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Thursday 4 December 2014

THE 3 'C' CHOICES FOR CO-WORKING = THE 'BIO-BIO-BIO MODEL' VERSUS THE 'BIO-PSYCHO-SOCIAL MODEL' - only systemic explanations can explain complex scenarios in which human beings find themselves trapped - particularly children.

The Three ‘C’s - Choices of Co-working for and with Child Clients who have Mental Health Needs.

Inspired by two recent statements by people at the cutting edge of their own professions I decided to try and apply their radical thinking to my main area of professional interest, at the moment, the controversial mass psychotropic drugging of our children in school,who have behavioural difficulties.

Surgeon and writer Dr Atul Gawande  has delivered the inspiring 2014 Reith lecture series on BBC Radio 4 in the last weeks. One phrase that resonated with me was his assertion that we collectively need to move from ‘the age of the molecule’ to ‘the age of the system.’ He went on to state that in his view wonder drugs like penicillin have driven us to search for ‘magic bullet’ cures for almost every human condition . Complex problems need systemic responses he feels not ‘wonder drugs’. I passionately feel that a child’s behaviour and response to the complexities of their environment is such a situation.

My second inspiring quote this week was as follows,“In recent years, psychiatry has embraced what a former president of the American Psychiatric Association has despairingly called a ‘bio/bio/bio’ model.” Professor Allen Frances – Psychiatrist. Huffington Post 2-12-14.

How does this affect the choices that exercise our professional minds when working with children and adolescents who are presenting in a distressed state?

1)   Co-Construction of a Formulation for a Child’s Mental Health Needs.
This is when more than one skilled health care professional contributes to a ‘bio-psycho-social formulation’ of a child’s emotional and health needs. Contributions are equally valued by the team working with the child and a formulation is arrived at which looks at Holistic world that the youmg person inhabits and hopefully helps them and their parents to  better accept the outcome of the professionals’ deliberations.

2)  Collusion with a ‘Medical Model’ or any other Uni-theoretical Formulation of a Child’s Mental Health Needs
This is where there is a ‘pecking order’ of professionals working with a client exists and their contributions are not considered to be of equal value by the team working on the child's problems. Consequently often a ‘bio-bio-bio model’ of formulation, for example, predominates the shared thinking process. Other perspectives are consequently ignored or minimized and the client may not even be made aware of their existence. This type of formulation is often delivered as a scientific ‘faits accomplis.’

3)  Challenge of the ‘Bio-Bio-Bio’ or Other Dominant Formulation of a Child’s Mental Health needs
This is where one on more health care workers decide that they are not professionally comfortable with the predominant process of formulation that they perceive themselves to be professionally  party to accepting. Following consideration of their Ethical Code of Practice e.g. the HCPC Duties of a Registrant, and following a supervisory conversation they decide to contact the perceived ‘lead professional’ to share their concerns and elicit a dialogue with that person, which is in the best interests of the child, with whom they both work. This is the process that I have developed by discussion with colleagues and is called the Practical Professional Protocol, it was published in the BPS DECP Debate (December 2014) to facilitate Safeguarding of Children.It is also available on the American Psychological Association - Division of Humanistic Psychology website : dxsummit.org  - under my name.

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