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the external contingencies around the child’s behaviour, for example, parent
training programmes, behavioural therapy for specific symptoms;
the internal world of the child, for example, cognitive therapy, interper-
sonal therapy;
family relationships and beliefs, for example, reduction in negative
expressed emotion, family therapy;
peer relationships, for example, social skills training, group therapy;
school activities, for example, extra help with reading, anti-bullying
programme;
the family’s economic and social environment, for example, change of hous-
ing, befriending programmes for isolated families;
alternatives to care in the family, for example, fostering, admission to a
residential community.
These are not mutually exclusive and several may be combined.Working with other agencies
Many of the children and families seen by mental health services also
need special input from other agencies, most notably education and social
services. It is essential that each agency defines its role clearly and works
in partnership with the other agencies, not at cross-purposes. Liaison
meetings should be a means to an end rather than an end in themselves!
Treatment need not mirror aetiology
A disorder caused by physical factors may need psychological treatment,
and vice versa. It is not always necessary to fight fire with fire; it is
sometimes appropriate to fight fire with water! Thus, a child’s hysterical
paralysis may respond better to physiotherapy than psychotherapy. Med-
ication may help a child’s hyperactivity even if that hyperactivity is due
to being raised in a grossly inadequate orphanage. Equally, a child with
genetically caused learning disability may benefit from special education.
An adolescent with biologically determined schizophrenia may benefit
from reduction of parental negative expressed emotion.
Selecting treatment approaches
There is increasing emphasis on evidence-based provision, with moves
in this direction generally being further advanced for health provision
than for educational or social work provision. An evidence base is vital
because clinical wisdom and commonsense are surprisingly fallible. ‘Self-
evidently’ beneficial interventions may turn out to be worse than nothing.
For example, one careful randomised trial of an intuitively appealing
package of social and psychological interventions for children at high risk
of delinquency showed that the intervention significantly worsened their