there’s a re-referral required, then we ask from there. But generally it’s mental health care plan to come in. Or the other main funding stream is NDIS. We see children with NDIS plans as well.

Joss Marsland (08:42):

Okay. Thanks, Marnie. It does sound like the GP is often the place to start if parents have concerns for the children’s social and emotional development. Does the mental health treatment plan provide some rebate to parents?

Marnie Winterford (08:54):

Under Medicare, part of it’s covered.

Joss Marsland (08:58):

When would you recommend that parents access some supports?

Marnie Winterford (09:01):

I would generally recommend that parents or carers seek support when they feel as though they’re becoming overwhelmed or just completely at the end of their tether with what’s going on for them in trying to support their child in their behaviour or any of their functional daily skills, then might be needing a little bit more input, some ideas around what they could do differently.

Joss Marsland (09:24):

I imagine it might at times be hard for a parent to know whether their child needs a psychiatrist or a psychologist. Would you be able to take us through the difference?

Marnie Winterford (09:32):

So the main difference is psychiatrists are medical doctors who have got specialist training after they’ve done their medical degree. So they do therapy and counselling as well, but they can also prescribe medication for children and teenagers, whereas psychologists can’t. So the therapeutic approaches might be similar, but the main difference is that psychiatrists will use medications if needed and where necessary. I think psychiatry and psychology compliment each other quite well. And there certainly a few clients I have really benefited from having both.

Joss Marsland (10:09):

Thanks so much, Marnie. Next we’ll hear from Gabriel, a child and adolescent psychiatrist. Thanks for coming in today. We’d love to hear a little bit about your work and your role.

Gabrielle Hart (10:19):

Sure. So I’m a child and adolescent psychiatrist and a family psychiatrist. And I work from my own practise in Dulwich private practise. And I generally work with inference from birth up to the age of early adolescent.

Joss Marsland (10:37):

Thanks, Gabrielle. So it’s probably not as well known to hear about the role of psychiatrist supporting infants mental health. Can you tell us some more about your work in that area?

Gabrielle Hart (10:47):

Some of the infants that I see are from families that faced difficult circumstances, and that can be issues associated with grief and loss, or relationship breakdown, and obviously sadly, violence, family violence, infants who have fled that kind of situation. So in that example, my role would be to assist the infant and their caregiver in their recovery process from a traumatic event. And that’s usually done carefully with both the caregiver and the infant supporting their relationship, ensuring also that caregivers have the care that they need for their own mental health.

Gabrielle Hart (11:32):

We are possible, it’s often a play-based intervention. But my work has many different aspects, such as helping the caregiver to understand the symptoms that the infant might be going through, what that means in terms of their development, and perhaps why the symptoms are there to give hope and foster recovery as well, and developmental support for the infant. I guess some other examples would be infants with troubles settling emotionally, so trouble settling to sleep, feeding troubles. And infant irritability. And occasionally, infants when they’ve been through a lot of trauma or distress can actually withdraw into their own little shell. So that can be a way that the infant shows us that they’re struggling.

Joss Marsland (12:25):

So Marnie and Gill have already mentioned some signs that infants and young children might show that indicate they’re having some struggles. What do you look out when it comes to infants?

Gabrielle Hart (12:34):

I think some red flags can be perhaps also noted… We’ve talked about perhaps infants struggling to settle, or to feed, or to sleep, or perhaps not engaging with their caregiver, with their gaze, infant gaze. Their eye contact is really, really important. So there’s those little signs that perhaps we might notice aren’t quite there, and we would like to know why. But I guess other red flags are to do with perhaps how the caregivers are feeling, because the world of the infant is very much the health and wellbeing of the caregiver and the family unit around the. So, for example, if we could see the caregiver was really struggling to see the infant for what they are. Sometimes they might be struggling so much with their own depression, or fatigue, or anxiety that they’re having trouble actually looking at what the infant is trying to say, or what the infant might be needing.

Gabrielle Hart (13:36):

And they can sometimes accidentally almost misinterpret things, or have some old ideas in their own mind due to their own stress or trauma from their own background. So some of the infant work to support the mother and baby or the main caregiver and baby to see each other, can be to take the time to really help the caregiver see their child and what their child might be trying to say with some of their symptoms or struggles. And trying to do that in a very caring way, where we wonder, and we are really curious together about what this baby is going through at this moment in time.

Joss Marsland (14:16):

Thanks, Gabrielle. If parents have concerns or want to access some supports when they feel like they’re needing some help, where would they go? This is with their infant.

Gabrielle Hart (14:25):

Well, in my role as a private practitioner, infants would generally be referred perhaps by the general practitioner, their local GP. At times, psychologists who have perhaps worked closely with mothers. And there are many perinatal psychologists and psychiatrists who work closely with mothers grappling with their own mental health issues, like postnatal depression. I guess community child and maternal health nurses are really important. They have contact with babies and their caregivers. So I can notice when things are perhaps not going so well, and can mention the role of an infant psychiatrist as a possible source of help.

