“What are your

best hopes for the group?”

“Big computers!!”

A Solution Focused Therapy A

pproach @ O

rmskirk

General H

ospital&

Geeks Club

Mark G

uyers A

ssistant Psychologist

Acknowledgem

ents

►D

r Rebecca Simm

(Principle Clinical Psychologist)

►D

r Dom

inic Bray (Consultant Clinical Psychologist)

►M

ichelle Quinn (Patient Advocate)

►D

r May N

g (Consultant Paediatrician &

Paediatric Endocrinologist and Associate Medical

Director at Southport &

Orm

skirk NH

S Trust)

►Alex W

addington (Assistant Psychologist)

►D

ominka Ziem

ba (Counsellor)

►All m

embers of O

rmskirk’s Paediatric

Diabetes/O

utpatients Team

My Best H

opes

►Share the good w

ork over the last year

►To discuss w

hat a SF approach looks like in paediatric diabetes team

– why

is this required?

►H

ow our m

ulti-disciplinary colleagues are finding w

orking with the approach

►G

eeks club

“Illness is the night-side of life, a more onerous citizenship.

Everyone who is born holds dual citizenship, in the kingdom

of thew

ell and the kingdom of the sick. A

lthough we all prefer to use

only the good passport, sooner or later each of us is obliged, at leastfor a spell, to identify ourselves as citizens of that other place.”

Susan Sontag, Illness as Metaphor, 1978

-Average of 8 blood checks per day

-Finger pricks, needles, pum

ps

-Carbohydrate ‘carb’ counting

-Insulin before and after each m

eal

-Checking in the night tim

e

-Routine

-That aw

ful word com

pliance

-Long term

risks (whilst w

e are here, let’s get something straight... fear...

it doesn’t work!)

What’s required?

Children and young people.. and their families... and... everyone else?

Illness happens to a

family... not just an

individualPatterson, 1994

CYP

Family

Comm

unity

Society

School

Teachers

Work

Friends

Relatives

Healthcare ProvidersSiblings

Parents

Pets

Grandparents

Values &

Attitudes

Culture

Social Policies

Health

Noticing the doughnut and not just the hole

Life is a doughnut

CYP

Family

Comm

unity

Society

School

Teachers

Work

Friends

Relatives

Healthcare ProvidersSiblings

Parents

Pets

Grandparents

Values &

Attitudes

Culture

Social Policies

Health

►The ‘routine appointm

ent’

►O

ccurs every 3 months

►Bloods ‘H

bA1c’ & a review

of their checks

►Review

of any difficulties

Beginnings

Mon

TueW

edThu

FriSat

SunM

onTue

Wed

Green = blood w

ithin ‘normal range’.G

rey = no check completed. Red = blood not w

ithin ’normal range

The old appointment style...

07:00

06:00

”That was m

e... honestly... I was that

person... I was that person for 20 years... 20

YEARS!”

►The graph w

ould be open on arrival to the appointment

►“So I have your blood results here...”

►The conversation w

ould be problem focused

►A

dvice giving

►Q

s: Why haven’t you? D

id you think about the long term effects? Could you

start? You need to start doing this. They need to be much better. You know

w

hat you are doing don’t you, see you in three months

~ Dr M

ay Ng

Mon

TueW

edThu

FriSat

SunM

onTue

Wed

Green = blood w

ithin ‘normal range’.

Grey = no check com

pleted. Red = blood not within ’norm

al range

What w

ould you be curious/ask about?

07:00

06:00

Feedback

Healthcare Professional:

Hello John, m

y name is M

ark. What w

ould you being doing now if you w

ere not here meeting the team

today?

John:W

ell... it’s nearly lunch time and I w

ould probably be thinking about the game of football w

e would be having at

lunch. Who is going on w

hat team. W

ho the keepers should be. I love football. Did you know

I’m the captain of

the school team?

HP:

Wow

! I didn’t know that. H

ow long have you been captain for?

