Welcome to The Croft!
The Croft Child and Family Unit is a residential or ‘in-patient’ centre near Cambridge for children with mental health conditions and their families. We provide intensive assessment and treatment for children with complex emotional, behavioural and social difficulties. We also offer intensive work with parents to help them develop their parenting skills.
Why do people come to The Croft?
At The Croft we work with families to understand the emotional or behaviour problems they are experiencing and to help find new ways to cope with the impact this is having on the whole family. We listen carefully to what you tell us and respect what you say. We agree a set of goals and the action that we are going to take to achieve them. We then record this and prepare a document called a care plan which is, in effect, a contract between your family and the staff team at The Croft.
We use a variety of treatments including family work, group work, one-to-one sessions, music therapy, behavioural management and medication. We discuss with you what is appropriate for your child.
Parents usually hear about our service from their local child mental health worker. If they wish to consider an admission we offer an initial appointment for the family to come to the unit, to meet the team and to discuss what an admission would entail. The Croft team, together with some parents who have used the service, have put together an information pack with detailed information about what happens at the Croft - there is a link to this document at the bottom of the main page.
If both the family and our team agree that an admission would be helpful we will arrange an admission date as soon as possible. Often a family will come back to the unit for one further visit before they start their admission to discuss practical arrangements and to meet the 'keyworkers' who will work with their child.
Children are usually admitted to The Croft with a parent or carer and sometimes with other family members, too. This can be a huge undertaking for most families and we discuss it in detail during your initial appointment with us. Children occasionally stay on the unit alone but this is usually after a period of being resident with a parent and is dependent on the clinical needs of the child and their age and maturity. The day patient service is available to children who live within easy travelling distance and do not require 24-hour treatment or observation. Some families have a combination of day and inpatient care. We encourage parents and other family members to participate in the unit programme as much as possible.
During term-time, The Croft's day is divided into two: the day programme (from 9.30am to 3.30pm) and the residential programme (3.30pm onwards). In school holidays we work slightly differently with what is known as the holiday programme. If you are considering an admission to The Croft we will discuss with you whether it best suits your child's needs to be at The Croft in term time, in holiday time or a mixture of both.
Children's Day Programme (during term time)
On weekdays, the day programme runs from 9am to 3.30pm. It is designed to mirror a child's day at school in that they have the opportunity to be separate from their parents and to be involved in structured activities with other children. The children spend the morning in the unit school and the afternoon in therapeutic groups. In addition, the child and their family may be involved in family therapy meetings and individual assessments and therapy. Please see the Children's Weekly Timetable below in 'more information'.
Parent's Day Programme (during term time)
On weekdays, there are a number of groups for parents to attend, e.g. mellow parenting, drama therapy group, coffee group and housekeeping meeting. In addition to these, parents will have scheduled therapy and appointments arranged around the timetable. In between these scheduled meetings, you will have free time to use as you wish, for example some parents catch up with work, go for a walk or go shopping. Please see the weekly Parents' Timetable below in 'more information'.
Families Residential Programme
Outside the day programme (after 3.30pm) the children are returned to the care and supervision of their parents. Parents work closely with nursing staff during these periods to think about and work on difficulties the family have been struggling with at home. Parents are encouraged to set goals with the nursing staff about changes they want to make and transfer to the home situation. Typical examples are: managing aggressive behaviour, improving meal times and tackling eating problems, addressing bedtime and sleeping problems, making family relationships more enjoyable.
Holiday Day Programme
During school holidays the usual day programme is suspended and children are under the supervision of their parents, just as they are in the residential programme. The holiday programme provides an opportunity to work on family relationships and difficulties and to bring more enjoyment to family life. Staff organise activities for the whole family. Typically there are activity groups in the morning and the afternoon, with children and parents taking part in cookery, art, drama and music classes, football and other sports and occasional off site events. We also continue to run the 'mellow parenting' sessions to help with behaviour management and the housekeeping group.
The Croft School
The Croft School
The Croft School is a fun place for all children, with lots of interesting things to do and learn.
