PRE-CONFERENCE WORKSHOPS

How to develop a winning child and adolescent mental health research protocol

Presenter:  Alan J. Flisher
M.Sc. (Clinical Psychology), M.B., Ch.B., M.Med. (Psychiatry),
M.Phil. (Child and Adolescent Psychiatry), Ph.D., F.C.Psych. (S.A.), D.C.H.

Duration:
Half-day

Numbers:
A maximum of twelve people who come prepared to discuss their own ideas/protocols.

Winning research protocols:
The aim of the workshop is to develop the capacity of participants to develop winning child and adolescent mental health research protocols. The workshop will begin with a presentation of what the components and characteristics are of a winning protocol. Thereafter, participants will be expected to present some of their own ideas for protocols, which will be discussed and reviewed in a supportive, constructive and collegial manner. The workshop will end with a review of lessons learned and concrete suggestions for further progress with the research ideas that were brought to the workshop.

Alan Flisher is a medical sub-specialist in child and adolescent psychiatry. He is currently Professor in Psychiatry and Mental Health at the University of Cape Town (UCT); Head of the Division of Child and Adolescent Psychiatry at the University of Cape Town (UCT) and Red Cross War Memorial Children’s Hospital; Director of the Adolescent Health Research Institute at UCT; Honorary Senior Research Fellow at
the Health Systems Research Unit at the Medical Research Council; and Adjunct Professor at the Research Centre for Health Promotion at the University of Bergen, Norway.  He has had visiting appointments at Columbia University in the City of New York, the University of Oslo, and the University of Leeds, and he was a Takemi Fellow at Harvard University.  His principal research interests are adolescent health and mental health services research. He has served as principal investigator for a number of school-based epidemiological and intervention studies addressing diverse aspects of adolescent risk behaviour including substance use, violence and unsafe sexual behaviour.

 When the Patient is the Baby: Assessment and Interventions in Infant Psychiatry 

Presenter: Astrid Berg

Assoc/Prof, Division Child & Adolescent Psychiatry

UCT Parent-Infant Mental Health Service

Red Cross Children’s Hospital and University of Cape Town

Duration: Half-day

Numbers:

Maximum of 25 people.

When the Patient is the Baby:

I Disorders of Infant Mental Health

The preservation of the mental health of infants could aid in preventing mental disorders later in life. 

While many of the disturbances seen during the first 3 years are phase specific and transient, 

there are others which require the attention of and intervention by mental health professionals. 

The diagnostic approaches during infancy differ from those for older children and adolescents 

– the Zero-to-Three multi-axial classification will be described and illustrated with case examples. 

II Assessment of infants and their relationships

When assessing a baby and his/her caregivers, 

the emphasis falls on the relationship between them as well as the close observation of the infant or toddler’s general developmental and mental status. 

Several challenges exist when having to assess a pre-verbal, pre-symbolic child. 

The use of the Infant-Toddler Mental Status Examination is helpful in sharpening clinical skills and in naming and ordering what has been observed.

III Approaches to treatment

Interventions vary according to what the infant and care-givers present with and this can range from information

-giving to counseling and supportive or insight-orientated psychotherapy and may include referral to other health professionals. 

In some cases the removal of the infant from his/her environment may be indicated.

Different types of presenting problems, the diagnoses and interventions will be described with the use of case examples. 

Audience participation will be encouraged throughout.

Astrid Berg is Psychiatrist, Child & Adolescent Psychiatrist as well as Jungian Analyst. 

She is an Associate Professor at the University of Cape Town and a senior consultant in the Division of Child & Adolescent Psychiatry

at the Red Cross Children’s Hospital in Cape Town where she heads the Infant Mental Health Unit. 

She is a founding member of the Western Cape Association of Infant Mental Health and has previously Chaired this body. 

She is also a founding member and past President of the Southern African Association of Jungian Analysts. 

She is currently Vice-President of the International Association of Analytical Psychology.

