Behind the Smile

Behind the Smile

2019-02-07T08:33:18+00:00 February 7th, 2019|

Children’s Mental Health Week this year (led by Place2B) is shining a light on being healthy inside and out. It makes absolute sense that our mind and bodies and how we feel physically and mentally are linked, but what does that look and feel like when you’ve suffered a life changing injury and even more so when you’re dealing with all that as a child?

We spoke to Sarah Boulton, Case Manager for the Child Brain Injury Rehabilitation Service and Social Worker, about how children with Acquired Brain Injury (ABI) may present with mental health challenges and what the people supporting them can do.

“The most important thing to note is that every single person is different. That may sound an obvious thing to start with but so many times people work to a single viewpoint and as a case manager you see every day just how different we all are.

When mental health in children starts to decline, you may spot some classic changes in behaviours such as withdrawal, erratic eating and sleeping patterns as well as a general sense of agitation.   For the children we work with at Bush & Company that may be different again. It’s not always easy for any child to articulate their feelings and when a child has ABI this arguably becomes more challenging; what they are experiencing is complicated to make sense of.  The most important way you can support a child with their mental health is get to know them, get to understand how they behave and what they need from people and at the centre of all that, help them to make sense of their day.

Daisy’s story

I’ve been working with a little girl and her family for over two and a half years now and for the purpose of this we’ll call her Daisy. Daisy is nine years old and a wonderful little girl who, on the face of it, seems very articulate but her Cerebral Palsy means that underneath her beautiful smile she struggles to process and retain information and make sense of the world around her.

Put Daisy in a school setting where she desperately tries to keep up and she struggles internally. She can’t do math or science how she feels she should and retaining what she was taught yesterday is such a huge challenge for her. This starts to create a huge amount of anxiety.  She can’t settle and becomes very teary; sometimes rocking to sooth herself or sucking her thumb and jumper. The saddest part is that Daisy then feels she has to apologise for her differences. She is extremely self aware and knows she has Cerebral Palsy. With this, Daisy can understand how this at times makes life less easy to manage, but also feels very sad that she is unable to be like many of her peers.

Daisy doesn’t attend mainstream school anymore. The support she was receiving wasn’t enough. People around her at school weren’t accepting of who she is as a person. Daisy’s experience proved frustrating and confusing, it was positive that people saw the huge amount of potential in Daisy, but they often pushed her too hard to get things right. A balanced pace is important to not make a child shut down, withdraw and feel vulnerable.

Enhancing environments

Daisy now thrives in her new school and this is enhanced by the additional organisations we work with for her. It’s important as a case manager that you look for ways to enhance learning in environments that support a child’s mental health.

At Bush & Company we work with some amazing therapy providers. Each child has different needs but for Daisy, Pace Rehabilitation has worked wonders. Her sensory needs are met and she can do things in a way that she wants to; she loves to type emails and organise the team at the Pace offices! She also loves baking and cooking and they have great spaces for Daisy to let off steam, deal with her emotions and come back focused and settled. They understand her needs; needs that will be so different from every other child.

Tomorrow is another day

Daisy has a wonderful family – a Mum, Dad and Brother who work hard every day to understand Daisy to make her life better. They let her know that it’s ok to be who you are and their motto is ‘tomorrow is another day’.

It’s important for a child with mental health challenges to participate in healthy activities. For Daisy they help calm her thoughts and activities like swimming and going for a walk (when fatigue allows), through to having a boogie in front of the TV when Strictly comes on put her at ease.

These types of activities also help her to have fun because after all, at the core she is a nine year old girl who wants to be just that. We work with so many children whose childhoods are taken over by appointments and anxieties and every day is exhausting. Having to ‘fit in’ can be soul destroying.

As a case manager there is only so much we can do. Daisy is lucky and has a supportive and loving home life which makes her rehabilitation and managing her mental health a little easier.

Reports help if you bring the child to life

Where we can help is through our assessments and reports. In my reports I try to give a sense of who that child is, give them a voice and make them a reality. Hopefully they have participated in a meeting which makes getting to know them easier but listening to parents and carers is key. It’s also important not to ignore behaviour and assume its part of the disability.

In the world of disability there isn’t enough understanding about mental health. We need to give people a voice by acknowledging their behaviour, listening, observing and getting to know them and then we must bring this to life in our reports. When we attend legal meetings, people comment that Daisy is a wonderful little girl and they enjoy reading the reports. Her solicitors even requested a photo for their office so they can remember who they are working for which the parents agreed to. If people understand her journey and support her she will achieve what ever she wants to. Own agenda’s shouldn’t be put on the table. Daisy’s clear message is, make sense of this for me, not for you.

If it isn’t working, fix it!

As case managers we should also find the right professionals to support a child’s mental health and if that isn’t working fix it. Find out how the child enjoys expressing themselves, listen to the parents and carers and also give them the tools to remain resilient and look after their own mental health. A family that has experienced trauma experiences immense grief. The legal process and giving evidence can often relive that trauma. Families need to be able to feel part of the process but also share their angst and be heard too.

Case managers should facilitate what needs to happen, look out for the child and their families and give them permission to have fun and enjoy each day, even if some days that’s just a tiny part of the whole day. It’s about not feeling lost and being forgotten about. They also shouldn’t feel frightened to challenge and never accept something that isn’t ok for their child.

The next challenge for Daisy will be moving from primary to secondary school at a time where she may be experiencing puberty- periods and hormones. For every child with mental health there will be challenges but with the legal, case management and rehabilitation sector looking out for them, we can make a difference.”

If you’d like more guidance on working with children with mental health challenges following catastrophic injury or want to find out more about Sarah and our network of case managers, get in touch at

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