Lecture 3- Working with Children and Families

Question 1

What are the four overarching ethical principles for psychologists?

Answer 1

• Respect for dignity of persons and peoples.
• Responsible caring.
• Integrity of relationships.
• Social justice.

Question 2

What is the overarching ethical principle underlying all of the foundational four?

Answer 2

Do no harm: don’t escalate the distress of the individual. There is a fine balance between addressing trauma and bringing up pain pointlessly.

Question 3

In relation to evidence based practice what do we have to keep in mind when we ‘do know harm’?

Answer 3

Even evidence based practice can do harm. It’s about catering to the individual and their needs. What works for most might not work for all. Constant reevaluation + checking is required.

Question 4

What is transference? What might you need to be prepared to do?

Answer 4

• As a psychologist you need to constantly remain aware of your own bias and how that might influence your treatment of patients.
• Even if you don’t agree with an individuals actions you still have to respect their world view
• If you feel that you can’t for whatever reason remain professional/ non judgmental then you should refer the patient on.

Question 5

What are some situations where you should refer patients on? What about the way psychological practices are set up allows this?

Answer 5

• Your own world views are biasing your treatment towards them
• If you think someone else could provide better care/ connect better with the patient
• Their issues rely outside your area of expertise/ scope or qualification(psychologists are registered in a certain area)

Often psychologists work as part of multi-disciplinary teams and so referring someone on is relatively easy

Question 6

In terms of integrity of relationships what is the concern ethics wise?

Answer 6

• Need to make sure there are no conflicts of interests i.e. you can’t be friends or pursue relationships with current or previous clients
• This is particularly important because of the power imbalance.
• Limit contact with the patient outside of the workplace i.e. if you brought a car from a patient they might feel like they have to give you a better deal because of your status in their life

Question 7

How is social justice an ethical concern and how does this relate to confidentality?

Answer 7

Psychologists have a duty to not just look out for the wellbeing of individuals but society as a whole. This relates to confidentiality in that while what is said in a session usually stays there if the person is talking about harming another then that’s something that needs to be reported.

Question 8

When should you clarify the confidentiality rules with a patient?

Answer 8

• At the start of seeing them you need to set out who will have access to the information they tell you
• Generally you keep it to yourself as much as possible but if you are a student it may be that your supervisor will or if you are in a multidisciplinary team it may be easier to share information with colleges in order to provide the best care possible + refer them to someone more suited

Question 9

When can you break confedienatly?

Answer 9

Only when individual is at risk of harming self (suicide, drink driving, elderly: dementia) or others

Question 10

In regards to confidentiality what does the court have access to? What do you need to keep in mind?

Answer 10

If a patient appears before the court a search warrant may be issued in which case the police can come and take your files on the patient - but the information in it can not directly be used as evidence in the case.

The notes may however influence their opinion/ how they approach the case. Therefore there is a fine line between recording sessions in enough detail but not incriminating the client.

Question 11

What is the purpose of the mental health act? How might you go about getting someone to conform to testing?

Answer 11

-Compulsory Assessment and Treatment.
-Can be used to ensure patients who are at imminent risk to themselves or others are assessed and treated.
-Always try and have patients volunteer for assessment and treatment - but if they are not able to and it is in their/others best interest they can be admitted under the Mental Health Act. However, family must be consulted and involved in the process whenever
possible.

Question 12

Does someone who suspects child abuse have to report it? What about of maltreatment and neglect- are the rules so clear cut?

Answer 12

• Yes if child abuse is serious then yes. Maximum prison sentence could be 10 years if you did nothing.
• For maltreatment and neglect it is not as clear. There is no legislatively mandated reporting in NZ (sometimes employer will require it though), but better to err on side of reporting rather than not reporting.
• Usually there is someone you can go to for consultation of whether you need to report without actually reporting. That way if you get called up in a court of law you can say that you did seek advice.

Question 13

What is the purpose of Oranga Tamariki and how does this relate to reporting/ breaking confidentiality?

