Identity and Change

This was the blog I wrote a few days before the US election. After the election I felt like the other stuff was more pressing, so that skipped the queue. I’d be interested in feedback about the topics and intervals of this blog, and whether the pot-luck and intermittent nature of it is disconcerting for readers. So do feel free to tweet or comment to let me know. Anyway…

My kids were given brass instruments at school recently, that they will get to use for the next 4 years. Every child in the school gets the use of a brass instrument for free, along with the group lessons to learn how to play it. One chose a trumpet, the other a baritone. It seemed like a nice idea, but I wondered why there was a scheme to learn brass instruments in particular, rather than woodwind, strings or percussion. The penny finally dropped when I searched for clips of brass bands on youtube and ended up with colliery bands and a poignant scene from Brassed Off! We now live in an area in which the coal mining industry was a major employer until the 1980s. There were nearly 200 mines in the county at the turn of the last century, and there are none now. So presumably the brass music scheme is linked with the idea of preserving local cultural heritage.

It made me think about other disappearing parts of British culture, from learning Gaelic and Welsh to Morris dancing, and how each culture around the world has different bits of heritage and culture to keep alive. There are stories told through the generations, losses to commemorate, celebrations to mark particular dates and events, rituals and arts to keep alive. Language and history seem to be bound into our identity. But why do we want to keep some parts of the past alive, and does it have any value? I’d hope that at least we can learn from our collective experiences, avoid repeating problems and continue the things that give us joy and bring us together. Which brings me back to music.

Music has been an integral part of human existence for an extraordinarily long time. Wikipedia tells me that “Music is found in every known culture, past and present, varying widely between times and places. Since all people of the world, including the most isolated tribal groups, have a form of music, it may be concluded that music is likely to have been present in the ancestral population prior to the dispersal of humans around the world. Consequently, music may have been in existence for at least 55,000 years and has evolved to become a fundamental constituent of human life”. Maybe that is why it is such an enjoyable thing to participate in. I know I value the half hour of singing I do with the children each night before bed as a time to wind down, but it also reconnects me to past experiences and brings out particular emotions dependent on the songs I choose.

I think there are loads of skills to be gained from being part of playing music with others. These include patience, persistence, co-operation, and other aspects of social skills and executive functioning. It reminded me how powerful various musical projects have been in changing the identity of people in socioeconomically deprived situations. The El Sistema project in Venezuela, although criticised for its strict regime and some examples of exploitation, has been praised for opening opportunities for young people from disadvantaged backgrounds and getting over 2 million children involved in orchestras. The Landfill Harmonic helped children living in a slum community on a rubbish dump to learn to play classical music and to have aspirations that were previously unthinkable to them.

The Big Noise project in Scotland has drawn on El Sistema but applied it to deprived Scottish communities. Independent evaluations cite positive impacts on different facets of the children’s lives, beyond just the gains in musical skills. Their education shows improvements in concentration, listening, co-ordination, language development, school attendance and school outcomes. Their life skills show improvements in the domains of problem solving, decision-making, creativity, determination, self-discipline and leadership. Their emotional wellbeing shows increased happiness, security, pride, self-esteem, emotional intelligence, an emotional outlet, resilience. Their social skills have improved along with increased mixing, cultural awareness, strong and diverse friendships and support networks. The project also has wider benefits to health, as there has been encouragement for healthy diet and lifestyle choices. The children have also had additional adults to confide in, a calm, safe environment and report reduced stress.

What I like about all these projects is that they help people to learn new skills and change their own identity to reflect that. Instead of being members of a deprived and devalued community pervaded with hopelessness, they have a new identity as musicians who can enjoy the process of creating, sharing and performing and gain aspirations outside of their previous horizons. Even the sense of belonging when singing along to a well-known track being performed live at a festival is up-lifting. How much more so to be performing music in front of an audience, and to travel to new places to perform.

But music isn’t the only thing that inspires change. We are all changing all the time. Life changes move us from being a child to an adult, through education and into professional or employment roles, bring changes in living arrangements and new relationships. In turn, aspects of our identity are sometimes defined by our role within those relationships and settings. We take on certain expectations and responsibilities when we become a being a partner, parent, aunt/uncle, grandparent. Our educational or work experiences can similarly add a facet to our identity (I am very much a psychologist as part of my core identity, even outside of work). So can being part of many different positive community projects or group activities, or even the act of learning new skills or trying new things at an individual level. I learnt to scuba dive a few years ago, and gained a new identity as a diver and a new world to explore. Likewise, the random act of supporting a friend who wanted to set up as a personal trainer introduced me to weight lifting, and for a couple of years that became part of my identity too (frustratingly since an RTA injured my shoulder I have not been able to lift for over a year, though I do hope to get back to it soon). I also like to grow fruit and vegetables, and to make preserves and bake, adding gardening and cooking to my repertoire and identity. And of course I am now a writer and blogger! Likewise I watch other members of my family gain new skills. This year we moved to a dilapidated farmhouse, and my husband has gained a new identity from learning to cut wood, keep chickens, and mow the fields with a tractor. As well as learning their brass instruments, my kids are learning to swim, ride bikes, write stories and poems, make art, and take part in outdoor activities. Their identities have expanded to include facets of artist, poet, writer, scientist, explorer and many more.

