Susan McPhee, Alison Budden, Graham Andrewartha

In the past 12 months, McPhee Andrewartha proudly welcomed two new staff members to the team. Angela Rutter, a registered psychologist, joined in July 2006 and came to us from an Adelaide-based injury rehabilitation provider. Before relocating to Adelaide, Angela held roles in inpatient and outpatient mental health settings in country New South Wales where she gained valuable experience in counselling adults with mental health conditions. Angela’s role in McPhee Andrewartha is largely the provision of counselling and support services to employees through our employee assistance programs. Within this she can provide both personal and career based counselling which also involves vocational and psychological assessments. In addition, Angela provides counselling to private clients.

Members of our professional team include seven registered psychologists, three advisers with extensive HR experience in the public sector, outplacement and career transition and a consultant psychiatrist who works with us two days a week.

We are also pleased to announce that Lyn Moseley was registered as a psychologist in February. Lyn has been working at McPhee Andrewartha part-time since 2004. She has been working towards her registration while completing a Masters in Clinical Psychology at Flinders University. Having completed placements in adult, child and adolescent mental health services as course requirements, she has had a broad training experience. Given her previous career in secondary school education, she is well placed to offer counselling and support services to children and adolescents and their families. She also provides the full range of counselling services to private adult clients. Lyn is currently completing a research project relating to adolescent well-being as a final requirement for her masters program. An article by Lyn on management of childhood anxiety has been included in this newsletter for your interest.

We have maintained a busy practice at Kelly House in Mount Gambier for over two years, with either Mary Bird or Michael Correll available at Kelly House on Mondays and Tuesdays for a wide range of psychological services, including therapy and assessments of adults, adolescents and children. In addition to our availability for private referrals, including referrals under the Medicare Better Access scheme, Michael also sees patients through the Better Outcomes in Mental Health program, which provides for a limited number of treatment sessions that are largely subsidised. Referrals to this program need to be made through the Limestone Coast Division of General Practice at Millicent. Private or Medicare Better Access referrals can be made directly to our practice. Please do not post referrals or other correspondence to Kelly House, as collection of post there is unreliable, but direct all correspondence and enquiries to our head office at Parkside.

Individual, couple and family counselling

Counselling services include individual counselling and counselling with partner and other family members. Individual and family counselling may encompass adjustment to change, stress management, confidence and self esteem issues, specific difficulties or individual conflict and relationship and family difficulties.

We are experienced in working with clients with drug and alcohol dependency, individuals with chronic and terminal illness as well as those with significant psychological or psychiatric illnesses. Our clinical experience, through the provision of employee assistance services and our private clinical practice also encompasses counselling for family issues, depression, anxieties and phobias, sleeping disorders, injury, illness and various life and work-related stresses.

We have also provided support to individuals experiencing significant health concerns and disabling conditions. We have a well-established network of medical providers, including access to a Consultant Psychiatrist for expert opinion for more complex clinical matters.

WorkCover

At McPhee Andrewartha we provide comprehensive counselling for people with WorkCover claims. We are experienced in working with WorkCover claims relating to psychological injury, such as stress and post-traumatic stress disorder as well as psychological injury resulting from physical injury, such as adjustment disorder, depression and anxiety. Significantly, we provide a range of treatments for people experiencing pain problems. Psychologists currently taking WorkCover referrals are Michael Correll, Mary Bird, Angela Rutter and Lyn Moseley. We require details of the WorkCover claim from people prior to their first appointment.

Child and adult assessment

At McPhee Andrewartha we are able to offer educational and vocational assessments using a variety of well-established psychometric tools.

We provide a comprehensive assessment clinic for children aged from 4 to 18 years. This clinic utilises a variety of psychometric tools to assess cognitive capability and potential to achieve at school. It also involves detailed analysis of parental and teacher observation and reporting. Referral to other professionals including speech, hearing, occupational therapists and optometrists can be organised in conjunction with the child’s general practitioner. Assessment in the early years of school promotes earlier detection of possible difficulties and positive potentials. It also allows for early intervention and maximum opportunity for remediation of difficulties.

We have extensive experience in providing vocational assessments. This process involves psychometric testing to identify cognitive ability, vocational preferences and personality factors, all of which may impact on career choices. Following the assessment the results are discussed in detail with the assessing psychologist and recommendations are provided.

Vocational and educational assessments can be booked through reception on (08) 8357 1800.

Employee Assistance Program services

McPhee Andrewartha is a provider of employee assistance programs for a variety of small and large South Australian organisations. We believe that the provision of a well run and well constructed employee assistance program can assist organisations as a foundation for their risk management strategy. It assists in reducing the costs of occupational health and safety problems including the reduction of WorkCover claims. Appropriate and individualised support for employees and managers is provided to resolve difficulties at an early point in time before they become intractable, adversarial and more difficult and costly to resolve. At McPhee Andrewartha we provide a range of services including personal counselling at all levels, career guidance, vocational assessments and managerial support. This service can be accessed through HR, manager or self referral and is an excellent and cost-effective service. As with all patient issues we work in conjunction with the general practitioner and other health professionals to ensure a coordinated treatment approach.

