Introduction
Methods
Ethical approval
Participants
CYP participant number | Gender | Age |
---|---|---|
CYP 01 | Female | 16 |
CYP 02 | Female | 16 |
CYP 03 | Gender neutral | 15 |
CYP 04 | Female | 20 |
CYP 05 | Male | 15 |
CYP 06 | Female | 15 |
CYP 07 | Female | 18 |
CYP 08 | Female | 16 |
CYP 09 | Male | 16 |
CYP 10 | Female | Undisclosed |
Data collection
Analysis
Results
Themes | Subthemes |
---|---|
Remote therapeutic experiences | Accessibility and flexibility |
Translating the elements of therapy | |
Practical issues | |
Losing the cues | |
Drivers of trust and rapport | |
Spaces and places of therapy | Spaces of comfort and safety |
‘When you’re at home it’s home time’ | |
‘You lack privacy to speak about things’ | |
Future of CAMHS | Moving to a hybrid model of provision |
Efficacy | |
Increased demand: Is social prescribing a solution? |
Theme 1: Remote therapeutic experiences
Accessibility and flexibility
It's helped some families have an easier access to CAMHS. So, either through the crisis line, or actually not having to get three buses across town to come to an appointment (HCP 04).
There's some increased capacity from doing it online, because in the building, we're quite limited in terms of the number of rooms available so you can be more flexible about when you can offer them appointments online (HCP 01).
They don’t have to come all the way to [name of NHS Trust], which probably takes a couple of hours by the time you've got out of school, driven there, parked, walked all the way across to the [name of CAMHS] building. Being able to do it from home without having to interrupt their day (HCP 01).
The biggest thing is no commute… For children who live far away from services having to get the train and having to pay a train fare, or put petrol in the car, it's decreasing accessibility to the service (CYP 04).
[It] got to the point where she didn’t want to leave the house… Her anxiety hit the roof… I wouldn’t have been able to get her to a face-to-face meeting… If there are kids out there with that anxiety where they can’t leave the house… I think this is the answer for them (Parent 01).
We are doing video calls at the schools a lot more. I suppose it’s flexible, that’s how the service has changed (HCP 05).
It's a lot easier to do it over the phone or over Teams than it is to actually go into CAMHS… It’s flexible… I can do a CAMHS call in college (CYP 02).
I think that's loads better because we're now having [multidisciplinary team] meetings easily, involving lots of people across Trusts (HCP 02).
Another positive is meetings such as social care meetings or school meetings, it’s easier as you haven’t got to travel to a school… Generally, online they are a bit quicker as well because there is no small talk (HCP 05).
Translating the elements of therapy
For those of us who are in the creative therapies space, it is much more tricky because our medium is that we rely on proximity to people to pick up nonverbal communication using action methods. Even if you think about role playing in a group, it's very tricky to do that online (HCP 04).
It feels like it's harder to be creative. It's harder to draw on all the things that you might be able to do face-to-face. So, I normally work doing a lot of things visually, writing things down, drawing things out, physically working on something together… Being able to do that two way was just lost (HCP 09).
She was giving me DBT [Dialectical Behaviour Therapy] but I wasn't properly engaging with it, because it's hard to understand what people are saying online whereas in-person, we'd have the worksheets in front of us and we'd have pens out… So, when we couldn't do that, it felt like a waste of time really… I feel like worksheets should be sent in the post. I remember she [referring to therapist] wanted me to print things out but I don't have a printer… I feel like I'm letting her down and I'm not doing good enough when I can't print something out (CYP 08).
I used to run DBT groups, and a lot of things that would make it really engaging involved things like props that we could pass on. For example, one of the tasks we used was holding something from the freezer that’s really cold to touch… It’s really rubbish the way we have to translate that virtually, it’s just saying ‘can you grab the nearest object or something that you can hold’… I think it's good when it’s something really cold and switching it between people can be quite fun, whereas that was really lost in therapy online… I know DBT would work better in-person… It's a lot of tactile things and ways to make DBT fun. There’s no way you can do that online (HCP 03).
It was a bit boring being online and doing stuff online rather than face-to-face because then you are actually moving and it’s more physical (CYP 05).
With that group work, especially on Teams, you're juggling two things. So, you're delivering the actual group, but then you've got to make sure you keep an eye on the chat as well… Talking at the same time and being mindful of the chat, I find that quite cognitively demanding (HCP 03).