Changes to our identity can also be out of our control, and negative as well as positive. Many of us survive traumas, or difficult relationships, or experience rejection or failure. From redundancy to car accidents, cancer to infertility, losses of people we care about, changes of home, job and relationships, we are each shaped by our experiences even as adults. I have blogged before about the impact of adverse childhood experiences, but how we recover from these also forms part of our identity. Do we remain wary and cynical, or learn to trust again. Do we try to shut out the past, or work through it. Do we aim to get closure. These questions have never been more live than in the aftermath of institutional abuse, and in the wake of the historic sexual abuse cases that were triggered by Savile and other cases coming to public attention.

Over the last few years I have been talking to a man in my extended social network who was groomed and then raped as a child by a member of the Catholic church, whilst at a Catholic school. He has had to make a series of decisions about whether to disclose his experiences to anyone at all, whether to share them with members of his family, with his therapist, with his partner, and with friends. Then he has had to decide whether to come forward as a witness and victim in a public enquiry, and whether to seek compensation from the government and/or church. Each decision has an impact on his sense of identity, which has been slowly evolving from a victim hiding the shame of his experiences into a survivor who is able to look back and place the blame firmly where it belongs and manage the consequences on his life successfully. That isn’t an easy journey.

Over the time I have known him, he has talked very movingly about how his childhood experiences made him question his gender identity, sexuality, sanity, and whether he would in turn present a risk to others (something I know not to be the case, but which has been his darkest fear, based on the fact that many perpetrators report having been abused themselves in childhood, despite the fact that the majority of survivors do not go on to perpetuate the cycle of harm). He felt that he did not want additional sympathy or allowances making, and said that other people had been through much worse. Nonetheless, his experiences have had a considerable impact on his well-being. He has experienced intrusive flashbacks and images, panic attacks, stress, depression, time off work sick, and at times coped through self-harm. He has struggled to have enough self-belief to assert himself appropriately, and always tries extra hard to please others even at great personal cost – a trait that has been exploited by some members of his network and employers. I know he has had mixed feelings about giving evidence in an enquiry; wanting to come forward to represent and protect others and to ensure that concerns are not dismissed or covered up, but knowing this will be at some personal cost. And he has had very contradictory thoughts about applying for any form of redress, whether an official acknowledgement and apology from the church, or compensation from the fund for victims.

I can empathise with the ambivalence about accepting money. I can understand that survivors don’t want paying off and that money doesn’t make their abuse go away. And yes, possibly things could have been worse, there are people who have crappier experiences or less positive aspects to their lives in mitigation. I get that the people who are in the lucky position of considering claims are already survivors, and probably don’t want to look backwards to the time when they were victim and to have to relive that experience for another second, let alone in statements and testimony and the flashbacks that will bring. I also know there is a discomfort with the idea of financial settlements as a panacea, and that it feels wrong to benefit in any way from the harm that was done to them.

But when we look at the population level we can see that experiencing abuse changes the path of people’s lives. There is impact to the person’s sense of self, their ability to form healthy relationships and to be happy. People who are abused in childhood have their norms and expectations about themselves, other people and the world changed compared to those who aren’t. They have neurochemical pathways that are more primed for fight or flight, and perceive threat that others do not see. As a result they are less able to concentrate and focus, more likely to switch to anxiety or anger, less able to aim high and achieve in school and employment, less able to trust in relationships. Their self-esteem and sense of identity is damaged, and this permeates their ability to enjoy life in the present and to plan for the future. So whilst that doesn’t have a monetary value, there is a quantifiable loss to their earning power and quality of life, and the compensation is just making a nod towards acknowledging that.

Those responsible for compensation are also massive organisations, and in the case of the Catholic church, organisations that have accumulated massive wealth that for the most part they are not using to benefit the needy – it is kept in stocks, shares and property, and some is used to fund the legal defence of the perpetrators and those who knew about the abuse within the church. That is one of many reasons that lead me to say that victims should always apply for any compensation on offer. My general advice is to “take what you can get, use it for whatever feels right, and build upwards from where you are”.

