Multi Disciplinary Team
There are usually three doctors in the team. Dr Jo Holmes is the Consultant Child Psychiatrist, this is also a part-time Paediatrician and we usually have a trainee child psychiatrist in placement too. The doctors are involved in initial assessments prior to admission and meet with parents regularly through the admission to co-ordinate the care plan. The doctors also carry out diagnostic assessments. They are also responsible for monitoring children’s physical well-being, prescribing medication, co-ordinating discharge meetings and compiling discharge reports.
The nursing team provide intensive care to families on a 24 hours basis and provide most of the day to day care. Each family is allocated a small team of nurses that work closely with them; the team is led by a senior nurse known as the case manager and two key workers. The aim is that the child and parents will have contact every day with a nurse that they know well. The care team work closely with parents to identify areas of need and to create a care plan to address these. They undertake close observations of children and work with parents to develop strategies to manage difficulties.
The nurses are involved in a variety of therapeutic activities. They facilitate and support the therapeutic day programme; planning and managing the child’s access to activities and running therapeutic groups. They also do individual work with parents and children.
Outside of the day programme the nurses do intensive parent-child work with families using the principles of psychosocial nursing. This is a model that utilises everyday activities in a therapeutic way. It involves the nurse working alongside parents as they work on areas such as managing risk and safety, behaviour, mealtimes, personal hygiene, bedtimes and sleep. Nurses also support parents to develop the positive aspects of their relationship with their child, modelling play and supporting parents to engage in activities with their children in circumstances that otherwise might make this challenging for them.
There is a part-time social worker at The Croft who can offer advice and support about things such as welfare benefits or housing issues. Where families already have a social worker or family support worker involved, The Croft social worker will liaise with them to make sure there is good communication during the family's stay at The Croft. Along with the rest of the team, the social worker is also involved in trying to ensure that there is the right level of support in place for families when they leave The Croft. If a child has a Child in Need or Child Protection plan the social worker will ensure that information about the child’s needs are shared appropriately.
There is a part-time clinical psychologist at The Croft and a part-time assistant psychologist. The psychologist uses psychological theories to help families and staff understand children’s emotions and behaviour and develop strategies to improve emotional and behavioural problems. The psychologist also completes assessments with children to answer specific questions raised by parents, referrers and The Croft team. The assessments can include formal assessments or observational assessments. The results of assessments are taken into account when we develop our care plans at The Croft and make recommendations to parents and our colleagues in the community.
The psychologist also works with parents in the Practical Parenting Group and individually. Individual work may be about developing specific strategies for managing their child’s behaviour, helping parents understand the impact a child’s difficulties may have on their future development and supporting parents in developing a better understanding of challenges to their own psychological well being (e.g. depression and anxiety). The psychologist may also offer individual therapy to children if appropriate.
This is an approach that tries to understand how a child’s difficulties connect with the key people in his or her life. These can include parents, carers, siblings, wider family, friends and school etc. Understanding the way these relationships connect can be helpful for all those involved.
Sometimes, the number of adults involved in a child’s life can be very complicated (parents, doctors, social workers, therapists etc) and part of the family therapist’s role is to understand how these complications may impact on the child and the child’s family.
Family therapy usually involves children being seen with their parents together with their brothers and sisters. At least two members of staff will be involved in most meetings. Sometimes, it may involve working with brothers and sisters without parents or it may involve working with the parents without their children.
The music room offers a wide variety of musical instruments for children to explore and express themselves with. The music therapist runs group sessions and also therapy sessions for children individually or together with a parent. Music therapy enables children to have fun, communicate non-verbally and explore emotions through music.
These sessions are carried out on an individual basis and make use of talking, play, and the therapeutic arts to facilitate the work. The focus of sessions is to provide a regular time and space to help the child begin to explore and reflect on their thoughts and feelings and how things are for them.
Cognitive Behavioural Therapy (CBT):
This therapy may be offered to some older children. It focuses on examining and challenging dysfunctional thinking patterns.
This therapy is closely related to CBT and involves the use of techniques to encourage desired behaviours and discourage undesired behaviours. It involves the use of carefully chosen rewards and consequences to help shape a child’s behaviour. This approach is used commonly in the unit programme.
We have a small school with one teacher and two learning support assistants. Children attend every Monday to Friday morning. The high adult to child ratio helps us to provide children with more individual support not only with their school work, but also with their behaviour. Every child has their own programme specific to their needs but will be involved in as many group activities as possible. We also maintain close links with the child’s own school to provide continuity and advice to the teacher in the future. Sometimes children continue to attend their own school one day a week during their stay at the Croft.