In the classroom you have a teacher who has two teaching assistants to help them. There are usually only five or six children in the class. Like other schools you do reading, writing, maths and science. Everyone learns at their own pace and you can earn special time to choose things you like to do - such as using the computer, playing with lego, having fun in the sand pit - if you've tried hard in your school work.
Here are a few of the comments made by children about the Croft School
“This school is better than other schools, but it is still school.”
“You have really helped me get back on my feet with school. The lessons I have at the Croft have helped me understand my work more.”
“Thank you so much for all the help and support it has really made a difference! Especially organizing my school trips and the changing them if I was uncomfortable! You make school much more fun.”
We have some rules at the Croft to keep everyone safe and to help them make the most out of their stay.
- Listen to each other
- Be kind (speak nicely)
- Share with each other
- Be gentle (don't hurt people)
- Take turns
- Keep your hands and feet to yourself
- Be in the right place at the right time
- Have fun!
- Call names
- Use rude words or gestures (eg, hand signs)
- Run away from the unit
- Damage things
When children fail to follow these rules we take various actions. You will first be given a warning to stop what you are doing. If you have still not stopped after a count of three, the staff may take time off your play time or you may not get treats such as stickers. At times staff may ask you to leave the room. If you are unwilling or unable to do this, staff may have to take you to somewhere safe where you cannot hurt yourself or others.
We would like you to think about the following anger rules. It's ok to feel angry but:
- Don’t hurt others
- Don’t hurt yourself
- Don’t hurt property
- Do talk about it
When children follow the rules they may be rewarded with treats such as stickers, free choices and special time. Following the rules helps make everyone at The Croft feel safe and happy.
What to bring
- Personal care items - toiletries, makeup, eyewear, slippers
- Clothing - day wear and nightwear
- Leisure activities such as books, mindful activities, puzzles
- Mobile phones, tablets or laptops for music, internet access and keeping in contact with family and friends
- Prescribed medication which should be easily identifiable and handed to staff on admission for safekeeping
- Small amount of cash or bank card (optional, there is a safe available in each room)
- Pictures or other familiar items to personalise your bedroom
Staff roles at The Croft
The Croft has a multidisciplinary team of doctors, nurses, health care assistants, psychologists, family therapists, a music therapist, a drama therapist, teaching staff and a social worker. We also have three administrators and a housekeeper.
The Ward manager is responsible for the overall management of the Croft, in consultation with senior colleagues.
The nursing team provide intensive care to families on a 24 hours basis and provide most of the day to day care. Each family is allocated a small team of nurses that work closely with them; the team is led by a senior nurse known as the case manager and two key workers. The aim is that the child and parents will have contact every day with a nurse that they know well. The care team work closely with parents to identify areas of need and to create a care plan to address these. They undertake close observations of children and work with parents to develop strategies to manage difficulties.
The nurses are involved in a variety of therapeutic activities. They facilitate and support the therapeutic day
programme; planning and managing the child’s access to activities and running therapeutic groups. They also do individual work with parents and children.
Outside of the day programme the nurses do intensive parent-child work with families using the principles of psychosocial nursing. This is a model that utilises everyday activities in a therapeutic way. It involves the nurse working alongside parents as they work on areas such as managing risk and safety, behaviour, mealtimes, personal hygiene, bedtimes and sleep. Nurses also support parents to develop the positive aspects of their relationship with their child, modelling play and supporting parents to engage in activities with their children in circumstances that otherwise might make this challenging for them.
Our housekeeper oversees maintenance issues on the ward, as well as ordering and organising the provision of meals and laundry.
Psychiatrists are doctors who are interested in how people think, feel and behave. A psychiatrist who specialises in children's problems is called a child psychiatrist. They work together with other members of the team to try to help children and their families manage better.
At The Croft, the consultant psychiatrist has a role in assessing children and families before they come to the unit and working with families to agree the aims of the admission. Once children and families are admitted to the unit, the consultant will oversee their care. They chair the weekly team meeting when all children are discussed and plans for the following week are worked out.
