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Child Clinical Services offered by Chartered Psychologists

1C.1 Pre-school Children

This age group spans the period from birth to about 4 or 5 years. Common problems at this age tend to be eating and sleeping difficulties, problems with wetting and soiling, tantrums, non-compliance and separation difficulties. Delays in development such as language and learning difficulties become apparent as do some of the sensory disorders. The assessment and treatment of children in this age group requires special skills and procedures and treatment is typically mediated through carers.

From the time of school entry until the start of the teenage years a range of difficulties become more striking. These include educational and social difficulties, developmental disorders such as dyspraxia, conduct disorders involving aggressive outbursts and, defiance as well as emotional problems such as anxiety, fears, phobias and bereavement issues. Family breakdown, parent/child relationship, and sibling or peer problems are increasingly common in this phase of development. Psychological interventions may involve working with families, parents, carers and/or directly with the child.

The psychological needs of individuals within this age group and the nature of the interventions required are increasingly influenced by emerging physical, intellectual and sexual maturity. Certain problems emerge or become more pronounced at this age particularly substance misuse, eating disorders, and depression. Interventions more frequently involve working individually with young people themselves. Consideration is given to their increasing personal and socio-legal responsibilities. Particular attention is paid to ensuring that services are provided in suitable settings and delivered in age appropriate ways.

Mental health problems are varied and include anxiety, fears and phobias, obsessions, conduct disorders, toileting, eating problems, family difficulties and hyperkinetic disorder. The assessment process will utilise a range of methods including standardized psychometric instruments, structured interviews, checklists and detailed observations. The assessment is tailored to address the needs of the child and their family and designed to obtain a thorough and clear understanding of the nature and extent of the presenting problems. The assessment will determine the intervention to be provided which may involve working individually, with parents/carers, or families using psychoanalytic, cognitive, behaviour, or family therapy based interventions.

Children with acute or chronic illness and their families require specialist input to ensure effective psychological management of their needs. Specific areas of involvement may include preparation for surgery, pain management, facilitating adherence to medical treatment regimes, bereavement counselling and helping individuals and their families cope with the consequences of acute and chronic illness. At a more general level, child psychologists will be able to offer advice about designing 'child-friendly' environments and ensuring that medical procedures are delivered in a 'child-appropriate' manner.

Specialist skills are involved in assessing the needs of looked after children, the strengths and skills of potential carers, and matching children with carers in order to ensure an appropriate placement. Interventions may also be required with adoptive families in order to facilitate their functioning as a family and help the child with adjustment issues such as loss of a birth parent or learning to trust their new carers. Specialist treatment interventions may be provided in order to prevent potential placement breakdown. Pre-placement training and preparation of carers and post-placement support and problems solving are also provided.

Legislation requires the increased involvement of professionals in undertaking specialist assessments, Court and other reports and providing consultation for individuals and agencies in relation to proceedings under the Children Act and other related child care law. Assessing children's wishes and feelings, the adequacy of parenting, assessing and treating children who have suffered abuse, and identifying children in need are some of the many services provided.

Many children sustain head injuries to the brain as a result of trauma or disease (cancer, inherited and other acquired conditions). Child neuropsychological assessment, and the management and rehabilitation of children with neuropsychological problems requires highly specialized skills. These involve a clear developmental and neurological perspective, a knowledge and understanding of neurological disorders, together with competencies in the use of psychometric assessment. Rehabilitation programmes are designed to improve the child's level of functioning and minimise possible effects arising from the condition such as anger, social problems or low self esteem.

The provision of specialist assessments and expert advice in legal proceedings concerning children. This expertise can take many forms and may involve assessing the post-traumatic effects of road traffic accidents or other traumatic events, providing an expert opinion regarding possible abuse or neglect, assessing the suitability of a child's placement, the ability of a parent to care for them, or the nature and frequency of access in custody proceedings.

Programmes designed to promote effective parenting and prevent family breakdown are available. These can be used with individual parents or in groups and aim to either promote positive parenting skills within the general population or are targeted upon parents experiencing significant difficulties parenting their children.

These services aim to promote healthy lifestyles and improve the psychological functioning and development of children and their families. This can be achieved in many ways including the development of child health screening and surveillance programmes, the provision of seminars for school students about modifying lifestyles or dealing with stress and the preparation of health education materials.

Consultation to, and supervision of the work of professionals, agencies and organizations involved with the care of children and their families. Consultation may focus upon general issues or problems encountered in working with children and their families both at an organizational and individual case level. Specialist supervision of psychotherapy is also provided and could focus upon the process of therapy or the use of specific therapeutic approaches.

Training and teaching carers and other professionals involved with children and young people in psychological principles and practice. The range of topics is large but may include normal and abnormal development, the identification and assessment of child psychological problems, training in specific skills such as pain management or communicating with children, or specific therapeutic techniques.

Consultation and supervision of applied clinical research including advice about research methodology, instrument design and selection, qualitative and quantitative data collection, and statistical analysis. These skills can be readily applied to clinical evaluation and audit projects to critically and systematically evaluate therapeutic interventions in order to promote effective evidence based practice.