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

      Kiyimba, Nikki; O’Reilly, Michelle; Karim, Khalid; University of Chester; University of Leicester (Taylor & Francis, 2017-07-04)
      Background: 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.
    • Question use in child mental health assessments and the challenges of listening to families.

      O’Reilly, Michelle; Karim, Khalid; Kiyimba, Nikki; University of Chester; University of Leicester (The Royal College of Psychiatrists, 2015-10-07)
      Background: 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.
    • “This is a question we have to ask everyone”: asking young people about self-harm and suicide

      O’Reilly, Michelle; Kiyimba, Nikki; Karim, Khalid; University of Chester; Leicester University (Wiley, 2016-08-08)
      Introduction: 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.
    • The use of why questions in child mental health assessments

      Kiyimba, Nikki; Karim, Khalid; O'Reilly, Michelle; University of Chester, University of Leicester (Equinox Publishing, 2017-12-18)
      Questions form the basis of mental health assessments and yet there is limited empirical evidence about the linguistic structure of question formats in these clinical environments. While many types of questions are used, the focus of this research was on why-prefaced questions with children. Interaction analysis was employed to interrogate the data, paying specific attention to the interactional organisation of how 'why-prefaced' questions were asked and responded to. Analysis demonstrated that when three core components were present in the question, then it was usual for a reason/explanation to be provided in response, and when one or more component was missing, it rarely elicited a reason or explanation in response. The three components were the sequential position of the question, how the question was indexically tied to the child’s prior statement, and the epistemic domain of the question. Implications for therapeutic communication and training were discussed.