Intervening Early With The Tree of Life – A creative way to help school children talk about themselves

Narrative therapy, children telling the stories of their lives and culture, can be an effective early intervention that prevents more serious mental health issues developing in children. Carl Dutton explains.

There is evidence that supporting families and carers, building resilience through to adulthood and supporting self-care reduces the burden of mental and physical ill health over the whole life course, reducing the cost of future interventions, improving economic growth and reducing health inequalities

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      string(5664) "There is a high incidence of young people with special educational needs in the youth justice system. For all those who enter the system with EHC Plans/Statements of SEN or additional needs, there are more than double this number who enter the system with unidentified needs. They have gone through the education system, without their needs being ‘picked up’. There is a moral imperative on society, and particularly on youth offending teams across the country to do something about it, to secure better outcomes for these young people. In this article Marius Frank looks at a Department for Education funded project, which aims to do just that and is having promising results.The project- the Youth Justice SEND Project brings together Achievement for All, the Association of Youth Offending Team Managers and Manchester Metropolitan University to support professionals to bring about a culture and behaviour change around effective SEND joint working. Funded by the Department for Education (co-managed with Youth Justice Board and Ministry of Justice) it builds on the pioneering work of both the Council for Disabled Children and Sheffield Futures. The project which endeavours to continue driving and embedding a culture-change around effective SEND joint working, transforming outcomes for young people with SEND who offend (or who are at risk of dong so)is focused around the following strands:  a)  Building local networks and sharing good practice: Creating effective, active and sustainable local networks of professionals and sector champions (including representatives of local authorities, Youth Offending Teams, health, social care, education providers and the secure estate) that are able to develop and implement practice that improves outcomes for these young people.b)  Continuing to build knowledge and understanding of the SEND reforms (building on last year’s work led by CDC and Sheffield Futures)- particularly around how the reforms impact on current practice within the Youth Justice System through research and through the networks established through this project (sharing evidence based effective practice and innovation). Engage busy professionals with ideas that help meet their needs, including new cross-cutting training.c)   Monitoring outcomes and improving the system – Helping the sector monitor and analyse local authority SEN and disability support and outcomes of children and young people pre-, during and post-custody and address identified weaknesses and gaps (using evidence and data to best effect). d)  Working with young offenders and their parents – Building a good understanding of the challenges that children and young people with special educational needs and disabilities and their parents, have prior to, during and post custody.ResultsThe results are promising and show that by embedding this type of joint approach around the young people, better outcomes are possible.  220 survey responses were analysed, from 86 Youth Offending Teams (YOT) covering 92 Local Authorities. Witness testimonies were gathered through a series of regional workshops across the country from nearly 400 professionals working across youth offending and LA SEND straddling nearly 120 Local Authority areas, as well as some staff from the secure estate, charities working in the sector and NHS England. Interviews were secured with over 30 children and young people within (or with recent experience of) the secure estate.Key Findings show that:a.  The proportion of children and young people they are working with who may have SEND is higher than official statistics suggest (both in the case of CYP with needs that are significant enough to trigger the EHCP process, and those that schools and academies would normally support through delegated SEN Support funding)b.  Information flow and case management between LA SEND Teams and YOTs appears to be adequate in some instances, with room to improve in many areas of the countryc.  Information flow and provision continuity between sending LAs and secure estate lacks consistency; whilst some outstanding practice is apparent, there is much that can be improved in terms of communication, liaison and meeting individual learner needs within elements of the secure estated.  LA Staff have welcomed a professional support and development resource to illuminate the youth justice pathway more clearly, and YOTs have welcomed a similar resource that helps all staff understand the types of SEN that are prevalent in the youth justice system, and a database of strategies ideas and advice from other providers to inform intelligent design and redesign of local services (The Youth Justice SEND Bubble)e.  Some YOTs find it extremely hard to secure adequate resources to support CYPs with SEN in the youth justice system. However, there are examples of local effective practice that other areas can learn from.Effective practice includes:1. The co-location of specialist provision (e.g. Speech and Language Therapists, Ed Psych, CAMHS) takes unnecessary delays out of the equation that sometimes occur if provision needs to be “commissioned in”2.  Access to high needs funding through local delegation policy and practice3.  Multi-Agency “Teams Around the Child” working together, not in isolation, meeting regularly4.  Proactive awareness and intervention work with YOTs working within early intervention teams, Fair Access Panels and within Local Inclusion"
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Emotional and Behavioural Difficulties

Caught in the Youth Justice System!

