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Therapy during COVID-19: Moving to Telehealth

6/8/2020

With the ever-rising COVID-19 pandemic case numbers across Victoria, it’s more important than ever that we all take steps to protect ourselves and the larger community from the spread of this virus, as well as other colds, coughs, and ‘flus that can be common at this time of the year.

You, as the client, need to feel empowered to take the steps that keep you and your family safe.
Hopscotch and Harmony are committed to helping you do this by moving 100% to Telehealth across both the Geelong and Melbourne practices while we are in Stage 3 or 4 restrictions.

Telehealth services will continue until the COVID-19 situation stabilises. Unfortunately, as we know, this is taking a lot longer than any of us had thought or hoped for!

New to Telehealth services?

We sometimes hear concerns from parents that they do not think their child will be able to engage in therapy over Telehealth. It might reassure you to know that Telehealth is an evidence based way of providing services to members of the community.

If you are considering Telehealth services but think your child might struggle, please remember that we can offer an array of options:

Shorter (i.e. 25 minute) sessions. For clients accessing their sessions under the NDIS, 25 minute sessions are approved by these insurers. For clients paying privately, these sessions are costed at 50% of your usual fee. If you usually claim a Medicare rebate, this means that, even without a Medicare rebate available, the session fee is less than your usual out of pocket expense.
Parent appointments for very young children, or those with special considerations or additional needs to help strategise and work with your child’s clinician on how best to support your child between appointments.
Split appointments, where a portion of the clinician’s time is spent with the child, and a portion working with the parent.
If you receive NDIS funding, your clinician may be able to help you with your child’s progress by assisting with the creation of resources for your home or at school instead of providing a direct Telehealth service. This can assist with your child’s therapeutic needs and goals.

Telehealth often gives clinicians and children an unusual opportunity of being able to work within the child client’s own space, within their comfort zone, and on issues that commonly impact them at home.

One common concern that parents can have is that their children struggled (or are struggling with) remote learning. This can sometimes lead parents to believe that their child will also struggle with Telehealth sessions, or that they won’t get much out of them.

It’s really important to remember that your child’s sessions with a therapist should look and feel VERY different to school lessons, and your child’s clinician has a range of options to make your child’s session engaging, fun, and helpful. It’s also really important to remember that even where attended face to face, sessions in the clinic don’t look or feel like ‘normal’ (i.e. pre-COVID) appointments at the moment!

Masks, eye protection, physical distancing requirements, hand sanitising, lack of wait rooms, and the necessity to clean and sanitise all rooms, toys, and therapeutic tools between clients mean that our sessions would look very different to what our regular in-clinic sessions are like. In fact, Telehealth often gives the clinician and your child MORE freedom and ease with which to connect and work together.

What if Telehealth isn’t right for me or my child?
For the vast majority of clients, Telehealth services will be an appropriate therapeutic modality.
If, in the rare instance, your child’s presentation means that Telehealth services are just not right for them, it may mean waiting until Stage 3 and 4 restrictions are behind us. Unfortunately due to a very high demand of clients currently requesting Telehealth appointments we are unable to reserve your spot and there may be a wait when you are ready to return.

At present, Medicare will continue to offer a rebate for Telehealth sessions until the end of September 2020. Should this change and affect your rebates for Telehealth, we will be in touch to discuss.

Whilst we hope to see you back in the office sooner rather than later, this may take longer than any of us had wished for. In the meantime, please consider Telehealth services as an evidence based alternative to face-to-face appointments to protect you, your family, your clinician, and the community at large.

Stay safe and warm and we look forward to seeing you soon!

Medicare changes: Increase in rebatable sessions for psychology

4/8/2020

Laura Park, Practice Manager

The COVID-19 Pandemic has seen us all wrestling with changes to the way we live our lives and how we connect in our communities. We have all had to adapt quickly to rules and restrictions quite beyond our control. Many families are juggling reduction or loss of employment with the added pressure of kids learning from home.