Psychiatrists have particular skills in diagnosis and working with other members of the team to suggest appropriate treatments. At The Croft we usually have child psychiatrists in training working on the unit. Doctors on the team will monitor children’s medication and suggest changes as needed. They will also work with the nursing team to monitor children’s physical well-being.
There is a part-time clinical psychologist at The Croft and a part-time assistant psychologist. The psychologist uses psychological theories to help families and staff understand children’s emotions and behaviour and develop strategies to improve emotional and behavioural problems. The psychologist also completes assessments with children to answer specific questions raised by parents, referrers and The Croft team. The assessments can include formal assessments or observational assessments. The results of assessments are taken into account when we develop our care plans at The Croft and make recommendations to parents and our colleagues in the community.
The psychologist also works with parents in the Practical Parenting Group and individually. Individual work may be about developing specific strategies for managing their child’s behaviour, helping parents understand the impact a child’s difficulties may have on their future development and supporting parents in developing a better understanding of challenges to their own psychological well-being (e.g. depression and anxiety). The psychologist may also offer individual therapy to children if appropriate.
Family therapy is an approach that tries to understand how a child's difficulties connect with the people in his/her life. These can include parents, carers, siblings, wider family, friends and professionals (for example from schools). Understanding the ways in which relationships connect can be helpful for all those involved. Family therapy at the Croft usually involves weekly meetings, starting with parents or carers, and then including the child, followed by siblings, wider family members, or other significant people.
A dramatherapy group is offered to all parents at the Croft. Individual sessions for parents and children are also offered. The dramatherapist can also provide play based dyadic sessions for parents and children. Play activities are facilitated to help build the relationship between parent/s and child and also enable the child to find additional ways of communicating.
The art therapist at The Croft can provide individual, dyadic (parent/carer with child) and group therapy. Art therapy offers children a judgement-free, safe and creative space to express and explore feelings, ideas and concerns. It is helpful for children who find verbal therapies difficult and/or who can't easily express themselves with words. Children don't have to be 'good at art' to benefit. They are encouraged to be playful and the spontaneous. Themes will often emerge in children's approach and imagery which help to understand their needs and difficulties. Art making can also build self esteem and confidence.
The music therapist provides individual/family and group sessions to the families at The Croft. Music Therapy offers a non-verbal way of relating and a means of expressing feelings and processing experiences that might not otherwise be easy to articulate. The music therapist uses his/her musical skills and therapeutic knowledge to offer musical interaction to supportively explore ways of relating, expressing and sharing. Musical interactions may shed light on abilities and challenges of the child or family. Individual/family music therapy sessions give opportunities for family members to explore feelings, ways of expressing and strengthen relational skills and bonds. The music group is a group for the children at The Croft to play together, share feelings, and to explore relating with one another.
The teaching staff are committed to reengaging you with your education and keeping you up to date with your mainstream school work as far as possible.
There is a part-time social worker at The Croft who can offer advice and support about things such as welfare benefits or housing issues. Where families already have a social worker or family support worker involved, The Croft social worker will liaise with them to make sure there is good communication during the family's stay at The Croft. Along with the rest of the team, the social worker is also involved in trying to ensure that there is the right level of support in place for families when they leave The Croft. If a child has a Child in Need or Child Protection plan the social worker will ensure that information about the child’s needs are shared appropriately.
Head of Patient and Parent Involvement (HOPPI)
The HOPPI seeks constant feedback on parent/carer and patient experience, to give you a voice and to help the service develop.
The administrative team play a pivotal role in helping the effective and smooth running of the service.
The advocate will listen to the views being expressed by all young people to make sure that important issues are raised with the staff team at the Croft.
Assessments and therapies
The Croft uses a range of therapies and assessment strategies in supporting children and helping their development, including the following:
This therapy uses techniques to encourage desired behavious and discourage undesired behaviours. It involves the use of carefully chosen rewards and consequences to help shape a child's behaviour.
