 Good evening everybody and welcome to our 325 participants tonight in this webinar. You're joining us from all over the countryside. Some are joining the webinar, some in the podcast and it's great to see people on the chat line introducing themselves and see where you're coming from. This is a joint webinar tonight with Kids Matter between Kids Matter and MHPN. We welcome everybody from both those sectors and many other besides. I just need to remind you that the case study was a couple of pages long, so I hope you did pick that up before logging in tonight and were able to read that. My name's Vicki Cowling. I'm facilitating tonight's webinar. I'm a social worker and psychologist and have worked for many years with children, young people and their families in quite a number of settings currently in private practice. My role is to facilitate tonight and first introduce our panel and then that will lead into the discussion that we hope, I suppose, generates more discussion. It may not solve immediate problems but we hope it gives people ideas about collaborating. Now you would have seen the panelist bios before tonight and I'd like to start off by introducing Sally Letho. Sally's a primary welfare officer from Victoria. Sorry, Sarah. I beg your pardon, Sarah. Welcome, Sarah. What are some of the most... Yeah, you work in primary school, Sarah. What are some of the most satisfying changes that you've observed following the introduction of Kids Matter into your school which has been quite a feature there? How's it been beneficial? Yeah, I've been at the school now for two years and we have had Kids Matter as long as I've been there so for two years now and just the overall positive school community having staff recognise mental health and how it affects children and how to best help the students and the families. There's lots of ways I've felt that it's been really beneficial and I guess I've been touching on it a little bit through the slide by addressing all the four components of Kids Matter. So we'll get into that soon. Yeah, that'll be interesting. Thank you. I'd like to next welcome Michael Fasher. Michael's a GP and joins us in New South Wales. Michael, you've been involved in training medical students for many years and I just wonder what some of the changes you may have seen in medical training over the decades you've been involved. Thank you. I think preparing people for general practice today has been revolutionised in areas where there have been good Medicare locals soon to transform into public health networks because they are the federally funded group that are working on promoting the kind of collaboration that we're celebrating tonight. Stitching up service providers in the community to provide more collaborative and efficient services to communities. Great. Thank you, Michael. And Lynn is a psychologist and is in Melbourne. Thanks, Lynn, for joining us tonight and you've worked in and with schools for over 20 years and I wonder what some of the changes that you've noted across the education system over those decades. Yeah, I think the last 20 years there's been a lot of changes in society as a whole and schools often are a microcosm of what's happening in society. So some of the pressures that are in communities often come into schools and changes in families, cultural changes, people from ranges as cultural backgrounds, all of that I think has come into schools and schools are then sort of adjusting to that. I think one of the biggest changes of course is technology and the role of technology in the lives of all of us in schools is trying to keep up with children and people around that. Absolutely. Thanks, Lynn. And finally I'd like to welcome Sally Young, a social worker from Queensland. And Sally, you work in both public and private sectors. What are some of the two key differences you would comment on in working in those different sectors? Between the private and the public. Yeah, yeah. I think there are different advantages in different sectors but one of the wonderful advantages of working in the public sector is the possibilities of doing collaborative network work as part of the work. Of course in private practice it's much more the relationship between the therapist and the family coming along. For the sort of severe end of the spectrum, I feel multidisciplinary teams are a much more preferable way of assisting with severe difficulties. Okay, Sally, thanks. Now we have some ground rules there on the screen about how we communicate via the chat pages and I have to get closer to Sir. Posting comments and so on. So I'll just leave you to have a look for that for a sec. Now if you find the chat box too distracting you can minimise it by clicking on the down arrow at the top of the chat box. So you're free to do that if you want. Now each panelist is going to give us a short discipline specific response to the case followed by a Q&A between the panel and the audience and we have lots and lots of questions that many of you have submitted before tonight so thank you for those. The learning outcomes tonight, it's around collaboration obviously, relating to the Harper family, developing an increased awareness of the benefits of collaboration, strategies to achieve effective and timely collaboration to support primary school children and their families and developing an increased awareness of the benefits and opportunities for involvement with initiatives such as Kid Matters when working with primary school children. So our discussion tonight centres on the Harper family who have two children, Tina and John with some Zoe and Tom and they're concerned that Zoe, 10, is placing too much pressure on herself to perform academically and is becoming increasingly worried about adult type issues and Tom, who's 7, is having issues with controlling his temper. And we'll start off with Sarah, a primary welfare officer and her slides relating to the Harper family. Thanks, Ziggy. So just to briefly give you a little bit of background before I go into the slides. So as I said before, I'm working in the primary welfare officer role at the school, at Kingsley Park Primary School in Frankston, Victoria. And we've had Kid Matters at the school for two years now so I'm just going to break it down into the four different components and how Kid Matter relates to the case study. So although Kid Matters primary isn't specifically designed to help schools prevent and address anxiety, the four components do help schools address many diverse factors related to anxiety and other mental health disabilities and they also help build the protective factors that prevent and reduce mental health difficulties. So Firstly Component 1 is based on building positive school community culture that provides security and safety for children that can take on many forms and often becomes the innate culture of a school that can be difficult to write about and talk about but becomes embedded within the primary school. Once you have been within the school, you kind of get to understand the school perspective on mental health and wellbeing. So in terms of how fan back primary school has supported Tom and Zoe, it seems as though they've got quite a good understanding in understanding Tom's behaviour, in particular around his age and physical behaviour. They seem to have some kind of school wellbeing policies in place, not that they're mentioned, but there seems to be some good processes there around that and there