Preventative approaches in clinical psychology
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Transcript of Preventative approaches in clinical psychology
Preventative Work & Promotion of Psychological Wellbeing
in Clinical Psychology
Shona BrownFleur-Michelle Coiffait
Gráinne O’BrienLouise Roach
Trainee Clinical PsychologistsUniversity of Edinburgh
Monday, 14 May 2012
Preventative Approach
• “…interventions that anticipate a disorder, or promote optimal health prior to the onset of a disorder (Goldston, 1977).
• Physical health – immunizations, obesity
Monday, 14 May 2012
Why useful in mental health?
• 450 million people alive today suffer mental health disorders (WHO, 2001)
• Personal impact
• Economic implications (Layard Report, 2005) – Focuses on individual level
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Focus of interventions
• Why don’t individuals seek help?– Stigma– Failure to identify symptoms– Unaware of local resources
Targeted by prevention of mental health problems and promotion of mental health wellbeing.
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Types of Prevention Programmes
• Universal• Selective• Indicated
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Prevention Programmes
• Depression in adults – prevention of development of moderate depressive episodes and reduction in symptoms of anxiety and depression
(Seligman et al., 1999; Munoz et al., 1995)
Monday, 14 May 2012
Prevention Programmes
• Depression in children – reduction in depressive episodes and symptoms of depression
(Clarke et al., 1995; Jaycox et al., 1994)
• Substance misuse, anxiety, suicide...
Monday, 14 May 2012
Recommendations for Prevention Programmes
• In order to be most effective, a screening process should be used. Focus on participants especially at risk
• CBT is a popular model on which to base a programme
• Group programmes are common, but individual approaches are also possible
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Prevention Programmes?Early BirdThe NAS EarlyBird Programme is autism-
specific and has three content 'threads'. It helps parents to:
• understand their child's autism • structure interactions in which
communication can develop • pre-empt problem behaviours and handle
those that occur.
Monday, 14 May 2012
Prevention Programmes?
Mellow Parenting / Mellow Babies• Aims to support parents with relationship
problems with their infants and young children
• Combines personal support for parents with video and direct work with parents and children addressing parenting problems
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Prevention Programmes?
The Solihull Approach• Integrated model of working• Resource packs and training for care
professionals• Focuses on containment, reciprocity, and
behaviour management• Research suggests 66% reduction of
parental anxiety
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‘Mental capital’ over the course of life
Beddington et al. (2008)
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Early Intervention in Childhood
• Maximising protective factors: proactive approach to mental health and wellbeing
• Minimising effect of threats to mental wellbeing: early intervention
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Pyramid Clubs
• Screening of children at risk: Strengths and Difficulties Questionnaire
(SDQ; Goodman, 1989)• Multi-agency meeting to select 10 children• 10 week activity club hosted by schools• Trained volunteers provided by National
Pyramid Trust (charity) run the clubs
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Pyramid Clubs
• SDQ completed as follow-up measure • Rich data set (pre- and post- activity club)
but little published research• Children with and without difficulties
appear to benefit from attending. • Significantly larger effect size for children
with identified difficulties (Ohl et al., 2008)
Monday, 14 May 2012
Nurture Groups
• For primary school children with social, emotional or behavioural difficulties (as measured using Boxall Profiles)
• Small ‘nurturing’ class with increased staff ratio
• Taught social skills and practical skills as well as curriculum based work
• Routines, explanations in context
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Examples with Adults
• Role for CPs in training, consultancy and research at multiple levels. Some examples:
- media e.g. BBC’s “Headroom” - specific programmes e.g. Positive Mental
Attitudes Workplace Intervention in Glasgow
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Media
• May 2008 BBC launched 2 year “Headroom” campaign
• Includes on air programming, outdoor events and interactive website
• Aim “to actively encourage people to assess their mental wellbeing and take simple, practical steps to manage or improve it”
Monday, 14 May 2012
Media
• Peter Kinderman (Professor of Clinical Psychology at the University of Liverpool) developed “Mind Spa” component of website
• Participants complete online assessments of their mental wellbeing and receive offer of personal life coach to explore results and develop plan with goals for the future
Monday, 14 May 2012
Media• Benefits = BBC so reaching large
audience, multifaceted “intervention”, increasing knowledge?, reducing stigma? (need for well conducted research)
• But.. Many similar websites (e.g. Chris Williams’ LLTTF, Mood Gym). Waste of resources? Risk that users (and possibly referrers) will feel overwhelmed with choice?
Monday, 14 May 2012
Positive Mental Attitudes (PMA) – Workplace Programme
• Visit workplaces throughout Glasgow to provide mental health awareness sessions to staff.
• Assist organisations to develop mental health and wellbeing policies
• Claim benefits to organisation (e.g. reduced staff absence and staff turnover).
• Broader aim of increasing knowledge and reducing stigma
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Positive Mental Attitudes (PMA) – Workplace Programme
Aim for participants to leave with increasedunderstanding of:• Mental health, mental health problems
and their causes• How to maintain their own mental health
and that of those around them• Mental health and wellbeing resources
Monday, 14 May 2012
Positive Mental Attitudes (PMA) – Workplace Programme
• PMA run other projects (Later Life, School based, Asylum Seekers and contribute to Scottish Mental Health and Arts Festival)
• Funding and management input from NHS • Input from CPs based in primary care
mental health team – consultancy role with regards content of programmes and research supervision
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Why are psychologists best placed?
• Knowledge base - expertise in area - Increase own knowledge
• Interdisciplinary working
• Scientist Practitioner– Research, audit and evaluation
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Barriers to preventative mental health practice
• Who to target?
• Is it possible within current resources of clinical psychology?
• Where responsibility lie?– ‘Bystander effect’ (Ball, 2008)
Monday, 14 May 2012
Future Directions
• Shift in paradigm needed – become more prevention focused
• Further research needed– Need to ascertain validity and effectiveness of
interventions.
• CPs well placed to contribute to this research agenda
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Any questions?
Monday, 14 May 2012