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Improving the Pediatric Patient Experience by Providing Communication Training around Mental Health
What was the challenge, opportunity or issue faced?
Trainer: Could you tell me what you’re hoping to get from today?
Staff: Do you want the honest answer? Or the one I’m expected to give?
Trainer: The honest one
Staff: I’m here because when I know there’s a patient on the ward due to their mental health I turn and walk the other way.
Healthcare professionals working in hospital settings report a lack of confidence and competency in caring for children with mental health needs.1 Young people report overwhelmingly negative experiences of staff attitudes when presenting to hospital due to their mental health2 with as many as 43% of young people reporting they wouldn’t go back to the hospital for mental health support because of a bad previous experience.3 A lack of education and ability to identify, support and respond compassionately to mental health needs leaves vulnerable young people feeling unable to access emergency support.4 These factors create missed opportunities where intervention as part of acute physical care could alter the potential negative outcome for a patient dealing with a mental health crisis and lead to a more positive health outcome.5 Negative experiences in hospital settings also compound young people’s distress making them less able to cope when they leave hospital and less likely to engage in follow-up with Child and Adolescent Mental Health Services (CAMHS).6
The ‘We Can Talk’ Children and Young People’s Mental Health (CYP MH) project sought to tackle these issues by giving staff the tools and confidence to improve their approach and communication skills around mental health to ultimately enable all patients to have improved experiences and better outcomes.
What did you do to address it?
Hospital based children’s mental health education, where it does occur, is generally led either by hospital need (“please can we have training on X”) or mental health expert direction (“we think you need training on Y”) and rarely if at all by children and young people’s views (“it would be helpful if hospital staff had training on Z”). The We Can Talk approach was to combine the expertise of hospital staff, mental health professionals and children and young people to create something better than could be done individually. To oversee this project and ensure all views were literally at the table, a CYP MH steering group was established at Barts Health and included representatives of Child and Adolescent Mental Health Services (CAMHS), three acute hospital sites and a young advisor employed in the project team to ensure young people’s voices were heard at both a strategic and consultation level. In order to ensure the research and impact evaluation data was of the highest quality a team from CORC was recruited to oversee this part of the project.
Engaging with Staff
In order to gain the views of as many hospital staff who encounter young people (up to the age of 18) in their job role, a trust-wide electronic survey was conducted over a two week period with over 300 respondents across three hospital sites. The project team visited every pediatric emergency department and pediatric ward (general to specialist) and all adult (16+) emergency departments along with various other settings including neonates, maternity, safeguarding and security. A range of views was sought from nurses to healthcare assistants to pediatricians to porters. The survey focused on staff’s confidence and educational needs in relation to CYP MH and served to help not only develop but also promote the training and raise awareness within the trust.
The survey reporting showed that most staff encountering CYP with mental health difficulties occasionally and one in five staff encountering them almost all the time with self harm / overdose, depression and anxiety their top three concerns. Most staff were not confident or only slightly confident in caring for children and young people with mental health concerns; “I personally feel we let our CYP down. Not through being terrible people but by our lack of knowledge and understanding”.
Young people’s involvement
It was an essential part of this project to have young people represented at every stage. From day one a young advisor was employed with experience of CAMHS and of presenting to hospital due to their mental health. They led a literature review of past surveys and research on young people’s experience in the hospital and conducted focus groups with young people on their views of what hospital staff need to know about their mental health. The overwhelming theme was that the hospital is not the first choice for young people experiencing mental health difficulties and that often when they are forced to seek medical care they do so with feelings of shame and unworthiness; “They wouldn’t touch me... they looked at me as if to say `I’m not touching you in case you flip on me’... they didn’t actually say it, it was their attitude...”. Contrasting, the most positive encounters were when young people were given a chance to talk about their problems and receive non-discriminatory care; “All they have to say is, we’re here if you need us, don’t think you’re on your own. Young people perceive a lack of staff knowledge but report that staff attitudes and behaviours have more impact on their experience; young people want hospital staff to acknowledge and address their mental health needs regardless of title or profession.
Alongside gathering the views of staff and of young people, a review was conducted of existing mental health competency frameworks, professional standards and care guidelines including those aimed at health and non-health professionals (teachers, social workers, etc.). Combined with stakeholder views we developed ‘We Can Talk’ core competencies.
Alongside the competencies the educational approach was developed to create a highly interactive training day taught by hospital and mental health staff, a communication expert and a young advisor. A key ethos of the training was for hospital staff to recognise the important role they are already playing in supporting the emotional and mental health of young people. The morning session focuses on understanding emotional and mental well-being and developing the link with existing practice as well as additional knowledge around common mental health problems and self harm. The afternoon session explores young peoples experience of presenting to hospital due to their mental health and helps staff develop their skills to communicate effectively about mental health concerns
What outcomes were achieved?
We Can Talk has now trained over 150 hospital staff across three hospitals.
The final impact data utilizing pre- and post-impact assessment forms was overwhelming positive.
- 100% of attendees would recommend the training to a colleague
- 96% of attendees reported the training would make a difference to way they do their job
- 93% agreed it was valuable to have a young advisor co-delivering training
- 93% thought the topics were presented in an accessible way
- 97-100% reported they had a good understanding on all knowledge items after training
- 96-100% agreeing they were confident in all areas after training
The data also showed the strength of agreement on knowledge and confidence items increased from pre- to post-training demonstrating that even in areas where staff already felt confident the training had an impact and left them even more confident than before. The free text responses from the trainees emphasized the importance of the training delivery team and the inclusion of our young advisor; “The speakers were very well-spoken - adding own experiences and humour which kept the session interesting. Having a young person was especially great.” The increase and confidence was also reflected in free text as many trainees gave similar feedback that the day “made an extremely difficult topic easy to discuss and empowered me to realize that we ALREADY do a lot to assist CYP with mental health issues”. The team and the stakeholder group were extremely pleased with impact of the training and the learning gained by those staff that attended; “What I will take from this is to talk and listen to young people, ‘better to say something rather than nothing’”.
We have also seen hospital wards make real changes to practice. For example, some wards now no longer use additional agency mental health nurses, as the pediatric nurses and healthcare assistants now feel confident to care directly for young people with mental health difficulties.
About We Can Talk
We Can Talk was led by Barts Health NHS Trust, the largest acute hospital trust in England, in collaboration with Healthy Teen Minds, Common Room and the Child Outcomes Research Consortium (CORC) and was funded by Health Education England’s local team in North Central and East London.