seems to be quite a good collaborative relationship between the teaching staff from year to year and between the parents and the teachers as well. So there's a few background factors there that look like they've set up quite a good positive school community so far. It would be good to kind of come back further knowing a little bit more about the school. So we're just going to complain it to the next slide. A complain it to is based on social and emotional learning, or SEL. So SEL is looking at or emphasising children's learning and how to cope and feel better equipped to deal with challenges that might arise. So Kids Matter promotes social and emotional learning on their website with all the different evidence-based programs that a school can utilise in addressing social and emotional learning. In the case study, it wasn't explicitly said which SEL program is used. However, I'm sure it's there, given that it's been to use into the Kids Matter initiative, that would have been good to find out a little bit more about that. Just as an example, at Kingsley Park time we used the You Can Do It program, which looks at five kids, and they are a resilience organisation getting along confidence and persistence. So those skills are practised within the classroom. Okay, so moving on to component three. The third component is based on building strong relationships with the families, parents and carers. Together the school and family can help assist the child by developing their social and emotional learning and how to manage strong emotions. So some of the emphasis in this component is being through the case study in that it seems as though there's been a good connection between the teachers and Tina, the mum, and also just their sharing of their concerns about Tom and Zoe, although I feel as though more discussions would be needed to be said about Zoe. The case study has also addressed the family relationship difficulties, particularly around Tina and John arguing about their working hours and who should be looking after the children, so I feel as though they don't need to be quite a lot more information around what's happening for the family. There's also the grandparents who are playing quite a big, caring role in looking after the children before and after school for some of the week, so it will be good to talk about that a little bit more. And also just addressing the risk and protective family, risk and protective factors that are present within the family and how that's impacting on the kids and the school as well. So that's what component three kind of addresses. So the next component is component four, which is quite targeted in addressing children with mental health difficulties. So I feel as though the case study has utilized component four quite well, it focuses quite a lot on the mental health interventions for Tom in particular. So for example, teachers were able to recognise some of Tom's underlining mental health difficulties at the time. There seemed to be a school policy that was followed in terms of referring Tom in terms of speaking to previous teachers and raising concerns with Tina as well. From there, Tom's teacher referred him to the school councillor for three sessions. I would probably want to know a little bit more about who the school councillor is. Is he a school councillor, a psychologist, or a chaplain or a social worker? It would be good to get more information about that. The councillor did address some anxiety concerns, but it appears that there was some time constraints. So then the school councillor had to refer externally. From there, Tom was seen by a GP due to some physical complaints, which led to a discussion around some of the psychological concerns that were happening with Tom. And from there, the GP looked at a possible referral to Cairns and then some one-to-one work with an ATAP psychologist. Lastly, the case study discusses that a student support group type meeting would be set up at the end in terms of linking it all together and where to go next. So it looks like the school has done really well in linking the family and the students in terms of the component for capacity. So just checking on time. Do I have a little bit more time? About half a minute. Okay. So just the next slide is just some further comments. I mean, there's so much I could talk about, but just briefly... Yeah. It looks as though Fernbach family have utilized all the four components quite well, particularly around component four, as I said, and probably component three. It would be good to talk a little bit more around what the teachers themselves can be doing for Tom and Zoe in the classroom. I've just touched on a little bit of on the Kids Matter BETLS approach, which is a useful tool on their website around how to address common Zoe's behavior. In terms of the Cairns referral, we probably wouldn't go down that path at this stage due to lack of severity, I'd say, but probably we would do the last some other support, such as on-site or the old child China's program or the triple SO's in terms of some work at the school and some possible family services, and looking a little bit more around who can protect the factors for Zoe and Tom. So there's lots to discuss, but that's just a little bit of a snapshot of what it looked like from a primary welfare officer perspective. It's illustrated well the relationship between the Kids Matter program and that particular family too, so thanks very much, Sarah. Michael, would you like to proceed now with your reflections from a GP's point of view? Thanks for you, and thanks for that, Sarah. I love it. I read the Harper's story and it criggled some thoughts that I hope will provoke and promote some discussion. This building is an anxiety universal, and one of the challenges of childhood is learning to recognize and name strong feelings such as anxiety. It seems to me that's the first step to understanding them, managing them and living with them, and this process can be retarded if adults discount children's feelings, as we've all heard people say. What's he got to be anxious about? He's only a kid. Students may collude in their child's avoidant behavior and therefore promote anxiety, and of course living anxiously is very often modelled by anxious parents. Professor Tim Ocher will do his professor of general practice at Westmead, and I like his tip which I think is relevant to our discussion tonight. In most consultations, particularly in general practice, it's important that the Psycho-Social Inquiry proceeds in parallel with the Biological Inquiry. The value of this tip was powerfully illustrated to me by another child who was sent home from Fernbark Primary School. She came to see me, seven years old, a people who had frightened a teacher by complaining of the ruin, swaying and having difficulty seeing. But really after careful listing and thorough examination, it became clear that this presentation at first sight of biological disease was in fact the effect the anxiety triggered adrenaline. And I was pleased that I got that one right, but roofily reflected on the fact that I had missed the Psycho-Social Inquiry when Tom Harper, Tom Harper had previously presented with belly ache. Of course there was plenty to be listed back then. In the absence of accessible local pathways to quality care, it is here for doctors to medicalise Psycho-Social distress. What we've heard about kids matter at Fernbark is really an excellent example of how