Complex cases involving young people come in a whirlwind of politics, spent and burnt-out workers and a trail of services that, for whatever reason, have been unable to help. In fact, Taz the Tasmanian Devil, the animated cartoon character, comes to mind. He usually moves around in a whirlwind of chaos, but sometimes steps outside to watch from arm’s length. And that’s exactly what we need to do: step back in order to separate the actual presenting problem from the chaos in a complex case.
Complex cases involving young people can seem chaotic. There’s the trauma of their own experience; the multitude of variables introduced by the families, carers and agencies supporting them; and the confusion that can arise from interagency politics, policies and rules. It can be difficult to know where to start in formulation and treatment planning.I suggest taking a step back, like Taz. In my experience, what follows is the clarity that leads to formulation and treatment that are useful. Here’s what you should consider:
It may be a cliché, but it’s important to separate the young person from their behaviours and to describe what can be observed rather than search for a diagnosis. For example, “she self harms by cutting her arm”, “he’s not home by curfew”, “he verbally abuses staff”, or “she set fire to waste baskets at the residence”. It’s much easier for everyone concerned to agree on an objective description of actual behaviours. And then you can begin your formulation.
When you stop and step back from the chaos, your first thoughts should be about minimising harm. Reactive strategies outline behaviours and what to do in response.Included in every good intervention, reactive strategies tell you how to react to precursors and how to respond to dangerous behaviour. They allow safe containment while you plan.
Establish a collaborative working relationship with the young person. In my experience, they may not trust you straight away but may do in the long term if you are true to your word and consistent, even though this can be extremely challenging. With their trust, your formulation and treatment should be informed by your understanding of the young person’s interpretation of events, feelings, thoughts, beliefs and behaviours.
In summary, when you step back, define the problem, plan for safety and build a relationship of trust, you’ll find the clarity needed to develop formulation and treatment plans that lead to helpful outcomes. Otherwise, a complex case involving a young person will only continue as a messy whirlwind.
I know that when I take a step back from the chaos, I’m a step closer to supporting troubled children, young adults and their carers.
While Shona is regularly engaged to assess complex cases involving young people, she also offers workshops and master-classes in formulation and treatment planning for complex clients. To find out more, call Shona Innes Psychology on 0400 150 106 or email firstname.lastname@example.org