Answer 13

• Many professionals are afraid of the consequences of reporting. Keep in mind that Oranga Tamariki operates on a principle of supporting the family to care for the child. They do not remove the child until it is absolutely necessary.
• Reporting can be done in a way that keeps the patient- therapist relationship intact if it is framed in a way to help the individual/ provide additional support.

Question 14

What take precedence in the ethical code in terms of safety?

Answer 14

The safety of the child

Question 15

What does the assessment of children usually involve?

Answer 15

• Interview child.
• Interview as many family members who are frequently and actively involved in the child’s life as possible (e.g., parents, siblings, grandparents etc..).
• Interview the teacher.
• Collect ratings.
• Administer neuropsychological tests (if appropriate to the referral question).

Question 16

In assessing a child what are some things to keep in mind?

Answer 16

• What is developmental normal
• Culture is an overarching organizer in determining norms
• Gender: certain conditions are more common for particular genders
• Appearance: what does it say about the child and how well they are cared for

Question 17

What balance exists between the child and parent involvement in assessing psychological disorders?

Answer 17

• The child is the patient and you want to keep their trust
• But at the same time it is appropriate to inform the parent of what is found on sometimes
• Every child exists as part of a wider unit and so the environment is often a huge part of their behaviour and can be enlighted/ controlled to a certain extent. Having informed parents is part of that.

Question 18

How might age/ level of development influence interview techniques?

Answer 18

• Often young children will just say yes to whatever you tell them
• It is therefore very easy to lead them a certain way
• Don’t ask too many closed questions for young children leave it very open as to what they want to tell you

Question 19

What should we take note of in terms of appearance when interviewing a child?

Answer 19

• Height
• Weight
• Clothing
• Body odor
• Signs of malnutrition
• Breath (smells of alcohol)
• Signs of conditions (e.g., anorexia)
• Marks on body (bruises, needles, cutting)

Question 20

What nonverbal behaviour should we take note of in children? Why is this so important?

Answer 20

• Vision
• Hearing
• Motor skills
• Gait

Often it may be that physical conditions/ difficulties are causing defiant behaviour in children so that is something that always needs to be ruled out in children. For example a child might always stand up because he can’t see what is written on the board otherwise. This could be mistaken for hyperactivity.

Question 21

What is a technique used to assess naturalistic behaviour in children?

Answer 21

• Look at what the child does in a waiting room

- What relationship do the parent and child have when they don’t feel they are being observed

Question 22

What is the purpose of clinical psychology interventions? Do we want the relationship to extent over long periods?

Answer 22

• No, the goal is to assess and give the patients the necessary tools to solve their own problems
• The relationship shouldn’t extent over extreme periods of time

Question 23

What needs to recognized in terms of the assessment outcome?

Answer 23

• No child wants to be different
• Fully recognize that is you diagnose a child with something that is going to have a big impact on their life (effect of labelling)

Question 24

For young children is it always appropriate to introduce yourself with your full title? How does appearance relate to this?

Answer 24

• No, Dr may be intimidating/ children may associate it with needles/ bad experiences with medical doctors
• Clothing also relates to making the child/ patient feel comfortable. Of course you don’t want to tailor everything you wear to match the patient in an extreme way but you should always be aware of the effect clothing/ appearance can have

Question 25

What balance exist between being prepared/ making the most of past patient information and hearing it for yourself?

Answer 25

- You should read the notes of previous health professionals as often clinical psychologists are the last step in a series of visits - The patient may feel not heard/ get annoyed if you get them to repeat everything they have already said - On the other hand, you need to make sure you have understood the issue correctly and are not coming in with false assumptions - Therefore, often a good approach is to summarize the information you have received and just check if the patient agrees with what you have said.

Question 26

How might your approach to interviewing differ between younger and older children i.e. what different challenges to they present?

Answer 26

- Younger children often have issues with separation so you need to ensure that you develop a good relationship with them from the start to make them feel comfortable. You wouldn't for example call them into the room without a parent. You would bring them both in, get them comfortable then ask the parent to leave. - Older children often have a lot more anxiety/ apprehension about the process. Although it varies from individual to individual they often want a lot more information about the implications of findings before they start talking. Fine balance though as don't want to freak them out.

