Audio transcript: Sharing information and engaging with parents about child mental health

Audio transcript (edited)

DAN MOSS

Good afternoon everybody, and welcome to today's webinar, which is Sharing information and engaging with parents about child mental health. So this is the third in a series of five webinars on children's mental health that will be facilitated in partnership between CFCA and Emerging Minds throughout 2018 and 19. So my name's Dan Moss, and I'm the workforce development manager here at Emerging Minds, the National Workforce Centre for Children's Mental Health. And today's webinar, we'll be talking about some of the resources, and particularly the learning resources that our workforce centre has produced to really help practitioners support and engage parents around the mental health and social and emotional well-being of their children.

But before I start, I'd just like to acknowledge that Emerging Minds and CFCA, that we pay respect to the Elders past, present and future for the memories, the traditions, the culture and hopes of Indigenous Australians. And we wanted to also acknowledge the artwork, the beautiful artwork that we have here today, which is present on much of our products. And that artwork is by Elizabeth Close, an Aboriginal and contemporary artist, who bases her work on really women and children, placing children in the centre of the family and wider community that contributes to the physical, emotional and spiritual growth of the whole community. So we thank Elizabeth for her contribution to that.

We – as I mentioned, we'll be speaking a lot about two eLearning products, in particular, that both Angela and Myfanwy have been really instrumental in producing today, and we couldn't have done that alone. We've done that with the help of many different members and partners, and we thank them very much for their support, particularly the Peter MacCallum Centre, the Raising Children Network, the Victorian Mental Illness Research Fellowship, Let's Talk about Children Project and the Family Project, as well as Canteen. Also we'd like to thank the many child and family partners that we have collaborated with, who have lived experience, and have helped us really to focus on the type of work that practitioners really need to provide to help parents think about the mental health and the social and emotional well-being of their children, so we thank them as well.

Okay, so before I introduce our speakers, I'd just like to talk about the webinar series. As I said, today is the third webinar in this really exciting series that we're running in partnership with CFCA, and we do have two more in April and June of this year. The next webinar in April will be around supporting the social and emotional well-being of Aboriginal children through a community approach. And Emerging Minds has some of its Aboriginal consultants on that panel, and we really look forward to bringing that to you. And then Webinar 5 is "Curious Practice with Children and Parents Affected by Violence and Disadvantage", which will feature Professor Sarah Winch, from Flinders University. So watch this space regarding those webinars.

And so just thinking about the learning outcomes today. We really want to talk about the products that we've produced for you, with a particular focus on identifying key steps for sharing information with parents about children's mental health. We want to help recognise how sharing information with parents is an opportunity for engagement, identify key process involved with effective parent engagement and barriers to effective engagement. We want to reflect on the experiences of a parent, Mandy, who has sought help for her child, and raise awareness of additional resources for practitioners to learn more about the topic; and Myfanwy in particular, will be talking about that.

So just a little bit on the eLearning courses that we're talking about. These are available on the Emerging Minds website, and they're Building Blocks for Children's Social and Emotional Well-being, which is a longer course of about six to seven hours; and Engaging Parents and Introduction, which is up to about two hours in length. Both courses seek to make the child and parent visible for practitioners; to focus on practitioners who work in adult focused services, not just child focused services, with a view to engaging every adult who works into that service, if they are a parent. The courses are not didactic, but experiential, and the courses include features designed to engage adult learners, including videos featuring fictional families, scenarios of support, experience practition, and reflection exercises.

So before I introduce our wonderful presenters today, I just want to let you know that there is a CFCA information exchange opportunity today, where you can post your questions. We really look forward to those questions because we're able to ask our panellists the questions that you provide in our chatroom. Please note that any of the unanswered questions may be published, along with your first name on the CFCA website, for a response from the presenters after the webinar. Please let us know if you don't want your question or first name to be published on our website.

We'd also like to continue the conversation we begin to hear today, and at the end of this session we'll let you know how this can continue and information around a short survey, which will open in a new window. As always, we would really like to appreciate your feedback. So moving on to the main presentations; and I think we're really fortunate today to be able to speak with Myfanwy McDonald who's the workforce development officer, who works in the Emerging Minds partnership as part of her role as a knowledge translation specialist at the parenting research centre.

We have Angela Obradovic, who is a workforce development officer, specialising in adult mental health, here at Emerging Minds, and also the really generous and insightful contribution of Mandy, who has done a lot of work with Emerging Minds and previously to that with COPMI, as a child and family partner with lived experienced and a consumer of services. So moving right along, we're going to invite Myfanwy to start out proceedings today, to talk about the importance of sharing information with parents around the mental health of their child.

