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Decision-making with
young people in CAMHS
Kate Martin, Emma Karwatzki, Duncan Law, Amy
Feltham, Grace Jeremy, Daniel Hayes and Robin
Barker
#YPOpentalk
@_Common_room
@drduncanlaw
@gracie_stardust
@CAMHS_EBPU
Welcome and introductions
Open Talk is designed to support open decision-
making between children, young people and
mental health professionals in inpatient and
community mental health services.
Drawing on evidence from a number of innovative practice and
research initiatives, including two current PhD projects, we have
worked in partnership with young people and CAMHs professionals
to develop:
• The Open Talk decision-making model
• A one day masterclass with a ½ day follow up session
• A website and online resources
Key messages upfront
Open Talk isn’t about the basic principles of decision-
making. It aims to:
• build on your existing skills and experience
• explore challenging or difficult scenarios
• think and learn together as a team and service
• explore how we can make decision-making (and the
constraints) more open and explicit with children and
young people
“Being involved in decisions made me realise that I can
make choices. It helped me to know that I always have
options. Even in the most difficult moments, it makes me
stop and think… ‘I have options, I might not know what they
are right now, but this isn’t the only way.’” Young person
• How did or didn’t these highlight your sense of
purpose in contributing to decision-making or
close you down in this process?
• How might these experiences have influenced
your life at the time?
What memories do you have from your
own adolescence of decision-making
processes?
Closing the gap
There is often a gap between our intent to involve young people in
decisions and their experience of it.
What could cause this?
- From the experience of the young person
- From the practitioner
- How can we close the gap and make decision-making more
visible and explicit?
Alliance in child and adolescent psychotherapy
Shirk, Stephen R.; Karver, Marc S.; Brown, Renee
Psychotherapy, Vol 48(1), Mar 2011, 17-24.
Meta-analysis:
“Overall the strength of the link between
alliance and outcomes equated to an effect
size of 0.22, a statistically significant link
representing a moderate relationship which
accounts for about 5% of the variance in
outcomes….....The more solid the working
relationship …...the better the outcomes”
Goal consensus and clinical outcomes
Tryon, Georgiana Shick; Winograd, Greta
Psychotherapy, Vol 48(1), Mar 2011, 50-57.
Meta-analysis:
“Across the relevant 15 studies with 1302 clients,
…....the link between goal consensus and therapy
outcomes equated to a medium effect size of 0.34.
This statistically significant link accounted for
nearly 12% of the variance in outcomes –
indicating that better outcomes can be expected
when patient and therapist agree on therapeutic
goals and processes to achieve these goals”
Key principles
• Open and explicit decision-making
conversations
• Deliberation, negotiation and thinking together
• Learning and internalising
• Epistemic trust
• Reflection – level of influence
• Positive risk taking
Talk with me about the decision
and how much say I have
Support me to know:
• That there is a decision to make
• What the decision is about
• How much influence I have in the
decision
Ensure I understand the options
that are available to me
• Ask me what options I think there are
• Talk with me about what options you think I have. This
may include deciding to do nothing.
• Explore what each option entails
• Explore what I have already tried, what has and hasn’t
worked, and whether I want to revisit these again
• Remember to be open to discussing all options, even if
you may not be able to support me with these – I need to
explore them all to understand what will and won’t work for
me and why.
Talk with me about the pros and
cons of the options available
• Support me to think through and weigh up the pros and
cons of each option
• Consider whether there is information to help me to
understand the pros and cons e.g. is there an evidence
base?
• Be open to discussing all the pros and cons – I need to
explore them all to understand what will and won’t work for
me and why. If you don’t know the answer tell me, and we
can explore it together.
• Explore what we disagree and agree about and why
Discuss my views, values and
preferences
• Talk with me about how I feel about the different options,
their pros and cons, their impact, and what is important to
me
• Explore any worries or concerns I have
• Explore what I think others in my life might think and feel
about the different options, and how I feel this could
influence my decision
• Remember that a whole list of pros might be outweighed
one con, if that is the thing that’s most important to me
Explain your views
• Explain what you think is the best option for me, based on
what you know about me, research evidence, your
professional experience, and what has (and hasn't)
worked for other young people – be careful not to
‘recommend’ one ‘option’
• Consider that your preferred option might not be what is
best for me or what I feel able to do
• If there are options you cannot support explain why,
acknowledge my views, and talk with me about what we
can do together.
Discuss if I feel able to do this
• Clarify how able I feel to do this. This might be
different from what I think is the best option
• Talk with me about how I could do this and what
support I might need
• If I don’t think I can do this, we may need to
revisit earlier options
Discuss what we are going to do
and how we are going to do it
• Check in and clarify my understanding about what
decision has been made and why
• Plan with me how I will put this into practice, and what
support I may need
• Check if it would help to record our discussion and
decision, and what format would be best for me for this
• Agree when will we reflect on and review the decision
What will one thing will you
try?