They type rather than speak out loud if you ask a question. You then have to sit there awkwardly for a minute or two, and then you have to gauge is anyone actually typing a response… The group sessions don’t work at all (HCP 01).
It's going to be difficult for them to engage next to each other and choose who they engage with and engage individually in a way that we would ordinarily, you know, when a couple might pair off and have a discussion about something they might have heard in the group wouldn't be able to do that online necessarily (HCP 02).
If they go into a physical space, for any number of reasons, they might position themselves where they're not sitting next to each other… If they were in a physical space, you might actually comment on that… Whereas you may be less inclined to say that if they're scrunched up on a couch. What's lost as well is maybe movement, activity… So often, the young person or the family are just sat in front of the screen and I probably do the same whereas sometimes you might be more active [in-person] (HCP 06).
Practical issues
It also felt a bit disconnected in a way because online internet fails, and you'd have to do just wait and then it's like you've gone off topic… If you’ve gone off topic then going back would be hard (CYP 06).
If that happens to a client [referring to connection issues], it already puts them in like a really stressed state of mind when they're already doing something really challenging in seeking mental health support… Sometimes if you're on a Zoom call, and you can't find the password… it makes it really stressful for you and going to mental health support is already stressful enough (CYP 04).
If a child is anxious, the anxiety can build a little bit while they are waiting to have the meeting or if the meeting drops because of signal (Parent 01).
Technical issues have been an issue… There were times when the sound doesn't quite work. There were times when you're not getting linked up properly or the young person's internet isn't working (HCP 02).
A lot of the time I’ve had tech issues. So, I do a lot of groups and a lot of young people tend to have trouble going on to links and that really puts me off my flow. I feel like I almost get a bit flustered (HCP 03).
Losing the cues
A lot of what I do as a therapist is about nonverbal and non-spoken communication, so the nuances of a body language is lost. I think that applies maybe to whoever is receiving the therapy too. They might not necessarily pick up on some of my nonverbal cues, clues, communication (HCP 06).
I think we do miss things non-verbally. I only see your head and shoulder… I can't see if you're holding your stomach now, because you're really anxious, or you're fidgety in the seat, you know, those very subtle movements that you might have that might indicate you're in distress, you're upset, you're hiding something, that you as a therapist might pick up (HCP 04).
I don't like to talk a lot about my mental health but sometimes the clinician can see if I'm folding myself up or if I'm not maintaining eye contact, that maybe means I am anxious about a certain issue or there might be something that needs to be explored more whereas that's harder to do on a 2D surface on the screen. So that requires the person on the other end to open up more and be more literal about themselves, which is really challenging (CYP 04).
I have bad anxiety but if you look at my face, you'd think that I’m a really happy, bubbly person but below the camera, I'm fidgeting, and I can't stop my leg from bouncing… I feel like you can’t really be understood properly over the phone like you can in-person (CYP 01).
The therapist might have picked up on his cues a bit more easily if they had of been face-to-face… Quite often he'd be quite fidgety, and you can't really see that on a screen (Parent 02).
I hate it [remote provision] so much… You just can’t get the body language from people, especially if it's someone you've never met in real life. You can't get them the same as if you were to be in-person with them (CYP 07).
You can't tell their body language… It's more like you can't see what's going on, and you don't know how they're reacting to what's happening because really you just only see the face. It's harder for people to get through to other people as well on it. I think in-person appointments are so much better than telephone ones or Teams ones (CYP 01).
I think it was just harder work for him to do it online because you've got to read people's expressions through a screen, and you can see yourself which is weird. And there is sometimes a slight delay in talking and the other person hearing what you're saying, and you crossover (Parent 02).
I don’t usually go to the group ones at the moment because I find them hard to do… I find it difficult to talk in a group on video because it’s harder to almost catch social cues or when the next person is going to speak or when to speak. Normal social stuff is made impossible by video calling (CYP 05).
Being more conscious of my position, if you like, in terms of my body language and how I might present. So, I'll look up at myself sometimes on the screen to check my emotional expression, for instance, or how I might be presenting (HCP 06).
Where we had to be working remotely and that being then the choice between telephone and video, I think lots of young people opted for telephone because they didn't want to see themselves on video… We're talking about often quite difficult things and thinking about when people are at their most vulnerable, and they might appear the most vulnerable and then that's very visible if they can see that and very aware of somebody else seeing that (HCP 09).
