Aims and Objectives

We are a child and family psychology practice who aim to reduce psychological distress and improve the interpersonal relationships and resilience of children,

families and adults who have experienced adversity and those supporting them in their recovery. Evolving Families is a Social Enterprise, which means that our priority is to provide a worthwhile service to the community, and we invest the majority of our profits in doing that work.

We particularly work with the following groups of people:

• children who are looked after and adopted
• perinatal and parental mental health
• adults who have experienced trauma or poor care in their own childhoods
• patients with physical health conditions
• children and adults with neurodevelopmental disorders

We are trained to offer therapy to:

• Children and young people
• Adults
• Parents and carers
• Families

We work in an individualised and person centred manner. Where possible we like early intervention and preventative work, but we also believe it is never too late in the lifespan to make positive change.

About the BERRI

The BERRI is a checklist to explore Behaviour, Emotional well-being, Relationships, Risk and Indicators of psychological or developmental conditions in children and young people, written in the words of foster carers and residential care staff.

The BERRI was developed by Dr Miriam Silver in Northamptonshire, through a series of focus groups with carers and professionals who work closely with children and young people who are living in adoptive families, foster care and residential settings. It came to prominence when Dr Silver chaired a national working group amongst the network of Clinical Psychologists working with Looked After and Adopted Children (CPLAAC) to develop a set of measures to supplement those offered by the CAMHS Outcome Research Consortium (CORC), with regards to young people who are Looked After. The BERRI was recommended alongside Kim Golding’s Relationship Questionnaire for foster and adoptive carers, a goal-based assessment and a consultation evaluation form. The BERRI is now widely used with Looked After and Adopted Children, but also with users of adolescent forensic services, residential special schools and other settings for children and young people with complex needs.

The BERRI is a checklist of observable behaviours and concerns that are prevalent in this population, and gathers information related to the frequency of a particular behaviour or concern and the difficulty carers have in managing it, giving a real sense of the impact of these behaviours. It can help identify presentations that externalise and internalise distress, make caring for the child difficult or place them at risk. It also provides indicators of neurodevelopmental disorders, such as ADHD/Autism, and psychiatric conditions such as psychosis and obsessive-compulsive disorder. Overall it is able to provide a more detailed and holistic profile of the young person’s needs than existing more generic measures.

There is a computerised reporting tool which aids interpretation and gives some generic advice based on areas of high score. We are currently developing norms for this measure.

To use the BERRI for your organisation, to attend our BERRI training or to register to use the BERRI reporting tool, please contact us at info@evolvingfamilies.org.uk

Children who are Looked After and Adopted

We offer assessments and support to placements at a variety of levels, direct to the children or young people, via their carers and through the professional network.

In terms of direct work, we offer therapy to parents, carers, children and family groups. This includes Dyadic Developmental Psychotherapy and Theraplay (techniques to help strengthen the bond between parent/carer and child) and individual psychotherapies such as CBT (including ‘3rd wave’ approaches) for both adults and children. We also offer our highly effective and well-liked group for non-birth-parent carers: Managing Behaviour with Attachment in Mind, which we can also train other professionals to deliver. This group helps adoptive and foster parents to recognise the impact of early experiences on their child’s way of behaving and relating to others, and practical strategies to help move things in the right direction.

We can offer consultation for professionals about mental health issues, and the impact of their work on their own wellbeing. We are able to provide training about attachment, mental health, the impact of abuse, trauma and neglect, and differentiating developmental disorders. Past feedback suggests our training is engaging, relevant and effective.

We are also able to help with outcome evaluation, holistic assessments of children’s needs, and evidencing the quality of service provision. This includes training in using the BERRI measure, which explores Behaviour, Emotional well- being, Risk, Relationships and Indicators of developmental or mental health conditions.