This is an approach that tries to understand how a child's difficulties connect with the people in his/her life. These can include parents, carers, siblings, wider family, friends and school, etc. Understanding the ways in which the relationships connect can be helpful for all those involved. Family therapy usually involves children being seen with their parents together with their brothers and sisters.
Once a week parents meet to explore and understand their own past and current difficulties and how they may impact on their parenting. The group allows parents to feel supported by other parents who share their experience, and helps to make them feel less isolated.
The music therapist works at The Croft for two days a week. Individual sessions, group sessions and sessions for children and their families are offered as part of this service. The music therapist uses his/her musical skills and knowledge of music to establish musical interactions with children and families. These musical interactions may shed new light on the children’s and/or the families’ strengths and difficulties. Music therapy diagnostic assessments can assist the team in assessing children or families. Short-term music therapy treatment may be able to address some of the difficulties a child or a family may be experiencing.
The dramatherapist is on the ward for 13 hours per week. It is an activity-based therapy which uses various creative methods to explore issues. It is also a strength-based method which enables children or their parents find helpful qualities in themselves that they may have forgotten about or that have been hidden. A weekly parent group, individual sessions for children and parents and dyadic work is offered. The parent group is a space for parents to gather together and use creative activities offered by the dramatherapist to reflect on themselves.
Parents usually find the group helpful to build their resilience and sometimes to just have fun together. The families at the Croft are often in crisis and the relationship between parent and child compromised. The dramatherapist uses her specialist knowledge of play to plan interventions to work on exploring and improving the connection between parent and child through various dramatherapy tools and techniques. Often children can struggle to communicate. Dramatherapy interventions provide alternative ways for the child to relate and also help the parent understand their child’s presentation.
In this technique,children are presented with a range of different family scenarios as the beginnings of a story, using doll and animal figures as well as language. The child is then invited to complete the stories in whatever way they like. This allows assessment of the child's expectations and perceptions of family roles, attachments and relationships, without asking the child direct questions about their family which might cause them conflict and anxiety. It also has the advantage for younger children of allowing both verbal and non-verbal means of representation.
Autism Diagnostic Observation Schedule (ADOS)
The Croft uses ADOS to provide accurate assessment and diagnosis of autism and pervasive development disorders in children related to their age, development level and language skills.It consists of four modules each requiring 35 to 40 minutes to administer. The child being evaluated is given just one module depending on his or her expressive language level and chronological age.
Autism Diagnostic Interview (ADI)
The Autism Diagnostic Interview is a structured interview conducted with the parents of children who have been referred for the evaluation of possible autism or autism spectrum disorders. The interview measures behavior in the areas of social interaction, communication and language, and patterns of behaviour.
Wechsler Intelligence Scale for Children (WISC-IV)
WISC is an individually administered intelligence test for children between the ages of 6 and 16 that can be completed without reading or writing. The WISC test takes 65–80 minutes to administer and generates an IQ score which represents a child’s general cognitive ability.
Parents' experiences of the Croft
Here is a small selection of feedback we receive regularly from the parents and carers of Croft children.If you would like to share your views on the service provided at the Croft, please click here
The Croft advocacy service
Advocacy means enabling people, including children, who sometimes cannot say what they think or how they feel, to be heard. The Croft has an independent advocate from NYAS (the National Youth Advocacy Service), who is available to help with this process.
The role of advocates is to:
Safeguard the rights of service users (ie, patients, parents, cers and anyone else who uses NHS services)
Empower service users to make informed decisions about their care and treatment and to take greater control over their lives
Support service users to get their views heard
Represent the views of service users as if they were their own if the service user wishes it
Support service users in seeking resolution to issues which concern them
Protect service users who are particularly vulnerable for reasons of their illness or lack of capacity to make informed decisions.
Feed back issues raised by service users to those providing and commissioning services so that services can be constantly improved. You can contact the Advocate at firstname.lastname@example.org. They only provide direct services to children but they can help find advocacy services for parents if requested.