improving health literacy in the community increases the capacity of the community to support parents and children managing strong emotions and other similar issues. To the Harpers, some preliminary thoughts. The fact that Tom did well at school last year is encouraging and pointed, I thought, to strengths in the way his family had been functioning and that would be something I'd want to celebrate with them. The fact that Tina and John recognise that their arguments have had an impact on Tom is another strength that I'd want to draw attention to and celebrate. The fact that there are ongoing arguments suggests an area to be worked on. I thought it was good that Tom did so well at school last year. That made developmental disorders unlikely. Now the fact that he often plays alone made me think. And whilst there are multiple word flags in the case study for anxiety being a problem for both children and possibly their father, I need to keep in mind that Tom's behaviours may reflect that he's having difficulty coping with increased academic demands of moving up to year one. And so wrapping up, before I rushed to intervention stroke therapy with this family and family members, I'd be really keen to be clear about where each of them were as individuals and as a group on the cycle for change. Are they ready for action? Or are they preclinical employers? Or are they ready for action? Because if they're not ready for action, I'm going to proceed slowly. Thanks, Vicki. Thank you, Michael. Lynn, you're talking from the psychology perspective about the Harper family. Yeah, thanks, Vicki. I've thought a few sort of initial thoughts as I was looking through the case study. But while there's some challenges, there's some work to work to do and people have identified that I also think this is a time for opportunity. And the school's awareness and responsiveness, which is due to kids better and the work that's been happening there for two years, it hasn't just happened like that and it doesn't always work. But the work of kids matter, I think, has really shown the capacity of schools and families to work together and identify concerns at a pretty early stage. And the parents have been willing to hear that. And that means, like Michael just suggested, we can go a little bit slowly texting down. We don't need to rush to a crisis response at this point. And I think the children are young enough through effective interventions for the families to grow and develop at this stage and strengthen the family unit. So I think it's really hopeful in terms of the timing of this, but we're not waiting until they're adolescents and then it's much harder to encourage young people to seek help. I think another question that often is useful is a question around why now? And this is trying to tease out the context web. And we could be saying, well, why now is really to do with the change that's happened with Tina returning to work. But I think there's more to it than that. And I think we'd be tempting just to say, well, it's an adjustment period, we'll let them go. But when you actually look at what's going on underneath, the level of conflict and tension that's been there for a while, some things that are happening at school, both Tom and Doi. And Doi, of course, has left out a little bit because Tom is the one that's showing what we tend to notice. So Tom's been targeted a little bit. But there's things going on for Doi as well. There's previous concerns when you do a little bit beyond the current situation. We know that Tom is being typically separating during his early schooling. So there's a bit of a history of this. And development means there might be some things that are happening as well and might be suggested around the learning challenges that might be going on to Tom and Doi as well, which is getting older, becoming more aware of what's happening in the world. In the family, even though it might present as a time of change. Anxiety within the family and looking at who should be focussed on is another important point, I think. And again, Michael has talked about the patterns of behaviour with families and anxious families and anxious children. But do we focus on Tom, which is kind of where the story's gone so far, that Tom has been targeted for the intervention, but clearly the family is also experiencing some challenges. So looking at this child within the context of family is really important and we know that if we want to support children we can really do a lot to support them by supporting the adults in their lives and the parents, the primary people. So looking at what's going on in terms of their family anxiety and tensions, communication style, what's actually happening with them. I think it's also really important to remember that parents can find it very challenging when a school talks about concerns with their child. So it's quite hard sometimes to hear that when you're doing your best and you might be seeing some concerns and then when people talk to you about those, that they're noticing that school and your children are not happy and struggling with things, it can really get any confidence. So I think that being aware of that, building their self-efficacy, promoting their resilience, which will then so on for the children as well, looking at the strengths, which is what Michael talked about as well, what's worked before, what seems that they're doing well. I think those messages are really important and again, that hopefulness coming through is crucial. Social support, again, not being alone with struggles. So parents are sort of getting a sense that this is something that a lot of parents and families struggle with. Anxiety is not an unusual thing. Family changes, family dynamics and pressures on families is very common for lots of families go through this. So it's really helped for families to hear that from others who are going through similar things. Enhancing parenting skills is obviously how do we deal with these sort of situations. Family change is really important part of that family communication pattern and getting some information about anxiety. So it's clear that there's some anxiety happening, whether there's other things as well. We need to check that out. But certainly the anxious signs that we're seeing, getting some more information about that can help on this matter to have that information. Other adults in the lives of this family, grandparents, are having a really important role to play here. So they've got a caring role at the moment. So that might be a change in the grandparent role. They might be spending more time with them. We don't know. They might have always played a very active role. There's some hope for them. It's probably really important that kids get into school at the end of the school day. That can be really challenging. So the grandparents bearing the brunt of that at the moment, so including them and getting their perspective, because they've been through parenting, they've also got some insights probably that we should really use. So I think that would be really useful thing to do. And then the classroom teachers and school staff are really aware of, and really wanting to be responsive and supportive. So they're dealing with Tom and Zoe in the classroom throughout the school day and having to respond to issues like attendance or issues that are happening for them. And the teachers are often quite anxious themselves and wanting to do what's best for