For more information on the BERRI click here

Therapy

We are a child and family psychology practice with a particular interest in (Click on each category for more information):

• children who are looked after and adopted
• perinatal and parental mental health
• working with adults who have experienced trauma or poor care in their own childhoods
• early intervention and preventative work

The client groups we can offer therapy are:

• Children and young people
• Adults
• Parents and carers
• Families

We work in an individualised and person centred manner. Some of the therapeutic modalities we employ are:

• Third wave Cognitive Behavioural Therapies, including Cognitive Analytic Therapy, Schema Therapy and Compassion Focussed Therapy.
• Theraplay
• Group work (both psycho-educational and therapeutic)
• Dyadic Developmental Psychotherapy
• Family Attachment Narrative work

We can offer therapy on an individual basis or as part of a block contract.

Assessment

We can provide a range of assessments tailored to the needs of the individual child or family including:

• Cognitive ability (IQ) assessments for adults and children
• Personality and mental health assessments for adults and teenagers
• Memory assessments of adults and children
• Assessments of parenting capacity (including exploration of mental health, stress, personality, mind-mindedness and insight)
• Psychological and developmental assessments e.g. assessing whether a child or adult has Attention Deficit Hyperactivity Disorder (ADHD), Autistic Spectrum Conditions, Specific Learning difficulties (eg Dyslexia), or mental a health condition such as Depressive or Anxiety disorders.
• Emotional and behavioural assessments
• Differential diagnoses (eg considering whether symptoms are due to poor care or a disorder such as ADHD or autism)
• Developmental trauma and post-traumatic stress
• Sibling relationship assessments
• Attachment and family relationship assessments, including:
  • Adult Attachment Interviews;
  • the Marschak Interaction Method (a structured observation technique designed to assess the quality and nature of child-carer interaction);
  • Story Stems; Family Relations Test (exploring children’s perceptions of normal family life and their relationships with others).
• Fostering and adoption placement planning, including assessment of contact
• Psychological assessment of potential foster carers and adopters, including those with a metal health history
• Psychological case formulation

Consultation

We can offer consultation for professionals working within child and family settings. This can be offered on an individual basis or as part of a block contract. Particular reasons for accessing this service may be:

• Support regarding the emotional impact of work and burn out prevention.
• Help evidencing decisions regarding placement or contact.
• Case formulation and intervention planning.

Training

We have highly skilled and qualified professionals who can offer training on:

• Attachment
• Perinatal and Parental Mental Health
• Autistic Spectrum Disorders and differential diagnosis from attachment difficulties.
• Managing Behaviour with Attachment in Mind.
• BERRI user training.

Research, Evaluation and Service Development

We are able to offer research and audit services to evaluate your service and evidence outcomes, staff knowledge and milieu. We can create individualised research/audit plans, and can also create online systems to produce individualised reports regarding the needs of children in placement.
We have for example received a research grant from a major health funder to provide and evaluate solution-focussed psychological intervention to enhance treatment adherence for diabetes patients (click here to see more information about the Wellbeing in Diabetes Project).

Adults with a History of Developmental Trauma

Neglect and abuse in childhood can often result in psychological distress and relationship difficulties in adulthood. These adults may not fit any diagnostic mental health criteria, but may experience shame, guilt, anxiety, low mood, anger and a range of other emotions that are often triggered by interpersonal relationships.

Evolving Families provides a range of specialist and evidence based psychological services to support adults who experience psychological and relationship difficulties linked to adverse childhood experiences, including:

• Attachment-Focussed Assessments.
• A range of therapeutic and psycho-educational groups.
• Third-wave cognitive therapies i.e. those that target the underlying cause of psychological distress as well as the 'here and no' (including Cognitive Analytic Therapy, Schema Therapy and Compassion Focussed Therapy).
• Supporting clients to develop new coping mechanisms and to break unhelpful patterns or 'life traps'.

Clients may self-refer and can pay for sessions based upon their individual means. Assessments and interventions can also be commissioned by health and social care services on a case by case basis or in blocks.

We can also provide groups for individual services, training on mental health difficulties linked to childhood trauma and work in partnership with other services by adding specialist input to packages of care being offered by other providers.

