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ACQ
Volume 11, Number 3 2009
ACQ
uiring knowledge in speech, language and hearing
for depression and anxiety following major trauma for her
and her family around her original diagnosis and treatment.
After a year of treatment her mother commented that her
daughter lost her smile at 4 years of age but now has it
back!
The most common type of leukaemia in children and at
the CCC is acute lymphoblastic leukaemia (ALL). Current
treatment is very successful; however, some children relapse
or move into palliative care. Referrals for psychosocial
support for these children and their families are also made
with an additional role being to support team members.
Referrals are also accepted for siblings’ issues around loss,
grief, anxiety and depression. One young girl, a sibling of an
adolescent, was referred for her apparent “withdrawal from
school and family life” following her sister’s relapse, with the
fear she could die.
A major part of the position is the prevention and
promotion of mental health during treatment for a significant
medical illness. The most difficult group to engage are those
in active treatment as children and families do not have
the emotional space at that time to deal with emotional
issues. A lot of “holding of issues” is done with this group as
engagement tends to be better post treatment once children
are in remission. Therefore, it is essential to maintain links
throughout the two years of treatment to engage children
and families if and when they are ready.
As a communication specialist, I think about my mental
health clinician work from a communication perspective.
For example, children and families are initially engaged with
“telling their story”, the narrative component of the journey.
Communicating what has happened is also important for the
child and family as a therapeutic tool to help them process
where they are at and assist me in treatment planning. It is
important to give space to listening to the child and family
about their journey at various stages. At initial diagnosis,
grief, fear and trauma are explored. At remission the loss of
the close intense relationship with staff comes to an end and
is worked through. Topics discussed might include how the
child and family get back to normalcy; how the child slots
back into life after being absent from school, from peers,
and from family. As the mental health clinician it is important
for me to be available to hear how the young person and
the family are managing and to respect when they are ready
to communicate. Often my role with the children involved
understanding what the children needed to communicate to
their families and the medical team but they couldn’t say in
person.
The procedural pain therapist provides diversion strategies
for children undergoing procedures. In consultation with the
child and family a plan is devised where the child has some
choice in how procedures are delivered. I found a significant
benefit in using therapeutic stories. Hospitals are scary
places; the child is in pain, subjected to painful procedures
and exposed to scary looking equipment. Parents are also
I am a clinician with many years of experience
as a paediatric mental health speech pathologist and as a
child and adolescent mental health clinician. At the
commencement of 2008 I took on the challenge of providing
a mental health service to paediatric oncology, at Southern
Health’s Monash Medical Centre in Melbourne. This position
at the Children’s Cancer Centre (CCC) was funded for three
sessions a week by the Kids Oncology and Leukaemia
Action Group (KOALA). KOALA is a philanthropic group
formed in 1992 and is run by parents and carers for children
who are, or have been, treated for cancer.
The CCC previously had input from the Child and
Adolescent Mental Health Service (CAMHS) consultation
liaison team but was keen to create a dedicated mental
health paediatric oncology position to provide support to
current patients in addition to consultation and liaison.
They also wished to provide case management for the
children and adolescents including those in remission and
those siblings needing psychosocial support. The position
was integrated into the medical team with the support
and expertise of CAMHS. As the mental health clinician,
I provided a key role in supporting the medical team and
children of the CCC. Close working relationships exist with
the CCC nurse coordinator, social worker and allied health
team, which includes a music therapist and procedural pain
therapist. I often worked jointly with all members of the allied
health team. Most intervention consists of consultation and
liaison with team members. When more support is needed,
the children and their families receive comprehensive
psychosocial assessment and case management.
Referrals are spread across the age range with the
majority of referrals for children under 5 years. Referrals
of children in active treatment are taken from all members
of the team but discussed with the social worker who
meets with all families in active treatment and acts as the
first point of call for most children. Often children in active
treatment have issues with procedural pain, compliance,
behavioural issues, adjustment, anxiety or depression. For
example a young boy was referred for ongoing sadness and
lack of interaction and engagement with the medical team
when attending appointments, and a 3-year-old child was
referred who did not respond to distraction techniques when
undergoing procedures causing great distress to the child,
his mother and the nursing staff.
For children in remission, referrals come from the medical
staff and are not known to the rest of the team so are taken
on directly. These children are often referred with issues
around behaviour, anxiety and depression post treatment.
For example the child who was struggling with the return
to school where he had lost his place as the “smartest
kid in the grade” and with fitting back into “normal family
life” where he was no longer “special”. These issues
were causing behavioural issues at school and at home.
Another adolescent was referred 12 years into remission
Speech pathologist to mental health
clinician in paediatric oncology
Diana Russo
Outside the square
Diana Russo