Reflecting on our childhood experiences, among the happy memories of care-free moments, we are also likely to recall the concerns and worries that used to distract us from our pleasures. Somewhere between six and eight years of age, I recall having an intense fear that tall buildings would fall on me as I made my way through city streets. I can also recall keeping my eyes on the town hall ceiling to make sure it would not fall during concerts. I reflect back on this fondly now and thankfully have no lingering fear of being in the city or sitting in concert halls. As is normal for children, my worries were developmentally appropriate for my age and as I matured they were outgrown. However, for some children worries and fears are symptoms of anxiety disorders that have a significant impact on their psychosocial functioning. It can be difficult to distinguish normal childhood worries from anxiety disorders, and it is essential to ensure children receive appropriate and timely treatment from clinicians.

Normal children display a range of developmentally appropriate fears and concerns. For example, around nine months of age, infants typically will exhibit signs of fear of strangers and concern at being separated from principal caregivers (Rapee, Spence, Cobham & Wignall 2000a). Toddler fears can include fear of imaginary creatures (e.g. monsters), animals (e.g. dogs) and fear of the dark. During this time, separation anxiety is also a normal developmental experience (Connolly & Bernstein 2007). During early school years, fears about natural events such as storms and injury to self or loved ones is typical. In later school years, greater awareness of peers can contribute to self-consciousness and social concerns, with this reaching its peak in adolescence (Rapee, Wignall, Hudson & Schniering 2000b). Concerns about school performance, health issues and world events also feature during later childhood into adolescence. (I recall being greatly concerned about nuclear war during high school, in the way students now express worries about terrorism and global warming.)

While fears are normal developmental experiences for children, they become problematic when they do not settle with time and when a child’s functioning is impaired as a result of ongoing concern (Connolly & Bernstein 2007).

Large epidemiological studies report prevalence rates for having at least one childhood anxiety disorder as ranging from 6% to 20% (Connolly & Bernstein 2007). Common diagnoses, as delineated in DSM-IV-TR, include separation anxiety disorder (SAD), generalised anxiety disorder (GAD), social phobia, specific phobia, panic disorder (with and without agoraphobia) agoraphobia without panic disorder, post-traumatic stress disorder and obsessive compulsive disorder. It is worth noting that research has shown that most cases of selective mutism meet the criteria for social phobia (Connolly & Bernstein 2007). While not in DSM-IV, school phobia, frequently presenting as school refusal, is often associated with separation anxiety disorder or social phobia (Rapee et al. 2000b). When considering treatment, it is important to also note that subthreshold anxiety symptoms that do not meet full criteria for a DSM-IV diagnosis can be associated with impairment in functioning for some children (Angold et al. 1999). Age of onset of any single anxiety disorder varies widely and children with anxiety disorders are highly likely to have a concurrent diagnosis of another childhood disorder or an additional anxiety disorder. This overlap of symptoms can make assessment difficult.

The development of childhood anxiety disorders involves a complex interplay of biological and environmental risk factors (Connolly & Bernstein 2007). While genetics and child temperament contribute to the biological risk factors, environmental risk factors such as parent-child interactions also play their part. Research suggests that there is an increased risk of anxiety disorders among children for whom one or both parents have an anxiety disorder. Anxious parents often unintentionally reinforce a child’s anxiety through overprotective parenting, by modelling fear and anxiety, rewarding anxious behaviour, anticipating anxiety provoking situations and maintaining avoidance (Connolly & Bernstein 2007; Rapee et al. 2000a). Life stressors such as parent separation, loss of a loved one, family violence, victimisation and school bullying, illness, and specific negative incidents (e.g. animal attacks or accidents) can produce a natural anxious response in most children. It can also have an additive effect to the already anxious or sensitive child and for some it may trigger an anxiety disorder.

Anxious children are more likely to have more thoughts about negative outcomes and dangers and interpret ambiguous situations as threatening (Rapee et al. 2000b). These cognitive factors are key in maintaining anxiety disorders in children and adolescents. However, children who have effective, active coping skills and use problem-focused rather than avoidant-focused coping are more likely to respond effectively and manage their anxiety in response to life’s demands. This suggests that effective mental processes are a protective factor in childhood anxiety disorders (Spence 2001). Various programs developed to assist anxious children include cognitive skills training to help them learn to monitor and change their anxious thoughts.

Effective treatment and timely intervention for children with anxiety disorders is important in reducing the long-term impact. Research has shown that the more severe the anxiety disorder the more likely it will persist and some prospective studies have predicted a two-to-threefold risk of anxiety or depressive disorders in adulthood among children with a clinical diagnosis (Connolly & Bernstein 2007). Unfortunately, despite high success rates of group and individual treatments for childhood anxiety disorders, only a small proportion of such children receive timely intervention from appropriate mental health professionals (Spence et al. 2006).