”Did I tell you I Lego”? The M

agic of Problem Free Talk in Paediatric D

iabetes

Healthcare Professional:

Hello John, m

y name is M

ark. What w

ould you being doing now if you w

ere not here meeting the team

today?

John:W

ell... it’s nearly lunch time and I w

ould probably be thinking about the game of football w

e would be having at

lunch. Who is going on w

hat team. W

ho the keepers should be. I love football. Did you know

I’m the captain of

the school team?

HP:

Wow

! I didn’t know that. H

ow long have you been captain for?

John:The last 6 w

eeks

HP:

I know m

y football and that’s an important role in the team

. How

did you get the job?

”Did I tell you I Lego”? The M

agic of Problem Free Talk in Paediatric D

iabetes

Healthcare Professional:

Hello John, m

y name is M

ark. What w

ould you being doing now if you w

ere not here meeting the team

today?

John:W

ell... it’s nearly lunch time and I w

ould probably be thinking about the game of football w

e would be having at

lunch. Who is going on w

hat team. W

ho the keepers should be. I love football. Did you know

I’m the captain of

the school team?

HP:

Wow

! I didn’t know that. H

ow long have you been captain for?

John:The last 6 w

eeks

HP:

I know m

y football and that’s an important role in the team

. How

did you get the job?

John:W

ell… the teacher said I’m

good at organising things but I think it’s because I always score goals and I’m

good at

telling others what to do on the pitch in big m

oments. I never used to score goals either but I am

now. I’m

glad

I’m scoring because the team

needs them.

HP:

Amazing! So you have a key role in the team

and you have an ability in motivating others by the sounds of it…

You’ve also gained some goal scoring abilities too? H

ow have you done that?

John:I’m

always w

atching Match of the D

ay with m

y Dad and w

e discuss players and goals together. I think it helps. I

also like watching goals on YouTube and then practicing w

ith my brother. I even taught m

yself how to do an

overhead kick from w

atching YouTube! I haven’t tried it in a match yet though…

I don’t want to w

aste a chance

at goal on it just yet.

”Did I tell you I Lego”? The M

agic of Problem Free Talk in Paediatric D

iabetes

Healthcare Professional:

Hello John, m

y name is M

ark. What w

ould you being doing now if you w

ere not here meeting the team

today?

John:W

ell... it’s nearly lunch time and I w

ould probably be thinking about the game of football w

e would be

having at lunch. Who is going on w

hat team. W

ho the keepers should be. I love football. Did you know

I’m the captain of the school team

?

HP:

Wow

! I didn’t know that. H

ow long have you been captain for?

John:The last 6 w

eeks

HP:

I know m

y football and that’s an important role in the team

. How

did you get the job?

John:W

ell… the teacher said I’m

good at organising things but I think it’s because I always score goals and

I’m good at telling others w

hat to do on the pitch in big mom

ents. I never used to score goals either

but I am now

. I’m glad I’m

scoring because the team needs them

.

HP:

Amazing! So you have a key role in the team

and you have an ability in motivating others by the sounds

of it… You’ve also gained som

e goal scoring abilities too? How

have you done that?

John:I’m

always w

atching Match of the D

ay with m

y Dad and w

e discuss players and goals together. I think

it helps. I also like watching goals on YouTube and then practicing w

ith my brother. I even taught

myself how

to do an overhead kick from w

atching YouTube! I haven’t tried it in a match yet though…

I

don’t want to w

aste a chance at goal on it just yet.

”Did I tell you I Lego”? The M

agic of Problem Free Talk in Paediatric D

iabetes

Changing the conversation...► H

oped for outcome

► Describing life w

ithout the problem –

the preferred future

► Progress already made tow

ards solving the problem

► Further signs of progress – noticing. Exam

ple of Bamboo the Panda!

