geek's club ukasfp [autosaved].pptx€¦ · h. le t cyp y y y l s k nds s s ngs s s s s e s h...
TRANSCRIPT
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“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
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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
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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
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“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
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-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?
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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
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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
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►The ‘routine appointm
ent’
►O
ccurs every 3 months
►Bloods ‘H
bA1c’ & a review
of their checks
►Review
of any difficulties
Beginnings
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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
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”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
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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
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Feedback
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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
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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
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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
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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
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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)
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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
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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.
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Big ideas. Big computers.
Whilst w
e are here.. what’s a Pokém
on?
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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.
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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.
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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!
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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.
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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?
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What
we did!
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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
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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!
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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
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A Dragon Called
Derek..
►W
e have heard all about a pet dragon called D
EREK
►It w
ears clothes! How
am
azing!
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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..
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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
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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...
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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
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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).
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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
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Keep the good work going..
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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%
)
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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
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Alan Turing 'Som
etimes it is the people
no one can imagine
anything of w
ho do the things no one can im
agine.'
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Disney Club! 31.52 -