It seems there is a good message in that for us all: Don’t let your past define you. Build your identity on who you are now, your values and aspirations, and the things that you enjoy. Then find a pathway towards self-actualisation and happiness in the future. Take on new facets to your identity. Become the diver, the weightlifter, the mother, the partner, the poet, the film buff, the cook, the gardener, the video gamer, the artist, the builder, the bookworm, the collector or whatever combination of roles and interests makes you happy. And seek out personal and professional allies for the journey to support you until the wounds of the past heal to become scars that don’t stop you from doing the things you enjoy.

Seeking collaborator to change the world

LifePsychol Ltd is a company with a clear social purpose – to improve outcomes for people who have experienced adversity through the application of clinical psychology, particularly children who are Looked After in public care after trauma or maltreatment. We deliver effective psychological services for Looked After and adopted children by providing assessments, formulations, therapeutic interventions, consultation, training and outcome measurement tools for placement providers. And we are very much in demand. But at the moment we are clinician led, and we really need a COO with complementary business skills as the company scales up, to ensure that we make the maximum impact going forward.

We are at a very exciting time, with the potential of rapid growth and the first evidence of efficacy for our pathway emerging. We have started the process of applying for DfE Innovation Programme funding, and we have great support from key people (Sir Martin Narey, government advisor who just reviewed the future of children’s homes in the UK, described our pathway and tools as “the missing link for the sector”, Jonathan Stanley at the Independent Children’s Homes Association described them as “the new gold standard for our members”, whilst Lord Listowell said the government should fund part of the cost to ensure there is input from a clinical psychologist in every residential care home). Despite having done no marketing, we have more enquiries about joining our system than we can keep pace with. We are already used in over 100 children’s homes, and we have a growing number of local authorities who wish to roll out our pathway across their entire catchment. We are looking at how we train and license other clinicians to deliver the model both in the UK and internationally.

We have a great clinical team, a graduate project manager/admin, a fantastic professional network and a great product set. What is important to us now is getting the right person to drive the business side forward at this critical time. To do that we really need someone with business skills and experience, combined with a passion for making social change to take on a leadership role on the financial/business side of the company. We are therefore seeking an extraordinary COO who will help us achieve extraordinary things.

Who are we looking for?

You need to genuinely care about making the world a better place, and to share our goal of making a measurable difference to the lives of vulnerable children and young people. As a clinician CEO it is vital for me to have someone I trust to bounce ideas around with, who will ensure that we are on a sound financial footing to enable us to deliver our ambitious plans. You will be familiar with all aspects of the finances for running a business, have a good working knowledge of the UK social care system and be a dynamic manager, but with a willingness to turn your hand to other aspects of the business (from fundraising to recruitment to CRM) until we are large enough to take on a full team. You understand the value of evidence-based practice and you have a good awareness of the financial demands of the social impact sector. You are the kind of person that can nail down complex ideas and grand ambitions into concrete and achievable plans that will make genuine social change.

You will ideally be based in Derbyshire at our new Matlock office and will help to develop a team there, but with some travel to other sites. However, we already have a base in Milton Keynes that I visit fairly regularly, along with existing relationships and use of shared working space in North London (Kings Cross), so if you are the right person then these might be possible alternative locations, provided you are prepared to travel regularly to meet with me in Matlock and are comfortable using video chat in between times.

How to apply

If what we are looking for sounds like you, and you are looking for a new challenge, please get in touch and we can set up a meeting. Or if you know someone that might be the right fit, please pass this information along to them. Email lifepsychol@gmail.com to express an interest. No agencies or recruiters please.

Background information:

LifePsychol currently consists of a small clinical team who provide assessment and therapy services, particularly for children and families, and services commissioned by local authorities to support Looked After Children, adoption or families at the edge of care. Our Clinical Psychologists also provide expert assessments for the family court and to local authorities considering entering proceedings. We provide consultations advice on service development and service evaluations for social enterprise and third sector organisations. Our main specialist area is around attachment, trauma and maltreatment and how this evidence base can inform the care of children who do not live in their family of origin. We therefore provide training for adoptive, foster and residential carers, as well as health, social care and legal professionals, and have a network of associates who provide regular consultation into organisations.

However, our primary goal at present is nothing less than to improve the quality of placements for all Looked After Children in the UK. LAC are a particularly vulnerable group of children and young people because their needs are complex, and often include mental health, developmental difficulties, problems with relationships and behaviour. We hope to achieve this ambitious goal by training carers and implementing a new set of standards for care providers (PRIME) and through regular use of outcome measures (BERRI).

The PRIME standards are about ensuring that strategies carers use are evidence-based, individualised to the background and needs of each child, evolve as the child’s needs change, and are based on a thorough psychological assessment and a multi-faceted formulation of the child’s needs. We believe that having advice from a clinical psychologist to inform the care of all Looked After Children (and other children with complex needs) will both reduce stigma and improve outcomes, whilst helping carers to feel better equipped to meet the children’s needs. We have developed a training program and care pathway as one means to implement these standards for placements.