It is hardly surprising that these circumstances have resulted in additional stress and anxiety levels, and an increased need for psychological support.

We are grateful that the Government have acknowledged the need for this additional support and have announced measures to ensure that people can continue to access rebated sessions with their psychologist beyond the existing ten rebated sessions through the Better Access to Mental Health Scheme.

As of Friday 7 August, clients who have already accessed ten rebated psychology sessions after completing a Mental Health Treatment Plan with their GP and receiving a referral to Hopscotch and Harmony can return to their doctor to request a review and a re-referral for an additional ten rebated sessions. This will help our clients to continue to work towards their therapy goals with that financial assistance from Medicare.

What do you need to do to make this happen?

If you currently have a Mental Health Treatment Plan (MHTP)

You don’t have to do anything until you reach your tenth rebated session (your clinician can keep you determine how many sessions you have used so far)
At your tenth session, you will discuss future treatment plans with your clinician. They will write to your referring GP, either to advise that you have finished treatment for now or that further sessions would be beneficial and to request a review and re-referral.
Following your tenth session, you should make an appointment with your GP to complete a review of your MHTP and ask them to fax the re-referral directly to H&H so that we can update your file prior to your next session.

If you have already exhausted your ten rebated sessions for 2020

you should make an appointment with your GP any time after 7 August to complete a review of your MHTP and ask them to fax the re-referral directly to H&H so that we can update your file prior to your next session.

At Hopscotch and Harmony we are committed to supporting our clients to reach their therapy goals and to emerge from this most unusual time with increased resilience, insight and skills to thrive in the next chapter of their lives!

If you would like to book an appointment please click here

Some ideas for homeschooling an apparently “Defiant” Child

3/6/2020

**Enjoy this guest post from friend of the practice, Charlie. We came across this piece when Charlie's mother shared it in a homeschooling Facebook group. Charlie accepted our invitation for this to be published on our Hopscotch & Harmony Blog because we knew how helpful it would be to other children and parents. Thank you Charlie!

Hello, I'm Charlie.

I started homeschooling at the beginning of year 6 in 2020. I will admit that sometimes when it comes to schoolwork I can behave in ways that some people might call “defiant” and “stubborn”. I want to help other families find a way to have a happy and fun time homeschooling, so I'm writing this to help other people even though I don't love writing.

I'm going to talk about possible reasons for defiance now (these are from my experience and are not 100% going to apply to all children). Most of the time I don’t know what triggers me to become defiant in the first place. But later, when I can think about it I realise I was anxious. I don't always know the reason for me being anxious. But sometimes I do, for example–

In public I am very good at hiding my emotions and that applies at school also. So when I started homeschooling - it was at home so I wasn’t needing to keep my feelings hidden, so I let them out and started having lots of meltdowns when mum tried to get me to do work.
Some subjects at school I was very good at but didn't get the support I needed when I needed help. For example, in maths I am well above average so when there were a few gaps in my maths I got no help so I got very bored and found I had no motivation anymore. When I started homeschooling I still had that experience in my mind, so I started having meltdowns with maths because my body was so used to screaming inside me whenever I did maths at school.
I feel I'm not very good at English/Writing but at school there are about 20 other kids to take the attention away from me if I feel I'm not doing well. At home, however, I am the only ‘student’ so I have all the ‘teachers’ eyes on me. It took me a while to get used to this and caused me anxiety.
Also mum was a bit anxious too. She wanted to do a great job homeschooling me and was trying really hard. I think she was trying to win the “Homeschool Mother of the Year” Award. Her anxiousness made me anxious too.

So, we have looked at some things that caused me to behave in ways that some people would call “defiance”. Here are some solutions to try which I think might work. Once again these are not 100% going to accommodate every child's needs, but they helped me.
.

Remember your child is probably not trying to be “defiant” - they are just anxious.
Make sure everybody feels safe and secure (ask your child what will make them feel safe).