For those adults who live outside Milton Keynes and the surrounding area, for busy professionals, or for people for whom therapy within traditional working hours does not fit in with other commitments, Skype Therapy may also be an option. This involves an initial face-to-face contact with us in Milton Keynes with subsequent sessions being offered over the internet via Skype (as long as this mode of therapy is deemed appropriate during the assessment).
The same evidence-based therapies are provided by Skype, can also be commissioned by partnership agencies, or can be self-funded.

Children who are Looked After and Adopted

We offer assessments and support to placements at a variety of levels, direct to the children or young people, via their carers and through the professional network.

In terms of direct work, we offer therapy to parents, carers, children and family groups. This includes Dyadic Developmental Psychotherapy and Theraplay (techniques to help strengthen the bond between parent/carer and child) and individual psychotherapies such as CBT (including '3rd wave' approaches) for both adults and children. We also offer our highly effective and well-liked group for non-birth-parent carers: Managing Behaviour with Attachment in Mind, which we can also train other professionals to deliver. This group helps adoptive and foster parents to recognise the impact of early experiences on their child's way of behaving and relating to others, and practical strategies to help move things in the right direction.

We can offer consultation for professionals about mental health issues, and the impact of their work on their own wellbeing. We are able to provide training about attachment, mental health, the impact of abuse, trauma and neglect, and differentiating developmental disorders. Past feedback suggests our training is engaging, relevant and effective.

We are also able to help with outcome evaluation, holistic assessments of children's needs, and evidencing the quality of service provision. This includes training in using the BERRI measure, which explores Behaviour, Emotional well- being, Risk, Relationships and Indicators of developmental or mental health conditions.

For more information on the BERRI click here

Perinatal and Parental Mental Health

Becoming or being a parent can trigger psychological distress for many reasons (both biological and environmental). This can occur at any time from conception onwards and can affect people from all walks of life. Parents may have had experiences of abusive or neglectful parenting in their own childhood, they may have been brought up in the care system, been bullied in adolescence or their previous coping responses may be ineffective once they have become a parent. Shame, guilt, anxiety, fertility problems, complications during pregnancy and birth, family complexities, lack of support, or parenthood not feeling as 'natural' as expected can all be contributory factors.

Evolving Families provides a range of specialist and evidence based psychological services to support parents who experience psychological difficulties linked to parenthood, including:

• Assessments and therapy for mothers who are experiencing anxiety, depression or distress in the perinatal period (conception to age one).
• Psycho-educational groups with a focus on parental mind-mindedness (incorporating elements of attachment theory, child development and the ability to see the world from their child's perspective).
• Attachment focussed assessments and interventions for the parent-infant dyad (including TheraplayTM and Dyadic Developmental Psychotherapy).
• A range of therapeutic groups targeted at perinatal mental health, parenting and attachment.
• Assessments and interventions targeted towards being a parent of a child with physical health and/or learning difficulties.
• Third-wave cognitive therapies i.e. those that target the underlying cause of psychological distress as well as the 'here and now' (including Cognitive Analytic Therapy, Schema Therapy and Compassion Focussed Therapy).
• Whilst many of the parents who come to see us are mums, we offer services for dads too.

Please note that parents are not required to meet diagnostic criteria for any specific mental health disorder to access our services. Experiencing distress linked to parenthood is enough!

Parents may self-refer and can pay for sessions based upon their individual means. Assessments and interventions can also be commissioned by health and social care services on a case by case basis or in blocks.

We can also provide groups for individual services, training on parental mental health issues and work in partnership with other services in a variety of ways:

• To add specialist input to packages of care being offered by other providers.
• To provide assessments and help prevent admissions to specialist mother and baby units.
• Assessment and/or therapy for pregnant mothers who have previously had children removed.
• To provide preventative services and early interventions.
• To support parents in the period after a stay in a mother and baby or parenting assessment unit.
• To rehabilitate babies and children home after a period in care linked to parental mental health difficulties.

Groups

Managing Behaviour with Attachment in Mind

An ongoing group allows adoptive parents or foster carers to learn about the ideas of attachment and re-parenting in more depth. The group format is of six 2.5 hour sessions, which allow participants to get to know each other, and let people put the ideas into action between weekly sessions. The content of the group is evidence based and has been shown to be effective as well as well-liked by participants (see Holmes and Silver, in Adoption and Fostering, Spring 2010). We will run the group according to demand, normally termly during the school day (normally 10am-12.30pm). There will be 6-20 participants per group.

