Hi, my name is Kevin. I am one of the Asthma Clinical Nurse Specialists working for the Children & Young People’s Health Partnership (CYPHP). When I first joined CYPHP in 2016, I had no real idea about what a mind and body approach to care was, and I am still learning more about it every day.
What was clear from working with children and their families in the community instead of in the hospital wards, is that it is virtually impossible to ignore all of the emotional and contextual factors that influence a child or young person’s health. I think it was a real benefit to be able to see children in their communities, in school, and some even in their homes, as you are directly exposed to the many challenges that children and their families can face. All of which play a crucial role in helping a child to stay healthy and well.
I think the best way to explain this is to give an example, created by combining my experience of working with different children over the last few years. I hope this example will help to explain just how a mind and body approach to care can help children and young people with their health and wellbeing, and improve their care of asthma.
Meet Tobi
Tobi is 14 years old. He was referred to CYPHP by our colleagues at King’s College Hospital for extra support at home for his asthma. Whilst seeing him, we kept in close contact with the team at King’s to ensure that treatment regimens and plans were coordinated and shared.
Recently, Tobi’s asthma became a lot worse and he had to go to A&E. While in the A&E department, Tobi mentioned to the staff that he had suicidal thoughts. As such, following an emergency assessment of his mental health needs, Tobi was referred to CYPHP because of ongoing concerns over his mental health and asthma medication adherence.
Visiting Tobi and his family at home
When I first met Tobi, another asthma nurse and I visited him and his family at their home. We found out that Tobi lived in a two bedroom flat with his parents and three siblings. This meant he shared a room with all of his siblings, which he described as not being ‘ideal’ for a teenager.
I also noticed that their home was extremely damp with almost no ventilation. There was a lot of mould, which covered about two-thirds of the external walls. According to the family, the mould had been treated several times, however there was a leak coming from the property above them and this was not being fixed. I also noticed that the flat smelt of cigarette smoke, with some ashtrays lying around the living room and kitchen.
After getting to know the family environment, we spoke about Tobi’s asthma and his general wellbeing. It was clear that one of Tobi’s asthma triggers was the mould in their home. My colleague and I explained that mould spores have been proven many times to affect asthma, and by breathing in the spores, Tobi was putting himself at a greater risk of having an asthma attack. In fact, Asthma UK states that around 42% of people tell them that Mould and Fungi affect their asthma, and cause asthma symptoms.
We also mentioned that if Tobi is around cigarette smoke, managing his asthma will be a lot harder even if he is following his Asthma Action Plan and taking all his medication as prescribed. We explained that cigarette smoke can undo the effects of his preventer inhaler, and can contribute to a more disturbed sleep because he might be coughing more at night. All in all, by Tobi living in an overcrowded environment where there is cigarette smoke and a lot of damp causing mould, it all added up to put huge strain on his health.
While my colleague was speaking with Tobi’s parents about general advice and resources, including the cleanliness of their home and quitting smoking, I took the time to speak to Tobi by himself. Tobi did say that he had been having trouble sleeping at night, and that his coughing was also keeping his siblings awake. Other things that he described as getting him down included that his asthma was getting worse, he was not happy with his living situation, and he felt that there were other family issues at home. With all this going on, he felt that he was never going to get better and didn’t see the point in trying anymore.
I listened to his concerns, and I tried to offer advice about managing his asthma better. This included sharing top tips about putting a reminder on his phone for his preventer inhaler, how to manage his symptoms better, when to use salbutamol, and how much and often to use it. We also talked about some clubs that he could join outside of school, to help him spend time with people his own age while having some fun.
The importance and impact of considering body, mind, and context
It was clear from our first visit, that Tobi and his family would benefit from the help of the CYPHP mental health team. As such, I arranged my second visit to include one of the mental health workers from CYPHP. During the visit, my colleague spent some time with Tobi on his own and then with his mum and myself, and also spoke to his mum on her own. This gave me a chance to take Tobi out for some fresh air and to speak with him alone again. I believe this time was extremely valuable, as it gave him a chance to open up more about any concerns or worries he had, and the progress his family has already made.
He mentioned to me that both his parents had agreed to quit smoking and have looked at the NHS Choices website to receive support. They also now opened windows more regularly so that the home is better ventilated and smells less damp, and they have set up a cleaning schedule so that everyone helps to keep the home clean and tidy. Tobi seemed happy about this because this means he gets a bit more pocket money, which he is saving to buy a new guitar.
He also mentioned that his family was excited as they have been starting to look at a few larger flats after being put on a waiting list from the council. This was helped by myself writing a letter to the council requesting for the family to receive more appropriate accommodation.
For the family, by bringing the care to their home and using the CYPHP Body, Mind, and Context approach to care meant that Tobi and his family felt that they were getting the help and support they needed. I was glad to hear that Tobi started to feel that there was ‘some light at the end of the tunnel’.
Tobi’s mental health assessment helped to name his difficulties with low mood and some anxiety, and that he would benefit from ongoing therapy. Tobi agreed to a referral to the specialist respiratory psychologist at King’s, and CYPHP planned the transition with Tobi. Also his therapy appointments were offered when he was already attending his asthma appointments at the hospital, to reduce the time he might be missing school.
Tobi’s asthma medication was changed, he engaged with his therapy, and his asthma improved.
At point of discharge from the CYPHP team, Tobi’s mum was viewing properties regularly and the family were very hopeful that they would be moved soon. Both his parents had also been smokefree for four months, and he said he and his siblings were all sleeping much better at night because he was not coughing anymore.
Tobi completed his therapy with the psychologist at the hospital, and felt much better in himself. His asthma control had also improved. Whilst he remained on regular treatment for his asthma, it was hopeful that once the family moved, his treatment may be able to be reduced.
What have I learnt?
When working as a ward nurse, I never understood how many external factors can affect a young person’s health and wellbeing. I would hope that this example I created helps other professionals to see how valuable it can be to see a child or young person at home to get to know their environment, and to create the space to talk to them to better understand their worries and concerns.
I have learnt that housing can be a serious issue affecting health, and that it is important to advocate on behalf of families for better housing conditions. My experiences has enabled me to offer advice to others, and also help them understand the system a little better too.
Take home message
It is important to ask the difficult questions, and I believe that at CYPHP we are making a difference to families by asking those difficult questions and giving families the time and support they need. Not only to deal with the physical condition, but offering a well-rounded body, mind, and context approach to their health.
Further advice:
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