A Day in the Life…Clinical Burns Psychologist

Celebrating 25 years of Children’s Burns Trust & our relationship with the incredible people working in the UK Burn Services, we have asked those involved in the care of children who experience burn and scald injuries and who receive treatment in the specialist Burns Centres to answer a series of questions about their work. We hope you will find these stories as interesting and moving as we have. Our sixth story comes from Aayesha Mulla, a Clinical Paediatric Burns Psychologist working with children following a burn injury at the Chelsea and Westminster Hospital.

I’ve been in burns psychology now for just over ten years!

One of the things I really enjoy about working in burns is that no two days are the same, so it’s difficult to describe a typical day. There is something of a routine though. The morning always starts with a check in with the rest of the psychology team. One of the team (usually not me as I’m probably the least morning person in the team) will attend the 8am handover with the multidisciplinary team (MDT) to find out who is new on the ward, and hear updates on existing inpatients. The psychology team meet at 9am to go over the patients who may need psychology input, and the tasks are divided up based on our other commitments over the day.

The psychology team is made up of four qualified clinical psychologists and an assistant psychologist. Lisa leads the service overall and works with burn injured adults, I’m the lead for paediatric burns psychology and work with burn injured children, young people and their families; Harriet and Raph work across the lifespan so split their time between adult and paediatric patients. Mollie, our assistant also works across the lifespan and is the glue that holds the rest of us together!

The reason it’s important to know who is new on the ward is that, following the national guidelines for burns psychology, we try to meet with all families on the ward where a person has been an inpatient for over 12 hours. We go through a psychosocial screening questionnaire we call the ‘Time 1’ questionnaire. This is a list of questions we ask families to understand their existing strengths and challenges, their support networks and their social context.  Going through the questions with families gives us a chance to talk about what to expect behaviourally and psychologically for themselves, the burn injured child, and any siblings or family members following a traumatic event like a burn. It’s also a good opportunity to let them know about our service, how they can contact us if they feel they would like more support now or in the future and it provides a space for them to ask any questions that they might have. I feel that parents and carers find this meeting reassuring because we go through common responses and behaviours seen in burn injured children and their parents and we talk about things to look out for that may be of concern. More specifically, we explain what are common, helpful or healthy responses to traumatic events, and what might meet the criteria for post-traumatic stress.  We also offer a ‘Time 2’ questionnaire, three months on from the burn injury, which means we can check in with families on how they are doing a bit further along in their journey.  The questionnaires are a good way for us to identify families who might need more psychological support because the burn injury itself is not a good predictor of which families are most likely to struggle psychologically.

Once we have divided up the Time 1 screens, and I’ve carried out those allocated to me, I will often check in with Mars ward (the paediatric burns ward) staff to see how they’re doing, if they have any concerns about any families not currently on the ward, or want us to be aware of someone they saw in outpatient clinics.

As well as the inpatient Time 1 questionnaires, we might offer ongoing inpatient support to families on the ward as needed.  I’ll usually head back to the office to do some notes, admin or phone calls. The Time 2 questionnaires are often either emails or phone calls, so I might try to make the phone calls allocated to me for Time 2s at this time.

We also call families who have been referred to us for outpatient support for a brief initial phone call to better understand what they’re hoping for from psychology, and to make sure that we’re the right service for them. Sometimes a family might get in touch about a mental health or psychology need that may not be burn related, or may be better supported by another service in the community. If that’s the case, we might make or support onward referrals to other services. For families that meet our service remit and would like support, we would then arrange outpatient appointments.

We offer outpatient appointments face to face, via video call or over the phone, depending on what is clinically most appropriate to meeting the patients’ needs. I will usually see my outpatients in the afternoon. Therapeutic support is individually catered to a family’s or individual’s goals. Some people may be looking for specific strategies to help them to manage aspects of their recovery journey, some may want a space to process their experience or trauma, and feel more able to accept their new reality. We offer support for the burn injured child, parents, siblings or any other member of their family impacted by the burn injury.

I will also spend some of my time liaising with the other services in a child’s life. This might include school, children’s services, or other hospitals also looking after them. We support families and schools to think about how best to reintroduce children to school, especially if they have been off for a long time following a burn injury. We might think with them about techniques or ways to handle questions from other students; what accommodations they might need in order to look after their burn at school, such as rest breaks; how they might catch up any work they might have missed; and any social concerns they might have about going back to school. We can also help teachers and school staff think about how they can support a child’s return to school. That might include what they might say to the other children, what they might look out for, and what to expect from the school day. In the initial few days, children might find it tiring to be back full time, so may need to gradually increase the time they can be at school. We’re very lucky that we have a hospital school within our hospital, which can help children stay on top of work while they are on the ward.  For older children, our school can provide a space for them to do their GCSEs or A Level exams if they are still an inpatient with us during that time.