MS McDONALD

Thanks Dan. And thanks everyone for listening in to the webinar today. The first thing I wanted to start with, I guess, was just talking about the rationale for sharing information with parents about children's mental health. So there's three key rationales that I want to talk about. The first one is around prevalence and long-term impact. So in terms of the rationale for sharing information with parents, we know that a significant proportion of Australian children have a mental health difficulty, and we also know that if those issues aren't addressed in childhood, they can go on to become chronic mental health difficulties in adulthood. And obviously, you know, there's personal costs associated with that as well as economic and social costs for sort of the broader community.

And then also there's a lot of research to show that there's considerable stigma around child mental health difficulties, and possibly even higher stigma for child mental health difficulties than adult mental health difficulties. And it's a complex kind of stigma, I guess, because it's not just the child themselves that's at risk of stigma, but also the parent and the family as well. So parents can often feel like it's their fault if their child has a mental health difficulty; and even if they don't' feel that way, they can feel that other people sort of judge them in that way. So there's sort of this stigma associated with child mental health, as well as some dominant misconceptions around child mental health difficulties.

For example, quite a common one seems to be that children just can't have mental health difficulties, or that they grow out of mental health difficulties naturally, and they don't really need sort of treatment for those difficulties. And then the final rationale for the reason why, you know, you might want to share information with parents about child mental health is that we know that parents want to know how they can support their children's health and well-being, especially their children's mental health and mental well-being.

So it's not only about letting parents know about how to support their child if they have a mental a difficulty, but also just on a more sort of general level, even if their child doesn't have a mental health difficulty, how can they support their children's mental well-being generally. How can they support their children's mental health, even if their child's doing okay. And, yeah, I guess the point there is, as society generally becomes more aware of the importance of mental health generally, then parents are going to want to know more about how they can support that for their children. So they're the sort of three key rationales for why we think it's important for practitioners to share information with parents about child mental health.

Okay, the other thing I just want to touch upon is around early intervention and prevention, and how sharing information with parents about this topic is a form of prevention and early intervention, or can be a form of prevention and early intervention. So I guess the other thing that comes out of the research is that parents, not just in Australia, but in Australia and countries similar to Australia, often face barriers in getting support for a child who might have a mental health difficulty. So for example, they don't know where to go, they don't know who to ask about the issue they might be seeing in their child. They don't trust that they'll get the help they need from practitioners. And also just going back to that point around stigma; they're afraid of the consequences of seeking help. So they might be afraid for the child or afraid for, you know, themselves as well, in terms of the risk of being judged.

So obviously those barriers are then going to impact upon the number of children who get support for mental health difficulties. So just going to back point around, you know, the proportion of children in Australia who have a mental health difficulty, if parents are facing barriers in getting support for children, then that's going to impact upon how many children are actually getting support for mental health difficulties, because parents are the ones who are making the decisions around when to seek treatment and where to seek treatment. And multiple Australian studies have shown that a significant proportion of Australian children with mental health difficulties get very little support for those difficulties.

So recent research, I think it was 2015, showing that between the ages of one and a half and six years of age, around about 13 to 14 per cent of children have a mental health difficulty, and only a quarter of those had support from a general health practitioner, so saw a general health practitioner for that issue, even less than that saw a specialist mental health practitioner. So yeah, I guess that just reinforces the importance of sharing information with parents about child mental health.

The reasons for that are it enhances child mental health literacy among parents; it's a way of breaking down some of the misconceptions and the misunderstandings around child mental health, and it also, even if their child isn't having difficulties at the moment, it's an avenue for parents to know a little bit more about child mental health, should they have concerns later. So I guess it opens up the opportunity for the parent to come back to that practitioner or another practitioner and say, you know, I'm having concerns.

Okay, so in terms of the key steps for sharing information with parents. There's a few key steps we think are important when you're sharing this information. And look, it's pretty straightforward, but I guess the four – there's four sort of key steps that we think are important. Firstly, obviously keeping up-to-date with the resources. So if you're sharing information with parents about these topics, you need to know what information is out there, what resources are out there for parents, and therefore it's important to sort of keep up-to-date with what happening, and we know that that can be really difficult for practitioners to do.

If you've got a million things to do it's difficult to sort of – you know, you don't have time to keep up-to-date with every single resource that's coming out, and I guess in terms of resources, where talking here about things like tip sheets, booklets, websites about child mental health; the kind of information that you might be able to give parents so they can learn a bit more about child mental health. So because of lack of time, things like subscribing to newsletters, asking your colleagues and networks about which resources they rely on, sharing your own resources within your networks, conferences, seminars, that kind of thing; just as a way of sort of keeping up-to-date with which resources are available, that you can share with parents.