Comprehensive assessment of a child’s anxiety symptoms requires obtaining information from multiple informants including the child, parents and school staff (Connolly & Bernstein 2007; Rapee et al. 2000b). Psychologists are qualified to use a variety of assessment tools that can screen for anxiety related symptoms to assist in diagnosis and in developing a treatment plan. In the assessment phase, differential diagnoses of physical or psychiatric disorders that may mimic the child’s anxiety symptoms should be considered. Side effects of prescription and non-prescription drugs that mimic anxiety should also be considered. Somatic symptoms, such as abdominal complaints and headaches, are often associated with childhood anxiety disorders and a mental health assessment can be useful in the early stages of medical evaluations of children with such complaints (Connolly & Bernstein 2007).

Treatment of childhood and adolescent anxiety disorders is best approached using a variety of treatment modes as outlined in the practice parameter for treatment of childhood anxiety (Connolly & Bernstein 2007). For children with anxiety disorders of mild severity, treatment should optimally begin with psychotherapy.

Currently, cognitive behavioural therapy (CBT) has received the most empirical support and has been shown to reduce anxiety symptoms for children and adolescents across anxiety disorders (Connolly & Bernstein 2007). Five recommended components of CBT for anxiety disorders include psychoeducation for children and their parents, management of somatic symptoms through skills training in relaxation and diaphragmatic breathing, cognitive restructuring, exposure methods that facilitate gradual desensitisation to feared stimuli, and relapse prevention (Albano & Kendall 2002). Motivation for children to attempt exposure tasks can be increased using positive reinforcement schedules given that these tasks initially increase anxiety (Connolly & Bernstein 2007; Rapee et al. 2000b). Psychologists are well placed to assist families in the appropriate design and implementation of interventions.

Therapy that targets parent-child interactions can also be beneficial in reducing parental anxiety and in promoting adaptive coping skills that can be reinforced by parents at home. This then increases the likelihood of continued improvement post-treatment. For children with moderate or severe anxiety, combined treatment of psychotherapy and medication may be advisable especially where there is a need for acute symptom reduction or where there has been a partial response to psychotherapy (March 2002).

Psychologists are well able to assist general practitioners in assessing children and adolescents with anxiety and in developing an effective treatment plan. By working with the child and family during treatment, psychologists can introduce skills and behaviours that continue to have an impact on the family beyond therapy. They are also able to advocate for clients with school personnel where necessary. Timely intervention including short-term psychotherapy, as a minimum, is therefore highly recommended as best practice for children and adolescents with anxiety disorders.

References

Albano, A. M. & Kendall, P. C. 2002, ‘Cognitive behaviour therapy for children and adolescents with anxiety disorders: clinical research advances’, International Review of Psychiatry, 14, 129-134.

Angold, A., Costello, E. J., Farmer, E. M. Z., Burns, B. J. & Erkanli, A. 1999, ‘Impaired but undiagnosed’, Journal of the American Academy of Child and Adolescent Psychiatry, 38, 129-137.

Connolly, S. D. & Bernstein, G. A. 2007, ‘Practice parameter for the assessment and treatment of children with anxiety disorders’, Journal of the American Academy of Child and Adolescent Psychiatry, 46(2), 267-283.

March, J. S. 2002, ‘Combining medication and psychosocial treatments: an evidence-based medicine approach’, International Review of Psychiatry, 40, 115-117.

Rapee, R. M., Spence, S. H., Cobham, V. C. & Wignall, A. 2000a, Helping your anxious child: A step-by-step guide for parents, New Harbinger Publications, USA.

Rapee, R. M., Wignall, A., Hudson, J. L. & Schniering, C. A. 2000b, Treating anxious children and adolescents: An evidence based approach, New Harbinger Publications, USA.

Spence, S. H. 2001, ‘Prevention strategies’, in The developmental psychopathology of anxiety, eds M. W. Vasey, M. R. Dadds, Oxford University Press, New York.

Spence, S. H., Holmes, J. M., March, S. & Lipp, O. V. 2006, ‘The feasibility and outcome of clinic plus internet delivery of cognitive-behaviour therapy for childhood anxiety’, Journal of Consulting and Clinical Psychology, 74(3), 614-621.

Our corporate advisers, Michael Correll, John Wallace and Annie Shepherd, specialise in providing expert advice and consultancy in the following areas:

·           Business and life coaching

·           Performance management implementation

·           Management and leadership development

·           Negotiation and conflict resolution

·           Mediation and formal investigation

·           Career transition services

McPhee Andrewartha products

Through our Corporate Services Division we are delivering a management and people skills audit for general practices. For a relatively small fee ($2,000 plus $200 GST) we will audit your practice on a number of key indicators. This fee includes the provision of a comprehensive report including recommendations for issues that the practice needs to address. Assistance in implementing the reported recommendations is available as a follow-on service.

We have a Performance Management Pack based on the latest balanced scorecard approach for GP practices. For more information you can email us through our website: www.mcpheeandrewartha.com.au or you are invited to telephone our office ((08) 8357 1800) and speak with Michael Correll or Graham Andrewartha to discuss your particular needs.

As always we appreciate your ongoing support through referral of your clients to our practice.

We hope you find this newsletter informative and relevant. We look forward to continuing our liaison with you.