Psychology in the CDC

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.

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 family what is needed and agree together what might be useful – this can be short-term or may involve contact on-and-off over the long term, depending on need. We also discuss this with the treating team to make sure their thoughts are included in the decision.

A way of describing what the interventions we offer are, is to say that first off all we meet with the young person concerned, usually along with their parents/carers, and talk together about what has happened 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 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 can, where possible, adjust how they deliver the treatment.

As team members we are also available to professionals to help them understand the psychological impact of illness and treatment on their patients, too. 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 predict, and resolve, particular difficulties or responses to aspects of treatment, and 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 that 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; children with an allocated Community Children’s Nurse (CCN); children seen by the nurse-led chronic constipation service (Telford only); and sometimes with 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 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 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. 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 CAMHS rather than this service. The service does not accept referrals for areas other than the targeted ones above.

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 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 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. For example, this may include helping parents manage the demands of poorly children at the same time as thinking about how their brothers and sisters feel and react; helping parents with different ways of coping try and 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 looking after them. Patients can also be referred by their Community Children’s Nurse.

For children requiring help with preparing for an invasive procedure, a discussion would take place regarding what is needed, and a referral would then need to be made by a professional 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 by the family 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 support is unlikely to be successful without the willingness of the young person to accept 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 more effective to work with those teams who know the best way to help children cope with their procedures and 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. The team tries 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 would be seen by CAMHS (Child and Adolescent Mental Health service) rather than this service. The service does not accept referrals for areas other than the targeted ones listed above (see "Our Services").

 

Special Educational Needs and Disability (SEND) and our "Local Offer"

What is the Local Offer?

The local offer provides information for children and young people with special educational needs (SEND) and their parents or carers in a single place. You can find out more about information about this on our SEND reforms and Local Offers page.

Service Description

The Paediatric Psychology Servce (PPS) works with children and young people with serious physical health problems, within certain targeted teams or conditions, including for those with special educational needs or disabilities.

Please see the web page for the service for details about how they work.

What do you provide to children and young people with an additional need and or disability 0-25yrs?

Initial contact with the paediatric psychologist can be made with families either in the medical clinic, or following a referral the team will contact the family directly to discuss what would be the best way to help. Sometimes we work with other teams already supporting the family rather than seeing people face-to-face ourselves - for example we might advise the CAMHS LD team or Children's Disability Team (DCT Shropshire or DCT Telford) on issues about physical health specifically. Discussions will include thinking about what kind of help is needed, who needs it, and how/where it can be arranged.

Do you provide support for parents and carers?

When 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. For example, this may include helping parents manage the demands of poorly children at the same time as thinking about how their brothers and sisters feel and react; helping parents with different ways of coping try and 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.

Who can use our service? Age? Disability?

This services works with children and young people who live in Telford and Wrekin or Shropshire aged 0-18 and their families.

The support we offer is for young people who have; diabetes; cancer; life limiting conditions; cystic fibrosis; muscular dystrophy; an allocated a Community Children’s Nurse (CCN); support from the nurse-led chronic constipation service (Telford only) or are requiring preparation for a planned operations.

However, children or young people with a learning disability may be best served by the CAMHS LD service which can offer specialist psychological interventions. Where there is overlap discussion about the best service is held between the relevant teams.

How to access our service (inc. referral routes)

The specialist doctor or nurses who the young person sees about their condition will be able to make a referral to the Paediatric Psychology Service except where support is needed because of a planned operation or procedure. These referrals would be made after a discussion by the treating doctor and the team manager.

How can families contact the service?

Families can speak to the specialist doctor or nurses that they are already in contact with and request a referral to the paediatric psychology service. Alternatively, families can discuss meeting up with us themselves when they attend clinics and see us there.

For external agencies: is the service free or charged?

Free

How can families complain if they are not happy with the service?

All complaints are handled by our Patient Advice and Liaison Service (PALS) and Complaints teams.

 

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