The other big thing, I guess, is having an understanding of the parents' context and circumstances. So you're wanting to ensure that you give parents information that's appropriate and relevant to their circumstances and their context. So it's important to sort of learn a little bit, if you haven't worked with a parent before, learn a little bit about the child and the family and the home environment, parenting values and beliefs. These kind of things can help you better understand what kind of information might be useful for that parent.

As well as practical issues, such as things like access to transport and things like the format that they would prefer the information to be in, the language that they speak; these kind of practical issues, will obviously help you give them the information that's appropriate and relevant to their needs. And then I guess another important step is just confirming how those resources will be used. So once you've you know, talked to the parent a little bit about the context and the circumstances, and you have a bit of understanding what kind of information might be useful for them, just you know, confirming how the resources might be used.

So for example, if you're giving them information about a particular service or a particular website or a resource, just sort of reviewing that with them and saying, okay, so you're going to look at this resource, and then you're going to come back and talk to me or you're going to check these websites and see if it's got the information that you need, and then also linking it back to the child's social and emotional well-being, so just reinforcing, I guess, that the reason why they're doing that is because of their child's social and emotional well-being, just to sort of make it clear that that's what the focus is.

And then the last point, I guess, is just follow–up. So obviously follow–up is not always possible in every circumstance, but if it is possible, it's useful to sort of just follow up with parents around whether the information you gave them was useful, whether it provided them with the information that they were looking for. And I guess that helps you if you're working with that family on a longer term basis. It helps you understand what kind of information might be useful to them, and then also it might help you in your work with families in the future.

So if there's a particular sort of resource that parents are coming back and saying this was really useful to help me understand a particular aspect of my child's behaviour or my child's emotional well-being, then perhaps that can give you insight into how to use that, that you can use that information with other families. I mean, if you're interested in those sort of key steps, learning a bit more about those sort of key steps, it's outlined in the resource that we've referenced at the end of this webinar around how to share information with parents around child mental health. But that's the sort of summary of some of the things in that paper. So I'm just going to hand over to Ange now, who's going to talk a bit about engaging with parents.

MS OBRADOVIC

Hi everyone. It's really great that you've joined us today. My part of this webinar is to place some focus on the variety of factors at play in the task of engaging with parents, which as Myfanwy has pointed out, is a fairly important part of prevention and early intervention. So why parenting engagement is important to that – well to help us understand that a little bit, this diagram that's on the screen offers a fairly visual way of understanding and remembering those dynamic interactions that shape the social and emotional and well-being of children. So it's in a sense a demonstration about how your engagement with parents can support that well-being in an early fashion.

The arrows highlight an interconnection between each element in the parent/child relationship, and bring into focus one aspect of the parent and family circumstances that we've amplified, those of the child in the family. That's the circle on the right. So there's a feedback loop process here, which I'm sure you can see from the diagram, imply that sometimes when parents are seeing or hearing things in their child, they might begin to express some sort of concern or develop some sort of worry.

They might not understand why the child's acting in that way; they might not know quite how to respond or have the capacity to respond due to their own level of worry and stress, and that in itself could increase their own stress, which again increases the impact on how they might engage or interact with their child. So that cycle could continue, and the impact on the social and emotional development of the child and their future mental health is a possibility here.

So what do we know enables effective parental engagement? The six principles that are listed on this slide won't be unfamiliar to most of this audience, I'm sure. However in saying that, it's important not to underestimate their efficacy, because of your familiarity or because your bread and butter relates to parents and children. They're actually based on evidence about what's been found to be effective engaging parents in particular, and also draws upon practice wisdom and the combined expertise of the Emerging Minds partners.

In the course, we unpack each of those particular principles and provide you with some examples, but I just wanted to highlight an important point or two about these, that relate to individual practice. We'll often talk about the concept of client centredness in practice and service design, but the evidence here, and these principles argue that you also need to be family focused in doing that, so that the full range of relational roles and responsibilities that adults have as individuals, are visible and validated. And the other point is that, when we talk about collaboration, we're not just talking about that at an individual parent/practitioner level, but also at the level of needing to maintain and develop trusted and reciprocal inter-agency partnerships.

Parent and family circumstances don't just influence the parent/child relationship, they also influence engagement between practitioners and parents. So becoming familiar with a parent's life situation background, their family of origin, their family of choice or procreation, their child raising, culture, spirituality and their attitudes to parenting and childhood, allows us to build a much richer context informed understanding of how that has been shaped. Within the engaging parents course, we provide summaries and additional references and resources to deepen or broaden knowledge about each of these contextual influences, particularly on the task of engagement itself, so you can go into that course and learn a lot more from each of those particular subject tiles. One of the examples of a resources would potentially be a practice paper that the CFCA developed with us a number of years ago, called "Supporting Recovery in Families Affected by Parental Mental Illness".

