Relational practice in our Camden adolescent intensive support service

Clinical Lead Alex Finnegan and Clinical Nurse Specialist Natalie Macfarlane explain how relational practice helps inform how they engage and treat young people in the Tavistock and Portman’s Camden adolescent intensive support service.

Despite being poorly defined, ‘relational practice’ generally refers to approaches in practice, on all levels, that place importance on relationships.

On an organisational level, the complex ecosystem of services can be protected and strengthened by relational practice – though this is beyond the scope of this article. On a team level, relational practice not only allows practitioners to be recognised as individuals with unique experiences and complex lives outside of work, but highlights that in doing so, a deeper understanding between individuals within a team can be established. On a therapeutic level, it allows for
recognition that the ‘professional’ and ‘patient’ are humans first, existing both individually and in relation to one another, thus allowing meaningful relationships to be built.

The Camden adolescent intensive support service (CAISS) is an intensive outreach service offering crisis care to young people, aged 12 to 18 years old, with significant mental health difficulties, often in addition to complex social contexts. Young people with the team often have had numerous relationships with professionals before and/or admissions to adolescent mental health units, and consequently often feel hopeless that anything can help.

Relational practice forms the foundation of our day-to-day work and as true of most foundations goes largely unnoticed. CAISS is a nurse-led team of 10 clinicians, currently formed of nurses, social workers and doctors. It is a diverse team, both professionally and individually. Within CAISS, relational practice is reflected in our team-based approach.

The phrase ‘being held in mind’ can sum up the importance of relational practice in our clinical work.

Every young person we work with has at least two allocated clinicians, meaning all team members have the opportunity to work together, thus sharing experience and expertise. The team share an office, which facilitates relationship building, clinical discussion and debriefing after sessions. Asking for advice is a daily occurrence. Supervisors are curious about colleague’s lives outside of work, and how this may impact them in work. This dynamic ensures that contributions are valued, and that clinicians feel safe to share concerns, knowing they will be responded to with respect. This not only improves clinical practice, but team members routinely report high morale and positive feelings about work, with low rates of sickness and burnout.

Relational practice also permeates the clinical work of the team. We aim to build trusting relationships between clinicians and young people through presence and availability, recognising that feeling seen and heard can provide greater safety than lists of triggers and coping strategies. Young people can message their allocated clinicians during office hours, offering direct access when needed and responsiveness to any difficulties they are experiencing. Knowing that the benefit of having this direct access needs to be respected fosters trust between patient and professionals. Additionally, the two-clinician approach means that even when one clinician is unavailable, the young person can still contact a clinician they have an existing relationship with. Young people cared for by our team make remarkably infrequent use of out of hours services.

The phrase ‘being held in mind’ can sum up the importance of relational practice in our clinical work. To CAISS, it is the foundation of understanding, safety and trust in clinical practice which we all share responsibility for maintaining. In knowing we each have the needs and experiences of team members in mind, clinicians have the space to hold the young people in mind too.

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