Introduction

 

Today, more than ever, joint working is essential for services to identify and best meet the mental health needs of children and their families. The Link Programme is a major national initiative, specifically designed to enable collaboration between education and mental health professionals. 

 

Our approach to mental health and well-being is underpinned by our participation in the Link Programme. The Link programme is led by the Anna Freud Centre and supported by NHS England and is designed to get more children the help and support they need and deserve.

 

Central to the Link Programme is the CASCADE framework which is a tool developed by the Anna Freud National Centre for Children and Families.

 

It is intended to help organisations including schools to examine their mental health provision and working with partner agencies to better support children’s mental health.

 

Mental Health and Well-being

Mental Well-being has been firmly placed on the national agenda with an increasing number of children experiencing behaviours that indicate anxiety or stress. These behaviours include attachment issues, attention seeking behaviours, reluctance to come into school, negative thinking traps, friendship problems, anger, lack of focus, and negative or destructive behaviours to name but a few.

 

We know children learn best when they feel safe, secure and emotionally stable. We also know that providing a mentally healthy, nurturing culture for our children, parent and staff community contributes to good mental health which then improves a child’s prospects of leading a full and active life.

 

What Is Mental Health?

We all have a degree of mental health just as we have a degree of physical health. Mental health includes emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices.

 

Mental health is important at every stage of life, from childhood and adolescence through adulthood. It is quite natural for children to worry and to be anxious at various stages of school and home life.

 

However, there comes a point where anxieties and worries can consume a person’s life to a point it affects their emotional, psychological, social well-being and ability to think, act and function.

 

Risk factors

We are all exposed to risks that can contribute to increased worries, anxieties and ill health.

 

These risks can be linked to differences in a person's temperament (for example, being more emotionally placid or more volatile) as well as exposure to harmful experiences, environments or events including trauma, family disharmony, loss, separation, parental divorce, domestic violence, physical, sexual and emotional abuse, friendship/school issues, poor self-image/esteem, discrimination, poverty, neglect, homelessness etc. 

 

Not all children exposed to risks develop mental health difficulties. This is because each of us has different levels of resilience. Resilience is the ability to cope with setbacks and thrive despite the challenges of life. Some children are more resilient. The good news is that resilience can be developed and nurtured with the right support, encouragement and environment. We call resilience a ‘protective factor’.

 

The ability to stay calm and put things into perspective can be particularly 'protective’ as can the ability to view mistakes as positive opportunities for growth rather than something to dwell on and worry about.

 

Children learn empowering attitudes and resilience through their interaction with adults around them through their language they use and their own behaviours. These key adults include parents, carers, family members, teachers and friends and all have a role to play in developing a child’s capacity to display resilience and cope with change and setbacks.

 

We also know that certain harmful experiences in childhood can be detrimental to children’s development. Sometimes these events can go unnoticed and what may seem trivial can result in hidden trauma that later leads to physical and mental health problems, school disengagement and risk-taking behaviours.

 

These adverse childhood experiences include:

 

• neglect and abuse – including sexual abuse
• violence between parents/carers
• parental separation
• poor parental/carer mental health
• substance/alcohol misuse 

 

For this reason, the ability to cope and thrive is not just about children learning skills and empowering attitudes, but also about how adults in children’s lives, in their schools and communities take action to offset the family and environmental factors and barriers that can undermine children’s ability to thrive.

 

 

Who is responsible for children’s mental health?

This is a shared responsibility between parents, school staff and in some cases partner agencies such as the NHS, voluntary sector providers, independent providers, school nurses and educational services such as Educational Psychologist.

 

Who is responsible for children’s mental health at school level?

All staff and the Governing Board have a part to play.

 

The Governing Board and the head teacher is responsible for policy development. The head teacher is responsible for implementing policy and creating a school culture and environment that supports mental health and well-being.

 

The head teacher also ensures the school works effectively with partner agencies, builds relationships with external agencies and supports staff in developing their awareness of mental health including the schools approach to supporting children.

 

Teachers are responsible for creating a classroom environment where mental health and well-being can be nurtured both through the curriculum and classroom ethos including teaching approaches. Teachers also identify mental health and well-being needs and offer pastoral support to individual children.

 

Learning Support Assistants help the teacher deliver these objectives and are often in a good position to work closely with children to support and identify needs.

 

How do we promote good mental health and well-being?

 

There are a number of ways we promote good mental health and well-being. These include:

 

Physical health

• Promoting an active life and opportunities for physical exercise, play and outdoor activities as good physical health is a precursor to good mental health.
• Encouraging healthy eating, a balanced diet and the importance of staying hydrated.

 

 

Environment and culture

• Creating a positive, safe, healthy and nurturing culture and environment that reduces unnecessary stress and anxiety.
• Focusing on the positives, praising and celebrating achievements in order to build confidence and self-esteem.
• Creating opportunities, time and places within a busy day for spiritual and emotional development in terms of mindfulness, appreciating the intangible, the value of silence, stillness and reflection

 

Curriculum

• Teaching and reinforcing positive behaviours, decision making and protective factors such as social and emotional competency, growth mind-set and resilience.
• Encouraging and modelling the importance of community spirit, appreciation and helping/supporting others in need.
• Encouraging and teaching about good physical health including healthy eating, exercise and the importance of drinking water and sleep.

