Abstract
The National Health Service (UK) offers initial screening appointments for children referred to child and adolescent mental health services to determine clinical need and assess risk. Conversation analysis was utilized on 28 video recordings of these assessments, lasting approximately 90 minutes each with a multidisciplinary team. This article 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.
Highlights
22 23During their lifespan, approximately one third of children and adolescents experience an 24emotional, behavioural or neurodevelopmental difficulty (Merikangas, Nakamura, & 25Kessler, 2009), with global prevalence ranging from 10-20% (Kieling, et al, 2011)
In 26the UK, mental health services are provided by the National Health Service (NHS) and 27young people are seen by child and adolescent mental health services (CAMHS). 28CAMHS is a service provided for those who experience emotional, behavioural or 29neurodevelopmental difficulties (Karim, 2015), and assesses, diagnoses and treats 30individuals, using approaches including pharmacological and talking therapies. 31Typically, access requires a referral from the General Practitioner (GP) for assessment. 32 33In CAMHS, a multidisciplinary approach is taken for assessments and treatment 34(Karim, 2015), usually including psychiatrists, clinical psychologists, community 35psychiatric nurses, occupational therapists, and other psychological therapists
41to the child/adolescent or others, to develop an initial formulation of the presenting 42problems, and to consider what might be the steps (Mash & Hunsley, 2005). 43During assessments, the agenda relates to the institutional requirements for 44information-gathering, and questions put forward by practitioners tend to be 45focussed around these requirements (Thompson & McCabe, 2016). 46 47In relation to family-centred practice, it is important to account for the views of 48children/adolescents and their family, to ensure that services meet the needs and 49expectations of the families involved
Summary
22 23During their lifespan, approximately one third of children and adolescents experience an 24emotional, behavioural or neurodevelopmental difficulty (Merikangas, Nakamura, & 25Kessler, 2009), with global prevalence ranging from 10-20% (Kieling, et al, 2011). This approach 158recognizes that the question itself was situated, in the sense that it was asked by a 159practitioner in a mental health assessment of a child/adolescent referred by the GP. When the child offers their first wish, in their turn the practitioner treats this as sufficient and the talk moves to talk about the child’s difficulty.
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