Don't forget to ‘deschool’. Mum and I both needed to learn how homeschooling is different to regular school.
Be a friend to your kid. Take time to have fun together, play games, do cooking and have fun in general.
Be firm but make sure to be kind :)
Give them something they can succeed at.

And have fun :)
Give lots of encouragement.

Do lots of hands-on lessons. Don't be stuck at a desk (this really helps me).
Focus on what your child enjoys learning about. If they don’t seem to enjoy anything, help them discover their passion.

Make sure to not have any stress. Try to relax and don't be in a rush. Nobody learns when they are stressed out!
Find a method that suits both the parent and the child.
Check that the level of the work is just right. Make sure the level is not too hard or too easy otherwise the child will become bored very quickly.
DON'T FORGET TO HAVE FUN!!!!

If I can help one family homeschool more happily, this will make all this writing worth it!

Thank you

Charlie.

Charles Reeves is 12 years old and lives in Sydney. He is autistic and struggled in school because of anxiety. Charles wants to help other kids like him and to make a difference in the lives of others. He also enjoys playing with his dogs and gaming (way more than his mum likes 😃).

Is your child's education at risk by remote learning instead of attending school?

29/4/2020

For most children, there is not going to be a long-term negative impact on their education by stepping back from school-based academic learning for a few months. If remote learning is creating more problems than it's solving for your family, it might be time to step back and consider your options.

You have a choice here. I know it's far from perfect. I know things are hard right now. But there is another option. Check out the video...

Not real homeschooling

8/4/2020

Jessica Cleary, Psychologist

As a homeschooling parent of many years as well as a psychologist, I can tell you right now that what you're being asked to do is not real homeschooling. This is SO much harder. And looks very different.

It is schooling at home during a crisis.

Let me tell you what to focus on if you're feeling lots of anxiety and stress with schooling at home during this time of Coronavirus (COVID-19).

7 things parents need to know about online counselling for kids (Telehealth sessions)

31/3/2020

Tamsyn White, Principal Psychologist

I don’t know about you, but for me the world seems to have changed so much in the space of just a few short weeks.

At the end of February, COVID-19, or the Coronavirus, was barely on my radar and I certainly wasn’t aware of just how much it was going to start impacting my life. Lots of the clients I work with, my colleagues, and my friends, have reflected the same thing back to me, too.

One of the biggest changes for my clients is that, before COVID-19 really hit our consciousness, the word “Telehealth” was probably rarely heard. These days, if you’re tracking the news like I have been, the word seems to be everywhere!

So what is Telehealth?

Well - despite lots of people just hearing about it for the first time - Telehealth is not new. In fact, there are practitioners from lots of different disciplines who have been offering Telehealth services for many, many years. Some services ONLY offer Telehealth services.

For example, our clinic’s director, Jessica Cleary, has been offering Teleheatlh appointments to women around Australia who have been experiencing parenting stress for a number of years now; our Speech Pathologist, Meg Tasker, has worked for a Telehealth provider, offering speech pathology services to clients locally, and some who don’t even live in Australia; and I myself have provided Telehealth treatment to clients who live rurally in the past.

Telehealth has really broadened the scope of the clients who we can reach out to and help. We, as a clinic have almost always had Zoom (like Skype) appointments as an option if a client can’t attend the rooms on the day of their appointment.

You might also be reassured to know that there is some really good evidence that tells us Telehealth can be just as effective as face-to-face therapy in most cases. In fact, there can be a stack of benefits to Telehealth for clients - not least of all that we get an insight into where you (or your child!) lives, and can help you identify things in your own home environment that can be used in your journey to wellbeing.

There are some things to think about that can help you and your child get the best out of their sessions:

Your child might be more comfortable with Telehealth than you’d imagine. Technology is like the second language for many of our kids, and they often understand it better than we do.