 

Clarity of roles, provision and intervention 

• Ensuring staff are aware of their responsibilities for providing each child pastoral support and informing all staff of the importance of mental health, signs and symptoms and what help is available.
• Developing a shared responsibility or identifying and responding to early warning signs of stress, anxiety and mental health concerns.
• Providing timely in house pastoral support for those in need.
• Signposting parent/carers to the right external routes for support including counselling services such as the Emotional Well-being and Mental Health Service formerly CAMHS or other agencies.
• Raising awareness that staff and parent/carers may have mental health issues, and the routes of support available to them.

 

Evidence based approach to intervention

 

Where we use an intervention to improve the well-being of a young person, we identify clear, desirable, specific and measurable outcomes.

 

How do we use evidence to support children’s well-being so that we know what we are doing is working?

 

Firstly, many of the presenting factors or problems signs begin to disappear as a child’s well-being and mental health improves. The problem or presenting factors are identified before any intervention and the changes we want to see.

 

Secondly, we use validated questionnaires that are designed to elicit how children feel. These may include scaling where children grade how they feel.

 

https://www.corc.uk.net/outcome-experience-measures/

 

Thirdly, we draw on the expertise of external agencies and specialist to provide evidence based interventions. Some of these interventions are provided by specialists.

 

Signs and symptoms (presenting factors)

Mental health issues are not always obvious and can quickly become progressively worse and more apparent if left unchecked. Early identification and intervention is important to avoid matters escalating. To do this, we need to know when a person is in need as they are not always aware themselves. Concerns may be raised by people who know them well, for example a parent or a member of staff who notices something is not quite right.

 

We recognise the family plays a key role in influencing children and young people’s emotional health and well-being; and will work in partnership with parents and carers to promote emotional health and well-being.

 

Signs and symptoms to look out for include:

 

• Feeling unusually confused, forgetful, on edge, angry, upset, worried, or scared
• Sleep problems
• Bed wetting
• Eating or sleeping too much or too little
• Intense worries or fears that get in the way of daily activities

• Sudden overwhelming fear for no reason, sometimes with a racing heart or fast breathing.
• Yelling or fighting with family and friends.
• Mood swings that cause problems in relationships
• Persistent thoughts and memories you can't get out of your head

• Pulling away from people and usual activities
• Low or no energy
• Feeling numb or like nothing matters
• Unexplained aches and pains
• Feeling helpless or hopeless
• Hearing voices or believing things that are not true
• Thinking of harming yourself or others
• Inability to perform daily tasks.

• Self-harm or making plans to do so
• Involvement in many fights or desire to badly hurt others
• Severe out-of-control behaviour that can hurt oneself or others
• Extreme difficulty concentrating or staying still that puts a child in physical danger or causes problems in the classroom

 

These 'problems' or presenting factors are not helpful on their own. We need to understand the story behind the problem. This will help shape the solution because the presenting problem might be the same for different people but the most appropriate solution may differ.

 

We can better understand the story behind the problem using the 5Ps model.

 

 

 

Presenting factors – what is the problem?

e.g. self-harm, poor attendance, anxiety, behaviour, relationship difficulties).

 

 Predisposing factors – what are the risk factors

  e.g. abuse, illness, SEN, parental conflicts

 

Precipitating factors – what are the triggers

e.g. exams, drugs, alcohol, new school, divorce, bereavement.

 

Perpetuating factors – what keeps it going?

e.g. missed appointments, not taking up offers of advice, support, lack of understanding of a problem, self-denial, lack of support or access to support, inadequate support

 

Protective factors – what helps prevent any further deterioration?

e.g. they ask for help, self-awareness, attitude, motivation, family support, systems, school           

 

 

 

Provision

We have adapted a graduated approach and refer to them as waves. 

 

Wave 1

Wave 1 is a universal offer for all children. It includes a curriculum and curricular opportunities designed to build resilience, self-awareness, good physical health, self-help strategies, developing positive attitudes, appreciation, gratitude, reflection, self-help, the ability to put things into perspective and a growth mind-set. This is achieved through our Relationships, Sex and Health Education programme.  

 

Further, carefully planned activities help children to value stillness and silence, the intangible, music, the arts, appreciation, gratitude, a sense awe and wonder and dealing with negative thinking traps

 

Wave 1 also includes developing an environment, culture, policies, staff awareness and procedures that reduce anxieties for children so that school can be a safe and secure environment. 

 

Class teachers also provide pastoral. Pastoral support provides a listening ear to share worries as well as providing information, advice and guidance to children.

 

This can help identify what might be the root of a person’s difficulties through the 5Ps model and help find solutions. It may also identify a learning need that the class teacher can plan for.

