I was recently asked what a psychologist working in a paediatric setting does and what their job is like on a day to day basis, so I thought I’d share my experiences of working in paediatric psychology.
Firstly, paediatrics is a branch of medicine specialising in the care of children and young people (it is spelled ‘pediatrics’ in the US). A paediatric psychologist therefore usually works with children and young people with a medical condition and/or physical symptoms that are directly impacting on their wellbeing or mental health.
Paediatric psychologists are usually a clinical psychologist by training, although there are some health psychologists working in paediatric settings, in addition to paediatric clinical neuropsychologists who have undertaken further training to specialise in brain functions in children and young people. Paediatric psychologists also work with children, young people and families who are finding it difficult to cope with a physical health condition, whether this is in terms of managing the required treatment or adjusting more broadly to life with a medical condition and the impact of this on them and their family. Paediatric psychologists are usually based in acute medical settings such as children’s hospitals and specialist children’s services, as a lot of their work will involve being part of a multidisciplinary team (MDT) involved in the young person’s care.
The psychologist may advise the MDT on the impact of a treatment or a medical procedure on a young person’s emotional wellbeing or provide advice on how to engage the child or young person. In addition to providing ad hoc (‘on the spot’) advice and guidance on issues relating to the young person’s emotions and behaviour, paediatric psychologists also encourage and support colleagues to consider the impact of psychological factors (e.g. emotional and behavioural) on medical care. They may offer formal training and support to develop the psychological knowledge and skills of their colleagues in medical settings. For example, this comprehensive resource produced by NHS Education Scotland was developed by a clinical psychologist to support staff in specialist children’s services to think and work in a psychologically informed way.
In common with psychologists working in other medical settings (a field known as clinical health psychology when working with adults), paediatric psychologists may provide clinical supervision (in an individual or group format) to colleagues employing psychological interventions or wishing to develop their psychological knowledge and skills. These are often what we call ‘low intensity’ psychological interventions that can be undertaken by staff under the guidance of a psychologist, but are not so complex as to require specialist and comprehensive training in the theory and practice of psychology for their delivery.
Doctors, nurses, occupational therapists and other professionals can have a central role in providing psychoeducation and supporting children and young people with low intensity psychological interventions, under the guidance of psychologists. This makes their practice more psychological which potentially ‘nips problems in the bud’ and also increases the capacity of paediatric psychology services as psychologists can then focus on the more severe/complex cases.
This model of service delivery is called ‘stepped care’ and is based on similar principles to the model adopted in mental health services (e.g. in IAPT services). In a nutshell, stepped care involves provision of different levels of intervention that can be matched to a person’s level and complexity of need. Upskilling and supporting non-psychology colleagues in psychological interventions means that these can be delivered more widely, thus increasing access to such input and making use of the skills and experience of other professionals.
With regard to what is involved in the role of paediatric psychologist on a day to day basis, working in paediatric psychology is different from working in child and adolescent mental health services (often abbreviated to ‘CAMHS’) because the majority of paediatric psychology services see children and young people who have behavioural or emotional difficulties that directly result from or are linked to their physical health. This includes anxiety, low mood, eating issues, anger, adjustment problems, general coping problems or obsessions/compulsions that arise as a result of having a particular condition and it having particular effects.
CAMHS, on the other hand, see children and young people who have behavioural or emotional / mental health issues where their physical health is not the main causal or maintaining factor in their presenting difficulties. In some areas, there isn’t a local paediatric psychology service, so in this scenario CAMHS may see children and young people who would otherwise be seen by paediatric psychology.
Something that seems to vary a lot in different areas where paediatric psychology services and CAMHS are both present is who will see young people with medically unexplained symptoms (also referred to as ‘functional’ symptoms). In some areas this particular area of work is done by CAMHS as it can be seen more as a mental health issue, although there’s lots of different opinions on this. In the paediatric psychology service I worked in for a year, as long as the child was under the care of a consultant at the children’s hospital where the service was based, we would accept referrals for young people who were experiencing physical symptoms that had been investigated (or were in the process of being investigated) where no organic cause had yet been identified.
The focus of this work was slightly different and was more on coping with and managing the physical symptoms and any associated presenting problems, such as tiredness, lack of energy, pain, sleep problems and lack of (or over-activity). Here is a presentation I gave as part of some training I delivered a few years ago with a colleague about working with functional symptoms in CAMHS that gives an overview of some of the things to consider in this type of work and how you might support the young person.
The other main issue that paediatric psychologists work with is when children and young people’s behaviour is impacting on their medical condition or physical health, or their adherence to treatment. Psychologists in paediatric services also help children and young people prepare for medical procedures, as a large body of research has shown that increasing understanding of conditions, procedures and treatments helps people feel more in control of their health (referred to as an internal locus of control) and predicts better outcomes in terms of their physical health and psychological functioning.
In addition to direct work with the children and young people themselves (which may be on an individual or group basis), psychologists in paediatric services may also support parents/carers, siblings or other family members who are involved with the child. Paediatric clinical psychology (and clinical health psychology more broadly) is very much focused on supporting the systems around the person so they can develop a better understanding of the young person’s needs and provide a better standard of care and support to the person.
If you are interested in finding out more about working specifically with children who have very complex and chronic physical health issues, I recommend taking a look at the resources produced by the Managed Clinical Network for Children with Exceptional Healthcare Needs, especially the videos “How does it feel?” that includes parents’ and professionals’ feelings about the emotional impact of tube feeding, and “How do you want me to talk to you?” about health professionals’ communication with young people with little or no verbal language. There are lots of other useful resources, including free workshop materials, available on the MCN CEN website.