ACQ_Vol_11_no_3_2009

Mental health

The clinical education experience in Child and Mental Health Service Melissa Saliba and Carly Littlewood

and anger management difficulties, to anxiety, depression, developmental delays, and social withdrawal. Frequently, these young people lacked the language skills to verbally express their emotions and therefore resorted to disruptive behaviour or social withdrawal. The role of the speech pathologist is important in teaching the communication skills to allow these young people to express themselves. Speech pathologists also have a role to advise those working with the young people of the best approach to use when communicating with them. My placement was spread across two distinctly different CAMHS sites, the Port Adelaide community service and the Adolescent Services Enfield Campus (ASEC). During my days at the Port Adelaide CAMHS, there was an element of the traditional speech pathology service, in that I saw clients and their significant others individually once a week for assessment and/or intervention. However, that was as far as the “traditional” element went, as the client’s behavioural and emotional issues directed the assessment, goal planning and therapy approach in most cases. For example, I found creative ways to assess the language skills of a client with selective mutism and developed tactics to contain a 3-year- old who was notorious for running away in a therapy room. On the alternate days, ASEC landed me into a world of contrasts. Each minute was completely different to the next. For example, one day the morning group session was running smoothly and then … the duress alarm rang throughout the whole building, sending all available staff to the location of the shouts. There was confusion and outbursts of abusive language. The glass door was smashed. The young person was very upset and torn between going back to the house where he doesn’t even have a bed and staying at the refuge of ASEC where he struggled to control his emotions and behaviours. Amid the management of behaviour, emotional arousal and critical incidences, I was given many opportunities to develop my speech pathology skills. I learned how to break down the language barriers to communicate with the young people in highly emotional situations. I led social skills groups, administered language and social skills assessments, and implemented voice therapy with a client with schizophrenia. Within the space of 40 days, I was astonished at the array of clients I managed, programs I took part in, and projects I successfully completed and presented. It was a rollercoaster of emotions for not only the clients but also myself. I am, however, extremely grateful to both my supervisors who provided me with a wealth of knowledge, ongoing support and guidance, and the opportunities to extend myself in such a fascinating area of speech pathology. Melissa Saliba is the Senior Speech Pathologist at Adolescent Services Enfield Campus (ASEC), Child and Adolescent Mental Health Service (CAMHS). Carly Littlewood is a student speech pathologist at Flinders University, South Australia.

Reflections from a clinical educator When I’d decided to offer a student placement at Adolescent Services Enfield Campus (ASEC), I was excited about the learning opportunities and about being a support for an upcoming professional. I had some of the (probably usual) anxieties about how I would perform in this role; manage my workload; and the possible challenges that lay ahead. Additionally, questions arose, such as: “What kind of experience can our service offer a speech pathology student?” Child and mental health service (CAMHS) speech pathologists rarely work on speech pathology issues in isolation because we work with complex clients in the context of their mental and emotional wellbeing. At ASEC our clients are generally aged between 12 and 16 and present with a variety of issues, including a history of “failure” socially and academically; school refusal/non-attendance; learning/language issues and exposure to domestic violence. Subsequently, the young people often present with low self-esteem and can present as angry or withdrawn. The clinical placement for the speech pathology student was split between the Port Adelaide Community CAMHS team and ASEC. Rather than worry about what specific speech pathology work ASEC could offer the student, I began to see that this placement could offer some broader experiences. It could provide opportunities for the student to learn how communication and literacy problems link in with mental and emotional well-being, attachments with caregivers, and connections with broader systems such as schools, and other agencies. I also realised that a student placement in CAMHS offers a great opportunity to increase one’s self awareness of work–life balance and emotional well-being. There were many opportunities to be creative in order to provide suitable learning experiences for the student, such as preparing and running social skills groups, using visual supports, working closely in a multidisciplinary team, working on projects, and managing difficult behaviours. I found that it was important to be organised and open in communication across both clinical educators and the student – what one side of the split placement couldn’t offer, the other one could make up for. In the end, I think the student had a unique opportunity to work with toddlers to adolescents in a holistic way, strengthen her generic skills, and learn to work in partnerships with clients and systems. Lucky for us, this speech pathology student was a very capable and competent person – we wish her all the best for the future! Reflections from the student There is a lot of stigma attached to the label of mental illness, such as hallucinations or confinement in observation cells. For me, when I found out I was placed at CAMHS, my first reaction was “How can a speech pathologist help people with mental illness?” My misconception of mental illness was dispelled the first week into my placement. What I had been considering mental illness was only seen in a very small proportion of the clients presenting at CAMHS. The majority of young people at CAMHS did not have psychotic disorders; rather they had complex emotional and behavioural issues. Most young people had a history of physical, emotional or sexual abuse combined with a family history of mental illness. The presentation of the young people’s mental health issues ranged from behaviour

Melissa Saliba (top) and Carly Littlewood

Correspondence to: Melissa Saliba Senior Speech Pathologist Adolescent Services Enfield Campus (ASEC) Child and Adolescent Mental Health Service (CAMHS) email: saliba.melissa@saugov.sa.gov.au

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ACQ Volume 11, Number 3 2009

ACQ uiring knowledge in speech, language and hearing