It’s always recommended for you to try the technology out in advance of your appointment. We usually offer Telehealth appointments through Google Meet or Zoom. You may have to create a Google account, or download Zoom if you’ve never used it before. If you're unsure about the technology, let us know and we'll call you and take you through it before your appointment.

Sessions won’t be exactly the same over Telehealth as they are in-person - but different doesn’t equal “not as good”. Kids generally LOVE the opportunity to show their clinician their bedroom, favourite toys, favourite room of the house, and introduce them to their siblings. The clinicians generally love learning about the child’s life too, and having the opportunity to get a much clearer sense of what your child’s home life is like than they usually would.

Parents often need to be more closely involved in their child’s therapy than they might expect. It’s easy for kids to treat Telehealth appointments like an hour long FaceTime session with a friend - we need you to help us keep your child on track, to defer sibling questions, make sure the child’s space is protected and private (where necessary), and sometimes to be our hands on co-therapists.

iPads can be great for Telehealth sessions if your child has access to one - they’re portable and easy to use. Please be mindful that your clinician will end up feeling seasick if your child holds the device in their hands for the whole session though! A device stand can be really helpful to create a stable place that it can be put down if not moving from room to room, and to ensure that we don’t end up looking up at the roof (or up your child’s nose!) for the whole session.

Your house doesn’t have to be tidied up especially for your child’s session! I can promise you that your clinician doesn’t have a perfectly spotless show home, and is not there to judge your home - most of the time, they won’t even notice if there are unwashed dishes in the sink or unfolded clothes on the couch. Having said this, it’s perfectly okay for you to set your own boundaries about where you want Telehealth appointments to take place - your clinician won’t be offended or upset if you want your child to remain in the lounge room, for example. Some families have a rule against devices in bedrooms - and we want to make sure we’re not encouraging your child to break any of the family rules - so just let us know if you have any concerns about where in the house your child goes for their appointment.

We have the power to be flexible! Because we’re meeting you in your own home - often from our own homes - we can offer 25 minute appointments, or more frequent sessions. We’re finding lots of parents are needing additional support for their children at these times, and we can structure the appointments in such a way that both your child and yourself are getting the support you need - let us know what your thoughts are and we can work it out together.

Above all - we’re all in this together. I’m so glad that we have this option to continue working with you through this hard and stressful time in the world. Please don’t hesitate to reach out to us if you think we can help you with something we haven’t thought of.

If you live in Australia and would like to book a Telehealth session with Hopscotch & Harmony for you or your child, please click the button below to complete our booking form and we'll get back to you as soon as possible.

Book online counselling

Tamsyn White is the Principal Psychologist at Hopscotch & Harmony. She sees children, young people, adults, and families when challenges have presented themselves and feel overwhelming. Tamsyn has a strong working history with psychological trauma for people across their lifespan. Tamsyn loves working with people when they want to develop their skills in areas such as: loving and accepting themselves; being a fantastic parent; being a skilled communicator in their relationships; just as some examples.

How to talk to kids about coronavirus to ease anxiety

14/3/2020

Jessica Cleary, Psychologist

Parents and educators are in uncharted waters as we seek to support ourselves and the children in our care through the current pandemic. Here are my thoughts on how to navigate conversations with kids on coronavirus.

Helping your child or teen manage suicidal thoughts and/or plans

2/3/2020

Tamsyn White, Psychologist

In our work as psychologists, we often hear from children and young people that they are feeling so distressed that they are experiencing suicidal thoughts. Of course when they hear this, many parents feel extremely worried.

Such distress in children and going people can manifest in lots of different ways in terms of behaviour, emotions, and impact on relationships and functioning at school, home, and workplaces (where relevant).

What to look out for - warning signs:

Hopelessness: If a child or young person feels trapped in their circumstances, and as if there is no hope for the future, it can lead to them feeling sad, to having depression, or to think about suicide.
Suicidal ideation: Thoughts of taking one’s own life are relatively common amongst teens, but should ALWAYS be taken seriously.
Changes in behaviour: When a child or adolescent experiences significant changes to their eating or sleeping patterns, mood, concentration, or ability to participate at school or home, these signs should be taken heed of.

