AdCAMHS, East Sussex


Therapeutic programme that supports adopted children and their adoptive families who are struggling emotionally.

  • Offers a range of therapeutic interventions and treatments to adopted children to help them overcome any early childhood trauma, and to their adoptive families
  • One-to-one sessions take place in clinics and at home; group work extends to the local theatre and "woodland days"
  • Work is based around psychoanalytic thinking and reflection, examining dynamics and relationships within families and between professionals

ACTION

The Adopted Child and Adolescent Mental Health Service (AdCAMHS) is jointly run and funded by Sussex Partnership NHS Foundation Trust and East Sussex County Council.

Set up in February 2014, it supports adopted children and young people and their adoptive families who are struggling emotionally through consultations, assessments and treatments.

The service is based on understanding the nature of difficulties around being adopted and offers tailored expertise and therapy to children and families referred to it by the council's post-adoption team.

Alison Roy is a senior child psychotherapist and the clinical lead at AdCAMHS. She says the service sees a range of issues affecting children and their families, from early trauma, neglect and deprivation, to adoptive families reporting they are struggling to cope and wish for the child or young person to be taken back into care.

Roy leads a six-strong team that also includes three other psychotherapists and two social workers. They begin by holding a consultation with the adopted young person in order to understand their history, current difficulties and capacity to form relationships.

Roy emphasises that gathering as much information as possible at the beginning is key to forming a sound assessment. Further consultation involving the adoptive parents may follow, she says. "They have their chance to talk as active participants in helping their children recover. It is really important to include adoptive parents when you can as they feel very much involved in the process."

After the consultations, the service decides what intervention and level of treatment is required. It will typically offer a "multi-treatment intervention" that may include a combination of individual child and adolescent psychotherapy, individual psychology, child psychology, family work, and couples work. Other options include psychological assessment clinics and group therapy for both families and for adolescents.

The majority of individual child psychotherapy and psychology sessions are delivered in clinics. But sessions also adapt to children's needs and can take place where the child feels more comfortable, be that at home or in an open space such as a park. Adolescent group sessions take place in an Eastbourne theatre, where the stage is used to do music and therapy work.

The service also offers "woodland days" and camps to address trauma and loss in an environment of nurture and neutrality. "Woodland days or camps, alongside therapeutic group work and individual therapy, helps to cement some of the experiences of learning to be with, and trusting of, others," Roy explains. "We find that many adopted young people can get themselves into a ‘tell-all' or hide and ‘shut down' response when it comes to relationships."

Roy says that what makes AdCAMHS stand out is its "use of psychoanalytic thinking and reflection at its core - at every stage - examining dynamics and relationships not only within the family but also between professionals".

The service undertakes its own research and delivery material for group work. It also draws on Dyadic Developmental Psychotherapy, a method for children with complex trauma and attachment disorders developed by the psychologist Daniel Hughes. Other sources of inspiration include the clinical psychologist Kim Golding, who has written widely on nurturing and creating loving attachments.

Looking ahead, Roy says the service is hoping to secure further funding from the government's Adoption Support Fund and CAMHS transformation fund so it can be expanded.

IMPACT

An in-house evaluation of AdCAMHS last year aimed to capture its strengths and weaknesses, develop the service further and assess the importance of a therapeutic service for adopted families.

The service was providing psychological support and therapy to 60 adopted children and their families, which is 50 per cent above its commissioned target of 40. The evaluation also set out to collect information on the number of referrals, consultations, and sessions with individuals, parents and groups by routinely gathering data.

A strengths and difficulties questionnaire was completed at the start of treatment and every six months afterwards. The team analysed the data and picked out common themes.

Responses from parents showed they felt listened to and understood and valued the need for a specialist adoption support service. The adopted children and young people appreciated having the same person to work with and not being stigmatised, and as a result they felt less alone or different.

However, parents flagged up a range of gaps including access to wider health assessments, waiting too long to receive treatments, and the need for professionals to understand when a family is in crisis.

The service has now begun putting a range of measures in place to respond to the feedback such as the creation of "session cards". These require children writing down three themes from their sessions to share with parents, and is designed to address parents who are feeling excluded from the child's therapy.

This practice example is part of CYP Now's special report on attachment and neglect. Click here for more

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