16 Oct 2017

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      string(298) "Numerous studies have shown how much teachers can do to help depressed young people. But, in reality, most teachers don’t have enough time, enough support from parents or enough health service support. Dr Cathy Street shares her research into teacher’s views on mental health."
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      string(5849) "alreadywww.teachingtimes.com n Vol 1.1Health Every Child Journal53experiencing some form of mental health problem, thesedifficulties can be exacerbated.Some of the barriers include practical issues. Some parentsmiss meetings at school because of work commitments.Engaging with parents is more likely to succeed when theschool offers a flexible approach. It was noted that parents aremore likely to participate in schemes that take up less time.Any answers?Despite the wide-ranging concerns highlighted by schoolstaff, they reported progress in a number of areas. In agrowing number of schools, avenues for young people toaccess support are becoming more established and a moreembedded part of the school.School staff said using the PSHE curriculum to supportsessions on promoting strong freindships, tackling stigmaand discrimination was effective. Some of the projects orinitiatives aimed at providing support– like the provision ofmentors, counselling, learning support assistants and drop-insessions – are now showing outcomes for pupils.A number of reports on this topic also provide usefulpractical advice and pointers for what school staff should lookout for. For example, Young minds in our schools is a usefulchecklist of warning signs school staff should monitor.The checklist includes: changes in general behaviour(for example, kids becoming anxious or restless, aggressiveor disruptive), changes in patterns of work (including beingunable to settle, losing interest and not handing in work),changes in patterns of attendance (including being reluctantto leave school at the end of the day) and changes inrelationships – for example, having few friends and avoidinggroup activities.The National Institute for Health and Clinical Excellence(NICE) has also produced a range of guidance for theeducation sector. It can be downloaded for free from the NICEwebsite – nice.org.uk. In March 2008, NICE issued guidanceon promoting children’s social and emotional well-being inprimary education. Their guidance for the secondary sectoris expected in autumn this year. The Institute has alreadypublished guidance on depression in children and youngpeople, eating disorders and Attention Deficit HyperactivityDisorder (ADHD). It offers easy to follow charts setting outwhat to do at each stage. Its range of publications also includeadvice and information for young people, their families andcarers. Within this guidance there are lots of ideas – includingself-help options for children and young people.School staff can also find downloadable resources fromthe website of the National Healthy Schools Programme– healthyschools.gov.uk. Many of the national charities andvoluntary sector organisations working to promote themental health and emotional well-being of children andyoung people also provide materials – like:For the primary schools sector, Partnership for Children(partnershipforchildren.org.uk) supports an in-schoolprogramme called ‘Zippy’s Friends’. It helps children todevelop coping skills.The My Life programme produced by the Children’sSociety as a result of the Good Childhood Inquiry(mylife4schools.org.uk) aims to support Key Stage twoteachers through the use of six interactive units thatprovide case studies and activity sheets for use in class.Rethink (rethink.org.uk) has produced several packswritten for the education field – including one for traineeteachers tackling the stigma surrounding mental health.There is also a resource pack with information sheets forschool staff and pupils explaining mental health.A more widespread strategic approach toin-school supportOver the last decade, there has been much emphasis onschools and staff in specialist Child and Adolescent MentalHealth Services (CAMHS) working together. A nationalpathfinder programme with £60 million of governmentmoney, Targeted Mental Health in Schools (TaMHS), hasbeen launched to support the development of mental healthsupport in schools. These are welcome developments. Therehas also been a general increase in work at a strategic levelthrough local commissioning structures. Hopefully, this willensure that provision in schools is planned within the rangeof services supporting the mental health of children andyoung people.The growth of consultation support from colleagues inspecialist Child and Adolescent Mental Health Services isanother welcome development.The challenge, however, remains for making thesearrangements sustainable and mainstream. When staff feelinformed, supported and connected to their local networkof services, pupils with mental health problems can not justcope in school – they can flourish.Dr Cathy Street is the lead researcher for a study intosupport in schools for young people with depression. It isfunded by the YAPP charitable trust.nnn1 Mental Health is Everybody’s Business: A Handbook for Schools and other Agencies in Northamptonshire. (2007) Northamptonshire Children andYoung People’s Partnership2 DCSF and DH (2008) Children and young people in mind: the final report of the National CAMHS Review3 Pettitt, B. (20030 Effective joint working between Child and Adolescent Mental Health Services (CAMHS) and Schools. London: DFES RR412/Mental Health Foundation4 Shucksmith, J. et al (2005) Investigating the Links between Mental Health and Behaviour in Schools. Report to the Scottish Executive EducationDepartment Pupil Support and Inclusion Division. Available for download at www.scotland.gov.uk/Publications/2005/11/29105508/550915 Study of Glasgow school students by Gordon and Grant in 1997, cited in"
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Special Needs