The other aspect of engagement relates to the professional factors at play. Evidence shows us consistent findings in these three common domains of practice; your role focus, your skill and knowledge, your personal experience. And although some practice contexts and roles offer more possibilities for parent engagement than others, practice context always provides opportunities for parent engagement, even within particularly adult focused services. For instance, even in a brief one–off interaction, a practitioner can acknowledge client concerns that might be expressed about children and highlight parenting strengths by normalising parenting as a legitimate focus of discussion and support, even in a brief interaction that wasn't intended to be about that. We know that that facilitates subsequent engagement by other practitioners who might have more opportunity to engage actively over a longer period.

The personal experience of practitioners is often not overly focused on in the range of factors affecting engagement, but those practitioners who talk to us about the concerns they have, not being parents for example, are things that do need attention and support and strategizing within potentially supervisory relationships, and that leads to an area that's often not paid attention to within thinking about this area. So in the diagram that you can see there, we've acknowledged family and child and parent circumstances, we're acknowledging that the practitioner, the professional has their own professionally related and personal factors that are at play in interactions, but they also share a space together, and when effective engagement contributes to a shared understanding of the parenting context, it can also lead to an awareness of the mutual and parallel experiences practitioners might have in common with the parent.

They would include, for instance, what the parent brings to the relationship, what the practitioner does, how the parent and practitioner interact interpersonally, and factors that relate to the external world, that the parents and the practitioner are both part of, and which impact on both of them, so at a community, institutional, societal and cultural level. So those shared influence exist at all levels of the system of human development and can be both a source of enhancing empathy, trust and the therapeutic alliance, but also a source of unconscious or unnamed tension or a protective defence, and the importance of recognising this is that if it's unexamined as a phenomena in your practice or you don't have opportunities to actively reflect upon them, they can potentially interfere with the ability to maintain a collaborative non–judgment and curious approach. And of course we know that consistent and quality supervision or peer reflection and even personal development can actively assist practitioners in attending to what they might share with parents.

Barriers or challenges that are often cited by practitioners include parental hesitancy, parental distress and family and cultural context. Both of courses refer to these in detail, but I just wanted to highlight one today, and that relates to the issue of hesitancy, when parents might be reluctant to talk about or explore areas of concerns, and that can be often interpreted in varying ways by practitioners. The point I wanted to make here is that it's really important not to underestimate that hesitancy is often the result of a fear of judgment. But it can also appear in other forms other than what you might call an active resistance.

Parents often find it difficult to disagree, for instance, with a professional, and might reply with a yes or a nod to what's being said, rather than challenge the professional that they're working with. Sometimes this acquiescence, when a client accepts or agrees with something without protest or comment, is another form of hesitancy around engaging. So for instance, on this slide and the course, we provide some particular tips around managing that sort of scenario in terms of, for instance, being able to sit with and respect negative feelings that might arise in those interactions. Sometimes parental concerns will come with higher emotions like anger and fear.

I'm going to also just very briefly let you know that the practice approaches that most of you may be familiar with generally incorporate the principles that are effective in parenting engagement. And within the resources of Emerging Minds and in our particular courses here, we offer some additional in depth introduction to those particular models of practice, or simply the approaches of a practitioner in their work. There are a number of courses that we run such as Let's Talk About Children, our eLearning course, and also we have new course coming out called, Perks, which is a concept within the course that we've designed for GPs specifically.

These practise approaches and specific interventions that you can see on the screen, embody those effective parental engagement principles. They particularly honour the interconnection between parental health and recovery and child mental health and development, and they largely focus on strength based and collaborative approaches. Some of them are individual and some of them are group based programs. So if you're interested in learning more about any of these, the eLearning course of engaging parents, an introduction and its follow-up, would be a great place to go to.

And I think Dan, I'm going to hand over to Mandy here, who we're very appreciative of her sharing her personal experience, as she sought help for her daughter, and a number – she actually has some really lovely examples of effective engagement practice and also perhaps overlooked opportunities for information sharing in the journey that she's had. Thanks, Mandy.

MANDY

Good afternoon everybody. My name is Mandy, and I'm mum to a girl aged 13 and a boy aged nine. The story that I'm about to share with you is the journey our family has travelled, trying to help our daughter overcome a major health difficulty. I am keen to share this story and experience, as I hope the next person who finds themselves in our position doesn't face the difficulties we have. Here's my story, or our story.