Withdrawing socially
Giving away valued possessions
Increased drug or alcohol use
Disturbing or emotional posts on social media.
Acquiring medications or weapons
Talking about death or suicide

What can you do?

Talk and listen to your teen:
The expert on how your young person is feeling is your young person themselves. Check in with them often about how they’re travelling and let them know you’re always there for them, even if they don’t want to chat.

Check in on yourself
It’s natural to feel frightened, overwhelmed, or even angry if your teen lets you know they’ve been thinking of harming themselves. It’s important to let your child or adolescent know that you love them and support them, and that you need to keep them safe. Try to communicate calmly, without judgement, and try to help them see that it’s safe to talk to you.

Make sure you ask them directly
Parents are often worried that if their teen or child hasn’t had thoughts of suicide, they will be created if asked directly. This is a myth, and research has shown us that asking directly can be very protective. Avoid using euphemisms such asking if they’ve been thinking about “doing something silly” to themselves. Rather use direct, non-judgemental language. Simple is best: “Have you had thoughts about hurting yourself, or taking your own life?” should be a question we are all comfortable asking our loved ones.

Plan with your child for their safety
If your child or adolescent does let you know that they are having thoughts of harming themselves, make sure you’re prepared to engage in some safety planning. Ask them whether they have a plan to hurt themselves, and ask them to work with you as a team to help keep them safe. This might mean removing access to means, helping them manage their social media time, increasing their connection with supportive family and friends, and seeking professional help.

Be prepared to contact services
In a crisis where a young person has, or is just about to harm themselves, it is best to present to your hospital's emergency department - via ambulance if necessary. In situations of less urgency, where future potential risk is identified by you, you can gain assistance from your own General Practitioner, the local hospital Child and Adolescent Mental Health Services, and sometimes from school counsellors, if they are available.

Where to go for help:

Kids Helpline is a free, private and confidential 24/7 phone and online counselling service for young people aged 5 to 25. They can be contacted by phone on 1800 55 1800 or website: https://kidshelpline.com.au/get-help/webchat-counselling/

Lifeline provides free, 24-hour Telephone Crisis Support service in Australia. Volunteer Crisis Supporters provide suicide prevention services, mental health support and emotional assistance, via telephone, online, and face-to-face. Call 13 11 44 or visit their website: https://www.lifeline.org.au/about-lifeline/contact-us

Area Mental Health Services (AMHS) triage provides mental health information, advice and referral. Each AMHS has a centralised triage number. www.health.vic.gov.au/mentalhealth/services

ARAFEMI Carer Helpline provides free, confidential information, support and referral for family, carers and friends of people with a mental illness. 1300 550 265, 9am to 5pm weekdays www.arafemi.org.au/family-support/telephone-helpline.html

Australian Centre for Grief and Bereavement provides a range of education, counselling, research and clinical services for those working in and affected by experiences of grief and bereavement. 1800 642 066. www.grief.org.au

Beyondblue provides information about the signs and symptoms of depression, available treatments, how to get help and links to other relevant services and support groups. 1300 22 4636, 24 hours/7 days. www.beyondblue.org.au

How to respond if your child is acting aggressively

24/2/2020

Jesse Diggins , Psychologist

Part of my role as a school psychologist is responding to critical incidents that involve aggression and violence. I’ve learned to be able to face these situations with calmness and confidence. Many of the techniques I employ are taken from Therapeutic Crisis Intervention developed by Cornell University.

The techniques and principles in this model are highly generalizable and can be applied by families. The beauty of this is that as complex and daunting as aggressive behaviour can appear, the way to respond can be simple and involves answering 3 questions:

1. What emotions am I feeling right now?

If we are not emotionally regulated when we respond to a child there is a high likelihood that this will only perpetuate the situation. The child’s need remains unmet and they now also have additional stress. As the saying goes (and neuroscience attests to), ‘when we are at our angriest… we are at our stupidest’.

