① What are your STRENGTHS?

It's important to meet people in their happy place, what IS working, what are they good at and what do they enjoy. It's always important to go broad, so outside of school and work, what's fun and what are they a natural at?

During the interview I always like to pause if they have overcome a difficult time in the past, I will point to the strengths chart and ask "How did you do that?".

This step often gets missed because because we're under pressure to help with the problems but it's a gold mine in 3 ways:

• It reminds people of what they CAN do and they open up and it's easier to build rapport.
• You get to know them more broadly, complete with secret superpowers and creativity.
• These strengths can be mined later to assist with the problems, even as a reference point to "How do you feel when things are going well?", but also "How can we use this to build confidence?".

② To-do list of CHALLENGES.

• I now we want to invite everybody in the room, starting with the young person and family, to list all the issues at the moment. The treating team can then add to the list.
• When listing the issues I start with headings and make them technical such as difficulty getting to sleep, mood low most of the time, conflict with X, getting frustrated, risk issues (cutting, feeling suicidal), etc.
• If emotions are expressed I will also draw a small emoji beside it to call back to later when we see behaviours through a polyvagal lens (Step ⑦).
• We figure out what we have to deal with today?
• You might find in the triage prior to referral issues have been identified, but it's important to use this process to make sure we're across everything that's going on and make sure our help is client centered.
• Before we dive into unpack the highlighted issues, I pause and gather more background (Step ③-⑥).

③ How old are you?

• Next I ask the young person's age in years and months.
• A lot changes in a short amout of time through out childhood, but expecially in adolescents such that 6 months can make a huge difference with impulsivity and risk, so it's important to be accurate.
• Once I've filled in the age, I add dashes for all the years so as new information comes in we can place it on the relevant part of the timeline.
• This includes information such as when did the anxiety start, when did x happen. This helps everyone make links between life events and problems.

④ Where were you born?

• Next I ask where were you born and where have you lived?
• This is easy information to give and not too confrontational, but can help the clinician get a sense of how much the family has moved around.
• This can be helpful as often we move because major life events or, moving can be a major life event.

⑤ Who lives in your house?

• Now we're ready to move onto demographics:
• First I like to know who is living in their house.
• Then I move onto the family history, looking for mental illness, developmental or learning difficulties, or people who have passed. If there has been a death in the family I will add it to the timeline.
• I also want to know who is the child or young person close to and turns to for help.

⑥ What's hard, what's easy...

• Next I ask about school or work looking at "What's easy?" and "What's hard?".
• I draw list activities under a "League table" or happy or sad emoji
• I use this as a basic cognitive and functional screen.
• If they are a bit older noting the highest level of education at school, or vocational training is also helpful.

⑦ Presenting problem + Polyvagal lens.

Now we're ready to return to the "presenting problem" or identified problems on the To-Do List.

As well as the conventional approach to diagnostic clarification of mood disorders, anxiety disorders, substance use, I will also look at things through a polyvagal lens.

Polyvagal Theory - Triggered Not Bad

• Stephen Porges describes 2 nervous systems: Social Engagement (Think + in-control), and Survival Mode (emergency-override, reactive flight, flight or freeze, emotion driven).
• Adrenaline release switches on Survival Mode by amplifying emotions and turning of parts of the brain to focus on the threat and negative.
• Anger, fear or numb feelings drive the survival reactions of fight, flight or freeze to what the body percieves as a threat. So FOLLOW THE EMOTIONS (and emojis)!
• We can understand "problem behaviours" as a Survival Mode response, and move to understand what triggered it.
• The solution is to switch off the Survival Mode is breathe with the diaphgram, cue the body to safety and rebalance the adrenaline mobilised body, or activate the parasympathetic driven freeze shutdown of the body.

⑧ Always use the Emoji Dictionary.

• When ever an emotion is mentioned I clarify by drawing the matching emoji.
• It helps to be able to draw the basic emojis of happy, angry, sad, scared, numb, stressed.
• When I am exploring emotions I will draw different emojis and probe by saying, "Often when X happens people can feel angry 😠, or sometimes stressed 😨, I wonder if you felt that way?".
• I will to help the young person tell the feeling story associated with each emotion.
• When the young person is shrugging and can't identify how they are feeling I pull out a sheet of emoji faces and explore the different emotions to try to identify the likely one.
  

⑨ What does BETTER! look like?

At some point we need to move from problem focused - once it's fully understood, to solution focused.

• How will we know when things are better?
• What are the actionable steps we will take to manage the problem when things are better?
• I use guided imagery where we imagine a year from now and the young person is feeling happier, more confident and smarter, how will that version of them manage the problem?
• What is the first step in that journey?

⑩ Take a picture and ID gaps.

• Step back and assess the timeline for any gaps in information, then ask additional questions to fill those gaps.
• Make sure you have a full understanding of the young person's early life and developmental history, especially for individuals with Autism Spectrum Disorder (ASD).
• Use the timeline to identify areas where there may be a lack of background information or discussion around important transitions.
• The timeline serves as a valuable tool for supervisors to identify areas that require further exploration and understanding.

• Offer the family the opportunity to take a copy of the visual assessment home. Encourage them to take a photograph of the assessment for sharing or future reference.
• This approach promotes a co-created and client-centered understanding of the situation.
• Print and scan a copy of the visual assessment for future reference and to enhance report accuracy.