We visited the psychologist together, just my daughter and I. It had become apparent that she had a developmental issue. I can't remember who had recommended a psychologist, but a health professional had. We were directed to our local community health centre to see a psychologist. She was female and young. I expected that the appointment would revolve around my daughter. My only other experience of interaction with a psychologist was in my work as a teacher. I would refer students to the school psychologist, and when a time was scheduled the psychologist would come and collect the child, and the appointment would be between the child and the psychologist.

I was unsure if this was going to happen. I knew I wanted to know what was said during the appointment between my child and the psychologist, but I didn't realise that the appointment would be about me, that I would be the focus of the appointment. We travelled the corridors of the community centre to a room where the psychologist resided. There was a large desk and chair, and there was also a child's desk and chair. My daughter was directed to the little furniture and was given paper and pencils to draw with, to occupy her.

The psychologist and I sat on chairs face-to-face with each other. I hadn't expected this appointment to be about me. This is was to continue. My expectations and thoughts about this and subsequent visits, very much derived from my prior experience with psychologists, with my only experience being in my work as a teacher. I believed a psychologist treated the patient in isolation. I now understand that Amelia was and is part of a context. This issue was a family issue. It was not Amelia's issue on her own. Amelia and her problem only form part of the context. I wish at that appointment that the psychologist had explained this.

During this appointment I couldn't understand why they were asking about me and the greater context; it frustrated me. I just wanted to say, "Look, there is the child with the problem. Can you not worry about me and just fix the child?" I needed to be told upfront that to address this problem, would involve including the entire family unit. I would have also liked to have been reassured that this was not my fault, that the information would not be shared. Paranoia told me that I might be reported for being a bad parent, and that did happen in other families, to lessen the feeling that I was the only one going through this or we were the only ones going through this.

This appointment was to be one of many, as we tried to solve this issue. I then experienced post–natal psychosis after baby number two, and started a journey of my own mental health care. During this time and until now, I asked my mental health carers about my daughter's problem and how I could solve it. I received vague support around this issue. My daughter's issue caused huge angst in our family, and continues to do so, although we now try not to focus on it too much.

After my first mental health episode, I chose not to go back to my regular GP. This was for two reasons. I felt upset that she hadn't made contact with me when I was admitted into the psychiatric unit, and now thinking back, she probably didn't even know about it. I was also hugely embarrassed to face her and tell her where I had been. I had not taken any part of my mask off, the mask that portrayed me as a teacher from middleclass, good family, with this doctor and I knew I would have to start being very honest with her about who I really was if I went back to see her.

I am not sure why, I just couldn't go back and start being honest. Maybe I felt like she would think I was a liar and had lied about who I was and what sort of family I came from. I found myself during one school holidays, when Amelia was about four and Thomas nearing one year old, Amelia had had a wart on her foot and I decided she should see a doctor about this. I rang around trying to find another one; one who didn't know me. I found one not too far from home, and we visited her the next day. This doctor became a huge support in my life. She actually, to me, feels like part of my family, and I don't give people the family title easily, let me tell you.

This GP seemed real to me. She told me she was married and she had two children. She told me some of the difficulties she had faced with her children. She made me feel calm and relaxed. She dealt with my daughter's wart issue, and I decided that she would be the doctor I returned to, to retell my psychosis story. I am still so glad this doctor is our GP. She has been a solid and never ending source of support, comfort and reassurance. Importance of normalising through sharing their own or others' similar experiences, reduces the expert intimation phenomena and feeling alone.

I also want to make it known that this GP seemed to envelop and reach out to our entire family unit. She managed to always enquire about all of us. She never failed to address us as a family. This was and is also reassuring and comforting. She is a skilled professional, and I tell her this often. I find Dr J to be honest. She has never dealt with post-natal psychosis before, and she'd never dealt with the issue that my daughter had before. At first her honesty frightened me, and I wondered if I should see a doctor with experience in these problems.

Later I came to appreciate her honesty and have faith in her and her professionalism. I am completely happy with the way Dr J cared for us. Her sheer honesty and stories of her own life and family led me to feel completely safe with her, and I felt I could tell her about the real me; the real me without the mask. I also felt confident that she could and would care for not just me, but for our entire family. Things I know now, a doctor will only report children to Child Services if the child is in danger. Having mental illness doesn't automatically deem you to be a poor or dangerous parent. Be completely honest about your children without guilt or fear.

Health professionals want to help and keep the family unit health and together. You can be absolutely and completely honest with your health practitioner; they have seen much through their work and their own families. If they don't have children of their own, it is likely they have a relationship with nephews, nieces, friends' children et cetera. They will not judge you or think less of you; they have heard and know about (indistinct) families, family trauma and life's issues and difficulties. They will also be savvy with mental health. Telling them things such as yes doctor, I heard voices, will not make them jump out of their chair.