Joss Marsland (15:07):

What do you consider are some of the protective factors that enhances social and emotional wellbeing of infants and children? And how do you hope to strengthen these in families?

Gabrielle Hart (15:17):

I think, for me in my work, I most hope to intervene to support the relationship with the caregiver, because the infant’s world, of course, is also things like community in school. But the key source of health is the health of their family and their main caregivers. So the greatest force to strengthen the child’s health is the relationship. How do we foster that relationship? And like any relationship, it will have moments of struggles where perhaps the parent or the child are a little bit lost and have misunderstood one another, or they’re not seeing each other clearly. And that’s part of relationships. So that’s a powerful role for a child psychiatrist to help them to see one another. With difficult emotions, distress, sadness, anger, grief, younger children still require a lot of what we call co-regulation. And co-regulation is when the caregivers support the child to express their feelings, if they can. But also to help find ways to help them soothe the distress.

Gabrielle Hart (16:29):

And that’s the foundation for mental health. For mental health, we to be able to speak up and voice if we’re in discomfort or in distressed, but also learn soothing ways, and to know that painful emotions do pass. But we learned that in our early life, through our relationships and the soothing relationships, where, of course, parents can’t always be there. But when they are there, they try their best to try and be curious or respond as best they can if the child is in distress.

Gabrielle Hart (17:01):

And we know that we get it wrong and that’s okay, that’s all of us as parents. But that’s the spirit of trying to foster our children, having a voice and expressing their distress, and giving them super to show that we can help them manage that.

Joss Marsland (17:17):

What’s important for parents to consider when seeking support for their children’s mental health. Do you have any key recommendations?

Gabrielle Hart (17:25):

I know it can be very challenging, because the workforce can be limited and waiting lists can be significant. So, as we have said, your GP is often your very first port of call to support you in that process of finding the right person. I think children need to feel comfortable with the clinician, the professional they’re working with. And it’s important to listen to your child in relation to that. Mental health support is often based on a human relationship with the professional you see.

Gabrielle Hart (18:00):

So if the child is not comfortable with that professional, that’s a bit tricky. So it can be at times a little bit of time finding the right clinician. And I think in seeking support, it’s important to ask about, perhaps if possible, what that psychologist or mental health clinician, perhaps, specialises in, what their areas of interest are, and perhaps what models of therapy they may use in their practise. Because psychiatrists and psychologists vary greatly in terms of the conditions that they look after, and also their focus. Some focus more on developmental conditions, like perhaps the autism spectrum conditions. Some such as myself work more in the field of trauma or the parent child relationship, and improving attachments between children and their family. So actually, there’s a large variety of what is offered from a different mental health clinician.

Joss Marsland (19:03):

Thanks so much, Gabrielle, for chatting with us, and giving some insight into your role, and also where and how families can access some. So today we’re also going to hear from an occupational therapist and a speech pathologist about their role in supporting child mental health in the community. So welcome, Fiona. Thanks for joining us. Similar to Marnie, you work in an early childhood and family service. Can you tell us some more about your role as a speech pathologist in the team, and why children come to see you?

Fiona Bottroff (19:31):

I work in a multidisciplinary team for community health. So usually ,we’re the first port of call for children or families who might have concerns about their children’s communication. So my role is to assess and provide therapy, support those children and families for communication difficulties. So quite often we get referrals for children who are late to talk. We quite often get concerns from families about behavioural challenges. So children who can be either really quite aggressive, or have trouble making friends with other children, tricky to take places with their families. And sometimes the children who, if they are talking, they might not be clear, which can then also impact on their social, emotional development too. So that can really impact on how they interact with others.

Joss Marsland (20:19):

Thanks, Fiona. I’m also curious about what parents notice in their child that may lead them to access some help from you about their mental health.

Fiona Bottroff (20:27):

Quite often, parents wouldn’t name. They see it as a mental health difficulty, but they might come to us with concerns about their child’s behaviour being challenging for them, or the difficulty that they have interacting with other children in different environments. They might be shy or withdrawn or anxious children. So they’re the things that are red flags for us to look into and to support the family with in terms of accessing wider supports with our team. So we can certainly be a part of that process and assess their communication, because it can be bi-directional. So communication difficulties can impact on a child’s mental health, and then a child’s to health might really impact their ability to communicate and engage with their world and other people.

Joss Marsland (21:12):

So how do you then invite parents to consider that their children might be experiencing additional needs more than just their language development?

Fiona Bottroff (21:21):

So sometimes parents interpret their children’s behaviour as naughty or intentional. And they can be quite reactive to those situations. And they might think that their child’s doing it on purpose. Where we support families to look at, I guess, what the child might be experiencing from their perspective. It could be that the language difficulties are causing a lot of frustration. It could be that they’ve got some sensory processing difficulties that make processing things around them really tricky and interacting with others really tricky.