I think we lose the time when you're less focused on the assessment and the review. So, on the video link, you’re straight away face-to-face with the young person and starting a review. Whereas you lose that walking down the corridor bit where sometimes young people put on a face for a review and they might put their guard up, or they might prepare themselves in a certain way, and then you might find that a young person hasn't quite done that yet on the walk in or loses that face as they're walking away, and you can see them leaving in a slightly more relaxed way that you can then interpret (HCP 02).
When the sessions are ran virtually, it is the case of you're on a laptop, and you're just waiting for a young person to say login or appear or whatever, and then the session begins. Whereas the thing that I like in-person, which I think that has a big impact on the relationship as well, is it's not just the case of you know what therapy starts now and that's it. It's actually you're in the building, and there'll be sitting in their waiting room, and first you go up to them, and say hi, are you ready for your session? And then even just like little things, like actually walking to the therapy rooms (HCP 03).
It's really difficult to get a sense of what's going on for the young people [remotely]. When I'm then seeing them face-to-face, I'm getting a very different perspective… I got to a point where they are just not working [referring to remote appointments], and I don't feel like I'm being safe practising remotely (HCP 07).
I feel like you’re looking at a more stage-managed setting with them because they are all sat very still. It’s difficult to pick up more subtle cues about them… I found that the appointments are faster when I'm doing it online, so I don't know if conversation flows less easily, or whether I don't pick up on the cues that they give me as much. But I definitely get through the appointments quicker. I’m worried that I'm perhaps having less detail when I’m making my decisions (HCP 01).
I do sometimes feel more comfortable assessing and managing risk face-to-face than online… Last week, I met a young person for the first time after say three or four sessions online, and I met them face-to-face. We both said actually it feels better. That was a mutual agreement… From my perspective, it was around the management of risk. I don't know what it was, but when I met with her and there was some significant risk, it just felt that we connected more maybe… It was certainly something about risk for me and doing it online didn't feel as safe and I didn't feel as confident in assessing and managing risk than seeing them in-person (HCP 06).
I would need more training on the communication skills in an online environment. At medical school, we did loads and loads and loads of training about how to have your sessions, and how to pick up on all the cues that you would have when they're in the room with you and we don't really have anything like that for online stuff… So, I’m providing a lower quality service (HCP 01).
Drivers of trust and rapport
With online, you don't get anything out of it, you just sit there, and you don't really connect with the people… I feel like with online you don't get that connection. Fortunately for me, I already had my set people, but I can’t imagine just being referred to a system and not have met anyone and having to meet them for the first time over Teams or whatever. That would be hard because you can’t fully understand each other and you can’t connect (CYP 08).
It feels to me that you probably don't get as good a rapport. You don’t build up the same level of connection with them that you would do if you were doing it face-to-face. I speculate that they find face-to-face gives you a better relationship… The kids that I've seen face-to-face routinely, I've tended to have a better relationship with them than the ones I've seen only online (HCP 01).
Getting that engagement and rapport, I think, can be a bit more tricky [in the online milieu]… I just think my personal feeling as a professional, where our skills are not just in the words we say, but enormously in the human connection that we have with the young people, it's harder to get that quality of rapport (HCP 02).
There's an awkwardness to video links… you can't touch them. So those that might need a hand on their knee, that can be really valuable and really powerful therapeutically when somebody that you've been talking to about something that means so much, and there's an element of touch that you won’t be able to get via a video link (HCP 02).
If you're really having a hard time, they can come close to you and tell you it's okay [when in-person]… When you cry, it just seems really awkward and weird via a screen (CYP 10).
One young person I worked with would have sessions virtually, but she wouldn't really share a lot and it was really hard to prompt her to share… When it happened in-person, even the first time that I met her in-person, it just was almost like a radical change, and this person did start talking a lot and I discovered a lot in a very short period of time (HCP 03).
Online I was much more willing to be asking about the football and ‘oh you've got a dog’ to put the effort in. To put that extra 10 min of time or 15 min of time to get the relationship on track by using their interests (HCP 08).
I would tell them about my pets, and that was a really good way to avoid it becoming like stilted and stuff, because you have that shared thing to talk about and it helps you to connect as people (CYP 04).
Young people absolutely love it [when pets appear on screen]. I think because maybe they see that yes this person's a clinician, but they're also a pet lover as well like a lot of people are… I wonder if that's actually to do with the power dynamics as well, so they are not only seen as this clinician giving therapy or treatment, it's like, ‘oh that person has interesting pets’ (HCP 03).