children instead of family, not make things worse. So they'll really be looking for some support as well. And they will be feeling quite anxious. You've got anxious children in the classroom, amongst all the children in the classroom, just to configure your own anxiety. And kids might have provided some tools like the battle fund that's here mentioned as well that they can use. Collaboration, effective communication is really important. So we've already seen that, that's already started. But if we're going to be looking at some external mental health support being arranged, it's very important that we have this idea around collaborating together, working towards the same sorts of goals, being clear about roles, what communication is happening, what information can be shared and what information is kept private. Developing some short-term plans around the main priorities that are there for each sort of party and hearing the voices of children is still important. And maintaining the regular contact between home and school. So the people on the same path, the children are getting similar messages that the people are really working together. Meetings I think are really important to be set up as part of that process and I think the school psychologists or counsellors can be really good link-pins for that work and really be a person to pull that together and kind of have that sit-between health, education, family to really bring people together. And I guess lastly, again, returning to that hopeful notion, there's lots of interventions that we know have a good evidence base around working with children around anxiety and there's more and more that are emerging along the way. So there's a lot of approaches that we can take. Some of them can be in a therapy situation with the children, possibly with parents, the universal social-emotional school development that Sarah talked about that will be happening in kids' matter schools and it can be really helpful as part of this overall universal sort of and targeted approaches that can happen to be comprehensive. Parenting school training might be useful. Parents and teachers, adult resilience programs can also play a role in here and unfortunately we're looking at online programs that are being explored and being evaluated and there's one of the people that's being looked at at the moment and mindfulness as well is another kind of tool that's coming with mainstream that might be really useful. So I guess finishing off just in that hopeful notion again, we know that there's good evidence behind these kinds of approaches and so again to have trust and faith that we can be working together to really provide support to the family. And finally we have Sally presenting her perspective as a social worker. Thanks Sally. Oh thanks Vicki. I'll agree with what my fellow panelists have said so I'll try not to repeat what people have said but just taking the eyes out of what I've written. The importance of taking a developmental history and getting good instructional information to obtain a sense of the depth spasiveness and suffering that the anxiety causes Tom. Particularly in the assessment phase I think it's important to keep as open a mind as possible as to what's happening and certainly in the information gathering one also gains a sense of the dynamics of how different parts of the family system or professional system may relate to each other. With an anxious boy the importance of seeing both the parents and potentially the grandparents without Tom so that there's a clear space to both take a history but get a sense of how Tom is seen within his family family unit and what the different perspective. Also the importance of seeing Tom on his own in an age appropriate way to get a sense of how he thinks and feels and as Lynn mentioned that use of play with a child this age you know, listening for his anxieties there's a reference to sort of nightmares about dreams somatic worries, school friendship and separation anxiety. I think that separations are may be painful in terms of thinking about the family I guess one's trying to get a sense of is this an anxious or overwhelmed family and this is sort of a more recent thing there's a suggestion about the mother's return to work or is this more a longitudinal thing over time and important to get a sense of that understanding the effects on Tom. There is this question as Zoe is symptomatic as to whether it might be useful to see the whole family I think again in a sort of open hearted way to hear how the family manages stresses and changes and transitions. I've seen the meaning of separation there's a bit of a reference to separation anxiety change and developmental transitions what they mean in this family. Also this thing out for the sibling relationship there's a reference in the case study of Tom pushing his sister and I just wondered without any sort of clear conviction about it but whether there were perhaps sort of quite set roles in the family are boys externalizers and girls the internalizers are always seen as naughty and good and internalizing and have anxieties in a different way. So sort of listening out for what are the roles the characters have within the family and do these roles enhance secure attachments or create rivalry. Also just that last thought about is there a parallel between there's a reference to the parents having different opinions and arguing and also the fighting between the sibling. So sometimes there is a sort of echo in what's happening in the sibling group as to what's happening for the parent. In terms of referrals about sort of risks and challenges that it sounds like there's a clear case for Tom to be referred that the school counselor has a sort of limited time capacity but just the whole delicacy of referrals of how is the referral seen. The more agencies involved the more one has to be aware of different professional language and there may be different goals or views of what would be useful. So important to keep this sort of collaborative task in the mind of anyone seeing Tom. But any referral acts as a bridge to another service which may or may not succeed that important to listen for in the suggestion of a referral of how is this referral seen is there an anxiety about the mental health referral which actually may complicate it being a successful referral unless that sort of works through a bit. The advantages saying what sort of known but just the advantages of the ATAP system is that it has this wonderful level of accessibility but it doesn't completely support the practitioner to do family therapy or family work if needed so it's something to sort of keep in mind in terms of what might be the needs if it emerges that it's more a family based anxiety and is there a family agency that may be more appropriate. In terms of thinking of collaboration our overall theme of tonight's discussion I found this quote which I was quite fond of that collaboration is never easy which is why it's more talked about than practice it requires a great deal of work but I sort of feel collaboration is a bit like motherhood no one's against it but it's a much harder job than it sounds and that it takes work and it takes everyone keeping an open mind to what each of us have to contribute the dangers of professional rivalries and defensiveness and anxieties and misperceptions about what different professions may do and I think just as often as these sort of emotional anxieties that might be