We have also developed a set of online tools for commissioners and placement providers to use to identify and track the needs of children in their care. The tools are known by the acronym ‘BERRI’ because they explore Behaviour, Emotional well-being, Risk to self and others, Relationships and Indicators of psychiatric or neurodevelopmental conditions that may require further assessment or diagnosis. We want every young person with complex needs to have a service that meets their needs in an effective and evidence-based way. We have therefore developed tools that allow us to gain a more holistic picture of children’s needs, to track how this changes over time and to target particular concerns and monitor the effectiveness of interventions to address them.

Our first data suggests that we can reduce concerns about children significantly within six months of using the pathway and tools we provide, and our services gain exceptional feedback from carers and professionals, but we hold ourselves to tough standards of evidence, and gather data about our effectiveness every step of the way.

Note: The BERRI questionnaire and online tools were developed to improve the outcomes for children Looked After in public care in the UK. However, the system is also applicable to those receiving other forms of intensive or multi-agency input, such as those on the edge of care, attending special schools, placed in inpatient services, secure units or involved with services for young offenders. The system would also be equally applicable in other countries, and could be adapted to other populations (eg adults using mental health inpatient services, people with learning disabilities, or those within the criminal justice system).

How do we know what we need: differentiating evidence based treatments for the public

I am interested in making a website to help direct people at the right kind of sources of support when they are hitting a block or feeling unhappy with their lives. So I started to look at what was out there. I found lots of small silos full of professional jargon that would help people to identify a counsellor, psychotherapist or psychologist if they knew that was what they needed. But I also found lots of sites that point people at all kinds of snake oil that has no evidence of efficacy at all. For example, Findatherapy.org lists the following categories as “therapies”:

Abdominal-Sacral Massage
Acupressure
Acupuncture
Alexander Technique
Allergy Therapy
Aromatherapy
Arts Therapy
Autogenic Training
Ayurveda
Biofeedback
Bioresonance Therapy
Body Stress Release
Bowen Technique
Chiropody
Chiropractic Treatment
Clinical Pilates
Cognitive Behavioural Therapy
Colon Hydrotherapy
Colour Therapy
Counselling
Craniosacral Therapy
Crystal Therapy
EMDR
Emmett Technique
Emotional Freedom Technique
Energy Medicine
Flower Essences Therapy
Foot Health
Havening Techniques
Healing
Herbal Medicine
Homeopathy
Homotoxicology
Hydrotherapy
Hydrotherm Massage
Hypnotherapy
Indian Head Massage
Kinesiology
Life Coaching
Manual Lymphatic Drainage
Massage Therapy
Matrix Reimprinting
Maya Abdominal Therapy
Meditation
Microsuction
Mindfulness
Myofascial Release
Naturopathy
NLP
Nutritional Therapy
Osteopathy
Physiotherapy
Pilates
Psych-K
Psychotherapy
Reflexology
Regression Therapy
Reiki
Relationship Therapy
Rolfing
Sex Therapy
Shiatsu
Speech Therapy
Sports Therapy
Structural Integration
Tension and Trauma Releasing
Thai Massage
Thought Field Therapy
Yoga Therapy
Zero Balancing

That’s a list of 70 “therapies” of which at least 40 are obvious quackery, and very few could be said to have any form of persuasive evidence base for efficacy*. But the practitioners of each are persuasive, and the websites use pseudoscientific rationales that might fool those who are not as cynical or conversant with the scientific method as we are. So how do the public know what kind of help to seek out? How does someone who is feeling miserable, has a job they hate, financial difficulties and problems in their relationship know whether to get financial advice, careers advice, life coaching or therapy? And if they pick “therapy” how do they know whether to get CBT, psychoanalysis, art-therapy or non-directive counselling? And how do they know whether to get it from a therapist or a psychologist or a counsellor or a mental health specialist or any of a hundred other job titles? And within psychology, how do they know when to seek a clinical psychologist, a health psychologist, a counselling psychologist or any of the job titles that the HCPC don’t register?

I think apart from word of mouth and google, they don’t. Most people ask their GP or their friends for recommendations, and then go with something available locally within their price range. They don’t read the NICE guidance or understand the various professional bodies or regulatory systems. They trust that they’ll get a gut feeling as to whether it is going to help or not from the first session, and most of that “gut feel” is probably based on personality and charisma, and whether or not they feel listened to. The decision then rests on whether the therapist wants to work with them and has the capacity to take them on, and the price they ask for (assuming the service is in the private domain rather than the NHS).

