Leadership

Access To Children And Young People’s Mental Health Services – 2018

This report by the Education Policy Institute assesses the state of children’s mental health services in England. The research examines access to specialist services, waiting times for treatment, and provision for those children that are not able to receive treatment.

Over recent years there has been increasing understanding of the importance of young people’s mental health, as well as rising concern about the apparently increasing demand for such services and difficulties for some young people in accessing support. But promises about improved data and accountability have not, so far, been matched by the delivery of consistent and transparent data reporting.

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      string(5787) "role of senior management commitment and setting culture to sustain Emotion Coaching integration.8 Emotion Coaching, the voices of practitioner and model of engagement (Gilbert, 2018)Developing the research evidence-base for Emotion Coaching Although still nascent, Emotional Coaching in educational settings is proliferating and a number of further studies have yielded similar results to the first pilot study in England. The Attachment Aware Schools (AAS) project aimed to promote vulnerable pupils’ emotional, social and academic wellbeing with Emotion Coaching utilised as a whole-school strategy. Two of the AAS pilot projects, commissioned by two local authority virtual schools in 2014, noted improvements in pupils’ academic achievement scores, significant decrease in exclusions and significant reduction in challenging behaviours. Practitioners also noted increased confidence in dealing with challenging behaviour, which impacted positively on professional practice and self-regulation.39 Case studies also identified that practitioner-modelling encouraged parents to use Emotion Coaching at home, and the shared practice reinforced a consistent, supportive, approach for the child. The use of Emotion Coaching could be described as ‘a vehicle for facilitating supportive home-school collaborative partnerships with positive outcomes for vulnerable children and young people’.40 Another small pilot study in an independent SEMH specialist provision primary day school, arose from a dissatisfaction with the traditional behavioural-based approaches to support pupil progress: for example, using rewards, choice and natural consequences. The staff believed that this approach did fully support the emotional difficulties experienced by the pupils. After attending an Attachment and Trauma training course, the SLT introduced an attachment-informed relational approach, using Emotion Coaching as the basis for all communication and teaching about emotions to support the development of their pupils’ behaviour and learning. 41All pupils had statements of special educational needs or an education, health and care plan and 25 per cent of the children were from disadvantaged backgrounds. All school staff were trained in Emotion Coaching via in-house training delivered by the SLT. This included SLT modelling Emotion Coaching, providing Emotion Coaching ‘scripts’ for staff to use if needed, positively noticing when other staff members used EC, group discussions and personal one to one supervision. To support the adoption of EC, staff were encouraged to focus on using Emotion Coaching with one particular child. Once it was embedded as an approach, Emotion Coaching was then cascaded to the families, through school staff, who modelled Emotion Coaching in their interactions with families, and via individual support for families in using Emotion Coaching with their children and through family group training/information sessions at school. A range of data was collected from the school and generated the following positive results:the rates of pupil restraint decreasedpupils made better-than-expected academic progress staff absenteeism reduced families reported improved family life42 Further evidence from another pilot scheme in Somerset43 also implemented Emotion Coaching as a key strategy to increase understanding of emotional health and wellbeing, enhance skills in supporting children and young people’s emotional health and wellbeing, facilitate the referral process for children and young people and improve access to health and specialist services. It introduced Emotion Coaching into primary and secondary schools in southwest England. Echoing the findings from other studies, practitioners felt all relationships were improved with Emotion Coaching and a person-focused culture emerged. The data also showed how practitioners became less emotionally dismissive in their practice and there was a significant improvement noted in practitioner emotional self-regulation and awareness that correlated strongly with improved staff empathy and patience. Emotion Coaching provided a framework to support practitioners in managing their own emotional self-regulation and strengthened partnerships by cascading evidence-based activities on integrating Emotion Coaching into practice. A county-wide sustainable Emotion Coaching network reflects how different services can work together to support children and young people’s emotional health. 44What do educational setting-focused Emotion Coaching research findings suggest?Three key themes have emerged as a result of using Emotion Coaching in educational settings and these are: Theme 1 – Professional Practice: Emotion Coaching enables adults to communicate more effectively and consistently with children in stressful situations, to utilise fewer ‘emotion dismissing’ approaches, and helps to de-escalate volatile situations. For example, one participant noted, ‘Emotion coaching acts as a framework and a script that enables a consistent, positive approach’ to behavioural incidents without going ‘down the cul-de-sac of blame’. Theme 2 – Adult Self-regulation: Through using Emotion Coaching, adults found difficult situations less stressful and exhausting with a positive impact on adult well-being, ‘It helps us cool down while we collect our thoughts and I now shout less!’, ‘I am more patient now ’ and ‘I now focus on emotions as well as the behaviour and give time to validating emotions – it helps us all be reflective about our inner"
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Behaviour