I’d say definitely my psychologist, therapist, it definitely changed. I mean we weren’t really close but we had a decent therapeutic relationship but when it went online, I guess it went out of the window really. It was hard to get through to her and stuff. It did just change for the worse basically. Now I don’t see her at all really… So being online did really impact me and my DBT and my relationship with my therapist (CYP 08).
Theme 2: Spaces and places of therapy
Spaces of comfort and safety
They're very much more familiar with the technology… and find it quite comfortable and easy to use (HCP 02).
I think it helps to not be in a clinic setting. To be in a familiar place you might feel more able to open up more quickly because you're not in a drab room (Parent 02).
I think for some young people, they're more likely to attend… They've not had to have the stress of walking into the building… So, I think people are more at ease, more relaxed in their own homes and they feel safe (HCP 08).
It's like a barrier online. It doesn't feel like you're exposing yourself, even though maybe you have somehow but it just doesn't feel like that. So, it's more safer… You’re in the comfort of your own home… Online, it was relaxed. I didn't have to pressure myself to act in a certain way. It literally felt like someone's on a screen let's just talk (CYP 06).
I also like online support, because when I'm seeing someone… I get super anxious saying stuff, you can always take your camera off to help your anxiety or if you want to take yourself on mute for a second to take a breather you can (CYP 10).
Whenever you're talking to someone in the present, not through the internet, it's like a vulnerability comes out…When it's online, it's like you don't have that on the spot vulnerability… I'd say it didn't really meet my needs, because sometimes it was like maybe this is a bit too relaxed (CYP 06).
I think face-to-face is more challenging. So, it’s potentially a bit more therapeutic to be face-to-face… The anxious groups that would tend to avoid interactions and therefore will be quite comfortable online, but actually need to be challenged and from a therapeutic perspective, need that exposure to the real world really in order to start to work on their difficulties (HCP 02).
‘When you’re at home it’s home time’
It was harder to focus in my home, because there’s a lot more distractions. A lot of therapy rooms at [CAMHS building name]… have just a white wall and a table and a chair… Whereas at home, there's like way more stuff, and it's harder to focus in an environment that you've been conditioned to do one thing in. It would be like if I did my washing up at the cinema where I work (CYP 04).
You can’t engage. Online is just hard. It’s just not a proper therapy session, because you're just stuck at home. I think there's something about going into a place and it feels professional, and it feels like you're actually going to get something out of it. Whereas being at home, it just feels like ‘oh it's just a meeting and it'll be over soon’. You don't have to put as much effort into it, so your brain is not as simulated and ready to concentrate… It feels like when you're at home it's home time. But whereas when you go out, it's like it's therapy time. Your brain knows that (CYP 08).
When people are coming to CAMHS, they know they are coming to a quiet safe space, and they are guaranteed to get that, and they are in that frame of mind. Whereas sometimes they have just turned off the TV and turned on their phone to do a video call… Online is sometimes a bit too easy. If you say you’re going somewhere, right away you would put a bit more of an effort in because you’ve got up, you’ve got dressed and you know the purpose that you’re coming for… Maybe the focus and concentration isn’t there [online]… I’ve had many sessions with kids, and they are looking down and they’re on their phone you can tell that they are texting, and they are snapchatting other people and they are just not fully engaged (HCP 05).
Often they use their phone and then their phone might ring and then it’s like what do they want and then their mind is like what are they calling me for or if they’re anxious they are then worrying or are embarrassed (HCP 05).
When accessing it on a mobile phone, sometimes you get text messages come up and your camera will go off and your clinician will be like ‘oh where have you gone?’ But it's just because you've got a text message, and you can't really help it. Even if it's just a notification pops up your camera turns off… During the first lockdown, I had all of my therapy on my phone. That was challenging (CYP 04).
You're in own home. For example, I have got a little baby, and she's not in nursery on a Monday or a Wednesday. So, I can hear her sometimes crying in the background and I can hear her when I’m on call, even though they can’t hear her, I’m put off because I’m trying to concentrate but my daughter is upset (HCP 05).
They were getting distracted by the dog and then someone would come in the room. And then I just feel like they weren’t fully focused, and they were giving a different kind of therapy because they couldn’t say too much either because there were people in their house (CYP 07).
I also found that the quality of the therapy overall on online / remote therapy, I don't know if it's just me, but it seems to be generally a little bit lower as if the therapist doesn't really seem to be fully engaged with it as much as it would be, and to be fair, I feel like that as well. I feel like I can't really engage properly remotely and online. I feel like there's just something lacking (CYP 09).