Keep in touch
Kate Martin, Director, Common Room
Kate.martin@commonroom.uk.com
@_common_room
Daniel Hayes
Daniel.hayes@annafreud.org
Duncan Law mindmonkey@hotmail.co.uk
Our website will be launched soon: www.opentalk.info

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Open Talk - Decision Making with young people: Children and Young People's Mental Health Conference 2017

  • 1. Decision-making with young people in CAMHS Kate Martin, Emma Karwatzki, Duncan Law, Amy Feltham, Grace Jeremy, Daniel Hayes and Robin Barker
  • 4. Open Talk is designed to support open decision- making between children, young people and mental health professionals in inpatient and community mental health services. Drawing on evidence from a number of innovative practice and research initiatives, including two current PhD projects, we have worked in partnership with young people and CAMHs professionals to develop: • The Open Talk decision-making model • A one day masterclass with a ½ day follow up session • A website and online resources
  • 5. Key messages upfront Open Talk isn’t about the basic principles of decision- making. It aims to: • build on your existing skills and experience • explore challenging or difficult scenarios • think and learn together as a team and service • explore how we can make decision-making (and the constraints) more open and explicit with children and young people
  • 6. “Being involved in decisions made me realise that I can make choices. It helped me to know that I always have options. Even in the most difficult moments, it makes me stop and think… ‘I have options, I might not know what they are right now, but this isn’t the only way.’” Young person
  • 7. • How did or didn’t these highlight your sense of purpose in contributing to decision-making or close you down in this process? • How might these experiences have influenced your life at the time? What memories do you have from your own adolescence of decision-making processes?
  • 8. Closing the gap There is often a gap between our intent to involve young people in decisions and their experience of it. What could cause this? - From the experience of the young person - From the practitioner - How can we close the gap and make decision-making more visible and explicit?
  • 9. Alliance in child and adolescent psychotherapy Shirk, Stephen R.; Karver, Marc S.; Brown, Renee Psychotherapy, Vol 48(1), Mar 2011, 17-24. Meta-analysis: “Overall the strength of the link between alliance and outcomes equated to an effect size of 0.22, a statistically significant link representing a moderate relationship which accounts for about 5% of the variance in outcomes….....The more solid the working relationship …...the better the outcomes”
  • 10. Goal consensus and clinical outcomes Tryon, Georgiana Shick; Winograd, Greta Psychotherapy, Vol 48(1), Mar 2011, 50-57. Meta-analysis: “Across the relevant 15 studies with 1302 clients, …....the link between goal consensus and therapy outcomes equated to a medium effect size of 0.34. This statistically significant link accounted for nearly 12% of the variance in outcomes – indicating that better outcomes can be expected when patient and therapist agree on therapeutic goals and processes to achieve these goals”
  • 11. Key principles • Open and explicit decision-making conversations • Deliberation, negotiation and thinking together • Learning and internalising • Epistemic trust • Reflection – level of influence • Positive risk taking
  • 12.
  • 13. Talk with me about the decision and how much say I have Support me to know: • That there is a decision to make • What the decision is about • How much influence I have in the decision
  • 14.
  • 15. Ensure I understand the options that are available to me • Ask me what options I think there are • Talk with me about what options you think I have. This may include deciding to do nothing. • Explore what each option entails • Explore what I have already tried, what has and hasn’t worked, and whether I want to revisit these again • Remember to be open to discussing all options, even if you may not be able to support me with these – I need to explore them all to understand what will and won’t work for me and why.
  • 16. Talk with me about the pros and cons of the options available • Support me to think through and weigh up the pros and cons of each option • Consider whether there is information to help me to understand the pros and cons e.g. is there an evidence base? • Be open to discussing all the pros and cons – I need to explore them all to understand what will and won’t work for me and why. If you don’t know the answer tell me, and we can explore it together. • Explore what we disagree and agree about and why
  • 17. Discuss my views, values and preferences • Talk with me about how I feel about the different options, their pros and cons, their impact, and what is important to me • Explore any worries or concerns I have • Explore what I think others in my life might think and feel about the different options, and how I feel this could influence my decision • Remember that a whole list of pros might be outweighed one con, if that is the thing that’s most important to me
  • 18. Explain your views • Explain what you think is the best option for me, based on what you know about me, research evidence, your professional experience, and what has (and hasn't) worked for other young people – be careful not to ‘recommend’ one ‘option’ • Consider that your preferred option might not be what is best for me or what I feel able to do • If there are options you cannot support explain why, acknowledge my views, and talk with me about what we can do together.
  • 19. Discuss if I feel able to do this • Clarify how able I feel to do this. This might be different from what I think is the best option • Talk with me about how I could do this and what support I might need • If I don’t think I can do this, we may need to revisit earlier options
  • 20. Discuss what we are going to do and how we are going to do it • Check in and clarify my understanding about what decision has been made and why • Plan with me how I will put this into practice, and what support I may need • Check if it would help to record our discussion and decision, and what format would be best for me for this • Agree when will we reflect on and review the decision
  • 21. What will one thing will you try?
  • 22. Keep in touch Kate Martin, Director, Common Room Kate.martin@commonroom.uk.com @_common_room Daniel Hayes Daniel.hayes@annafreud.org Duncan Law mindmonkey@hotmail.co.uk Our website will be launched soon: www.opentalk.info