The young depressed - how teachers can help

9 Oct 2009

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      string(5731) "stories and use their imagination as a warming up process to the drawing/painting of their own particular tree.Warming up is vitally important to “build group cohesion and spontaneity” (Blatner, A. 1973. Acting-In, Practical Applications of Psychodramatic Methods, p.11. Springer).Each part of the Tree is worked through weekly and also can be gone back to the following week. Some young people feel the urge to do everything at once, while others take their time either, because they find it hard to start or that ideas take time to develop.Example TwoIn a session with teenage young people who were all newly arrived to the United Kingdom, we discovered in the roots the importance of cultural identity through shared languages, music and foods. One of the young women talked about her home in South America and how she missed the food, music and bright colours in the streets. During our time together as a group, we played music from different parts of the world via phones. The young woman spoke about how she never really got an opportunity to speak about her culture and how important it was in respect of identity.The Tree of Life also allows for stories to develop, both on an individual basis, but also as a collective and, during the many sessions I have run over the past few years, this has been the case. As the facilitator, it is important to be flexible within the framework and that doing something creative may mean that you go in a slightly different direction than you had originally planned. It is important to allow this to happen and encourage, as a shared story may develop which may lead to group discussion/reflection.Example ThreeOne young person in a group stuck glass stones in the Tree canopy which he said were special stones with magical powers. It developed into a discussion with the group about what magical powers would they want to change things and how would they use the powers. Again, stories developed and a shared story was created about things wished for and how they might be able to get them. Often not easily and usually through some adventure and obstacle to overcome.  It has been well-received in all the schools across Liverpool which asked for the programme to be run and initial feedback is very positive from the young people and the school staff who have co-facilitated the sessions.Over the time I have been using this method, it has been scored via questionnaire as 63% as excellent and 37% as very good with no negative feedback noted, although some schools wanted the sessions to go on longer, as did some of the young people.At the end of the sessions, we often do a combined tree together to represent the group and gain feedback in a less formal way and each child is given a certificate of attendance for completing the sessions. In some of the schools, we have also provided each child with a small plant to grow and nurture, such as rosemary, which is able to survive tough conditions and grow in most yards, in a pot, or a garden. It is important to mark and celebrate the work acknowledging what the children and young people have done.Final CommentsThe Tree of Life as a programme is easily implementable and requires only a small number of resources. It meets the needs of helping children and young people talk about themselves, their lives and culture, and is something that enhances emotional health and wellbeing in a normal way.It has potential to help schools and staff to support the emotional health and well-being of the children, offers space for children to be creative and expressive, and can aid assessment in terms of development.FeedbackTeachersIt was great. The children were allowed to explore their thoughts and thinking process in their own time.It encouraged them to consider wider issuesChild-ledIt gave the students time to share where they come from in a positive and creative way.Children and Young people.It was relaxing. It made me feel calmSome of the things we talked about were hardI felt creative.I felt happy and relaxed.It was hard to talk about family.I liked role playing.Carl Dutton is a Senior Mental Health practitioner working for FRESH CAMHS at Alderhey Children’s NHS Foundation Trust. He works in schools across Liverpool as part of the CAMHS Partnership, which is a unique jointly commissioned service involving statutory and third sector providers supporting the emotional health and wellbeing of children and young people.He can be contacted via email at carl.dutton@alderhey.nhs.ukReferences1.	Mental Health services provided in schools are some of the most accessible for CYP. This is because most CYP attend school, access to schools-based services does not require a clinical diagnosis, and schools are often the first point of contact for CYP and their families when they begin to experience mental health problems. A 2017 joint report by the Health and Education Select Committees emphasised the importance of a whole-school approach to mental health, mental health training for teachers, and co-ordinating schools and children and young people’s mental health services.2.	A key part of schools’ mental health work across the entire education system is preventative; for example, building resilience, promoting wellbeing, and destigmatising mental health issues through Personal, Social, Health and Economic education (PSHE). ( Postnote Number 563 October 2017 p.2).3.	Graham Allen MP was asked by the then Prime Minister to review the use of early intervention programmes for children and families and concluded that, “If we intervene early enough, we can"
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Inclusion and Pupil Premium

