Clinical support worker - interview HELP!!

[Kimmy12]

Dear all!

I am a Psychology graduate and I have an interview for a position of a Clinical Support Worker (reporting to Main Nurse) for a Child and Adolescent Mental Health Service in London. I was wondering if anyone with experience in this field could help me answer the following questions:

1. An adolescent patient runs out in the open and threatens to strangle herself with the respiratory tube if you come any closer - what would you do during the incident/after?

2. You see a colleague talking harshly to an adolescent patient during work. What do you do?

3. An adolescent patient may be experiencing violence at home and wants to confide in you, but asks you not to tell anyone. What do you do?

4. How would you handle a situation where a patient came to you and wanted to know some private information about you / your colleagues saying you know everything about her and she would like to know at least some things about you?

5. What would you do if a problematic patient was especially mean to you, not so much other members of the staff? How would you handle the situation?

Thank you in advance for your kind help!

Kimmy

[jadelpn, LPN, EMT-B]

You are only as trusted as your practice. This means a level of honesty about what you will or will not do, what you can or can not do.

There are talk down techniques that are imperative to know and use for situations that require it (ie: the tubing situation). However, it is also important that if you have a personality disordered or lack of control teenager, that the unit is free from possible harm--ie: the tubing needs to be locked and not accessible.

If a colleague is speaking harshly, again, you are only part of your own practice. For teenagers, I certainly would not use the term harsh, however, frank/clear/firm is more likely, and sets appropriate boundries. This is a gift, as it is not conducive to help function to emotionalize and personalize interactions with a teenage group--negative counter-transference.

Follow your facility policy on reporting, and be clear that you have a duty to act/report if you do. (and most licensed people do). If there's a violent home situation, just the disclosure itself can warrant a call to CPS. But again, team sport, and be sure that you have a meeting with the care team to discuss.

The last two questions I will again say, you are only as good as your practice. That a patient "wants to know about me" is a non-issue, as this is your job, and not your life. "I started here a short time ago. I am invested in helping everyone I work with to be able to function". Otherwise, it is inappropriate to discuss further and personalize. And on that note, patients are not in a position to be "mean" to you. This is personalizing a therapeutic relationship. If your communication is not effective, then it needs to be amended so it is. The goal is function. Behavior needs to be consistently dealt with per a patient's care plan.

Bottom line, you are not there to be BFF's. You are not there to have patients go beyond a therapeutic relationship with you. Mental illness is such a varied thing, however, part of the coping skills that teenagers can develop is the art of manipulation. Do not get caught up in it, as this ultimately doesn't help patient function.

Best wishes.

[Kimmy12]

Dear Jadelpn,

thank you for your answer, it helps a lot! I would just like to add that the scenario with the tube said she actually had the tube/apparatus on her the whole time and as I am not trained in de-escalation yet I was wondering what some examples of talk-down techniques would be?

The panel I saw last time also asked about what I would do after the incident - this probably involves informing the whole team as well as the parents?

And as for the colleague, I believe the question ran more in the direction of what I would do if I thought his tone/words were out of line/uncalled for..

Thanks again for your kind help!

Kimmy

[jadelpn, LPN, EMT-B]

Each facility should have policy on technique of de-escalation. It would also help to brush up on crisis intervention. And if there is a crisis intervention person available then I would look to them for direction.

Ultimately, if the patient can not function with some sort of appendage on them that could cause harm, then there needs to be an alternative. And they need to earn the priviledge of wearing anything beyond what you give them to wear, based on behavior goals.

The key is to prevent as opposed to react. Further, you would contact per your own facility policy, And again, I can not stress this enough, per your chain of command and team. You should not be doing this all solo.

[Kimmy12]

Dear Jadelpn,

thank you so much for your kind answers and guidelines, they help a lot!

Best regards,

Kimmy