The BEMH Pathway an integrated response to complex behaviours in children and young people With thanks to the Solihull Parenting course and Dr Gail Holliman, Educational Psychologist, CEPS Team
Session aims • An overview of difficult, complex behaviours in children • A whole family, multi-agency approach to working with this group of children • The BEMH Pathway • How to access the pathway
What is difficult behaviour?
Causes of difficult behaviour CHILD Tired , hungry, unwell Sad/unhappy/upset, Worried/anxious Hearing/vision problems Developmental delay / learning difficulties LOW SELF ESTEEM Medical condition HOME ASD/ADHD Family disruption SCHOOL Chaotic lifestyle Poor attendance Parental illness Bullying/teasing /disability/mental Learning issues - health issues /alcohol struggling to keep or drug misuse up/work too hard or Poverty easy / inappropriate Sibling illness/disability expectations Safeguarding issues Poor understanding Domestic violence about child’s needs Bereavement
Early brain development When we are born our brains are not fully developed. We already have about all of the neurons we will ever have. The cerebral cortex however is not yet complete and is rewiring itself constantly through early infancy. In fact it develops continuously throughout our lives, being sculpted by our experience of the outside world.
Brainy facts • Over 90% of a child's brain development happens before the age of five years old. Experiences and interactions during these first important early years, when the brain is most “flexible”, or plastic, can influence a child's health, behaviour and learning skills for a lifetime. • Our brains double in size in the first year, and by age three your brain has reached 80 percent of its adult volume. • At age two or three, your brain has up to twice as many synapses as it will have when you’re an adult. These surplus connections are gradually eliminated throughout childhood and adolescence, a process sometimes referred to as blooming and pruning.
• Our earliest interactions and experiences start to shape our brains, to help us “survive” in our environment. • The interaction the child experiences causes their brain to connect and grow according to what has or has not happened for them. Being left stressed or crying with needs not met, when very young will make a brain which is different from someone who had a trusting and responsive relationship. This taught them they can cope with and manage feeling uncomfortable for a short while, as help is coming.
Early brain development will influence a child’s ability to concentrate, regulate feelings and behaviour, and to learn.
Brain development and emotional regulation
If stress and threat are chronic in early life the connections to the cortex are not reinforced, leading to constant states of hyperarousal or frozen dissociative responses – that are hard to change. The emotional response centre produces very strong immediate responses, and the cortex does not develop well enough to moderate these. These children become very upset very quickly. They are genuinely upset.
Balloon Demo/Hyper-arousal state Key points – Brain development • Childs environment and experiences shape early brain development • The brain prioritises survival first, (Fight/Flight/Stress response) • Exposure to stress/trauma can cause changes in brain development and function
3 – 10 years old
Summary of behaviours when early relationships are not good enough
Evidence from Neuroscience – Brain Scans from two 3 year old children
Understanding the “why” • Is it learned behaviour – Has the child learnt that difficult behaviour is the only way to get their needs met? Are they copying behaviour and ways to manage emotions from adults around them? Have they learnt that if you “kick off” or threaten to kill yourself you don’t have to do things that are uncomfortable? • Is this behaviour stemming from not being ok, genuinely not understanding or anxiety, social difficulties, being overwhelmed etc.
Learned behaviour… • https://www.youtube.com/watch?v=CGnfKnfY6EM
More serious relationship problems • Some of the more serious issues arise when there are problems with attachments and relationships with a child’s key care givers. • Over time, these problems can compound into serious difficulties. • When children do not find adults helpful, supportive or reassuring, serious problems can occur, they deal with difficulties by themselves and become increasingly reactive. • These children may not seek help.
It’s not about blame! Parental factors: • Own experiences of attachment and relationships • mental health problems and past trauma • Alcohol and substance misuse • Specific learning difficulties and illiteracy • Intellectual difficulties • Domestic violence • Cultural issues • Poverty • …Parenting challenging children…
Struggling Struggling families Children
Nottingham City • Total population: Approximately 305,680 • Children and Young People in Nottingham City account for 22.4% of the city population. • High levels of deprivation in a number of areas, e.g. Aspley • 35.1% of Nottingham City children are living in poverty. Significantly worse than in either Nottinghamshire County or the national average
Get the basics in place first!! • What does the child want/need? What does the family want/need? • Universal services (GP, School Nurses, Health Visitors, Children’s Centres, Family Support Workers, Teachers) supporting parents to put structure in, be available for the child, show interest, and reinforce the positives! • CAF / multi-agency meetings between parents and agencies involved • Parenting programmes through Children’s Centre (e.g. 1, 2, 3 Magic)
When the basics aren’t enough: BEMH Pathway
Emotional and Mental Health Needs of Children and Young People in Nottingham City Pre school age children • The estimated numbers and prevalence of mental health problems among pre- school (age 2-5 years) vary considerably from 10% to 19.6%. Between 1539 and 3017 of 2 to 5 year old could have a mental health problem • School Age Children • Using Prevalence Data from the 2004 ONS Survey • 1500 children ages 5-10 years • 2234 children aged 11-16 years Using data from the 2000 Adult Psychiatric Morbidity Survey, Chimat (National Child and Maternal Health Intelligence Network) have estimated numbers of young people aged 16-19 living in Nottingham who would be expected to have a neurotic disorder • 6,201 Females • 2,147 Males
CAMHs Citywide (Tier 2): Children and Young People with mild to moderate mental health difficulties (anxiety, depression, eating difficulties, trauma). Ages 0 – 18 years old. • Consultation for professional network • Signposting • Choice assessments • Individual and group partnerships • Time4Me School sessions • Non-violent resistance (NVR) group parenting programme for parents of children with behavioural difficulties • Joint assessment with Specialist CAMHs
BEH Team Ages 0 – 18 years old (up to age 24 when EHCP) • Consultation to professional network • Signposting • Information gathering /pre-assessment for possible ADHD / Autistic Spectrum Disorder • 1, 2, 3 magic group parenting programme for parents of children with behavioural difficulties (ages 5 - 12) • New Forest group parenting programme for parents of children and young people with ADHD (ages 5- 12) • Cygnet group parenting programme for parents of children and young people with ASD (no age range) • Sleep tight individual parenting programme for parents of children and young people with a diagnosis of ADHD and/or ASD (ages 5 – 12)
Small group exercise
How to refer • Professionals: www.bemhnottingham.co.uk • GP’s: Via choose and book • Parents and young people: Self-referral by website above or directly to the SPA on 0115 8764000
What should a referral include • The reasons for the referral – what you are hoping for. • Presenting needs in relation to the concerns, duration, triggers, frequency and how this is impacting on their daily functioning. • Your own observations of the child. • Positive indicators for neurodevelopmental or mental health assessments. • Safeguarding concerns/ family functioning. • Who else is involved and what has already been done. What has helped . • Relevant family , birth and medical history.
Referring at the right time • Social Care Crisis: Not the right time for therapeutic intervention or pre- assessment for ASD / ADHD. However CAMHs may need to be involved to manage mental health crisis reactive to social care crisis. • Times of major changes: It is normal to show emotional distress and some behavioural changes after major events like a bereavement, school change or moving country. If these difficulties continue for more than a three month period after the event, consider seeking support from more specialised services.
Recommend
More recommend
