‘Outlook’: A Psychological Service for Children with a Different Appearance

Abstract

'Outlook' is a unit within North Bristol Trust which has been developing a psychosocial service for children, young people and adults with a different appearance resulting from congenital abnormalities such as cleft lip and palate and also burns and other forms of trauma. This study presents data collected from 29 children aged between 5 and 16 who received individual therapeutic interventions. The baseline assessment included a semistructured interview schedule, visual analogue scales and the CBCL (Achenbach, 1991) to provide the parents' view of their children's behaviour profile. Measures were repeated post intervention and at 6 months follow-up. The intervention consisted of four sessions of cognitive-behavioural therapy (CBT) including social skills and problem-solving components. Statistical analyses revealed significant outcomes on a range of measures. At 6 months follow-up children reported a reduction in the frequency of teasing and in the degree of distress it caused both in the classroom and in the playground. Parents reported reductions in their children's' somatizing behaviour and levels of anxiety. These outcomes suggest that this approach represents an effective therapy for children with appearance-related psychological problems.

Coping with Congenital Hand Differences

“…For example, among children with burn injuries, the presence of a burn injury in a visible area, such as the hands, is more strongly associated with psychological consequences than the overall severity of the burn. 24–26 Visible differences in appearance can exacerbate normal childhood experiences, such as comparison between peers, and have powerful psychosocial ramifications, including anxiety, depressive symptoms, and social withdrawal. 7 Certain coping and parenting techniques that prior research indicates are beneficial (e.g.…”

“…For example, positive coping taught through cognitive behavioral therapy techniques has been shown to significantly reduce anxiety, depression, and internalization of problems among children with visible differences. 24 Compared to conventional patient education, these techniques recognize the dynamic nature of child development and social interactions, and provide children with discrete skills that can be used to modify emotional and behavioral responses to stress. For example, cognitive behavioral therapy produces sustained improvements in coping as well as functional deficits among children with chronic conditions.…”

Visible difference amongst children and adolescents: Issues and interventions

“…Yet there are drawbacks to traditional CBT, including the cost of sessional time and the problem that it may not be appropriate for younger children [54]. Recent evaluations of web-based interventions (e.g., for people suffering from depression) suggest the internet has great potential for the cost-effective and accessible provision of CBT-based interventions and delivery through this format could be particularly attractive to an adolescent population.…”

“…'Outlook', the first designated disfigurement support unit within the UK National Health Service was established in 1997, in Bristol, providing one-to-one and group interventions based on social interaction skills training and cognitive behavioural techniques (see below), with interventions delivered by specialist psychologists. These have been shown to be effective in promoting positive adjustment and in developing positive coping strategies for managing social situations [53,54]. Outlook's work includes a summer programme which focuses on normalizing the experience of school transition, emphasizing that all children have concerns about leaving the familiarity of one school for the uncertainty of another.…”

“…Although evaluations of interventions are scarce, the available research consistently identifies CBT-focused interventions as being effective (see for example, Maddern et al [54]). Yet there are drawbacks to traditional CBT, including the cost of sessional time and the problem that it may not be appropriate for younger children [54].…”