Training to run Managing Behaviour with Attachment in Mind

I can also train professionals such as social workers, guardians, or health professionals to run the Managing Behaviour with Attachment in Mind group. This includes a folder of materials to use to run the group and permission to copy the handouts for participants, as well as use of the outcome measures.

Antenatal Mental Health and Resilience Group

Six-week group that focusses on self-image, baby and infant development, preparation for birth and motherhood and forming secure attachments. This course is particularly aimed at women who are experiencing antenatal anxiety, depression, or psychological distress linked to pregnancy and motherhood (no diagnosis required).

Postnatal Mental Health and Resilience Group

Six-week group that focusses on self-image, baby and infant development, adjusting to motherhood and forming secure attachments. This course is particularly aimed at women who are experiencing postnatal anxiety, depression, or psychological distress linked parenthood (no diagnosis required).

Perinatal Compassion-Focused Group

Twelve-week group that focusses on forming a compassionate relationship with the self, adjusting to motherhood and forming secure attachments. This course is particularly aimed at women who are experiencing perinatal mental-health difficulties linked to parenthood that are characterised by self-doubt, self-loathing, shame and guilt. Also suited to women who may have experienced a stay in a mother and baby unit.

Costs of Therapy

Therapy purchased by an individual for themselves or their child, which takes place at the LifePsychol offices in Milton Keynes typically costs £60-£95 per session, though we are able to subsidise some sessions for people of low means, particularly where these are provided by psychologists at an earlier career stage. Sessions are typically 50-60 minutes in duration. Reports and specialist assessments will be estimated individually. Where we have completed an assessment in person and feel this is suitable we can also offer therapy over Skype. This might be more convenient and allows greater flexibility about appointments times, but the session length, content and cost is similar to face to face.

Therapy purchased by a health or social care organisation normally start with a professional consultation. This is priced at £100 but the fee is waived where a package of therapy is then purchased. Therapy costs will be calculated dependent on the location and nature of the work required, and whether this involves more than one clinician.

Therapy is not eligible for VAT.

Wellbeing in Diabetes Project

We are running a project in collaboration with the Diabetes team at Milton Keynes General Hospital (MKGH) to provide and evaluate brief solution-focused psychological therapy to patients with diabetes.

Research has found an association between patient’s psychological wellbeing and their diabetes management – so the way you think and feel does affects how you manage your diabetes. Being given the chance to talk through thoughts and feelings with a Psychologist often helps people to cope with stress and worries, make sense of their diabetes, fit it into their lives and improve their metabolic control. Therefore by providing psychotherapy to diabetes patients we hope to improve their adherence to their diabetes regimes, consequently improving their physical and mental health outcomes.

The ultimate aim of the project is to help diabetes patients improve their mental wellbeing and diabetes management so that they are able to live happier and more fulfilling lives whilst reducing their chances of developing long-term diabetes related complications.

The service is open to people of all ages (children, young people or adults) who have Type 1 or Type 2 diabetes and are a patient at MKGH.

The therapy offered to patients is tailored to their needs, so the number of sessions patients have with the Psychologist will vary for each person depending on their needs. However, typically most patients are seen for between one and six sessions, each lasting 50 minutes.

As part of the project we are also asking all patients attending outpatient clinic appointments to complete a screening questionnaire about their overall wellbeing and experience of living with diabetes, which is then correlated with their most recent blood-test results, in order to build a model of risk factors for poor treatment adherence. It is hoped that this information will enable us to better target services to the most vulnerable patients.

The project is being funded by a £75,000 grant from the Health Foundation as part of their SHINE award program. Evolving Families is one of 30 project teams from across the UK whose innovative idea to improve the quality of healthcare is being put to the test in 2013/14. (You can find out more about each of the Shine 2012 projects by clicking on this link: www.health.org.uk/shine2012)

If you would like to find out more about the background to the project then go to the news section of our website by clicking here.