1.7.1 Clinical Team Non-Attendance Policy |
SCOPE OF THIS CHAPTER
This procedure outlines the policy and practice agreed within Bryn Melyn Care in relation to the persistent refusal of young people to engage in or attend therapy sessions made available to them.
The procedure outlines:
- The principles underpinning the policy and practice
- The role of Care and Education staff in relation to non-attendance
- The role of the Clinical Team in relation to non-attendance
- Decision-making: responsibility and process
- Safeguards
There are two contexts for refusal to attend:
- At the outset of therapy, when a young person first meets the clinician and a therapeutic relationship is still being established
- Once therapy is already established, the young person decides that they do not want to attend therapy.
The procedure applies in both circumstances.
Contents
- Principles
- Responsibilities
- Response to Persistent Non-attendance
- Integrated Therapeutic Care without Individual Therapy
- What Happens if/when the Young Person Changes their Mind
- Safeguards
1. Principles
Integrated therapeutic care is central to the service delivered by BMC. Integrated therapeutic care essentially means that young people are looked after and managed in a consistent way based on therapeutic principles, across the three strands within the organisation.
Integrated therapeutic care involves:
- The allocated member of the Clinical Team working closely with the Care and Education teams, providing input from a therapeutic perspective, to support the care and management of young people
- The Clinical Team making available individual therapy to the young person
Integrated therapeutic care is not dependent on the young person taking part in individual therapy sessions. The Clinical Team still has an important role in working with their colleagues in Care and Education in supporting and advising on the care and management of the young person.
Some young people will not be responsive to individual therapy; and finding other ways of ensuring therapeutic input is appropriate
It is appropriate at a defined point to no longer offer individual therapy sessions.
2. Responsibilities
Clinical Team
Ensuring that there are sufficient attempts to engage with the young person before withdrawing sessions
Making the final decision to withdraw individual therapy sessions
Care Team
Motivating the young person to attend and take part in therapy sessions. Refusal to attend should not be linked with sanctions.
Not offering alternative activities to replace therapy sessions.
Education
For motivating the young person to attend and take part in therapy sessions
Not offering alternative activities to replace therapy sessions.
3. Response to Persistent Non-attendance
Stage 1
When a young person refuses to attend individual therapy sessions, the therapist will initially make visits to the young person's home to meet with them less formally and to attempt to establish a relationship. The therapist will work closely with the Care /Education Teams to look at how motivation might be increased to engage in therapy.
Stage 2
If / when the therapist forms the view that the young person's reluctance to attend is unlikely to change in the short / medium term and that offering sessions is no longer helpful, the therapist will call a three-way meeting between the Clinical Team, Care Team and Education (where relevant) to discuss the young person and their response to therapy.
Stage 3
The therapist will make a decision in conjunction with the Head of Clinical Service to either continue with therapy sessions or to cease to offer individual therapy sessions.
The final decision remains with the Clinical Team
Stage 4
The therapist will inform the RCM, the relevant Operational Manager, and the Social Worker
This will be written into the young person's Care Plan by the RCM
4. Integrated Therapeutic Care without Individual Therapy
The therapist will work very closely with the Care and Education Teams, advising from a therapeutic perspective on the young person's care and management.
The therapist will:
- Liaise regularly with the RCM and Education (weekly)
- Attend team meetings on a monthly basis to ensure that there is a therapeutic input to the care and management of the young person.
- Review quarterly whether it is appropriate to begin offering individual sessions again
- Visit the young person at the home regularly (at least monthly). The intention of this is to assess (informally) the young person's functioning and well being from a clinical perspective and to continue working towards the young person engaging in sessions at a future point
RCMs and therapists need to work together to ensure that team meetings are set to ensure therapist involvement.
5. What Happens if /when the Young Person Changes their Mind
If the young person's position changes and they decide to re-engage with therapy, they will be allocated to the next available therapist. If possible they will be allocated to the therapist that has been working with their team but this will not always be feasible.
6. Safeguards
The Head of Clinical Service will have oversight of and involvement in any decision to withdraw individual therapy sessions.
The Head of Clinical Service will report to the SMT on a monthly basis the number of young people not in active therapy.
End