The Organisation of Access in Child Mental Health Assessments: A Conversation Analysis of Initial Assessment Appointments at a Child and Adolescent Mental Service

Initial child mental health assessment appointments are an under researched area of interaction. Within the appointment, parents and children work to present a case to the clinicians of the child’s difficulties which situates their cause as legitimate, doctorable, and as requiring specialist services. The clinicians establish the reason for the child’s attendance, build an understanding of the difficulties the child is facing, and formulate and communicate a decision about whether there is a mental health related concern. The objective of this research was to explore the sequences of interaction between clinicians, parents, and the children in order to understand the social actions that are being accomplished through the participants talk. A conversation analytic framework was utilised to explore the interactions at a child and adolescent mental health service within 15 video recorded initial assessment appointments. Access to mental health services is organised through the construction of each participant’s turns in the interaction. Clinician’s question design elicits certain responses from the child, which then further orient to their perceived right to knowledge. Parents work to build a case for their child’s difficulties using a variety of rhetorical devices such as extreme case formulations and contrast devices that legitimise their need for specialist intervention. Clinicians deliver their decision about the child’s difficulties in such a way that asserts their authority and accountability in the relationship, whilst parents’ responses maintains this asymmetry. In conclusion, through their turns at talk, all parties in the interaction perform and accomplish different tasks which impact on the shape of the remainder of the appointment as well as the clinician-patient relationship and the child centeredness of the interaction. Conversation analysis proves a valuable and appropriate resource for researching child mental health appointments; a communication centred methodology for a communication based service.