Paediatric Psychology Team

Who are we?

The children's Paediatric Psychology Service (PPS), delivers specialist treatment for children and young people with serious, life-threatening or significant physical health problems and their families, aimed at helping them to cope with, and adjust to their conditions. The service works only with specific targeted teams and diagnoses, which are:

• Diabetes
• Oncology & Haematology
• Cystic Fibrosis
• Chronic Constipation MDT (Telford only)
• Muscular Dystrophy or other neuromuscular conditions
• Children receiving services from the Community Children’s Nursing Team (CCN)

There is also some limited capacity for referrals where there is a need for a focused, discrete and short-term intervention preparing phobic children for a planned medical procedure. This work excludes detailed assessment/intervention for other difficulties falling outside our targeted paediatric remit.

When young people have serious physical health problems it can be very distressing for them and for everyone in the family. Our service offers a chance for young people and their families to talk about how this makes them feel, and where necessary suggest strategies or ways of dealing with things that can help them to cope better with their situation. The way individual children and families cope with, and adjust to, the challenges they face can be supported by offering well-researched and tested psychological interventions. (broadly, psychological interventions address how people think, feel and behave). Although we can offer emotional support as well, this is only a part of what we do.

When we meet, we aim to discuss carefully with each child, young person and their family what is needed and agree together what might be useful. This can be short-term input or may involve contact "on-and-off" over the longer term, depending on the need of the individuals concerned. We also discuss what might be helpful with the treating team(s), who may be local or regional services, to make sure their thoughts and views are included in the decision.

The first thing we do is meet with the young person concerned, usually along with their parents/carers, and talk together about their situation so that we identify what the important issues are to them. Being in receipt of long-term medical treatment and working with medical teams can be a challenge for families in itself, and so we also make sure that we work very closely with the medical teams to help them understand the impact of treatment on the child and family so that they in turn can, where possible, adjust how they deliver the treatment.

As psychologists we are also available to professionals in the relevant multidisciplinary teams to help them understand the psychological impact of illness and treatment on their patients. Psychologists can often help the team reach a wider understanding of the child’s needs and circumstances and they can help inform the planning of treatment as it continues. Psychologists might also help to predict, and resolve, particular difficulties or responses to aspects of treatment, and we may be part of discussions about why things might not be going smoothly, so that these can be sorted out wherever possible. Having a chance to talk regularly in a confidential session often helps children and families feel that their experiences are better understood by the whole team; so that their experiences, beliefs, choices, reactions and behaviours are taken into account as treatment progresses.

The psychologist can help negotiate how and when that agreed information is shared with the wider team afterwards so that everyone works together in a consistent and fully-informed way. This helps everyone feel they have a good working relationship and are pulling together in the interests of the child/young person. Psychologists also have an important role in helping everyone remember that some upsets and difficulties might be normal in these unusual circumstances, and can help reduce disagreement or misunderstanding at times of particular stress and difficulty.

Psychologists reach a “formulation” about what is happening for a particular child or family by thinking about a whole range of issues, not just the illness – these include thinking about the child’s life experiences in general, their development, their temperament, and their family and school life. In this way psychologists do not “diagnose” a difficulty, but they try to come to a wider and fully-informed understanding of the particular issues for the child/family, in the context they find themselves in, and adjust this understanding as things change and progress.

What type of professionals work for the service - who you are likely to see and why

The service is provided by paediatric clinical psychologists.

A clinical psychologist is someone who has been trained to help people make sense of their difficulties and think about the best way of dealing with them. This will include thinking about the background to their situation, perhaps learning to develop different ways of coping and sometimes having to make difficult or painful changes. Discussions often involve all those people in the family who are concerned, as long as they are happy to be involved.

Psychologists will not make decisions for you, but will take your difficulties seriously and, where appropriate, offer some help in dealing with them. Clinical psychologists are not medically qualified. Paediatric clinical psychologists have specialised in working with children with physical health challenges.