Even the NHS itself isn’t very consistent about evidence based practise. For example, the NHS still funds some homeopathy – possibly wasting up to £5million per year on this placebo treatment that is entirely without evidence or credible rationale. Likewise I’ve seen NHS therapists who have done training in models of therapy that are implausible and without evidence (eg ‘energy therapies’ like EFT). Perhaps this is why the majority of clients doubt the efficacy of talking therapies. Yet, despite this scepticism, most would prefer to try therapy than medication yet the use of psychotropic medications has risen much more rapidly than the use of psychological therapies.

So where do we draw the line? If we only deliver fully evaluated treatments and those where we understand exactly how they work, then the amount the NHS can do when it comes to therapy will be much more limited. Lots of therapeutic interventions in practise are derived from other models or by combining aspects of various models. This allows individualisation of care. Similarly, there are many therapies which are being developed that have promising methodologies and are tightly rooted in scientific knowledge, but have not themselves been subjected to RCTs that prove efficacy yet (eg DDP). And many RCTs seem far removed from actual clinical practise where clients have a variety of overlapping conditions and clinicians deviate substantially from the treatment manuals.

The other confounding factor is that when it comes to talk therapy, it turns out that the modality or adherence to the manual matters very little compared to the relationship between the therapist and client. It seems the key ingredients are listening to the client, genuinely caring about them, giving them hope that things could be different, and giving them the confidence to try doing things slightly differently. Whether we have years of training and follow the manual diligently or whether we are newly qualified and muddling through seems to make much less difference than we think. In fact, therapist variables are much more powerful in influencing outcomes than modality, and even than the difference between treatment and placebo. That is no surprise to me as I’ve personally benefited from physiotherapy that included acupuncture – despite having read studies that show it to be no more effective than ‘sham acupuncture’ where random locations are pricked with a cocktail stick!

In the paper I’ve linked above, Scott Miller argues persuasively that we don’t need to focus on understanding how therapy works, or in using the medical model to work out what works for whom with endless RCTs. He shows evidence that experts are defined by having deep domain-specific knowledge, earned by a process of gathering feedback and focusing on improvement. So he argues that in the same way, expert therapists are those who collect and learn from client feedback. So his answer to the issue of evidence-based practise is for us each to collect our own outcome data to show whether our work is effective according to our clients (and by comparison to other options), and to see if we can improve this by using simple ratings within each session that check we are working on the right stuff and that the client feels we understand them, and that the working relationship is good.

So what does this mean for the proliferation of made up therapies? Does it mean that we should leave the public to buy a placebo treatment if they so wish? Or does it mean we need to focus on the modality and evidence base after all? The ideal would obviously be better regulation of anyone purporting to provide therapy of any form, but given the HCPC remit doesn’t even include counselling and psychotherapy, I think we are far from this being the case. To my mind it throws down a gauntlet to those of us providing what we believe are effective and evidence based treatments to collect the outcome measures that demonstrate this is the case. If we are sure that what we offer is better than someone having an imaginary conversation with an imaginary ‘inner physician’ by feeling imaginary differences in the imaginary rhythm of an imaginary fluid on our scalps then surely we ought to be able to prove that?

And what does that mean for my idea of making a website to point people at helpful places to start a self-improvement journey? To me, it shows there is a clear need for simple and accessible ways to identify what might be useful and to allow the public to differentiate between sources of support that have evidence of efficacy, professional regulation, a credible rationale for what they do, reputable professional bodies and/or personal recommendations. Maybe such a website can be one contribution to the conversation, although I’ll need both allies and funding to get it to happen.

 

 

*I’d say EMDR, physiotherapy, speech therapy, CBT and some types of psychotherapy and counselling probably reach that bar. Mindfulness is probably getting there. Art therapy probably suits some people with some issues. Yoga, sports massage, pilates, osteopathy, meditation, life coaching and (controversially) even acupuncture probably have their place even though the evidence for them as therapy modalities is limited. Most of the rest are quackery.

How to recruit (and what to do with my therapy company)

My working life has been increasingly focused on improving outcomes for Looked After Children. I deliver training and consultancy to care providers such as residential care companies and fostering agencies, as well as to health, social care, education and legal sector professionals. I have also developed a suite of online tools to help commissioners and providers to assess needs, track progress and evaluate outcomes for Looked After Children, including www.BERRI.org.uk  I think the introduction of clinical governance processes to the social care sector is long overdue, and I’m hoping that I can contribute to a culture change that drives up standards for Looked After Children. Signs are good, in that Jonathan Stanley chair of the Independent Children’s Homes Association (ICHA) said “you have set the gold standard for care providers” and Sir Martin Narey said “this is the missing link” when it comes to residential care. So I am trying to make this my business.

