ACQ_Vol_11_no_3_2009

Outside the square

Speech pathologist to mental health clinician in paediatric oncology Diana Russo

for depression and anxiety following major trauma for her and her family around her original diagnosis and treatment. After a year of treatment her mother commented that her daughter lost her smile at 4 years of age but now has it back! The most common type of leukaemia in children and at the CCC is acute lymphoblastic leukaemia (ALL). Current treatment is very successful; however, some children relapse or move into palliative care. Referrals for psychosocial support for these children and their families are also made with an additional role being to support team members. Referrals are also accepted for siblings’ issues around loss, grief, anxiety and depression. One young girl, a sibling of an adolescent, was referred for her apparent “withdrawal from school and family life” following her sister’s relapse, with the fear she could die. A major part of the position is the prevention and promotion of mental health during treatment for a significant medical illness. The most difficult group to engage are those in active treatment as children and families do not have the emotional space at that time to deal with emotional issues. A lot of “holding of issues” is done with this group as engagement tends to be better post treatment once children are in remission. Therefore, it is essential to maintain links throughout the two years of treatment to engage children and families if and when they are ready. As a communication specialist, I think about my mental health clinician work from a communication perspective. For example, children and families are initially engaged with “telling their story”, the narrative component of the journey. Communicating what has happened is also important for the child and family as a therapeutic tool to help them process where they are at and assist me in treatment planning. It is important to give space to listening to the child and family about their journey at various stages. At initial diagnosis, grief, fear and trauma are explored. At remission the loss of the close intense relationship with staff comes to an end and is worked through. Topics discussed might include how the child and family get back to normalcy; how the child slots back into life after being absent from school, from peers, and from family. As the mental health clinician it is important for me to be available to hear how the young person and the family are managing and to respect when they are ready to communicate. Often my role with the children involved understanding what the children needed to communicate to their families and the medical team but they couldn’t say in person. The procedural pain therapist provides diversion strategies for children undergoing procedures. In consultation with the child and family a plan is devised where the child has some choice in how procedures are delivered. I found a significant benefit in using therapeutic stories. Hospitals are scary places; the child is in pain, subjected to painful procedures and exposed to scary looking equipment. Parents are also

I am a clinician with many years of experience as a paediatric mental health speech pathologist and as a child and adolescent mental health clinician. At the commencement of 2008 I took on the challenge of providing a mental health service to paediatric oncology, at Southern Health’s Monash Medical Centre in Melbourne. This position at the Children’s Cancer Centre (CCC) was funded for three sessions a week by the Kids Oncology and Leukaemia Action Group (KOALA). KOALA is a philanthropic group formed in 1992 and is run by parents and carers for children who are, or have been, treated for cancer. The CCC previously had input from the Child and Adolescent Mental Health Service (CAMHS) consultation liaison team but was keen to create a dedicated mental health paediatric oncology position to provide support to current patients in addition to consultation and liaison. They also wished to provide case management for the children and adolescents including those in remission and those siblings needing psychosocial support. The position was integrated into the medical team with the support and expertise of CAMHS. As the mental health clinician, I provided a key role in supporting the medical team and children of the CCC. Close working relationships exist with the CCC nurse coordinator, social worker and allied health team, which includes a music therapist and procedural pain therapist. I often worked jointly with all members of the allied health team. Most intervention consists of consultation and liaison with team members. When more support is needed, the children and their families receive comprehensive psychosocial assessment and case management. Referrals are spread across the age range with the majority of referrals for children under 5 years. Referrals of children in active treatment are taken from all members of the team but discussed with the social worker who meets with all families in active treatment and acts as the first point of call for most children. Often children in active treatment have issues with procedural pain, compliance, behavioural issues, adjustment, anxiety or depression. For example a young boy was referred for ongoing sadness and lack of interaction and engagement with the medical team when attending appointments, and a 3-year-old child was referred who did not respond to distraction techniques when undergoing procedures causing great distress to the child, his mother and the nursing staff. For children in remission, referrals come from the medical staff and are not known to the rest of the team so are taken on directly. These children are often referred with issues around behaviour, anxiety and depression post treatment. For example the child who was struggling with the return to school where he had lost his place as the “smartest kid in the grade” and with fitting back into “normal family life” where he was no longer “special”. These issues were causing behavioural issues at school and at home. Another adolescent was referred 12 years into remission

Diana Russo

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ACQ Volume 11, Number 3 2009

ACQ uiring knowledge in speech, language and hearing