Counselling behaviour change using motivational interviewing 

Presenter:  Prof Bob Mash
Division of Family Medicine, Stellenbosch University
Member of the International Motivational Interviewing Network of Trainers (MINT)

Duration:
1 day

Numbers:
Maximum of 20 people

Facilitators

• Prof Bob Mash: Division of Family Medicine, Stellenbosch University and member of the International Motivational Interviewing Network of Trainers (MINT) http://www.motivationalinterview.org.
• Members of the South African network of motivational interviewing trainers (MISA). MISA is a multi-disciplinary group consisting of doctors, nurses, psychologists, social workers, lay counselors and researchers (http://www.sahealthinfo.org ).

Motivational interviewing:
Motivational interviewing is a directive, but client-centred approach to behaviour change counselling that was developed and tested in the specialist addiction field and has now been extrapolated to different settings and other behavioural issues. In adolescence it is relevant to interventions that target health risk behaviours such as alcohol use, drugs, sexual practices and physical risk taking.

Aim:
To train psychologists, psychiatrists or other health workers in basic skills or improve their existing skills in motivational interviewing as a form of health behaviour change counselling. Motivational interviewing is of relevance to any counselling that deals with lifestyle issues such as smoking, drugs, alcohol, safe sex, adherence to medication or dietary choices.

Objectives

1. To understand the theoretical background to motivational interviewing as an approach to guiding people with decisions about lifestyle or behaviour change
2. To model or demonstrate the principles of and specific skills of brief motivational interviewing
3. To practice the skills of motivational interviewing through simulation and role play with feedback

Outcome:
To engage the spirit of motivational interviewing as a way of being with patients or clients and to be able to utilize specific principles and skills in consultations or counselling sessions involving behaviour change.

Course format / structure:
The course will integrate theory with modelling of skills and will focus on the practical use of MI by participants. This may involve the use of simulation, role-play, group work, audio and video tape. 

Target group:
The course is directed at psychologists, psychiatrists or other health care workers who counsel clients or consult patients and must help people make decisions about behaviour change.

Prof Mash manages postgraduate training in family medicine at Stellenbosch University and has a wide range of research interests that include diabetic eye disease, asthma care, family medicine training and education, motivational interviewing and the district health system. Clinically, he works in the Khayelitsha sub-district of Cape Town. In 2005 he became a member of MINT and in 2006 organised an international training of practitioners and trainers in motivational interviewing at Stellenbosch.

Members of the South African network of motivational interviewing trainers (MISA): MISA is a multi-disciplinary group consisting of doctors, nurses, psychologists, social workers, lay counsellors and researchers.

Child abuse and Complex PTSD: Effective psychosocial response

Your life or your liberty: When is it legitimate to limit human rights for the public good? 

Presenter:  Leslie London
Senior Specialist and Professor in Public Health at the University of Cape Town

Duration:
Half-day

Numbers:
Limited only by the size of the room available (to be advised).

Legitimate limitations on human rights:
Many public health policies are premised on an assumption that the health of individuals and communities is a public good that may justify a limitation of human rights. However, the history of public health has illustrated that such assumptions have led to adoption of policies that may significantly impair the quality of life of those adversely affected, as well as creating a culture in public health of authoritarianism and/or paternalism in which individuals’ rights may be subordinated to a perceived public good. This is particularly evident in the field of mental health and the way in which services provide care for chronically ill adults and in the way adolescents may be treated.  The advent of the HIV epidemic has challenged fundamentally the public health approach to major health problems, forcing a realisation that respect for human rights is actually a component of good public health practice. Nonetheless, despite a general recognition of the importance of human rights, this balancing of individual rights and public interests remains a contested area.

This presentation aims to explore the trade off between public health and human rights in more detail. It will explore firstly, what are human rights and what is implied by a human rights approach to health, including an elaboration of national and international obligations on states to take action to realise and protect the right to health, and the responsibilities of health care providers; secondly, it will outline the framework provided by international human rights law to decide whether a policy that limits rights in the interests of the public good may be justified; lastly, the presentation will explore the application of this framework to four examples of trade-offs in rights in the mental health context: the enforced hospitalisation of psychiatric patients, checks to limit exploitation in research, justified breaches of confidentiality; and the treatment of children in the criminal justice system. In doing so, it will reflect upon the importance of the indivisibility of human rights and the kinds of obligations placed on state parties to ensure the realisation of the right to health.  The presentation will hope to illustrate a generic approach to critiquing health policies such that they are able to maximise the synergy between health objectives and human rights approaches, and provide practitioners, researchers and policy makers with tools to evaluate the human rights impact of mental health and related policies affecting vulnerable groups.