I’d like to find someone to help me take that forward, who has the kind of financial/business/admin skills that will complement my clinical skills and ensure we run efficiently as a company. Perhaps a business graduate with lots of energy, or an experienced admin who wants a new challenge. Ideally able to come to meetings in Derbyshire at least once a week. I’ve been inundated with demand, which is great, but it means I need help to keep organised and on top of all the competing demands in my new line of work. And that means that I need to give up, hand over or sell on other things I have been involved in.

With that in mind, I am wanting to make a plan for what to do with my existing therapy and court work business in Milton Keynes when I move out of area in a month from now. It’s a profitable business, and meets the needs of a client group who fall between health and social care. We offer edge of care assessments, psychological therapy and support to prevent kids coming into care, to support placements, enable rehabilitation to family, or for children and families who want help with parenting or a mental health issue. We also do court expert witness work for the family courts, and provide consultation into two sets of children’s homes.  However, the only other qualified CP involved is going on maternity leave soon and there is nobody else to provide cover. If I was staying in the area and/or had the time and mental capacity to continue running it myself, I would. But given I can’t, I want to make a good landing for it. And that means either recruiting a temporary or permanent clinical psychologist, or selling the business on to somebody who has the capacity to build on it.

I also need to recruit to provide cover for the services that I supervise within Keys group whilst various staff are on maternity leave, as well as to new vacancies within Keys. But despite the enormous importance of the work, and the fact it is highly valued, and as part of a well-equipped team without many of the niggles of the NHS (for example, we provide tea and coffee, you get your own desk and computer, and the caseload is manageable) recruitment pathways are not as easy when you are outside of the NHS and the first point people look at when seeking work is NHS jobs. We’ve tried BPS appointments memorandum and various recruitment agencies and websites, but so far nobody suitable has applied. So what now?

If anyone has any ideas, the company information is below:

1) My company in Milton Keynes

Lifepsychol/Evolving Families offer therapy to about 10 families, some court expert witness work, and consultation at a day rate into Keys in south Bucks and Peterborough. The qualified CP is going on maternity leave and I am moving out of area. We therefore either need to:
a) sell the business as a going concern to somebody or a company who can pick up the clinical provision (this could potentially include the evolving families business name, bank account, social media, website and email address, with ongoing referrals and enquiries – to run either as a traditional company or as a social enterprise)
b) recruit a member of staff to pick up this work and be an ongoing employee
c) recruit sessional cover of 2 days per week for 6 months to cover the maternity leave

2) To help run my BERRI project

A business graduate or experienced admin who can turn their hands to all kinds of tasks to make a small business work effectively, from responding to email and telephone messages, to keeping on top of the finances, client account management, customer support and converting enquiries into subscribers. Basic salary, plus bonus related to success of company, and the chance to grow with us and earn ‘sweat equity’ in year three. We are flexible and family-friendly. May be able to work some hours from home, but must be able to meet in Derbyshire at least once per week. It may be possible to start part-time and build up, if you are returning to work after a career break.

I would welcome enquiries about any of the above options to lifepsychol@gmail.com

2) Within Keys we have several vacancies to deliver consultation as part of our psychology pathway, and to supervise the APs doing assessments. There may also be scope for some direct therapy. We would either be able to offer permanent contracts for full or part time work, or sessional work which would be contracted for six months initially and then potentially extended.

Vacancies include:
– Full time or part-time posts to cover Warrington/Manchester
– Full or part-time post to cover Shrewsbury area
– Full or part-time post based at Sheffield/Chesterfield/Peterborough
– Full or part-time post to cover Taunton and/or South Wales (we have about 2 days work in each location, but can top this up to full-time with input into another project)

With all of the above, hours, location and salary are negotiable dependent on experience. Email lifepsychol@gmail.com and/or juliehamilton@bettercare.co.uk

Also, if anyone has any contacts to circulate the same around the clinical courses, we would be interested in prospective applications for trainees due to qualify this year.

Gaining Influence

Quite a long time ago, I identified that it gives me most satisfaction when work gives me the opportunity to have 5 I’s: Intellectual challenge, Independence, Innovation, Income and Influence. This month I have really been working on the last of those, and trying to connect with the right people to make change within the Looked After Children sector as a whole, rather than individual by individual or company by company.

It transpires that over time I have accidentally built up a wide professional network, and a credible platform from which to connect with higher level influencers. It seems that all the time I’ve invested into unpaid stuff helps when it comes to connecting with new people and looking like I know what I’m talking about. This is helpful for me to hold in mind as committee work can all too often feeling like a drain on my time that is almost invisible to anyone else and may have little that is tangible as an outcome for what can be quite an onerous process. Logically I know that this type of activity is rewarded by the innate satisfaction of contributing to important work that needs doing, but this is something I find easier to recognise at the start of the process when I first put up my hand to volunteer and after the end of all the graft than whilst in the middle of it.

