“This is a question we have to ask everyone”: asking young people about self-harm and suicide

This is the peer reviewed version of the following article: O’Reilly, M., Kiyimba, N., & Karim, K. (2016). “This is a question we have to ask everyone”: asking young people about self-harm and suicide. Journal of Psychiatric and Mental Health Nursing, 23(8), 479-488. http://doi.org/10.1111/jpm.12323, which has been published in final form at http://onlinelibrary.wiley.com/doi/10.1111/jpm.12323/abstract. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-ArchivingIntroduction: Questions about self-harm and suicide are essential in risk assessments with children and young people, yet little is known about how mental health practitioners do this. Aim: The core aim was to examine how questions about self-harm and suicidal ideation are asked in real-world practice. Method: A qualitative design was employed to analyse 28 video-recorded naturally occurring mental health assessments in a child and adolescent mental health service. Data were analysed using conversation analysis (CA). Results: In 13 cases young people were asked about self-harm and suicide, but 15 were not. Analysis revealed how practitioners asked these questions. Two main styles were revealed. First was an incremental approach, beginning with inquiries about emotions and behaviours, building to asking about self-harm and suicidal intent. Second was to externalize the question as being required by outside agencies. Discussion: The study concluded that the design of risk questions to young people had implications for how open they were to engaging with the practitioner. Implications for practice: The study has implications for training and practice for psychiatric nurses and other mental health practitioners in feeling more confident in communicating with young people about self-harm and suicidal ideation

Question use in child mental health assessments and the challenges of listening to families.

This is an author-produced electronic version of an article accepted for publication in the British Journal of Psychiatry Open. The definitive publisher-authenticated version is available online at https://www.cambridge.org/core/journals/bjpsych-openBackground: The mental health assessment is a fundamental aspect of clinical practice and central to this is the use of questions. Aims: To investigate the frequency and type of questions utilised within a child mental health assessment. Method: The data consisted of 28 naturally occurring assessments from a UK child and adolescent mental health service. Data were analysed using quantitative and qualitative content analysis to determine frequencies and question type. Results: Results indicated a total of 9086 questions in 41 h across the 28 clinical encounters. This equated to a mean of 3.7 questions per minute. Four types of questions were identified; yes–no interrogatives, wh-prefaced questions, declarative questions and tag questions. Conclusions: The current format of questioning may impede the opportunity for families to fully express their particular concerns and this has implications for service delivery and training

New aesthetic, new anxieties

The New Aesthetic was a design concept and netculture phenomenon launched into the world by London designer James Bridle in 2011. It continues to attract the attention of media art, and throw up associations to a variety of situated practices, including speculative design, net criticism, hacking, free and open source software development, locative media, sustainable hardware and so on. In this book we consider the New Aesthetic: as an opportunity to rethink the relations between these contexts in the emergent episteme of computationality. There is a desperate need to confront the political pressures of neoliberalism manifested in these infrastructures. Indeed, these are risky, dangerous and problematic times; a period when critique should thrive. But here we need to forge new alliances, invent and discover problems of the common that nevertheless do not eliminate the fundamental differences in this ecology of practices. In this book, perhaps provocatively, we believe a great deal could be learned from the development of the New Aesthetic not only as a mood, but as a topic and fix for collective feeling, that temporarily mobilizes networks. Is it possible to sustain and capture these atmospheres of debate and discussion beyond knee-jerk reactions and opportunistic self-promotion? These are crucial questions that the New Aesthetic invites us to consider, if only to keep a critical network culture in place

How parents build a case for Autism Spectrum Disorder during initial assessments: “We’re fighting a losing battle”

Integral to the diagnosis of autism spectrum disorder (ASD) is the initial assessment through which the existence of a ‘problem’ is first ascertained. Despite this, there remains limited research on this early part of the diagnostic pathway. In this paper, we utilised conversation analysis to examine relevant issues in relation to the practitioner-family interactions that take place within this initial assessment context. Our findings illustrated that parents typically first raised the possibility of the presence of an ASD diagnosis through ‘building a case’, which professionals were then able to ratify or negate. Further, we found that the assessments unfolded sequentially and clinical decisions were typically reached through a distinctive pattern of interaction. These findings have important implications for clinical practice, including for the study of ASD assessments and diagnosis

Reflecting on professional self-disclosure and supportive relationships with foster carers during the COVID-19 pandemic.

Professional self-disclosure can be defined as a clinician revealing personal information about themselves to the person they are caring for. This article provides reflections from clinicians working in child and adolescent mental health services (CAMHS) and their navigation of professional self-disclosure during the coronavirus disease 2019 pandemic. The reflections focus on the use of self-disclosure in supportive relationships with foster carers. Drawing on the authors’ practice experiences as clinicians in specialist CAMHS settings, the article considers changes in the way that self-disclosure was approached following the shift to remote care delivery during the pandemic. The authors suggest that remote working involves a potentially increased scope for inappropriate use of self-disclosure and outline the implications for mental health nurses working with foster carers

A qualitative exploration of how adopted children and their parents conceptualise mental health difficulties.