in the air in collaboration often just the lack of time compromises how much we're able to do this successfully also the issue of consent for information is important to work out and that in itself takes quite a bit of time and working out what needs to be shared and what needs to be private I prefer in working with families and if I was working with Tom I prefer this idea of private using the word privacy rather than confidentiality because I think it captures something of what's emotionally needed there are some areas that he may need privacy about but one might need to negotiate around what are the areas that his parents may need to know that he worries about and equally what areas again the school may need to know if there's significant worries that are there for him at school so all of that takes quite a bit of negotiating and just just some service thoughts Sally it's Vicky could I just ask you to just summarise this last slide because we're starting to run out of time yes yes perhaps just to keep in mind that the family system and the professional network may actually end up as complex as each other and so for people to stay aware of that to try and resist sort of fragmentation in the work and that the more I guess this second point is perhaps the point I want to emphasise is the more anxiety about there is about the family the more vulnerable the system is to splitting and that the important the commonest family remain at the centre of the intervention I'm sure everyone knows that but I just think it's always worth not saying that again but also emphasise the importance of people having supervision as well to help with that look thank you all four of you for those complimentary presentations highlighting the issues from a systems and a family and a school perspective we now move on to some questions and discussion our panel members have put in some questions as well and I'm wondering if any one of you Sarah or Sally or Lynn would like to post your question to to one another I'm happy to okay thank you yeah I've mentioned already a couple of times technology and the role of technology that's coming into play in the Brave program is one of those programs so I'm just curious and interested in how people are feeling about that and the role that online support online programs families, children accessing and schools accessing online programs when they might have traditionally sort of a thorough and what the benefits might be but also what some of the caution or risks might be and how might it have a role in working in a collaborative fashion as well so Sally, Michael, Sarah any one of you have a comment about that yeah I'm in very briefly I'm not sure about the cautions but I did have a family in with a very young child with anxiety this week who has a teenager who refuses to come for treatment so he's well and truly a pre-contemplator and I wondered particularly for an adolescent that if an online anxiety program might be ideal any other comments about that oh it's Sally here just to add to that I think probably I imagine we'd all agree we wouldn't watch it as instead of the possibility of in-person contact particularly with Tom I wouldn't have I'd certainly not rush to any sort of online intervention given his age and vulnerabilities but I think just thinking of Zoe if I think sometimes when there's more shame involved regarding a difficulty it sometimes helps the online interventions can help form a bridge to helping people, young people feel some courage for seeking help from there but and I think some of the kid's helpline research also supports that young people who feel a lot of shame about their difficulties often prefer the but more the sort of using using their online counseling than on the phone counseling so I think that's an interesting thing to keep in mind can I jump in? You're certainly I haven't had any experience personally with children accessing online programs as yet but the first thing that came to mind was outside the case that is children on the spectrum on the autism spectrum in the high interest in using computers and technology and I guess that that their inability to interact socially at times it can kind of take that away it might be just a little bit more accessible for them at the same time we don't want to limit their social interactions and therapeutic interventions but there could be just another perspective to use for children on the spectrum given their interests and just kind of take down the walls that might limit the use around that that's another perspective but I am interested in reading a little bit more about the Bay program and if anyone has used it and I guess how it's worked for the kids that have used it but I'm not aware of anyone in our schools that have used it at this stage that's definitely something to put out maybe one of our participants has and they can type into the general chat OK can I just say that I think that was a very interesting part of the discussion it's really important for me to hear that we don't focus on Tom I think that some people might have the notion that you can take Tom out of this family fix him up and then put him back in it and I think that doesn't appreciate the shades of grey yes well I think probably a lot of this would have a family focused approach and each individual in the family and their particular needs including the grandparents yeah Sally you had a statement or question which actually relates to a couple of questions that participants submitted as well would you just like to read that out if you got it in front of you yes thanks Vicki it's an ethical dilemma and it is after the referral has been made to the ATAPS worker Tom's father rings both the GP in the school to say he's upset he hasn't been informed that this was happening he speaks at length that the family is falling apart with both children being more anxious since their mother returned to work he says the children need a mother not a mental health worker any thoughts on how to respond and I suppose in the framework of collaboration that's also remembering that we are collaborating with parents as well so they're part of the collaborative picture yeah so would other panellists like to comment on that I think this father if he has been left out has every reason to be upset about that and it goes back to my concluding point about being sure where everybody in this family is on spectrum from pre-contemplation to deciding to act and I mean with this sort of family this sort of stuff is usually easy to sort out once the family court's involved and we've got separated families then it becomes a nightmare but my approach to Tom as Sally has posed at Tom's father would be to invite him in to agree with him that things shouldn't have got this far without him and see him and his wife together to discuss the issues yes do you want me to Sally, Lynn, Sarah yep Sarah you're sure if you want to come in yeah yeah so I think I'd be concerned that Tom's father hadn't been aware of any of everything that happened so far but I think at the end of the case where the emphasis was on bringing a meeting together that would be a timely time for Tom's father to come in and talk about what's going on for him and why he hasn't been involved, what his goals are for the kids and discuss a little bit more around his comment about mum not being a mental health worker what is it that's going on for the family so I think having all the parties to come to a