Being chair of CPLAAC, on the national CYPF committee for the BPS, part of the NICE guidance development group and the BPS/FJC standards group have let me contribute to various publications that will hopefully reach wider audiences and influence practice. Whether that is in terms of the support and interventions offered for children with attachment problems or the standards that should be expected of psychologists who act as experts to the family courts or the chapter on best practise for psychological services for children and families with high social care needs in What good looks like in psychological services for children, young people and their families, the paper I wrote about Social Enterprises as a vehicle for delivering psychological services or the CFCPR issue I edited on good clinical practise around attachment difficulties, I feel like I have been part of some good work that establishes professional standards and reference points.

And with those things on my CV and a network of allies who share my goals about improving outcomes for Looked After Children, I have been able to meet with various decision makers and influencers about my ideas. The first important contact I made was with Jonathan Stanley, the chair of the Independent Children’s Homes Association. He has been fantastic at promoting my work to residential care providers and helping me to gain a seat at the table. I then met Almudena Lara at the DfE, although she was very new to the role of being LAC lead, and moved on before she was able to pick up our discussion again. I have also met with Social Finance. More recently I was able to meet with Sir Martin Narey, the government advisor (and ex-chair of Barnardos) conducting a review of children’s homes in the UK, and a representative of the DfE. And latterly I had the opportunity to meet Lord Listowel at a recent conference and hope to speak with him further soon.

In all of these meetings, I have been promoting the value of clinical governance in the social care sector. That is, the importance of being able to evidence clinical outcomes and substantiate that you are doing what you claim to do – in this case, that placement providers are improving outcomes for children and young people in their care. My wider goal is to allow commissioners, social workers and Ofsted to be able to see what kind of placement a child needs, whether a placement is making positive change for a child and who can provide the most suitable and effective placement. I’m also keen that the idea of “therapeutic care” is better defined, and that therapists working within care organisations need to be qualified, supervised, regulated by a professional body and practice within their areas of competence. But my main goal is to stop the situation in which placements are paid to provide care for the most complex and vulnerable young people in society, and do so by providing accommodation, food and transport to education but do nothing to address their emotional, behavioural, mental health, developmental/learning needs, risk to self and others, or ability to form healthy relationships with others. I think the tools I have been developing, like http://www.BERRI.org.uk, and the training I provide for staff/carers can help with that, but my goal is nothing less than to change the culture of care in the UK.

Evidence has shown that money invested in the most complex children during their childhood is repaid tenfold in savings to the public purse in reductions in use of mental health, social care and criminal justice services over their lifetime. So why is it that the placements for the most complex children and young people are primarily provided by carers with very low levels of qualification and training? The first steps to improving standards are to ensure that all carers in the foster and residential sector get training about managing the impact of trauma and disrupted attachments, and that all children in public care are regularly monitored on outcome measurements. But these need to be meaningful, and linked into practice, rather than done as hoops to jump that are disconnected from daily care.

I can think of nothing more worthwhile to do with my professional life than to improve care for Looked After Children in the UK, and I hope that I can achieve enough reach and influence to make a genuine difference.

 

 

Tipping points (an unusually optimistic blog about entrepreneurship in delivering psychology)

This is a really exciting month for my business. Things are seemingly reaching a tipping point at which all the effort I have put in to date is starting to pay dividends. Even some things I had given up hope on have come back in a more optimistic way.

1) I’ve been short-listed for a grant, in which I can pilot my care pathway for LAC in a new county, scope the level of need, validate my measure and find out whether my system is effective in causing positive change for young people in Care. I’ve just got to get the full application completed by next week, and get the signatures from health, social care and commissioning in that locality onto the form before the deadline. No problem. Well, actually quite a big problem, judging by the initial application where getting signatures on it in time turned out to be a total nightmare. But worth a stab nonetheless.

2) I’ve been contacted by a social impact investment fund who may want to fund a scaled up version of the diabetes project that I blogged about so bitterly here. (If you remember, it was a pilot of brief psychological interventions for people with diabetes, and we found that it more than covered its own costs in savings from physical health treatment costs within the 12 months of the study. I was immensely frustrated that it wasn’t commissioned after the pilot year and I had long since given up on reviving it). It is unclear what they are planning, but they may want to fund us to deliver the project again, perhaps on a larger scale either geographically or in terms of including other long-term health conditions such as cancer, which would be pretty exciting.

3) As if that isn’t enough, I’ve got a new little venture starting up. Its an internet based business, that has already attracted interest from a venture capitalist who likes seed funding projects from idea to proof of concept. Not something I’ll be delivering personally, or directly related to CP, but nonetheless pretty exciting.