Developing Resilience with Emotion Coaching

4 Dec 2018

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      string(5758) "The government’s current work to improve mental health support for children and young people is an important but modest step towards achieving its longer term aspirations. It includes initiatives to increase the proportion of children and young people who need support accessing NHS-funded mental health services from around 25% to 35%, estimated to be equivalent to treating an additional 70,000 children and young people per year, between 2015-16 and 2020-21. This reflects the Department’s assessment of what is possible within current funding and staffing constraints. However, the NAO has found significant weaknesses and unreliability in the government’s data which undermines its understanding of its progress and whether additional funding has been spent as intended. In particular, the NHS cannot reliably track progress against one of its key targets to treat an additional 70,000 children and young people. Slow progress on increasing the mental health workforce in England by 40% (4,500 staff) is emerging as a major risk to delivering the government’s ambitions and there are currently no data available to monitor any increase. New government estimates of the number of children and young people with a mental health condition are likely to be higher than previously estimated, which will make it even harder for the government to achieve its long-term ambitions. If prevalence is 50% higher than the previous 2004 estimate, this would mean NHS England would have to treat an additional 186,000 children and young people in order to achieve an access rate of 35% by 2020-21. The report recommends that the Department, working in conjunction with other departments, should set out the scale of the needs of young people requiring mental health services, building on the new prevalence data when available and identify what work and resources are needed to implement its 2015 strategy, Future in Mind, in full. Key Findings: The government faces significant challenges in transforming children and young people’s mental health services, as part of its commitment to parity of esteem between physical and mental health services. The government has not set out and costed what it must do to achieve Future in Mind in full. The government does not have cross-government accountability arrangements in place to ensure Future in Mind is delivered as intended. NHS England cannot be certain all the additional £1.4 billion funding to date was spent as intended, and does not have strong levers to ensure that CCGs increase spending in line with their intentions. Local transformation plans set out how local areas intend to transform services but national accountability is weak. The NHS is working to improve key information on how many children and young people receive mental health services, how much it spends on providing those services, and which treatments are most effective. Significant data weaknesses limit the government’s ability to understand progress towards delivering its ambitions around access to children and young people’s NHS-funded services. The number of children and young people with a mental health condition who need help is likely to be higher than previously estimated, which will make it even harder to achieve the government’s ambition. Slow progress on workforce expansion is emerging as a major risk to delivering the government’s ambitions, and understanding progress is significantly hindered by a lack of data. There is still limited visibility of what public sector bodies outside the health sector spend on mental health services, and what services they provide. Actions for Government: Set out the scale of the challenge, and understand the characteristics and trends in the needs of young people requiring mental health services, building on the new prevalence data when available. Set out what actions and resources are required to implement Future in Mind in full, and the main long-term and interim objectives and outcomes. The plans should set out what different parts of government are expected to deliver, be clear about the main uncertainties and build in opportunities to review plans. Establish clear leadership of the portfolio and responsibility for taking it forward and bringing together the national and local bodies, and individual programmes, intended to deliver Future in Mind. Put in place mechanisms to improve understanding of spend and activity on mental health support across the system, particularly in schools and local authorities. Undertake work to better understand the impact of preventative services and early intervention for children and young people on the demand for more intensive or specialist mental health services. WEB LINK Improving Children And Young People’s Mental Health ServicesKeywords Children, young people, mental health services, support, funding, staffing constraints, resources, strategy "
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Leadership

Improving Children And Young People’s Mental Health Services

10 Oct 2018

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      string(6022) "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 Two.In 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 via phones from different parts of the world. The young women 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 Three.One 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 a small amount 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.FeedbackTeachers:It was great. The children were allowed to explore their thoughts and thinking process in their own time.It encouraged them to consider wider issues.Child Led.It 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 calm.Some of the things we talked about were hard.I 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. ReferencesMental 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. 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Inclusion

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

17 Apr 2018

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      string(6046) "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