Healthcare

Professional:

WO

W! I w

ant to hear all about your next adventures with B

amboo

and how brave you both are together! W

ould you be able to do that

and bring Bam

boo to our next chat together? I can’t wait to m

eet

the coolest, bravest Panda in the world! You have a secret task from

me too, are you up for that? [H

enna nods] - but its very secret for

you and Bam

boo - make sure you both pay attention to how

brave

you are. Can you do that?

Henna:

Yes! I can bring him here as w

ell. I think he is going to come to

school with m

e later as well. M

um - can B

amboo com

e to school

with m

e in my bag?

Mum

:Yes he can! W

ill he need a packed lunch?

Doing diabetes differently (G

uyers, Simm

& Bray, 2019)

What the team

notices using solution focused approaches

1 Healthcare Professional > confidence, skills, focus

on the CYP,

2 Patient > Trust, relationship, involvement, fam

ily

3 Service > Managem

ent, team w

ork, consistency

All roles are within this approach – isn’t specific

to psychology mem

bers of staff

What’s w

ith the clipboard?

►M

y reflections: working w

ith this model m

akes you really listen.

►Previous w

ork in IAPT: Am I really listening?

►M

y clipboard says I’m not.

►The difference it m

akes to me – burnout, results,

interestingly what I can rem

ember about

appointments and im

portantly when I can

remem

ber, I’m m

ore of a visitor in their lives.

►I’m

allowed to say I don’t know

and I enjoy it.

►There’s no pressure on m

e to say anything particularly clever.

Big ideas. Big computers.

Whilst w

e are here.. what’s a Pokém

on?

A brief guide to:

►‘Back in m

y day’ There w

ere about 151 Pokém

on – there are now

807.

►They all have pow

ers and stuff

►Som

e of them are fluffy,

some are like dinosaurs

►Ryan Reynolds voiced one, once.

Big ideas. Big computers.

►6 children, w

e notice, when they com

e to their clinic appointments have

special interests.

►Com

puter games, technology, Lego, M

inecraft, art, subjects at school, Anime,

Pokémon, shared experiences (m

ore of this later).

►Parents, healthcare professionals noticed that additional adaptations or support/needs w

ere sometim

es/always required.

►CYP and their parents don’t feel they fit in.

A new one for m

e (and maybe you too)

‘Monotropism

’

In a nutshell, monotropism

is the tendency for our interests to pull us in more

strongly than most people. It rests on a m

odel of the mind as an ‘interest

system’: w

e are all interested in many things, and our interests help direct our

attention. Different interests are salient at different tim

es.

In a monotropic m

ind, fewer interests tend to be aroused at any tim

e, and they attract m

ore of our processing resources, making it harder to deal w

ith things outside of our current attention tunnel.

Workshop 2: W

hat would you

do? Discuss w

ith your partner!

Helpful hints

from the

evidence base:

Increase connections w

ith other people through the child's

interests: 'start where

the child is’.

Allow them

to pursue their ow

n interests, and build understanding

that way.

Make tasks and

connections more

meaningful.

The focus should not be just on the person's behaviours, skills or understandings; it is

vital - and rewarding -

for those around them

to put in work to

understand their perspectives, too.

A new one for m

e (and maybe

you too)

‘Monotropism

’

CLIP FROM

‘LIFE AN

IMA

TED’ O

SCAR N

OM

INA

TED

DO

CUM

ENTA

RY

22:49-27:10

Obsessions aren’t such a

bad thing, are they?

What

we did!

The First Rule(s) of G

eeks Club

CYP make the

rules – it belongs to them

NO

BOD

Y IS EXCLU

DED

(I learnt a valuable lesson here)

The Badger Song is BAN

NED

(although if the rule of talking over one another is broken it m

ay be utilised to rem

ind...)

Usual assum

ptions that SF has. N

on-expert, focus on resources

Cheesecake

We are visitors

to the group + steer it gently it only

Pokémon

Let’s stay curious

No talking

over each other

No

introductions

No fights, ever!!!

Unless w

e are in a scrum

debate

SHU

T UP

THE BAD

GER

RAND

OM

NESS

Photos

Zeg The Alien

►O

ne CYP attends the group

►W

rites a poem about ‘Zeg the

Alien’

►A poem

about how to m

ake others understand diabetes.