I remember it took me about four visits to tell Dr J that I had heard voices during my first psychiatric hospital stay. I was so embarrassed to tell this, and was convinced she would be so shocked. She wasn't. We were at this stage, directed – this is in regards to Amelia's issue – we were directed to the child psychiatrist. This child psychiatrist specialised in eating disorders. And I've got a question mark there. She was based at our local mental health hospital. We were told we needed to come as entire family unit. All four of us arrived to a large old building and were directed to a waiting area. This psychiatrist first asked to speak to my husband and I alone.

I can remember going over the same story again. I also told her of my recent mental health episode. I also felt somewhat uncomfortable and unsafe as I was near the psychiatric hospital in which I had stayed when I was first scheduled to psychiatric care. I never knew if this was connected to my problems, the problems that my daughter was having, but it felt like I needed to volunteer this information about myself. The psychiatrist then spoke to us as a family unit of four. We discussed the use of merit charts and reward strategies. This had been suggested to me many times before. The psychiatrist also suggested reading a book called "Sneaky Poo".

She then recommended we see a paediatrician to rule other things out, that it could possibly be. When I relay to someone what the appointment was like; it felt a little like going to visit Nana. I also forgot to mention that the psychiatrist asked to have a one-on-one appointment with Amelia only. Whilst this occurred, I couldn't help but listen at the door. I heard the psychiatrist get a little stern at Amelia, and it seemed she was attempting to discipline Amelia to rid us of this problem.

This appointment led us to a paediatrician. A paediatrician had not been suggested by any other health professional prior to this. I walked out thinking that I probably should have thought about this myself. Even though the appointment didn't seem to make any changes to our situation, it moved us off into another direction of care. I guess I wished at this stage that someone initially had suggested a paediatrician. The atmosphere of the place where Dr A was, made me feel depressed. I left hoping that my daughter would never have to experience a psychiatric hospital stay.

This appointment focused on seeking out if this issue was connected to something physical and not mentally based. We were sent to an ultrasound for Amelia. We had a second appointment, and it was at this appointment that it was suggested we visit the enuresis clinic at the Children's Hospital. The journey continued. With the help of the paediatrician, Professor C, who was the health professional at the enuresis clinics, we were bumped up her waiting list. She is well–known for assisting little patients with issues such as Amelia's. I wish we had initially been referred to Dr C.

Amelia was checked over physically again, and after numerous appointments and an ultrasound, we were then referred to the psychiatric medicine unit in the care of two young female psychologists. We had numerous appointments with them. During this time, I was in and out of psychiatric care. The visits mostly included Amelia and myself and then Amelia on her own. I found these appointments hard work, and the youthful appearance of these psychologists didn't fill me with confidence. I wish I had known we would still be in the same position years later.

We were then sent to the local mental health community centre, and Amelia started seeing a young female psychologist. She then directed us to the Cool Kids Cognitive Behaviour group therapy course which she helped to run. Every time we attended this course, Amelia would scream about going. Many times the psychologist would meet us in the car park of where the course was held and she would coax Amelia out of the foot well of the car. Amelia would enter the course in tears.

We currently have home visits from psychologist L. Amelia usually hides in the room when psychologist L visits, and psychologist L talks to me. She has become somewhat of a parent support for me also. Psychologist L tries to communicate with Amelia, but most times Amelia chooses not to respond to psychologist L's efforts of communication. During all of this, Amelia also visited and was visited by a private psychologist. At first this psychologist visited Amelia at school, and later I took Amelia to her rooms for appointments. Amelia often screamed to go these appointments, and there were times at school where she didn't like going because the children in her class questioned who the psychologist was and what she was did.

The medical practitioners often asked Robbie, my husband, Amelia and I if we could all attend the appointments. Robbie was at the time the only one working, and to have him keep asking for time off for this, was difficult. At one stage a practitioner asked if we could help Robbie with a medical certificate to explain to his workplace why he needed time off. At the appointment at the Children's Hospital we had conference calls together with Robbie and us. Somewhere in the middle of all of this we accessed a gastroenterologist. It was suggested by someone, one of the hundreds of people I had spoken. Again, this was fruitless. He did a simple physical examination, talked about the workings of the body, and suggested that we come back and see the psychologist that worked with him. I never returned. I didn't warm to this doctor.