meeting would be really useful it is difficult to get all the parties to collaborate due to time constraints and things like that at the one meeting but I think that would definitely solve a lot of Tom's father's difficulties around that so I think that would be I know at the primary school level that's what I would be doing and I find the most success when we have our student support meetings and have all the parties there on the table and have an action plan as a result of the concerns raised Okay, thanks Sarah or perhaps we'll move back to some of the questions that participants have submitted over the last few days or whenever and one of them is coming back to the core primary task I suppose for tonight addressing the issue of collaboration and what somebody has asked what other barriers that the panel see as existing in blocking a collaboration what specific barriers would you identify just one or two perhaps from each person that's a big question I think one of the biggest barriers that wasn't present in this particular scenario is getting the family on board and people might raise a concern with the family so people in the school might raise a concern and parents might not be ready to hear that so it's a bit like what Michael was saying about contemplation whether they're recognising some concerns whether they're open to hearing that and without that support it's really very difficult so that's a barrier before you can even start to look at referrals and sometimes that's very real Absolutely, I'm just looking at how do you approach parents without offending them is one statement another one is if parents don't want to collaborate to support their child, they're in denial if the word is used so it's very difficult to get things started and how does one manage that so others have comments about barriers to collaboration I think the two things I'd say one is collaboration takes a lot of time that we often haven't quite set aside enough time and I think often systems have a risk of being driven to solve a problem without working through a problem and we might describe that in our patients but it's also in our system that we have to go slowly to work through what's going to be the best outcome for Tom and his family and I think systems often need to sort of slow down to work it through properly Look, I totally Go ahead, Michael Sorry, look, I agree with that I think that but it just comes back to motivational counselling and the cycle of change I mean, if if you can't invite parents to share with you that they perceive a problem then what you have to do is keep on holding them and keep the relationship going and do what you can to move them on from pre-contemplation but there is certainly no point in darting ahead of achieving the mother, the parent, the family being with you and being ready to act Lynn, would you like to comment on that one or you've done that, sorry Sarah Yeah, well this is something that's very relevant in our schools teachers are often saying to me that they're concerned about the kids, how do they go about it and what we find is I guess I kind of call it planting the seed and raising it if it's concerned early on in preps but the teachers can see that the parents aren't really receptive to taking those concerns in that over time perhaps towards the middle primary school years unless things become quite severe it would be addressed earlier but just kind of building those relationships and that's where Kismata really comes into it building those relationships and support through the school early on can eventually help bridge that gap and hopefully the parents come on board a little bit later but unless like Michael said unless the parents are ready to come on board then we can only support the kids as best as we can at the school level Yes, do you think having Kismata in the school creates over time a certain culture and therefore makes these kind of supports more more presentable or more acceptable to families? Yeah, I think so I feel the school that I've been in has had a culture shift towards mental health and well-being particularly for teachers it's getting there more slowly for parents but just having the material on the website through the school, through the newsletters discussions around mental health there's little bits that are happening everywhere that are throughout the school that I think is helping bridge the gap and that stigma around mental health disabilities and making it more acceptable to understand the mental health presentation of our kids I think our schools have still got a long way to go but I feel Kismata really helps bridge that gap But I guess if you're seeking cultural change it does happen over quite a long period of time as Sally kind of alluded to Yeah, and that's what Kismata is sorry So I was going to say there has to be some patience here with this Yeah, and that's why Kismata is supposed to be done in a year it's not a program it's the overarching initiatives that we're into our we're into component 3 now at Kingsley Park and I don't think we will be finished Kismata until the following year so that's for years of rolling it out and then after that we will go back to component 1 to ensure that we're that everything is maintained so it is a slow change but it needs to happen for when everyone is ready to get on board Yeah Another question or statement was collaboration initiatives bring challenges about integrating different values of teams and people so I suppose just your observations about and it's fairly complex to ask I guess but it's sort of central to being able to collaborate from a systems perspective how do we accommodate different approaches that different groups have or different sectors have and their different goals how do we what kind of mindsets can we each have to accommodate these differences maybe Lynn could I ask you to start? Sure I think language is one of the biggest challenges because sometimes the value systems or the approach and the interest is quite similar I think we're working towards the same thing but might not really so I think it's terrifying taking some time to check out language share ideas and try and check out what is it that we're sort of saying and we're actually saying the same thing even though it's coming across in some different ways so I think that can overcome a lot of problems but it takes time which is one of the challenges Again time and there's so much pressure to reach targets nowadays I think Yeah Sally do you have observations about that? Yes I think there's sort of language and I think there's also anxiety that gets in the way of professional sharing there's always the confidentiality thing that needs to be worked out which is right and proper but I think we can sometimes hide behind confidentiality as a way of protecting ourselves from fully engaging with our colleagues whether it's teachers or other mental health professionals or the GP we can hide behind confidentiality as an offensive practice which may not be in the best interest of the family or the young person but I don't want to minimise confidentiality it's still a very important thing No a number of participants did raise that and how do you exchange information is it possible to exchange information if you don't have consent from parents but maybe we'll come back to that Michael do you have observations about the I guess the challenges of different approaches and goals and how we may overcome them I think that