Speaking of, when children are highly emotionally dysregulated they don’t have access to their pre-frontal cortex which is responsible for problem-solving, reasoning and perspective taking. So, asking them to ‘make a good choice’ at the height of aggressive behaviour probably isn’t going to work.

We should try and emulate what we can see a duck in a pond look like; on the surface it is calm and graceful, underneath is a little more frantic but that is hidden from view.

2. How are environmental factors influencing the situation?

Many times, behaviours are influenced by those observing it. Removing other children or adults can be the catalyst for de-escalation. Similarly, removing yourself partially or fully as a responder (when safe to do so) can also be what is required for de-escalation to occur.

3. What does my child feel, need or want?

Behaviour is almost always a form of communication that expresses a need. Identifying and reflecting back your child’s need or feeling goes halfway to solving the problem. There is a difference between caving into unrealistic demands and simply demonstrating to your child that you can hear and understand their frustration.

Children may need up to a few hours to recover and return to a baseline state. This is the time to have that conversation about what they can do to get their needs met next time in a more adaptive way.

Jesse Diggins is a Hopscotch & Harmony psychologist who works closely with children, teens and parents to make sense of emotions and challenging behaviour. He has been recognised at local and state levels for his counselling work and his passion to empower young people and enable them to flourish. You can make an appointment with Jesse at Hopscotch & Harmony's Belmont practice by clicking here .

Managing your stress bucket through self care: A strategy for teens

4/2/2020

Alyce Galea, Psychologist

Hopscotch and Harmony Psychology | Self-care for Teens

Early on in therapy, teenagers often find it hard to identify the stressors or triggers that might be contributing to their difficulties.

One way that you can start to identify your current stressors is by doing the stress bucket activity.

I often like to conceptualise our wellbeing as a bucket.

We all have a level of stress that we can tolerate healthily, and this is determined through our genetics, our general attitude towards life and how stress management has been modelled to us by our caregivers.
The everyday stressors in our life can be considered as glasses of water pouring into our bucket. Over time, the water level in our bucket will increase.
In order to avoid the water from overflowing, we need to find ways to poke holes into our bucket...this can be achieved by identifying and implementing problem solving, coping strategies and regular self care.

Stressors can be categorised into three domains:

Interpersonal (difficulties or stress that you experience in your relationships with other people such as a parent, teacher or boss)

Intrapersonal (difficulties or stress that is a result of thoughts or feelings within you, as well as any physical health issues)

Environmental (difficulties or stress that is a result of your external world, including the school or work environment, the temperature in your classroom, the lighting, and things happening in the wider world such as natural disasters)

Once we have determined what our current stressors are, it is important to identify those stressors that you have some control over, and those that you have absolutely no control over. That way, we can then focus on problem solving ways of relieving the stress of situations that you may be able to change, even slightly.

.
Two ways we can learn to relieve stress are:

Problem focused coping strategies: these refer to strategies that help change the source of the stress.

Can you change something about the situation?
If you had more skills or resources, would you feel less stressed about this situation?

For example: Can you speak to a teacher to clarify a question on an assignment? Can you drop a few shifts at work?

Emotion focused coping strategies: these refer to strategies that help alleviate the negative thoughts and feelings associated with the stress

For example: Regularly practicing relaxation or deep breathing, exercise, starting a journal, listening to music.

Alyce Galea | Hopscotch & Harmony Psychology

Alyce Galea is a psychologist at Hopscotch & Harmony who works with adolescents and young adults across a wide range of settings, including schools and community mental health services (Headspace). She is particularly interested in supporting young people experiencing mood and anxiety disorders, low self-esteem and interpersonal difficulties; and has a particular interest in working with young women exhibiting traits of Borderline Personality Disorder.

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