The Psychological Cost of Working With Traumatised Children

Objective To describe the use of an informal consultation opportunity provided by a Grade 'B' Clinical Child Psychologist to other professionals within the community in the north sector of Glasgow, between May 1995 and December 1996, and to evaluate the efficacy of consultancy as a method of service delivery by clinical child psychologists. Design A retrospective analysis was performed of all informal consultations between the clinical child psychologist and other professionals which had taken place May 1995-December 1996 using database information held by the former. A structured telephone interview took place with a smaller sample of professionals, identified within the database, who had used the service during a six month period (July- December 1996). Setting Yorkhill NHS Trust Community Child Health Services (Glasgow, north sector). Subjects Professionals in the community who made use of the informal consultation opportunity (July-December 1996). Results In total, 159 consultations were carried out between May 1995 and December 1996. The rate of requests for informal consultation opportunities showed an initial high demand followed by a decreasing trend over the full study period. The mode length of consultation time was 15 minutes or less. Consultations were mainly sought by clinical medical officers (42.8%), health visitors (25.8%), and paediatricians (13.8%) and predominantly concerned behavioural (52.8%) and anxiety (15.1%) problems. Most involved the clinical psychologist giving advice only (67.3%) and did not necessitate further direct work. Most consultations concerned pre-school children (67.9%) followed by those of primary school age (30.2%). Secondary school aged children were only involved in 1.3% of consultations. In the smaller sample analysed in more detail, twenty consultations were requested by fourteen different professionals. Of these, eleven professionals (73.3%) were able to complete a structured interview by telephone. The types of presenting problems, professionals seeking informal consultation, age-groups of children involved, and outcomes of consultation were largely consistent with the overall sample. Male children accounted for 45% and 55% concerned female children. The informal consultation opportunity was identified as a rapid means of harnessing clinical psychology input and was uniformly positively evaluated regarding its' usefulness, effectiveness, appropriateness, and accessibility. Findings suggest consultation provides an efficacious means of targeting scarce clinical psychology resources. Conclusion The informal consultation opportunity provided by the clinical child psychologist appears to be an expeditious means of providing diverse professionals with clinical psychology input. This method of service delivery appears to be an enabling and supporting process for other professionals in the community and to represent an efficacious method of service delivery. Recognition and development of the consultation role is recommended in order to maximise efficiency in meeting children's mental health needs