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Adopted children tend to have high levels of emotional, behavioural and developmental need and are more likely to present to a range of services, including Child and Adolescent Mental Health Services (CAMHS). Although research exploring adopted children’s’ perspectives is growing, it remains limited. Furthermore, there has been little work t0 engage adopted children in research. Our project aimed to examine adopted children’s viewpoints of mental health and services alongside those of their adoptive carers. Results indicated that, although there were some similarities between carer and child perspectives, they also frequently differed. They provided different constructions of the problem but agreed that family relationships were strained. Some acknowledgement of the role of the school was offered and other external sources of support cited. Coping was considered to be complex and, while some issues were analogous to ‘normal’ family life, much was inherent to the adoption status

Mother–infant interactions with infants with congenital visual impairment and associations with longitudinal outcomes in cognition and language

Background: This study investigated mother–infant interactions, including maternal maintaining of infant attentional focus and sensitivity, with infants with congenital severe and profound visual impairment (VI) and the association with developmental trajectories from one to three years. Method: Fifty‐five infants and mothers were video‐recorded playing together with a standard set of toys at Time 1 (T1) mean age 12.95 months (8.13–17.05 months). Maintain was categorized as the mother following and maintaining the child’s focus, and Sensitivity, the mother’s responsiveness and contingency to infant behaviour. Vision level was measured using the Near Detection Scale. Cognition and language were measured at T1, 12 months later (T2) and 24 months later (T3) using the Reynell‐Zinkin Scales. Results: Cross‐sectional analyses showed that mothers of infants with severe VI (basic form vision) produced higher rates of Maintain compared to those with children with profound VI (light perception at best). Linear mixed‐effects models examining developmental progression from T1 to T3 (controlling for vision level) showed an average increase of 5 DQ points (CI 95%: 1.03–9.08) in verbal comprehension for higher Sensitivity. No significant findings were found for Maintain. Conclusions: The findings suggest that mother–infant interactions (maternal Maintain) are associated with level of vision at infancy, but only maternal Sensitivity has a long‐term positive association with advances in verbal comprehension from infancy to about three years. They highlight the need for incorporating strategies related to parent–infant interactions, including increased sensitivity, into early intervention for children with visual impairment

The risk of secondary traumatic stress in the qualitative transcription process: A research note.

Kiyimba, N. & O'Reilly, M., The risk of secondary traumatic stress in the qualitative transcription process: a research note, Qualitative Research (16:4) pp. 468-476. Copyright © Nikki Kiyimba & Michelle O'Reilly, 2015. Reprinted by permission of SAGE Publications.It is recognised that transcribing is not merely a neutral and mechanical process, but is active and requires careful engagement with the qualitative data. Whether the researcher transcribes their own data or employs professional transcriptionists the process requires repeated listening to participants’ personal narratives. This repetition has a cumulative effect on the transcriptionist and hearing the participants’ personal narratives of a sensitive or distressing nature, can have an emotional impact. However, this potential emotional impact is often not something which is accounted for in the planning stages of research. In this article we critically discuss the importance of considering the effects on transcriptionists who engage with qualitative data

The clinical use of Subjective Units of Distress scales (SUDs) in child mental health assessments: A thematic evaluation.

This is an Accepted Manuscript of an article published by Taylor & Francis in Journal of Mental Health on 4th July 2017, available online: https://doi.org/10.1080/09638237.2017.1340616Background: Despite the ubiquitous use of Subjective Units of Distress scales (SUDs) in mental health settings to establish levels of distressing emotion, there has been little empirical research in this area. SUDs are commonly used in therapy and assessments, and are a particularly useful tool for establishing current and previous levels of distress in children and young people. Aims: To explore the use of the SUD analogue rating scale in initial child mental health assessments to better understand its application in this context. Method: The data corpus consisted of 28 naturally-occurring video recordings of children and young people attending their first assessment appointment at Child and Adolescent Mental Health Services (CAMHS). A thematic analysis was utilised to explore the specific interactional use of SUDs. Results: Four themes were identified; recency, longevity, context and miscommunication. The first three themes were found to supplement the child’s emotional score on the scale and were important in establishing the necessity for further therapeutic support. Miscommunication as a theme highlighted the need for clarity when using SUDs with children and young people. Conclusions: Recommendations were suggested for practitioners working with children and young people relating to the extended use of rating scales in clinical assessments

Children's claims to knowledge regarding their mental health experiences and practitioners' negotiation of the problem.

The objective was to identify how children's knowledge positions were negotiated in child mental health assessments and how this was managed by the different parties.The child psychiatry data consisted of 28 video-recorded assessments. A conversation analysis was undertaken to examine the interactional detail between the children, parents, and practitioners.The findings indicated that claims to knowledge were managed in three ways. First, practitioners positioned children as 'experts' on their own health and this was sometimes accepted. Second, some children resisted this epistemic position, claiming not to have the relevant knowledge. Third, some children's claims to knowledge were negotiated and sometimes contested by adult parties who questioned their competence to share relevant information about their lives in accordance with the assessment agenda.Through question design, the practitioner was able to position the child as holding relevant knowledge regarding their situation. The child was able to take up this position or resist it in various ways.This has important implications for debates regarding children's competence to contribute to mental health interventions. Children are often treated as agents with limited knowledge, yet in the mental health assessment they are directly questioned about their own lives