If we think about therapy, the difficulties might be at home… So if you do therapy and you go to a clinic and you bring some stuff up, you can walk out and leave that behind. Whereas if you’re in your own personal space or your home, you do therapy, and it stays in that room [or house]… When we are in a clinic, we can do a session, and then we might be able to speak with another colleague… But if you're in your home, it almost feels sometimes that you can’t separate… Working from home/ doing stuff online can have its own challenges in terms of detaching (HCP 06).
It’s nice to just have those corridor conversations or to have a cup of tea with someone or to go for lunch with someone. Because of the nature of the work, you’re working with people who want to kill themselves, so you just need to take 5 / 10 min to yourself but if you’re at home it’s not the best. So that’s certainly one of the challenges, managing your own wellbeing (HCP 05).
Personally, when they were reliving, remembering trauma and they were in another part of the city, it just didn't feel as held… There was one young woman that I worked with who had asked specifically for EMDR [Eye Movement Desensitisation and Reprocessing]. She didn't have the best support network round her. That left me thinking should I have done this?… I think with that level of trauma again, with a young person, I probably wouldn't do the EMDR online, not with that level of trauma (HCP 08).
‘You lack privacy to speak about things’
I was trying to do an appointment the other day [online], and somebody kept walking into the room. At one point the person walked into the room just as I was asking about suicide and risk. How can you be honest and open in that situation? … There's something probably about sitting there and trying to talk about things that are quite difficult for you in a space where you don't necessarily have the privacy. Here [referring to CAMHS building] I can guarantee that. I can ask the parents to leave, and the parents aren't going to overhear what's being said (HCP 07).
I feel like it's not confidential… What if my sister is outside the door or what if they can hear me downstairs? It stops me from opening up as much as I would want to (CYP 08).
When you do it at home, especially if you've got family in the house, you might not want to talk about something if your family are in the room (CYP 07).
Sometimes they may want to speak about things that they don't want other people to hear, and being in your home, it's easy for people to overhear what you’re talking about… When [she] used to go for meetings with [her therapist in-person], she would go into the room with [therapist] and I’d sit out in reception, or I’d pop out for half an hour… So, there was total privacy for her to speak how she wanted to and to say whatever she wanted to say. Whereas I think when you’re in your own home, I could hear some of the meetings that she was having (Parent 01).
I always think about what the parents might think about their young person having a session in their room… They're going to know that their child will be talking about stuff that their parent did and lots of conflict. What's really common in CAMHS is a lot of sexual abuse… The parents will know that the young person is probably going to say, ‘well I experienced this, because my mum was in a relationship with this person’. So, a young person is doing their session and the mum could be in the home tidying up (HCP 03).
Theme 3: Future of CAMHS
Moving toward a hybrid model of provision
She really doesn’t do well with Zoom or phone calls. She tends to just answer the questions they are asking her. She won’t interact. I think the face-to-face works so much better for her (Parent 03).
When I asked him about his experience, he said, ‘I would probably have never engaged with you if you'd asked me to come to the clinic’… We have to think about the individual needs/preference… Doing it over the telephone and then graduating to online, but the camera off really worked for him (HCP 06).
We do work with the children, and I’d say up to the age of 13 I don’t think a lot of those young people have those skills over the phone or video. I don’t think it’s something children can easily do… The younger people struggle, particularly people with neurodevelopmental conditions such as ASD [Autism Spectrum Disorder] and ADHD [Attention Deficit Hyperactivity Disorder] (HCP 05).
So young people who have any neurodevelopmental conditions, say autism for example, or any sort of learning difficulty, I think they tend to struggle with virtual working (HCP 03).
I would take a blended approach unless somebody expressed a clear preference for one, and then they could be given that. But in some cases, like some clients, they might prefer online. But you might notice that they have a communication difficulty, or they might learn better in-person. And you might have to do all in-person sessions. If you're going to require people to use online services, I think you could have like a laptop loan scheme or a mobile loan scheme, just so that people can access that (CYP 04).
I think a blended approach would be a good idea. It depends on the child and the young person as well… I think it would be a good idea to ask the young person and the family, ‘what approach would you like?’ (Parent 02).
I personally like being face-to-face but other people might like being at home… If I was to look at CAMHS, you want the option. You want some people to be able to do online if they want to and people to be able to have face-to-face when they want to (CYP 08).
