• Agenda setting with children using the ‘three wishes’ technique

      Kiyimba, Nikki; O'Reilly, Michelle; Lester, Jessica N.; University of Chester (Sage, 2018-03-15)
      The National Health Service (NHS; UK) offers initial screening appointments for children referred to Child and Adolescent Mental Health Services (CAMHS) to determine clinical need and assess risk. Conversation analysis was utilised on 28 video-recordings of these assessments, lasting approximately 90 minutes each with a multidisciplinary team. This paper focuses on the agenda setting strategies used to establish relevant goals with children and adolescents; specifically, the technique of offering ‘three wishes’. For example, “if you had three wishes, what would you like to make happen?” In cases where children initially volunteered an assessment-relevant wish, they tended not to articulate further wishes. Non-assessment-relevant wishes (i.e. fantasy wishes, such as being “rich”) were treated as insufficient, with many approaches used to realign establishing assessment relevant goals. Where responses were not institutionally relevant, practitioners undertook considerable discursive work to realign the focus of the three wishes task to assessment relevance. In these cases, the wish responses were treated as irrelevant and tended to be dismissed, rather than explored for further detail. Such work with the children’s contributions has implications for engaging children and child-centred practices.
    • “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.