►The em

otions, humour,

understanding self and others

►H

is family keep bees and he

brought bee wax lip balm

to the group!

Art Work

►Tw

o CYP have an interest in Art and design.

►G

eeks club became a place w

here they could discuss art and their m

ock exams

►O

ne of the girls never used to talk at her appointm

ents.

►Shared experiences of bullying... H

uh? I thought these CYP didn’t ‘do’ em

otions?

►The response of the group

A Dragon Called

Derek..

►W

e have heard all about a pet dragon called D

EREK

►It w

ears clothes! How

am

azing!

A Dragon Called

Derek..

►W

e have heard all about a pet dragon called D

EREK

►It w

ears clothes! How

am

azing!

►Later found out it actually w

ears a sock w

ith holes in..

How

You Can Build A

nything Out of Lego

►O

ne mem

ber can build anything from

Lego

►U

ses his mem

ory to build

►H

as made Star W

ars figures/aircraft and landing craft from

the D-D

ay Landings after w

atching a documentary w

ith his D

ad

A Talented Engineer

A National Com

petition winner in the

Club!

Showed videos of his team

collecting an aw

ard and how he did it

Wants a guitar w

orth £4,000 and we

are all in the ‘not knowing position’

of how he’s going to do it...

What Parents/G

randparents Have

Noticed

►O

ur children/Grandchildren love com

ing here

►The other groups just didn’t seem

to fit

►They have begun to talk m

ore

►“I can’t shut them

up”

►It’s great that you are doing this, w

e appreciate it

Stop measuring, start feeling

Stop analysing, start caring

►A

pplied Behaviour Analysis: The m

ost basic method starts w

ith "discrete trials" therapy. A discrete trial consists of a therapist asking a child for a particular behaviour (for exam

ple, "Johnny, please pick up the spoon"). If the child com

plies, he is given a "reinforcer" or reward in the form

of a food treat, a high five, or any other rew

ard that means som

ething to the child. If the child does not com

ply, he/she does not receive the reward, and the trial

is repeated.

►RESEARCH

: Music therapy. The difference w

as the quality of the relationship betw

een the autistic child and the therapist. The hum

an angle, in other words. The

kindness, the respect, the affirmation, the genuineness

of wanting that child to thrive, authentically (M

ossler et al, 2019).

If we w

ere to speak again in 6 months tim

e? What

would I and the team

like to be telling you?

WE D

ON

’T KNO

W

WH

ERE IT IS GO

ING

, W

HICH

IS GO

OD

WE W

ILL BE THERE TO

FACILITATE AS LO

NG

AS IT N

EEDS TO

IF IT END

ED

TOM

ORRO

W, TH

AT’S O

KAY!

ACCESS TO TH

E CLUB,

BUS, TAXI, TRYIN

G TO

ACCESS A G

RANT

Con

tinu

ing

to n

otice th

e d

ou

gh

nu

t an

d n

ot ju

st the h

ole

Transition Project

Let’s imagine w

e are holding tortilla chips

Keep the good work going..

HbA1c m

mol/m

ol

Year

62mm

ol/mol (7.8%

)

Paediatric Diabetes U

nit HbA

1cM

edian HbA

1c

77mm

ol/mol (9.2%

)

HbA

1c Trends- National Paediatric

Diabetes A

udit

34.3% ach

ieving H

bA

1c less than

58mm

ol/m

ol in

2016/1717.5%

achievin

g Hb

A1c less th

an 53m

mo

l/mo

l in 2016/17

DN

A rate 22%

11% ( 5%

for < 10yr o

lds)

Ho

spital A

dm

ission

s du

e to D

iabetes red

uced

by 1.8 Len

gth o

f Stay

Alan Turing 'Som

etimes it is the people

no one can imagine

anything of w

ho do the things no one can im

agine.'

Disney Club! 31.52 -