PBL EXERCISE

1
PBL Exercise 3 Anthony
Exeter 03 - 06 cohort Example of Presentation
from one group. This example refers to Child and
Adolescent Mental Health Scenario provided in
Section 5 - Resources. NB these are the basic
materials only and are kindly provided by the
trainees as an indication of some of the results
of their work during their PBL group meetings to
resolve the scenario.
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Referral information

• Referrer Social Services (Student SW)
• Issues for Anthony, aged 13
• Identity issues / mixed heritage
• Trouble at school
• Conflict with stepfather no contact with natural
  father
• ADHD?
• Issues in family
• Mother asking for Anthony to be accommodated by
  SS
• Domestic violence? Risk to children?

3
Initial considerations

• Does SS or CAMHS lead this?
• Joint agency team!
• Individual / couple / family therapy?
• Youth Offending Team?
• Community resources Planet Rainbow?

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(No Transcript)
5
Therapeutic Alliance

• Facilitating multi-agency work
• Contextualise and normalise difficulties
• Safety and containment
• Non-judgemental, empathic, genuine
• Gender, age ethnicity of those involved
• Instilling hope / empowerment

6
Family Assessment

• Introduction to therapists and therapy structure
• Confidentiality and Consent
• Risk
• Views of difficulties, expectations and goals
• Obstacles to therapy
• Questionnaires
• Self Concept Questionnaire (Robson, 1989)
• Strengths Difficulties Questionnaire (Goodman,
  1997 2001)

7
Ongoing Assessment

• Checking in
• Genogram (shared activity)
• Timeline (individual activity)
• Re-group
• Timelines pulled together
• Merges into formulation and intervention

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Risk issues

• To himself (self-harm, suicide)
• From others (racial abuse / high levels of
  suggestibility)
• Social risks (fire setting, exclusion, drug use,
  crime, accommodation1)
• Domestic violence2 child protection
• 1- Department of Health, 2000
• 2- Moffitt Caspi, 1998 Cleaver et al. 1999
  Devon Domestic Violence Partnership, 2003.

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Formulation 3 column model (Carr 2000)
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Contexts
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• the full complexity of who I am my plural
  self, if you like was never going to be
  nourished in a country that seemed to revel in
  its ability to reduce identity to easily
  repeatable clichés. The first time one is called
  a nigger or told to go back to where you come
  from, ones identity is transduced and a greater
  violence is done to ones sense of self.
• On growing up as a black child in Britain, Caryl
  Philips, The Guardian Review
• 11th December 2004

12
Belief Systems

• Angela
• Hes bad, just like his Dad
• There is something medically wrong with him
• Jeff
• Life would be easier if Anthony was out of the
  way
• I must control the situation or I am not a
  man 
• Anthony
• Mum will not meet my needs 
• Mum doesnt care if I fail in school 
• Everyone thinks Im shit Im bad to the
  bone
• Professionals are useless they dont help
• Hostile attributional bias

13
Circular Behaviour Patterns
Jeff dislikes Anthonys disobedience Angelas
permissiveness. Tries to control. (All arguments
end up being about Anthony - SCAPEGOAT)
Increasing bad behaviour with others increases
scapegoating at home, increases commitment to
peer group.
Anthony hates Jeff controlling
Misunderstood and lonely at home, Anthony tries
to fit in at school joins bad crowd.
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From formulation to intervention

• Formulation emphasises negatives positives exist
  but seldom highlighted
• Tension between acute and longstanding problems
• Domestic violence impact could change any family
  therapy intervention
• Community perspective

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Intervention

• Multisystemic approach
• Family therapy
• Community psychology intervention
• Sign posting - community resources
• Consultation within the multi-agency system

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Family Therapy

• Identity¹
• Explore family beliefs regarding race/culture
• Managing Karl's reintroduction into Anthonys
  life
• Racialism within the family²
• Focus on strengths and positives
• 1 - Goldberg Hodes, 1992
• 2 - Palazzoli, 1971

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Family Therapy

• Circularity, neutrality hypothesising
• Narrative approach¹
• Unique outcomes
• Thickening alternative narrative
• Solution focused therapy²
• Preferred future
• Scaling questions
• 1 White, 1990
• 2 de Shazer, 1992

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Community Intervention

• To tackle lack of awareness of cultural diversity
  in school which mirrors lack of awareness across
  the county
• Liaise with Community Development Worker for
  pupils and families (BME communities)
• Invite Turning Point to show their video and
  facilitate discussion in school

19
Evaluation

• Defining the problem and the intervention
• Internalising and externalising
• Messy reality vs. tidy research
• Multisystemic approach including community
• What evidence might be relevant?
• Multisystemic for conduct disorder (Carr, 2000)
• Family therapy for depression ?? (Carr, 2000)
• Clinical opinion
• Evaluating our interventions
• Varying degrees of formality to measures
• SDQ, SCQ, school attendance, scaling questions,
  risk factors, schools report, family report
  including Anthony
• Community intervention consultation??

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Reflection

• Group process
• Lessons learned changes made
• Evolution of the group greater cohesion
• Frustration with overlap between sections
  (assessment / formulation etc)
• Information gathering process
• Importance of liaison the impact of visiting
• Theme of frustration

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Reflection on PBL

• Complexity of case
• In our PBL he turns up, family engage how
  realistic is that?
• Suitability of family therapy given domestic
  violence
• Approach chosen, consideration of alternatives
• Theory-practice links
• Professional issues teamwork, supervision,
  self-care
• Ethical, legal, consent, risk issues
• Endings
• Learning for placement

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• Our thanks to.
• Please Note
• All names witheld for confidentiality -
  individuals represented Social Services,
  Assessment Teams, Community Workers, Race
  Equality Council, Police, Child and Family
  Guidance Team and specific community projects.