At one stage, a psychologist from a psychiatric hospital I was staying, in mentioned that my daughter had encopresis. I then started looking online for information for this condition, and joined a Facebook group for parents that had children with this condition. I was to find out through this group that my daughter did not have what the psychologist had suggested. There was never any communication between the health practitioners; I think it's important that I point out. An example of this is, after seeing the paediatrician and having had her rule out anything physical, we then headed off to the Children's Hospital, and again, they wanted us to see if there was a physical reason for the issue. The issue has always been and still is one that I must fix; well that's how it feels. Thank you for listening to our story.

MR MOSS

Thank you so much for that Mandy, and really appreciate you sharing the details of the journey that you've obviously been on for, yeah, quite a long time now, about ten years, and really appreciate what you've been able to present to us, and the learnings that we've taken from that, both as part of Emerging Minds and now the broader audiences that you present to.

So now we've got some time for some questions, and we do have quite a few questions coming through. So keep them coming in the chatroom; that's really good. The first is for you, Angela. We've had a couple of people enquiring about the training and resources that have been presented today. Are they available through Emerging Minds as part of a worker awareness training? For example where workers work in Child Protection or Corrections Department; is this an available resource that Emerging Minds provides?

MS OBRADOVIC

Thanks Dan. Emerging Minds resources are very much available and they're free of charge to anybody who wants to access them, and we provide some guidance about which ones might be most relevant for different practitioners at different times in their career or in fact, depending on their setting. So on our website you will find a considerable number of eLearning courses. They indicate the length of time that they take; they provide you with a description of what they focus on, so that you can make choices perhaps as individual practitioners, but also perhaps as a staff group when you're wanting to get together and do some professional development.

So that might be in fact a very efficient way of promoting some discussion within your practice group or your organisation about the issues that you feel you need more input on and discussion about. So those courses are all on our website. They are also supplemented, both within the courses and separately within a number of other resources on the website. Particular practice tools that you might be interested in and articles that have been specifically written for those people that are interested in how to best support and promote parents' efforts around maintaining their child's social and emotional well-being.

There's quite a plethora of resources, and yes, they're there for anybody to make use of, and our national to local consultants that cover each State of Australia are contactable to further discuss and provide some guidance about how practitioners, particularly organisations, might want to make use of those.

MR MOSS

Great. Thank you, Angela. Mandy, a question for you, which I think is a really important question. If there was one thing that you could tell us that could have done differently early within your journey, what would you say it might have been?

MANDY

Just off the top of my head, when you said that, I'm thinking I would have liked someone to devise a plan initially. So we seemed to travel some jagged path, with no real plan of where we were going with it or what we were trying to achieve. So I guess if we could have sat down at the beginning and said right, these are the people we could access for help, let's start to devise some plan, so we didn't end up having physical examinations three or four times. So, yeah, just some sort of – to project what might happen in the future and to stop the double–ups of different professionals and different strategies and thoughts. So a plan would have been good.

MR MOSS

Thanks Mandy. We've spoken a lot today about parent contact, and Myfanwy, in the context of what you were speaking about, I was wondering how parent contacts might influence the kinds of information you provide?

MS McDONALD

Yes, so I guess things like the family and home environment can, as a context to take into consideration, can sort of inform you about what kind of information might be useful for parents. So if a parent is sort of a single parent or living in a, you know, in a household with multiple sort of generations, it can tell you a little bit about what kind of services or resources might be useful for them. And also like I said in my presentation, I guess like practical things like do they have access to transport, you know, languages spoken at home. Even things like what information they've been given previously about the topic or what information they've been given that's been really useful or what hasn't been useful.

So just getting an understanding, I guess, of their social context as well as those practical issues, and then also their history with the issues. So how many other people have they spoken to. I guess Mandy's a classic example of that, you know, where else have they sought support and information about this, and that could sort of tell you a bit about where you could direct them to, I guess.

MR MOSS

Yeah, thanks Myfanwy. Angela a question for you; really about what you were talking about in terms of the shared space between professionals and children and their families. In the light of health professionals being trained often to keep strong boundaries or to keep the shared space limited or safe, how can this best be addressed do you think, in how we train our social workers, counsellors, psychologists and other professionals?

MS OBRADOVIC

That is such a good question. Thank you whoever had asked it. I think this is one of those areas where we can get particularly reductionist about tenets of practice. We all know the importance of boundaries and making choices about what gets shared, but often those sort of arguments are used as a reason for not providing levels of awareness or connection with the people that we're working with. So what I would be saying firstly, is that when we're training people, the issues that we might share or be mutually exposed to in our different parts of our lives, are thing that are about our awareness of. And so this isn't about full-on self-disclosure; this is about informing ourselves and being self-aware about the aspects of our common experiences that may in fact be useful for us to think about.