Fiona Bottroff (21:57):

Sometimes it could be attachment difficulties between parent and child, depending on the parent’s mental health. So as a team, we can support the whole family, not just child, in getting extra help, or we have social workers in our team. We have occupational therapist in our team as well, that can support us to work on those goals. Firstly, we’d like to address what the parents goals are. So we work very strongly with the parents and recognising the parents as the expert with their kids.

Joss Marsland (22:29):

Thanks so much, Fiona. So we also know that occupational therapists can work with children and families to support mental health. So let’s hear from Ali Chisholm about the role of OTs, working with families.

Ali Chisholm (22:41):

In my role, working with children, I’m often working with parents and children together. And my role is about supporting parents in their role as a parent and supporting their child with their development. So an OT will focus on the development of a child in all areas of development. So we may be looking at play skills, motor skill development, emotional regulation, social skills, children are often referred for occupational therapy, they may be experiencing difficulties with an everyday task or with their development. So there may be some difficulties with sleep issues, or feeding. Some children present with some fussy eating behaviours, or sometimes it’s around behavioural, or difficulties managing their emotions. And as an OT, we may be part of a bigger team to try and determine and what might be happening for the child and for the parent.

Ali Chisholm (23:33):

Some common presentations are that children, they may have a delay in their motor skill development. They may be having difficulties learning how to play or something might be getting in the way. Parents may report that they have really big feelings, and it’s starting to impact family functioning. Or that they may be having difficulties at childcare or at school. There are some occupational therapies that have additional training, and they’re endorsed to be mental health occupational therapists. And these OTs are available to access privately via a GP mental health care treatment plan. Families can go to their GP and talk to their GP about what might be going on, and explore whether an OT would be an appropriate referral and appropriate supports for that child and family.

Ali Chisholm (24:16):

And that will entitle them to about approximately 10 sessions per calendar year to have some Medicare rebate, to help with funding private occupational therapy. And sometimes that can be extended up to 20 sessions in a calendar year. So that can help families.

Joss Marsland (24:30):

Thanks, Ali. And what can a parent expect when they bring their child to a first session?

Ali Chisholm (24:35):

So the first session, when families are first coming along to a first session, they’re not sure what to expect. Because not many people know what occupational therapy is. And I think one of the core principles of any OT is to make it meaningful. So it relies meaningful occupation and what matters. And for children, that’s what are children… Their meaningful occupation is having fun, learning and playing often. And occupational therapy usually consists of a playroom and there’s lots of activities in there. So it depends on the age of the child as to what activities we might have. But a typical OT room may have some big physical play activity, and swings, and trampolines, and things to support child’s regulation.

Ali Chisholm (25:15):

And also they may have some plat toys, and play activities, some fine motor or drawing activities. And the first session is really about getting history from the parent and finding out what the concerns are. And then some opportunity to observe the child and see how they go approaching play, how they are interacting with others. And some occupationals then will do a formal assessment at that time, and provide feedback to the parent about how OT could support them with what’s happening for the child.

Joss Marsland (25:46):

Can you band on there a little? What can an OT offer a parent to support their child’s social and emotional wellbeing?

Ali Chisholm (25:53):

I think occupational therapy can take on many roles in their support with parents. They can provide parenting support, they can provide child development knowledge and information around child development, information around parenting, support with perhaps settling and sleep issues, support around feeding. So it’s really about working out what is it that is happening for the child in the context of their home, or school, or with their friends. And then trying to work together to identify the goals and then work out what’s going to best suit them. Often parents are looking for strategies that they can incorporate at home or strategies at school.

Ali Chisholm (26:25):

And so it really is a quite family focused and clients centred, and trying to work out what’s best for that parent. And often, an OT will work with other professionals to work out who might be providing more support for the child.

Joss Marsland (26:36):

So do you have any key messages for parents if they were seeking support for the child’s social and emotional wellbeing?

Ali Chisholm (26:42):

My key message is that parents that have any concerns about their child’s development or their social, emotional wellbeing, their behaviour, then I’d encourage them to ask them questions, speak to their GP about that. They may already have a paediatrician that they’ve seen before, or they could access a child and family health nurse. They may speak to their teacher, or their kindie teacher. It may be just through their local playgroup. There’s lots of people that could point them in the right direction. There’s a website, Raising Children. They may find some information around child development there.

Ali Chisholm (27:14):

But often just asking and seeking help. And there are services… There are supports out there that can really help families in their role as parents and parenting a child maybe having some struggles. I think the other thing that my key message is that it’s quite common that at some point, as parents, we’re having difficulties with our children and parenting, and it’s okay to reach out and ask them and say, “Hey, this isn’t really… This is not going how I expected it. This is not what I was thinking or I don’t feel like things are going well.” And it’s a good place to start to just ask for some help, or even just have a chat with someone about it. And that can be reassuring. And then if there’s any more support that’s needed, then the referrals can be made or they can reach out to who they need.

Joss Marsland (27:54):

Thanks, Ali. That’s great. And thank you to all of our guests today for sharing your insights, and thanks to our listeners for joining us.

Narrator (28:02):

Visit our website at wuww.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.