Question 27

Why do you need to be flexible in your approach to engaging children? What might this look like?

Answer 27

- Every child is different and so you often need to adjust your approach to make them feel comfortable - This means you have a 'bag of tricks' that you can pull out according to circumstance

Question 28

Is feedback important as a psychologist? In what forms might you receive this feedback?

Answer 28

- Yes, feedback is vital. You need to stay open and allow yourself to be critiqued in order to improve. - This is not a profession where you learn everything you need to know when you are studying and then from that point on remain static. Information/ times are constantly changing and you need to stay current. - To do this you need to engage in supervision and and listen to yourself (self- awareness is key!). Learn to monitor your emotions, body language and tone for desired effect. - Patients also give feedback often. For older patients this tends to be not as obvious but can come across in body language or in the amount the share with you. For younger children they are often very blunt and it is easy to tell what they think. If they don't like your approach they will tell you.

Question 29

How might you go about treating a child?

Answer 29

-Change problems into skills -Agree on the skill to be learnt -Talk about the benefits of the skill -Nickname the skill -Enlist the help of a power animal -Ask people to support the child -Talk about reasons for believing in the child - Plan a celebration -Others are told what skill is being learnt (remember child doesn't exist in a vacuum!) -Rehearse the skill -Plan for setbacks -Celebrate and thank helpers l Teach others the new skill

Question 30

How might you go about treating/ talking to parents?

Answer 30

Teach the causes of behaviour problems: -Genetic makeup (emphasis on it not being their fault!) Family environment, address: -Reinforcing misbehaviour -Escalation (if behaviour gets worse the child may get what they want) -Ignoring desirable behaviour -Watching others (i.e. copying parents undesirable behaviour) -Poor instructions given by parents (too many, too few, too hard, poorly timed, too vague, body language) -Emotional messages (calling the child names i.e. crybaby) -Ineffective use of punishment (not following through, used in crisis etc.) -Parent beliefs and expectations (do they think the child should be ahead of where they are developmentally) It's about supporting the parent and teaching them skills to help them develop a positive child-parent relationship. Frame it as how to manage the condition not that their parenting caused the behaviour to begin with.

Question 31

How might a parent help their child?

Answer 31

- Develop a positive relationship with the child (quality time, talk with child, show affection). - Encourage desirable behaviour (praise, attention, provide engaging activities, ‘catch’ them being good). -Teach new skills or behaviours (set an example, use incidental teaching, ask-say-do {ask what the first thing we do to brush teeth is; if no response then say what we first do; if no response do/help the child in the steps}, praise, repeat ask-say-do for each step, use behaviour charts)

Question 32

How might a parent manage bad behaviour from their child?

Answer 32

-Establish clear ground rules, use direct discussion re rule breaking, ignore minor misbehaviour, give clear instructions, gain the child’s attention, tell the child what to do, give them time to cooperate, praise, repeat. -If no cooperation: back up your instructions with clear consequences (e.g., withdraw the activity).

Question 33

How might parents use time out or quiet time? What lengths should time out be?

Answer 33

-Use quiet time - usually in the same room in which the trouble occurred. Explain what to expect before using quiet time. -Use time out for serious misbehaviour - put child in another room which is NOT interesting but safe. Explain why they are going into time out. Short periods are better than long periods. Ignore misbehaviour in time out. When time out is over do not talk about the incident again. -Time out = 1 minute per age year (e.g., 8 years old = 8 minutes)

Question 34

What are the four family survival tips provided in this lecture?

Answer 34

- Don’t argue in front to children - Work as a team - Get support - Have breaks

Question 35

What are some ways teachers can engage in children's learning of appropriate behaviour?

Answer 35

- Many similar Behavioural techniques as for parents. - Home-school contract. - Classroom placement. - Token/chart reward system. - Rewarded at home for good school behaviour. - Work with child’s special needs (e.g., allow to stand at desk rather than sit, send on errands). It's important that the techniques used at home match what is done at school