the mental health professionals network has inaugurated a meeting and disadvantaged a little suburb close to me here and that has produced a lot of respectful collaborative interaction in which people have felt mutually valued and been delighted it's been a in fact one whole professional group like early childhood nurses have actually stated that they felt valued for the first time so getting people together having the opportunity on a regular basis to have that discussion which generates respect Meeting outside the case conference sort of idea and Sarah do you have any further comments about the different challenges of competing or differing goals and approaches Yeah well it's similar to what everyone has said already definitely getting everyone together in a meeting format to put all of their ideas on the table but documenting it as well putting it all in one we might call it a behaviour support plan or something like that where all the goals are shared and their explicit and consistency between the teacher the parent and all the other professionals involved is crucial for any gains to be made for the child I mean I've got the thinking of one student who their team of people working with him we send a group email every week on how he's going at school and how the therapies are going outside of school with the consent of that parent and there's been so much communication around that and it's benefited him in he's had such a good year so that's just one example where communication has worked really well and that's the collaboration between the professionals but that was set from the beginning of his intervention so it was quite clear that that communication was going to occur and yeah so that's one example from my school anyway Well that's a great way to use email and internet yeah it's perfect or in a way that leads on to another question here somebody has asked how do you know strategies are discussed with the parents and the child in the school setting so the psychologist or the private practitioner outside the school but how can they be translated into the school setting so that the ongoing work at the school can be followed through what do you see about achieving that maybe I could start with you Sally I mean it is a challenge what I find a useful sort of just a way of thinking like if I was seeing Tom and I was going to see his parents for a review session I might say something to Tom like your words in here are private but are there any other things that we think about that you'd like me to talk to your parents about or would you be happy for me to talk about the themes of what we talk about and usually children are agreeable to that sort of negotiated confidentiality and I wonder if that same sort of theme can be with the family in the school I think it's very important people's words are kept private so we're not repeating what people say because that's just a form of professional gossip really but we translate it with the information into a formulation that might be useful to the school in thinking about how to manage Tom or how to manage Zoe I think if we can do it in that way if there's a disagreement the disagreement is between the professionals not a disagreement with criticism of the parents because they said such and such if we can sort of bear that I think the collaborative work can be an important breach to sort of keep all parties together as much as possible Yeah maybe what the question was also asking was the person has prepped on the work with the child and the family here how is that and I guess you have answered it to some degree how has that been translated back into the school and into the classroom so maybe I could ask someone else to think about that Sarah would you like to comment on that Yeah I guess from what I'm hearing from the teachers in my schools is the key for them is what are the strategies they don't they understand the confidentiality of what the child has been saying to the private practitioner but it's about what strategies will work for them in the classroom so keeping it really simple I see so making it applicable like if they're feeling anxious what can they do in that moment or what can they do in those early signs of feeling anxious they're the key things that the teachers want to know about and have it documented so other staff are aware of how to assist as well in case they're not there for the day but they're those little things that are just so crucial to preventing things like anxiety in the classroom or if they are feeling anxious and they know what to do Okay and Lynn do you have anything oh sorry Mark go on Look I agree with that and I think that things can often be very simple and easily overlooked and in our case study one of the things that Tom wanted to know was who was going to look after him after school and the fact that that moment passed without that being firmly and clearly addressed was a miss and so it was a simple strategy for managing a 7 year old's anxiety and on this occasion was missed Thank you and Lynn do you have anything further about this one? One thing that it's not to do with the case study but what comes to mind is an initiative that started in Victoria called CASIA which is Royal Children's Hospital and schools working together in parts of Victoria and some other models in our country and this is really looking at mental health practitioners coming into schools doing some work with all staff so it's sort of early intervention model working with some children and families that was targeted but then also working with the school as a whole so around mental health difficulties so it's really being staff along and having them in the school so I think that kind of approach it's a bit like the kids matter model really where you're sort of doing that kind of universal work so you're prepping if you like and having the staff there so then when they have a particular child and family they've got some backgrounds and they've got something to contextualise that in what you're doing Okay, thank you Can I just quickly Of course Just to let you know that we did do CASIA the CASIA program that Linda mentioned at Kingsley Park this year twice so we did it with a group of two and three students and then a group with preps and one students so I was quite heavily involved with that and it's very thorough the whole parent's background presentation is taken in very thoroughly and what's been really useful for us is assisting the parents in particular in how to help their kids and then the strategies for the teachers in the classroom and also if they were further concerned from those kids and they were able to be referred into ELMS which is our version of CAND so we found that really useful so thanks Linda for bringing that up I forgot to mention that that kind of is associated with other questions relating to schools particularly I suppose how I'll just read out a couple of them what can be implemented in schools to encourage and increase children's well-being meaning you know what prevention and early intervention I guess kids matter contributes to that and what can people are curious about how they can help break down misunderstandings about mental health problems in school settings and how can we support children so that they're not subject to sort of negative comments so perhaps if we start with a question about yes acknowledging kids matter but what can we do in schools how can we support schools to be I suppose