Arena flexible treatment method Jan Ivar Ernø Section of Children’s Mental Health Oslo University...
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Transcript of Arena flexible treatment method Jan Ivar Ernø Section of Children’s Mental Health Oslo University...
Arena flexible treatment method
Jan Ivar Ernø
Section of Children’s Mental Health
Oslo University Hospital HF
”Treatment hypothesis”
• Treatment intensity should follow symptom intensity
• Treatment results depend on gained skills• Treatment requires complete alliance
”Treatment hypothesis”
• Crisis give true information about family function• Symptom severity required for motivation• Home situation must be sorted before giving
therapy• Confrontations will threaten the alliance• Functional aggression must have consequences
Historical antecedents
• Two levels of treatment– Out-patient clinic– Hospital admittance – 5 days / week
• Same patient group• Admittance corresponded with level of crisis• Treatment focus on relation with the child• Treatment time 1-3 years• High number of aggressive outbursts• Overall good treatment outcome• Poor long term prognosis
General treatment goals
• Maintain patient integrity• Validating observations• Motivating change• Clearing obstacles (school and care etc)• Creating effective interventions• Evaluating results frequently• Modifying transactions• Generalizing skills and results
Patient distribution
• Emotional disturbances• Mood disorders• Behavioural disorders• Attention deficits and Hyperactivity• Tics / Tourette syndrome• Autism spectrum• Attachment issues / disorders
Systemic approach
• Child’s issues to be understood in its dependent relation to adult caregivers and contexts
• Symptom expression must be understood in correspondence with psychological development
• Troubled families evade functional networks• Troubled families lower their ability to generalize• Troubled families bad transfer of advices to
behaviour
Bronfenbrenner’s ecological model
Arena flexible treatment model
• Hospitalizing - Arena flexible - Ambulatory• On terms with the child and family• Least invasive measures• High observational validity• Treatment results are generalized to natural
context• Realistic treatment goals• Flexibility and structure
Therapeutic indications
• Referred from out-patient clinics• Previous treatment without reaching wanted goals• Referral assumption: Families would benefit from
higher therapeutic intensity (> 2 hrs / w)
• Symptom severity alone are insufficient indicators of treatment level
Patient / parent concent
• Families can be motivated to participate in an intense treatment program with high therapist presence in multiple arenas
• Unhindered work with natural collaborators
• Patient integrity through “control commission”
• Caretaking situation implicates results
Individually adapted school
• School problems for majority of patients• Assisting, adjusting and supervising home school
if possible• Assessing special needs• Temporary schooling in nearby localities• Safe return to home school or special school
Using the bed therapeutically
• Rapid stabilization (destabilization) for the child• Parents present• Indications
– Initial observations and alliance with family Family introduction week
– The need of further clinical observations
– Stabilizing sleep
– Testing pharma treatment
• Training basic skills ADL• Children have their own rooms to withdraw and
regulate
Arenas
Treatment teams
• Full understanding of the family and child requires diverse professional opinions
• Complimenting treatment modalities• Treatment plans are developed, discussed,
executed and evaluated by the team in cooperation with the family
Child therapists Doctor/psychologist Spec. Teacher Child therapist (night)
Treatment plan
Treatment planName: Treatment team:Planen period: Goal:
Goal formulationsChild: Parents: Referral: Others:
Date Issue and resource Goal Interventions Method Responsible EvaluationDate/Sign
Main therapeutic methods
• Child therapists working directly with the child and family in several arenas
• Adapted and assisted school
• Traditional family interventions• Psychoeducation• Individual therapeutic sessions
• Supervising external collaborators• Overseeing treatment plans and individual
coordination plans
Selected therapeutic approaches
• Multisystemic perspectives– Children can be understood only when considered in
their common context– Their skills are specific to context, likewise are the
eventual changed skills– Skills are best trained in their natural environment with
motivated trainers
• Individual approaches– Cognitive approaches, Coping cat (Kendall, 2006)– Selected narrative approaches– MIM and Theraplay (Booth & Jarnberg, 2009)
Selected therapeutic approaches
• Family and network approaches– Parental supervision (Marte-Meo)– Circle of security (Cooper, Marvin, Hoffman & Powell,
2013)– Reflective team (Andersen, 1991)– Behaviour modification programs
PMTO and Social skills training
• FOMA– Preventing and handling aggression in children– Revealing and developing adult stress tolerance– Careful physical handling
Historical comparison
• Two levels of treatment– Out-patient clinic– Hospital admittance – 5 days / week
• Same patient group• Admittance corresponded with level of crisis• Treatment focus on relation with child• Treatment time 1-3 years• High number of aggressive outbursts• Overall good treatment outcome• Poor long term prognosis
Historical comparison
• Two levels of treatment – closer relation– Out-patient clinic– Arena flexible interventions - X days / week
• Same patient group• Admittance based on prognostic evaluation• Treatment focus on alliance with family• Treatment time ¼ - 1 year• Low number of aggressive outbursts• Overall good treatment outcome• Promising long term prognosis
Academic collaboration
• Hospital is part of the University of Oslo• Education contracts with UiO and HiOA
– Students Medical training Psychology ½ year full time Child protection Trained nurses – Bsc and Ma
• Lecturing– FOMA 2 day course - HiOA– Flexible arena treatment method 3 day course - HiOA
Reference networks
• Community network – exchanging knowledge– Child welfare institutions
• Academic network – exchanging knowledge• Neuropsychological unit – assessment and
education• User evaluation representatives
Future proposals
• Opportunities– Precise indications for choice of methods– Attachment based interventions– More action less talk– Earlier referrals– Earlier treatment onset
• Possible challenges– Increasing clinical population– Validity of the model
Arena flexible treatment summarized
• Treating the whole family system• Customized interventions• Taking family function into account• Generalizing skills – parental and child’s• Still using the ward and the beds• Lowering the need of coercive care• Shortening treatment time• Reduces relapse
Section of Children’s Mental HealthOslo University Hospital
Jan Ivar Ernø, clinical psychologist