Our services

The targeted areas currently include:

• Diabetes
• Oncology and haematology
• Children with palliative care needs
• Cystic fibrosis
• Muscular dystrophy or other neuromuscular conditions
• Children with an allocated Community Children’s Nurse (CCN)
• Children seen by the nurse-led chronic constipation service (Telford only)
• (By negotiation) children requiring preparation for a planned invasive procedure if this has been agreed with the treating doctor.

The service is available across the whole of Shropshire, except for the nurse-led chronic constipation service which is only for patients in the Telford and Wrekin area.

The psychology input for children and young people with muscular dystrophy or other neuromuscular conditions is based within the Muscle Team at the Robert Jones & Agnes Hunt NHS Hospital Trust (RJAH Muscle Team).

The psychologists in the team also work to help and support other professionals in paediatric teams, giving advice, and helping them think about the broader psychological factors that might be impacting on children, young people and their families, so that everyone involved takes into account the "whole picture". Therefore at times the psychologists may be involved "behind the scenes" with the treating team, and not just seeing families face-to-face themselves.

The people we see

The service works with children and young people resident in Telford and Wrekin and/or Shropshire aged 0 to 18 and their families. It also has arrangements to see some families from Powys and other areas by prior agreement with commissioners in those areas.

Referral criteria include that the primary presenting problem is around physical health and its impacts - the service is not a mental health provision and children with primarily mental health needs would be seen by the "Bee-U" Emotional Health and Wellbeing Service (formerly CAMHS) rather than this service. The service does not accept referrals for areas other than the targeted ones above.

Where Will We See You?

Initial contact with the paediatric psychologist can be made with families either in the medical clinic, or following referral the team will contact the family directly to discuss what would be the best way to help. Initial discussions will include thinking about what kind of help is wanted or needed, who needs it, and how/where it can be arranged. We meet with children and families in clinics, in our own meeting rooms, or sometimes in their home if this is appropriate. The service is voluntary so we never arrange to meet people unless they are happy to do so.

When children and young people have serious physical health problems it is often very upsetting and difficult for close family members too. We work with parents, brothers and sisters and other family members to cope with the impact of these physical health problems at times, and if needed. For example, this may include helping parents manage the demands of poorly children at the same time as thinking about how their 'healthy' brothers and sisters feel and react; helping parents with different ways of coping and to try to keep working together as a couple; helping individual family members (including brothers and sisters) find a safe, confidential place to talk about what is happening and how it affects them.

New patients

Patients are seen following discussion with the treating team(s) looking after them. Patients can also be referred by their Community Children’s Nurse (CCN).

Children Needing Help With Procedures

For children requiring help with preparing for an invasive procedure, a discussion with the treating doctor needs to take place regarding what is needed, and if appropriate either advice is provided by the psychologist directly to the treating team, or a referral for face-to-face input is made by the professional along with details of the planned procedure.

When intervention is needed because a child has a severe anxiety about a planned operation or procedure the medic/team who is planning the operation, the community children’s nurse/school nurse, or sometimes the GP will contact us to discuss whether we are able to help. The discussion will outline the specific details of the procedure and what the difficulty seems to be for the child.

This part of our service is very limited and so we need to ensure that we only become involved if we feel we can be of help. For example, if the operation is not urgent/medically necessary or is voluntary, and the child concerned is declining it, providing our Paediatric Psychology Service support is unlikely to be successful without the willingness of the young person to accept our help. In these circumstances parental advice can be provided (please note leaflet on website). At other times if the child’s medical treatment (and the procedure) is not being done locally but is being carried out elsewhere, it is usually more effective to work with those teams in those specific settings.

Patients are usually seen with their parents/carers. For older children, the service would need to gain parental consent if they were just to meet the patient on their own. We try to make sure that everyone affected by the illness/condition is involved, if this is helpful, and if they wish to be. This includes parents and carers, brothers and sisters, and maybe the wider family as well.

We do not generally operate a waiting list for our services.

Services we do not offer

The service is not a mental health provision and children with primarily mental health needs should be seen by the "Bee-U" Emotional Health and Wellbeing Service (formerly CAMHS) rather than this service. The service does not accept referrals for areas other than the targeted ones listed above (see "Our Services").