Freephone: 0808 808 1001
Into The Croft …
Following the family’s initial appointment, once an admission has been agreed the family will be allocated a link worker, whose role it is to support the process of the family’s transition into and out of The Croft.
The link worker will contact the family to identify a provisional start date with them. As we sometimes need to extend a current admission or may have an emergency admission this date can be subject to change. We keep families informed if any change is needed and aim to confirm the start date one to two weeks before the admission is due to start.
The link worker will arrange to make a home visit to meet with the child’s parent/carer in order to complete our pre-admission paperwork. This includes consent forms, risk screen, and identifying goals for the admission that will form the basis of the child’s care plan. It also provides an opportunity for parent/carers to ask any questions they might have. The link worker will also arrange a date for the family to return to the Croft for a pre-admission ‘refresher’ visit, usually a week or so before the admission starts. This is an opportunity for the family to have another look round the unit, be given information about practical aspects of being at The Croft, and ask any further questions.
Where there are issues around school our teacher, the link worker or another member of the team will try to arrange a school visit before the admission, in order to gain a better understanding of how the child manages in class and what support the school is offering. Likewise if there are multi-agency meetings already in place, e.g. TAF, child in need or core group meetings, then with parents’ consent we may also try to attend these. Sometimes we arrange additional visits either to the family home, or for the child and parent to visit The Croft, where this is needed to aid the child’s transition into The Croft. This might also include input from our family therapist, or a member of the nursing team.
Out of The Croft …
The Croft can continue to offer some input/support to a family for up to 3 months after discharge to help transfer the gains made at The Croft to the home setting, and as part of the process of ‘handing over’ this work to the community teams involved. At the child’s CPA discharge planning meeting there will be discussion with parents and community professionals about post-discharge plans and what follow-up work by The Croft would be appropriate. This can include some home visits (to support parents with consolidating behaviour management strategies), family therapy, music therapy, psychotherapy or individual psychology sessions; also school visits or attendance at multi-agency meetings. Some of this work might be done jointly with the community team to ensure smooth handover so that the family continues to receive the right level of support.
Health promotion for children
We want to share the health promotion work that we have been doing with the children and families that use our service as part of a continuing quality improvement programme. First, we’ve been making sure that we carry out a thorough assessment and provide treatment for any physical health problems that the young people in our care may have. Second, we’ve taken advantage of this period of intense contact with the health service to stress the importance of good health habits in the early years as these will have a positive effect on health throughout our patients’ lives.
In common with other in-patient services, we carry out a health screen with all new patients to look for any physical health problems as well as side-effects of any prescribed medications. When we audited this we found that we were 100% compliant with the standard required.
Weekly health group
We have set up a weekly health promotion group, looking at everything from diet to dental hygiene. This safe use of the internet to reflect the personal, social and health education (PHSE) requirements of the National Curriculum. Children are encouraged to have daily physical exercise in break times and after programme time in the evening. We support this by planning recreation groups on a weekly basis that involve activities such as swimming, ice skating and trips to country parks and National Trust properties. Taking into account our patients with eating disorders, we have introduced a gentle yoga group which has also involved parents. We hope to develop this further as a means of promoting health and relaxation.
As well as group activities, we put together individually tailored plans, which include diet recommendations to meet the needs of children and families.
Children at The Croft are extremely unlikely to have engaged in smoking, drinking, or drug taking due to their young age, but we are always mindful that this may have occurred. We address these issues with the individual rather than in a group setting.
Children’s weights are monitored weekly and dietary advice given on an individual basis in conjunction with the advanced CAMH dietitian. All the food served at The Croft is home-cooked by our housekeeper who is undergoing additional training on specialist diets to cater for differing needs, including allergies and food intolerances. Even small changes such as a move to ‘high juice’ squash has reduced sugar intake. This means fewer ‘empty calories’ and better dental hygiene for our patients.
We review the content of our health promotion activities regularly and modify them to reflect the needs of current patients in respect of their age, gender and interests.
Links to websites that parents might find interesting
Parent Information Pack
This pack contains useful information for parents and carers of children staying at the Croft. Click the link below to download it.