You can see in Mandy's example, her GP, the person that she trusted the most, did enough limited self-disclosure about a commonality between them, that provided enough for Mandy to recognise that she'd put up a barrier out of very legitimate fear and concern about what she might share. It did not take much for that GP to put her at rest by some limited common experiences between them. She was also particularly honest with Mandy about what she did and didn't know, and so that is what I'd call a collaborative beginning to a relationship.

That was in a sense informed by that GP's recognition of the commonality that they may have shared, and for different practitioners they may be very different aspects of the life that they've led. People may have had personal experiences within their family and broader social context, that makes them more attuned to the issues that might be present, and they can be made us of. As I said, it can be a double-edged sword, but boundaries are there to be considered and shared issues helping us to be far more self-aware about what exists between us in the therapeutic alliance. I'm not sure if that fully describes it, but I'm happy to entertain any post-webinar questions on that one because it's a favourite topic of mine.

MR MOSS

Yeah, that's a really great answer. Thank you for that Ange. The next question's for you Mandy. So one of our chatroom participants said that they really liked what you said about creating a plan, but their question is around who's best positioned to have a bird's-eye view in the creation of this plan and the journey? Is it the GP or is it all practitioners?

MANDY

Where did we end up firstly? The suggestion of the psychologist, I can't remember where that came from, but I guess in an ideal situation it would be the person maybe that you first reach out to. So I'm guessing that might be a GP. For us, we were linked into community heath, so that was the – so we went to see the psychologist there. That was kind of like the start of it, so maybe it was appropriate for her, for the psychologist there, to suggest where we go from there.

Yeah, so I'm guessing it's whoever you're with at the beginning of trying to seek a remedy. But yeah, ideally I guess it would be a GP, because that is probably where most people would head off to first. But yeah, we were sort of linked in and then later, I then linked in with professionals, so it became a bit of a shemozzle of who I was seeing. I can't remember initially how we ended up at the psychologist, but I hope that's answered the question.

MR MOSS

Yeah, yeah it has. Thank you, Mandy. So the last of our questions that we have time for today is for you Myfanwy. So as a practitioner, where can access be found to information about children's mental health that can regularly be given to parents?

MS McDONALD

Yeah, thanks Dan. Look I think a really useful resource for practitioners is the Raising Children Network, and I mean a lot of you probably already know about that, but it's a great resource in terms of something you can direct parents to, or you can look at that resource together. There's a lot of information on there around – like a very comprehensive suite of information around children's – all aspects of children's health, but including children's social and emotional well-being. So that's a really useful place to go.

Also just the CFCA at AIFS also has some really useful information, not just about children's mental health, but you know, things around engaging with parents, the kind of broader issues around factors that might impact upon children's social and emotional well-being, just to sort of learn a bit more about that. And the other good one is the – I think it's called The Centre on the Developing Child, in the United States, which – look they've got some really accessible resources probably not so much for parents, but for practitioners just to learn a bit more about the latest evidence and the latest sort of knowledge around children's mental health that might help practitioners have a bit more of a comprehensive understanding around what we know about children's mental health.

MR MOSS

Thank you so much for that, and to all our three presenters. I'm sure everyone will agree that they've done a fantastic job today, both in the presentations that they provided and also in answering the questions which were posed to them. So thank you Myfanwy, Angela and Mandy. Really appreciate your time today. Before we leave, I'd like to make mention that we have some related resources for you at the end of this presentation, and please remember that this presentation has been recorded and the audio transcript and slides will be made available on the CFCA website and the CFCA YouTube channel soon.

So please also keep the questions coming in, because we will invite our presenters to continue to answer your questions after the forum has closed, and they'll be posted through CFCA website as well. So that's all we have time for today. I'd again, just like to thank our panellists, and thank you everyone for attending today. It looks like we've had a really good attendance. Please follow the link on your screen to our website to continue the conversation, and we will see you next time. Thank you very much.

WEBINAR CONCLUDED

IMPORTANT INFORMATION - PLEASE READ

The transcript is provided for information purposes only and is provided on the basis that all persons accessing the transcript undertake responsibility for assessing the relevance and accuracy of its content. Before using the material contained in the transcript, the permission of the relevant presenter should be obtained. 

The Commonwealth of Australia, represented by the Australian Institute of Family Studies (AIFS), is not responsible for, and makes no representations in relation to, the accuracy of this transcript. AIFS does not accept any liability to any person for the content (or the use of such content) included in the transcript. The transcript may include or summarise views, standards or recommendations of third parties. The inclusion of such material is not an endorsement by AIFS of that material; nor does it indicate a commitment by AIFS to any particular course of action.

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