Everything else is ticking over nicely. The therapy service we run at LifePsychol is now full to capacity, and profitable enough to consider taking on another member of staff. I’ve got a contract with Keys that takes just over half my working time, delivering training and rolling out the BERRI as part of a change to the training, culture and care pathways across their residential provision. And we are suddenly getting lots of enquiries and sign-ups to the BERRI from other organisations, and several other psychologists I know professionally are recommending it for work they are doing.

On top of that I’m getting free business development coaching from Shawn Jhanji, who is a really supportive and inspiring guy, as part of winning a place on the Impact Hub scaling program (I’m one of 10 small UK businesses focused on making a positive difference to the world that are getting a year of support to enable growth and expansion into new markets, as part of an international cohort of 100). And before that I had personal development coaching from Andy Gill, who was also awesome. I can genuinely say that I couldn’t have made this happen without them. My investment in personal development coaching over the past 18 months has made a tremendous difference to my clarity of goals and the way I want to work to achieve them. It’s been revolutionary in terms of changing my perception of myself and the impact I can make on the world.

Other positive things are also happening all at once too. I’ve had 2 professional publications appear in the last month – a paper on running a social enterprise in Clinical Psychology Forum, a chapter in What good looks like in psychological services for children, young people and their families. The NICE guidance I was part of developing and the practise standards for psychologists working as experts into the family courts are also nearing publication. This means I’ve been able to step down from various committees and unpaid commitments feeling that I’ve done my share of the bigger picture stuff. Finally, I’ve nearly caught up on my invoicing and have made a concerted effort to chase some of the unpaid invoices that are overdue.

Basically, everything is falling into place with my new line of work, and past work is starting to pay dividends. So rather than feeling small, isolated and just about able to make ends meet to run the business, it now feels like the future is much more likely to be secure. This has let me stop taking new instructions for the emotionally intense and time/energy demanding court work that was making me feel so burnt out.

Hopefully pretty soon, I’ll have some time to focus on home stuff – which is good because we are supposed to be moving house by the end of the year!

All of this change has made me feel much more optimistic. Instead of feeling like I’m thanklessly hacking away at the rock face alone, I’ve got to a point where other people can see the value of joining in with what I am doing, and bringing machinery and tools to help. It is by no means inevitable that I’ll be able to achieve my goals yet, but I’m starting to feel more optimistic. And that has given me much more energy and enthusiasm, which is contagious in itself. I’ve got this feeling of travelling beyond territory I know into the unfamiliar. Who knows where it will take me, but I’m enjoying the adventure.

Getting organised

If you haven’t realised it by now, I’m the kind of person that keeps a lot of plates spinning in my professional life. I end up getting excited about things and find it hard to say no, even when I don’t have the capacity to give things the time they deserve. Perhaps because of this overload, and my avoidance of putting a financial value on my work, I have always struggling to get on top of the finances of the business, keep up with invoicing, respond to queries and book things in with enough time to complete everything before the deadline. However, I have relentless standards for my own work, so I try to do everything to the best of my ability, even if it eats into my time out of work (or even my sleep).

Having so much on the go requires a lot of organisational skills, and I know that I sometimes fall short in this regard, so I am very reliant on having a good team around me and particularly a good PA. Thus it was a disaster for me (although fab news for her) when my admin decided to leave Lifepsychol earlier this year and go and bake cakes instead. Worse still, it came at a time that I had two new Assistant Psychologists without prior experience starting in post, and a whole lot of deadlines. I had also concluded that delegating the book keeping to the accountants was not cost effective, as they did not understand the ins and outs of the business, or have access to our files or close enough communication with me to resolve queries. I was starting to panic that I wouldn’t be able to keep up with the demands and everything would fall apart.

Thus it is great news that I have recruited a brilliant admin/operational manager, who is helping me to get everything organised, and has taken on the finances of the company, along with some of the personnel functions. This has been a lifeline as it has really taken the pressure off me, and allowed me to start chipping away at a to-do-list that has been growing much faster than I have been able to check items off it. It is helpful that there is a central point of contact for the company who is there on a full-time basis, and that is making all our lines of communication easier, especially as I seem to be all over the country at the moment!

Today we signed up for Google Apps for Work to set up shared cloud storage for the company, and a more professional company email, calendar and task-list system. We are gradually working through the state of the finances, and catching up with invoicing. We even sorted out the materials in the cupboards, and re-homed the five boxes of left over questionnaires from the diabetes study, some materials that were ordered in error, and a massive collection of used lever-arch files.

This really pleases my inner OCD, as I really dislike the feeling of disorganisation and clutter in my physical or psychological space. I have high hopes that once we are organised things can tick over in a much more satisfying way.

I’ve also been offered one of 10 UK places to be supported by ImpactHub to scale up one aspect of my business over the next year, so I’ll write more about that in my next blog!