more receptive to supporting children and families where certainly where children have some sort of behavioural emotional problems maybe Lynn could you pick that up I think kids matter is the obvious one that jumps out maybe thinking about what kids matter does and I think one of the things that happens with schools is that there's lots of different language again I keep talking about language but schools talk about well-being about resilience often not wanting to talk about mental health because they're concerned about the stigma as well so part of what kids matter does and that approach is really trying to break that down and trying to bring all of that together if schools are already doing particular programs or doing initial uses that might be anti-bullying focus or resilience focus bringing that together so you're actually understanding it from that mental health then and understanding well-being in a holistic way using language that speaks for that community so I think understanding that well-being is sort of connected to all of these other things and making sense of that and not going off on a whole range of different initiatives because I think that can be tempting that you go off and do one thing and then you look for something else so I think that's what kids matter as a framework bringing all of those things together and you keep it alive you keep it fresh and you can do new things is part of it that you've got an overarching kind of lens that you're looking through and looking it together and not bombarding people and confusing them by a whole lot of different terms and programs that are just coming and going in the school. I think that's really important. Yeah there are several questions where that concern is demonstrated about how to help schools work with children and kids matter obviously is the standout example at the moment. Sally do you have any observations about that? I just really wanted to resay what Michael said in his talk about the nature of childhood is to experience anxiety that's to grow up to separate from the mother to go into grade one all of these developmental changes are accompanied by anxiety and that I think sort of I'm not very fond of the word normalization but something about getting hold of that idea that anxiety isn't something to be stamped out it's something to be contained and managed and understood that I think that's an important sort of frame of mind that also can reduce something of the stigma but I think that requires a whole cultural shift for that to be to happen or else everyone's frightened of the anxiety which is part of the stigma. Yes, yes. Thank you Sally. Look we haven't got long about six minutes left so would each of you just like to make a statement about to summarize your perspective on what's been discussed this evening could I ask you first Michael your reflections on what we've been discussing just very briefly. I think I think they can be summed up by the concluding sentence in the article The Current Medical Journal of Australia by John Giovanese from Adelaide he says we need to give children the gift of being good at feelings of being able to make sense of uncomfortable but healthy sadness anger, fear and shame rather than the gift of feeling good which is shallow and evaporates in the place of adversity. Excellent And is the Medical Journal of Australia publicly accessible? I'm afraid Oh any bar subscription. Okay, oh well. Yes, well just maybe there are ways people can get hold of that. It's a great quote. Thank you. Sarah how would you like to sum up our discussion so far tonight? I think it's been a really good discussion and I'm really glad to see primary school mental health put on the agenda. I think kids matter is growing and I would love to see it in more primary schools as I've seen firsthand on how effective it has been just in one of my schools. I feel like there's still a long way to go in terms of funding and putting more money into mental health and education. One initiative I didn't get to talk about was safe minds and I think that's something that Could you say that again please? Is safe minds? Safe minds, yeah. It's an initiative put forward by the Department of Education in Victoria so if the participants wanted to look at that a little bit more online it's part of under the umbrella of kids matter as well in some part and it does enable parents and teachers to have a look a little bit more about approaching mental health around some of those physical questions that the participants talked about in terms of how do we talk to parents about a little bit of those concerns they might have in the classroom and safe minds give a really good perspective around that as well. I think knowing what resources are out there and utilising them is really crucial because there are a lot out there. I think there are some resources attached to tonight's webinar as well. Sally would you like to just summarise what your reflections are about our discussion this evening? I want to say here to the John Juridini quote I think that's wonderful and I sort of sometimes feel that the actual sort of descriptions of mental health, our language often get in the way of collaborative processes that the anxiety about mental and what that means I think often gets in the way and in a different sort of culture we might be calling this problems in living and be able to approach health in a slightly different different angle. I guess I also want to just appreciate all teachers are on some level whether they like it or not mental health workers and something of the appreciation of that. Thanks Sally. Aline would you like to conclude with your reflections? Thanks. Thanks Vicki. Just to tell you all to be above I guess it's coming in now but I think the importance of this work the importance of respecting family children teachers and all the workers I think that was sort of the sexual approaches to working together on what it's like for me. Well thank you to our panel members Sarah, Sally and Michael and did I leave someone out? Me. There are Sally, Michael and Lynn of course and collaboration is certainly incredibly complex and that quote that Sally gave us much earlier this evening kind of you know the sort of almost we want to collaborate. We're all on the same page in one way but there are the hidden reefs underneath the waters that get in the way and maybe sabotage and I mentioned earlier supervision and having support so that negotiating collaborative processes is made perhaps a little bit easier or less complex. The importance of talking to one another, working together keeping communication open using the internet as Sarah described a little while ago and not forgetting we are collaborating with parents and their children as well. So it's very worthwhile but it is very time consuming and to develop collaborative practices takes a long time it's not something one can just do in the snap of the fingers. So that concludes the webinar. I just have a couple of things to let you know think about establishing special interest networks yourself through mental health professional network and please do complete the exit survey. There are webinars coming up next year one next year is supporting mental health or victims of family violence in February so that's one to plan for and thank you all very much for coming along tonight and your questions that you submitted and your comments online so we'll say good evening and thank you very much.