Leslie London is a Senior Specialist and Professor in Public Health at the University of Cape Town. He heads the Health and Human Rights programme in the School of Public Health and Family Medicine and has developed under- and postgraduate teaching programmes on health and human rights. He serves on the Advisory Committee on Human Rights, Ethics and Professional practice for the Health Professions Council of South Africa, the National Health Research Ethics Committees, and has been active in human rights research and advocacy in South Africa and internationally.

Sensational Principles for Children with Autism Spectrum Disorders (ASD) 

Presenter:  Roseann C. Schaaf, PhD., OTR/L, FAOTA
Associate Professor, Vice Chairman and Director of Graduate Programs
Thomas Jefferson University, Philadelphia, PA

Duration:
Full day

Numbers:
25

Sensational principles:
This workshop provides the therapist with practical strategies for using sensory integration in occupational therapy with children who have autistic spectrum disorder (ASD). Updates in autism and sensory integration theory and practice will be presented.  Evidence-based, “sensational” principles for the classroom, home and clinic are presented using video examples and participants have the opportunity to try out activities that utilize each principle. This is a lively, participation-oriented workshop that combines current research with practical applications

Goals and Objectives
Through lecture, participation, observation and case analysis of clients with ASD, the participants will:

1. Update knowledge of children with Autism Spectrum Disorders including prevalence, common symptoms and etiologies
2.  Understand the incidence and nature of sensory dysfunction in children with Autism Spectrum Disorders
3. Understand the power of sensation in changing mood, arousal level, attention and motivation;
4. Be introduced to sensory-based principles for clients with Autism Spectrum Disorders
5. Experience and apply these principles to practice in school, home/community and clinic settings
6. Utilize a clinical reasoning framework for application of these principles within their professional domain

Roseann C. Schaaf is Associate Professor, Vice Chairman & Director of the Graduate Programs in the Occupational Therapy Program at Thomas Jefferson University in Philadelphia PA. She is an occupational therapist with a Ph.D. in Neural and Behavioral Sciences and has devoted her career to the study of the neuro-physiological mechanism of abnormal sensory processing in children with autism using psycho physiological procedures. She has been a Switzer Fellow of the National Institute on Disabilities and Rehabilitation Research and lectures internationally on issues related to neurobiology, sensory processing and autism.  She is the author of several articles and chapters on these subjects, and a new text entitled “SI:  Clinical Reasoning with Diverse Populations."
 

Ethical dilemmas in clinical practice – Pitfalls and problems 

Presenter: Professor Tuviah Zabow
Emeritus Professor of Psychiatry
University of Cape Town

Duration:
Half-day

Numbers:
120

Ethical dilemmas:
The workshop will aim to allow the participants to gain further insight into daily and potential ethical issues in their practice. The aim is to learn to apply reasoning skills of the principles and codes of ethics. The format will address the issues with case scenarios.

With audience participation and discussion of the case, the application of the underlying principles will be illustrated. The clinician will gain improved skills in order to anticipate and manage ethical issues which arise in practice.

The workshop will address the following topics in case scenarios:

• Children in foster care
• Legal surrogacy
• Psychotherapy and confidentiality
• Confidentiality, Privilege and Privacy
• Consultation and second opinions
• Relationships with colleagues
  o Supersession
  o Malpractice and deception 
• Boundary crossings and violations
• Hospitalisation of children and adolescents
• The “emancipated” minor
• Informed consent and assent'
• Family Law issues
• Domestic and child violence
• The clinician and the court
• Expert witness
• Report writing

Professor Zabow is an Emeritus Professor of Psychiatry at the University of Cape Town, where he headed the Research Ethics Committee for a number of years. He has a particular interest in clinical ethics in relation to mental health practitioners in the multidisciplinary team.