Intervening Early With The Tree of Life A creative way to help school children talk about themselves

16 Apr 2018

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      string(5715) "The frequently reported increase in the number of children and young people experiencing challenges to their mental health has prompted a description of the situation as a ‘perfect storm’ [Ref 1]. Given the critical role and position of teachers in the lives of children and young people, we could describe teachers as finding themselves in the ‘eye’ of that ‘perfect storm’. We know that an estimated one in ten children and young people have a diagnosable mental disorder, that this is described as the equivalent of three pupils in every classroom, [Ref 2] and that they are likely struggling with their mental health at a level that we should be considering referring them to specialist support such as Child and Adolescent Mental Health Services (CAMHS). The data that we continue to quote dates back to 2004, although it is hoped that a new prevalence study will be published early 2018, giving us a much needed update.  In the absence of recent national data, what we do know today is that senior leaders and teachers are reporting a rise in the number of children presenting with mental health difficulties within the school. In a recent joint publication between the National Association of Head Teachers and Place2Be, 93% of Head Teachers reported that pupils today are bringing more worries into the classroom than they did five years ago, with 96% of Head Teachers noting that their pupil’s ability to learn was impeded by these worries [Ref 3]. This is consistent with many academic studies demonstrating a strong link between mental health difficulties in children and young people with poor educational achievement and consequent lifetime disadvantage. These increasingly complex issues which teachers are facing in their classrooms are frequently outside of their skill set and training; 92% of surveyed Head Teachers identified that teaching staff are managing issues that go beyond their teaching role [Ref 3]. At the same time as we are experiencing an increase in both the numbers of children and young people reporting with mental health difficulties, as well as the complexities of these issues, we are faced with challenges in the retainment of newly qualified teachers. It is reported that half of young teachers are considering quitting the profession [Ref 4], with a third of teachers who started work in 2010 already leaving the profession [Ref 5]. The National Union of Teachers (NUT), Young Teachers Working Party, surveyed more than 3,000 young teachers in April this year [Ref 4]. Of those surveyed, 85% described difficulties maintaining an adequate work-life balance, similar to the recent findings from the NAHT annual recruitment survey [Ref 6]. Furthermore, nearly 50% of young teachers cited concerns about the effect of teaching on their own mental health. Clearly, the connection between an adequate work-life balance and the challenges on teachers’ mental health cannot be ignored. There is currently little attention paid to the mental health of teachers. They are expected to be ‘available’ (mentally, emotionally, socially and cognitively) to all their students and at times, for parents and carers. With a growing population of children and young people expected to attend school over the coming years, coupled with the complexity and challenges of the issues brought into school, are we simply asking too much of teachers today?Education can play an important role in promoting good mental health; the Government has recently committed additional resources to every secondary school by providing funding for a teacher from each secondary school to be trained in Mental Health First Aid [Ref 7]. This is a positive step forward in equipping some teachers with the skills and knowledge to identify and respond to emerging mental health problems in school, however these plans are currently limited to secondary schools and only one teacher per school. Whilst is it is important to remember that teachers are not mental health professionals, in many cases they are well placed in aiding the identification of children and young people with mental health difficulties through the relationships and understanding they are in a position to build with their pupils. Relationships are fundamental for children and young people to feel attached and secure in the educational environment, for some pupils this will be the only stable attachment that they have in their life. However, questions must be addressed about the availability of teachers to be present to build these relationships with their pupils when they themselves at times are overwhelmed and, for some, struggling with their own wellbeing. In the recently published report from the Education and Health Select Committee’s on Children and young people’s mental health – the role of education, the importance of initial teacher training and the inclusion of mental health training was highlighted. The initial teacher training framework published in July 2016 states that: “providers should emphasise the importance of emotional development such as attachment issues and mental health on pupils’ performance, supporting trainees to recognise typical child and adolescent development, and to respond to atypical development” [Ref 8]. With the implementation of this framework, mental health will feature more prominently on all initial teacher training courses. However, what is missing from the framework is the importance of teachers examining and protecting their own mental health.‘Mental Health Champions – Class Teacher’, is a"
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HR and Staff Wellbeing

In the eye of the ‘perfect storm’

17 Apr 2018