About once a week I will also check in with other professionals at the hospital who support a burn injured child’s overall functioning while in hospital. This might be the play specialist, the art psychotherapist, hospital school, and in some cases the safeguarding team.

Some of my time also goes to providing training and education to our MDT colleagues about the psychological aspects of living with a burn injury. All clinical psychologists are ethically required to have regular supervision, where we meet with a colleague to discuss our cases. I also provide supervision to some members of the psychology team, as well as receiving regular supervision myself.

I was working in paediatric psychology working with children with other long term health conditions when the role to specialise in burns came up and looked interesting. I went for it and never looked back! I really love the variety of work we do in burns. Although most of the children we see tend to be four and under, we do see a range of ages up to 18. We also see people from a real mix of social and cultural backgrounds, at different points in their recovery journey. There is a lot of scope for new projects as well, such as a psychosocial training manual that we are working on at the moment, or a message book project for parents. It’s really important to me that all the families we meet find our services accessible. This includes being aware of and curious about their cultural and social contexts, and language is a big part of that. We make sure we use interpreters and encourage MDT colleagues to do the same. I’m lucky enough to speak several languages so am able to speak to some families in their first language. This can be very comforting at such a distressing time, and I can see the real difference it makes being able to offer the service in a first language, regardless of whether the family has fluent English too. I like that I get to work with a variety of professionals from across the public, private and charity sectors too.

It can be quite challenging for families, more than for us, when they are facing economic or social challenges such as financial hardship or inappropriate housing conditions. We can see how the circumstances that caused the burn were so out of the parents’ control at times, and that being discharged home safely may be tricky for them. That can be difficult.

We also sometimes see families who don’t live locally and have had to travel from outside of London for their care. It can sometimes require extra work to link up with services outside of London, compared to those locally, and where we are more familiar with their set up.

Whilst we work well together as a psychology team, we  also work really well as a wider MDT to think about how best to support families in those circumstances, and we try to put them in touch with relevant services or charities who might be able to help address a need.

I’ve worked with children and families for most of my professional life , so working with a family network or system feels like my default setting. I think about what happens in the interactions of a family. That can be within the family; child to parent, parent to parent or step parent, siblings, grandparents; as well as the interactions outside of the home like hospital or school. I include all aspects of a child’s life into my thinking when forming an understanding of their challenges and strengths and invite different members of this little ecosystem to do things slightly differently to try to bring about change for the family as a whole.

I find it rewarding when families feel that the work we’ve done together with them has had a positive impact on their lives, whether that means feeling more comfortable talking about the burn, or doing things that they felt the injury or recovery had prevented them from doing in the past.  It’s really lovely seeing a child grow in confidence in their relationship to their burn, and when families see the burn injury as part of their life story, and not all of their life story. We’re lucky in our service that since we’re a lifespan service, we will sometimes hear how things have changed and how well children are doing several years down the line.

I think the support is invaluable; there is financial support for those in hardship, national campaigns focussing on prevention and awareness raising are so crucial.  We have some parents or carers who knew what good first aid to do because of a Children’s Burns Trust campaign or seeing the website when they looked up burns first aid on the internet.  You also give families access to stories of other families who are further along in their burn recovery journey, which I’ve been told has been reassuring to a lot of parents.

I’ve not done fundraising, but I have done some education in local cafes, talking to staff about burn injury awareness and prevention. So many cafes are gathering points for parents with young children.  I’m sure they have had health and safety training as part of their roles, it feels important to remind staff and managers of those basics.

Routinely keep hot drinks and fluids out of reach of young children, and make sure you turn saucepan and cooking pot handles away from the front of the cooker so little hands can’t get hold of them. Children often come to the burns unit because one day they suddenly make the developmental leap to do something they previously could not. They reach further, start moving faster or climb higher than a parent thinks they can, because possibly the day before they could not. This change happens rapidly, so getting into the habit of creating a safe environment before you absolutely need to is what I would like people to know.

I think that more people are aware of first aid procedures now. I see more parents or carers now who knew to do 20 mins cooling with cool running water compared with ten years ago.  That specific phrase of ‘20 minutes cool running water’ seems to be more widely known now. People may have done some cooling in the past, but it wasn’t usually 20 minutes. I think the other thing that feels very different is people’s relationship to social media. We see some older children or adolescents who want to share their stories online with friends or for content. This can be a positive thing, giving young people and families ownership over their own stories, but can also put some in a vulnerable or more exposed position. I think that’s particularly the case in circles where appearance is given a great deal of importance. On the one hand, diversity is celebrated and seen as a strength, and some young people are very confident in their appearance difference as a result. Conversely, some families express more experiences of racism or hardship, and the burn recovery has been an added stressor on already difficult circumstances.  

Happy Anniversary, and keep up the great work!

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