Child and Adolescent Psychopharmacology

Presenter:  Dr Ulli Meys
MB ChB (UCT)
FC Psych (SA)
MPhil (Child and Adolescent Psychiatry) (UCT)

Duration:
Full day (attendance in the morning only is also possible; i.e., this could be a half-day workshop for those interested in only the most common conditions).

Numbers:
Limited only by size of the available room (to be advised)

Target group:
This workshop is specifically aimed at mental health practitioners: child and adolescent psychiatrists and general psychiatrists who prescribe; and allied professionals want to gain a better understanding of the role medication plays in the management of child and adolescent psychiatric disorders.

Child and Adolescent Psychopharmacology:
I plan the workshop to be interactive and based on clinical case discussion/ examples to illustrate prescribing principles. At the end of each section, a brief literature review will be presented highlighting current empirical evidence and opinions on the subject. Depending on numbers, participants will be divided into small working groups to tackle subjects, which would then be discussed.

Part 1 would includes the more common conditions; Part 2 would focus on the less common conditions, that should be managed predominantly by (child) psychiatrists.

Part 1:  

• Introduction and workshop outline;
• The role of medication in the management of child and adolescent psychiatric disorders;
• General psychopharmacological principles when prescribing medication in children and adolescents;
• Psychopharmacological management of child and adolescent psychiatric disorders including:
  - Attention deficit hyperactivity disorder;
  - Major depressive disorder;
  - Anxiety disorder (excluding obsessive compulsive disorder);
• Principles and practices on discontinuing medication;
• Summary and conclusions. 

Part 2:  

• Introduction;
• Obsessive compulsive disorder;
• Bipolar mood disorder;
• Psychotic disorders;
• Tourette’s syndrome including chronic motor tics;
• Eating disorders;
• Pervasive developmental disorders;
• Children with impulsive and aggressive behaviours;
• Summary and conclusions.

Dr Ulli Meys works in private practice as a child and adolescent psychiatrist. He is also a consultant psychiatrist at Student Health for the University of Cape Town (UCT) and at the Ocean View Clinic. He is an honorary lecturer in the Department of Psychiatry and Mental Health, Division of Child and Adolescent Psychiatry (UCT).

Imago Relationship Therapy: Skills and principles applied to intervention with children and adolescents

Presenter:  Lindy Robertson
Clinical Social Worker in Private Practice
Based on the work of Dr Harville Hendrix and Helen la Kelly
Hunt, including their book "Giving the Love that Heals  -- a guide for parents”.

Duration:
5 hours

Imago Relationship Therapy:
The workshop will expose delegates to the intriguing and useful core concepts and communication skills within Imago Relationship Therapy as applicable to intervention with children, adolescents and their families.  These will be explored as catalysts for healing, as the processes used promote relationship connection, emotional safety and empathy.  Criticism and affirmation will be explored, with regard to their short and long-term repercussions on familial relationships. The importance and impact of various care-giving and supervisory adults will also be examined, including domestic workers, aftercare supervisors, child-minders and au pairs, within the context of Imago Relationship Therapy.

Learning outcomes will include developing a beginning understanding of the usefulness of Imago Relationship for therapeutic intervention with children and adolescents and their families, clarity about the importance of emotional safety in familial relationships and therapeutic relationships, interesting differences between personality and character within Imago concepts, sources of emotional reactivity in parents having roots in unmet childhood needs, and experiential learning of the central Imago skill, the Intentional Dialogue.

Lindy Robertson has worked for 25 years as a Clinical Social Worker in the field of individual, couple and family therapy and life-skills training. She has run a dynamic private practice in Cape Town for the past 19 years. She was trained at Red Cross Children’s Hospital Child and Family Unit, and has a Masters degree in research into family crisis intervention. She has been married for 23 years and has two teenage sons. She and her husband Hamish, a scientist, trained together in Imago Relationship Therapy 10 years ago and have subsequently run over 25 seminars introducing couples, businesses and educators to Imago Relationship Therapy.