Efficacy
There will be an element of patient choice and whether they want it in that style, but then there will be times when a clinician may be clear that they can't really do the therapeutic work effectively without the face-to-face (HCP 02).
Obviously face-to-face you get a bigger, better, more accurate picture, but I know there is research that suggests that interventions that have done CBT just with people over video, and it has been proved to be effective. So, it does work for some people, but certainly not for all… I found that it is effective [referring to online CBT]. I wouldn’t say it’s better. I think it depends on the individual. I’d say under 12 it’s best face-to-face. Thirteen plus I think video calls are probably just as effective. Not better (HCP 05).
With regard to family therapy, I do think that in-person remains still the preferred modality or the preferred way of working. I think it has to be about choice with the family. But I think we'd also have to think as a team about whether it was useful or not, or effective as it could be. So again, we could still give families choice. But we would have to make a clinical decision about whether we thought there was a difference between how things were online, and how they could be in person. So it's a fine balance really about providing choice, but also thinking about clinical effectiveness. Moving forward, I would say that we would probably be inviting our families to or even encouraging families to attend in-person. But if there was no option for that, we certainly wouldn't exclude a family from family therapy (HCP 06).
Group working and virtual working, I feel like it’s a big no no. It's hard. Young people and virtual work, I just don’t feel like you could just get the most out of anything (HCP 03).
It [online therapy] will never be as good as face-to-face… Clinically deep-down face-to-face probably has the edge (HCP 08).
I don't like online working. I think when I have tried it, more often than not, it's not worked. I think sometimes it's probably reduced the demand, because kids aren't engaging. So, then they are being discharged… Face-to-face should be our forward-facing approach, but the option for remote should be there and actually, it should be down to the person's preference (HCP 07).
I think the default position has to be everything is in-person, but if the young person does request that they might want virtual sessions, then yes, we can accommodate it… The main reason for this is that it [online provision] gives young people too much of a space to hide (HCP 03).
I suppose we do need… to evaluate how effective it is. What's effective? Who is it effective for? Why is it effective? (HCP 06).
Increased demand: is social prescribing a solution?
Unless they are seriously trying to take their own life then they are not seen as a risk… I wouldn’t discharge them as quick as [name of CYP] has been discharged. She hits herself… and she digs her nails right into her fingers where they bleed. I wouldn’t class that as minor… I just think the service are on a tight budget and they’ve got to prioritise the kids who are in serious need of doing real self-harm to themselves. I think each child should be given more time (Parent 03).
The length of waiting times has gone up drastically. So, the number of people seeking CAMHS help has increased… I think there's probably an element of, for some kids, school was the problem and for other kids, home is the problem and for other kids, it's just being in a pandemic. All of that is combined into one perfect storm so demand seems to have gone up quite considerably for I think all of the young people’s mental health services (HCP 07).
I think the kids who are accessing the mental health services now because of COVID, it’s scored through the roof (Parent 03).
There was a leaflet in the GP surgery, and it said social prescribing and I just thought ‘that’s it’. Our waiting lists are months long, and children are waiting in distress for help. So, I thought here is a way of helping children to have more child friendly interventions and to get seen more quickly (HCP 08).
We are developing a social prescribing offer which includes horticultural therapy, forest schools, arts, drama, physical activity for all of those kids who can’t sit still and just talk, of which there are vast quantities. Actually, talking and doing something at the same time, particularly for boys is probably better (HCP 04).
We've got this massive project about to launch… with Forest Schools, horticultural therapies, and this thing called Nature well. So, it's [referring to COVID-19] enabled us to think outside the box massively… There's going to be a massive sea change here because there is stuff about credibility [as] parents want a young person to see the psychiatrist or the doctor and we're saying ‘no, let's get them out in the sticks’ (HCP 08).
The social prescribing is art and outdoors… And then there's the community part of it, which is the proper social prescribing, so a lot of our kids won't rock up at some community thing, they won't go to the community thing because their anxiety is so great so that’s why we have created basecamp. The basecamp is doing these outdoor and arts-based things, with us basically but then hopefully we pass them over to the community-based services at some point (HCP 08).
A lot of the kids that we work with, if they're on the autistic spectrum, they often love art, that is the thing that calms them… The other thing we might do is I’ve had a long conversation with the Duke of Edinburgh award in Liverpool, and we think we're going to get a licence with them so that whatever the children are doing with us, they'll be getting some brownie points as well. There'll be getting a bronze or something like that. It's motivating, isn't it? (HCP 08).