 

For example, if a child is having difficulty in putting events into perspective, a plan may be put into place to help the child do this. Scaling is a strategy that we use to teach children about perspectives. Zones of Regulation is another strategy we use to teach children to grade their emotions which then offers them a menu of options or strategies to get themselves out of this negative thinking trap.

 

We do not have the funds or access to a school-based children’s counselor but we do have a dedicated person in the school who can assist with and offer more timetabled pastoral support.

 

Alternatively, pastoral support is offered by another adult in the school. It could be a Learning Support Assistant or Class teacher.

 

Some children may need a little more help and for this group of children we offer school pastoral support. If the need is beyond the school’s expertise, we may advise parents to turn to external providers. If the child is in immediate danger, we follow our Child Protection procedures.

 

Both parents and the school play an important role in teaching and modelling the following strategies and behaviours that can improve mental health and well-being :

 

1. Tell yourself something positive every day.

2. Try to live in the moment more rather than what might happen or has happened.

3. Regular exercise and fresh air (every day).

4. Make sure you have a good balanced diet and drink sufficient fresh water each day.

5. Get into the habit of talking and opening up to others.

6. Do something for someone else each day (an act of kindness).

7. Take a break including hobbies.  

 

Wave 2

This is where a child is identified needing further school based support. Further support can include :

 

Zones of Regulation

This is a programme designed to foster self-regulation and emotional control which helps children gain skills in the area of self-regulation. 

 

Scaling

This is where we teach the child to score their emotional response to a past or future event e.g. 1-5 to help them put events into perspective and then talk through strategies to help them change the score so it is perceived less stressful.

 

Emotional coaching

An emotional literacy intervention which helps identify feelings, recognise responses, and offers appropriate ways to manage feelings & improve confidence. This involves Naming and explaining emotions and their reasons e.g. ‘Look, you are getting hot and sweaty, this means you are feeling worried’.

 

Circles of Trust

This is a small group activity led by an adult that builds trust. The group is known as 'The Circle of Trust'. The exercise involves a group of people and aims to encourage co-ordination, co-operation, risk taking and trust e.g. children may work in pairs where one is blindfolded and the other must guide them round a room or to a destination or where children in a circle hold hands taking turns to lean in and out of the circle to test the trust and support of others.

 

Lego Therapy

Carefully structured opportunities to give and receive instructions in the context of a game or activity can be useful to understand roles and take the opportunity to lead.

 

Circle Time

Structured and safe group activities where the group learn early debating skills around motivational topics or around topics they have been asked to explore.

 

Friendship Buddies

Opportunities to support younger children at lunchtime where he can be supported to help them organise games and negotiate friendships in using what he has learnt to mediate younger peers.

 

Role play 

Opportunities to role play different scenarios with peers and adults and talk about each character and the feelings they may experience.

 

Therapeutic and social stories.

The use of therapeutic stories which touch upon different scenarios and leaves open discussions around feelings of the characters for example if another child is negative towards you or ridicules.

 

A Mentor 

A key adult at the school ideally selected for their ability to perform positive relationships-orientated support roles with children and the potential for them to work with him for an extended period of time to provide consistency. This person will need to build positive relationships with him by meeting with his/her regularly and providing a ‘safe’ space for him to feel comfortable talking to them.

 

Talk Groups (Bubble Groups)

Talk Groups are facilitated by an adult to discuss issues and help children see different perspectives, challenge negative thoughts, find solutions and share strategies.

 

Peer to Peer Support

Peer to peer support offers the child dedicated time to talk with another child. This can be an older child. Similar to Talk Groups, it can help children see different perspectives, find solutions and share strategies.

 

Mindfulness and Yoga

One of the most common benefits of practicing mindfulness and yoga is the decrease in stress experienced in people. It is also believed to improve focus, resilience and memory.

 

Dealing with anxiety

Talking strategies can be an effective way to shift negative thinking that causes anxiety. Recognising and understanding emotions and feelings can also be an important part of changing thoughts and behaviours.

 

Mental rehearsal/guided imagery.

This is where an adult helps a child to imagine themselves successfully completing something that they fear or are anxious about. They are guided to rehearse that event mentally or in their minds eye and are encouraged to imagine how they would feel when they successfully complete the task/event.

 

Sensory activities/breaks 

Access to sensory stimulation e.g. sensory materials/box, sensory circuits, therapy putty, (Chewy tubes for those who have a need to put things in their mouth). Some children feel the need for containment (to be covered). Sensory deprivation can lead to physical needs not being met which can lead to anxiety.

 

Sensory gym 

Daily access to a circuit of activities designed to meet a child’s sensory needs. Includes stretching, rolling, hanging, encouragement to walk across different textures and support when negotiating steps and stairs. Physical activity like this can reduce anxiety levels.

 

3 Step approach to dealing with a fear

One of the best ways to help young people deal with anxiety is to find ways to face feared situations. Plan ways for them to test out and be exposed to their fears gradually. Avoiding the situation can make matters worse and make them more anxious as they replay their fears over and over again, magnifying the emotion each time.

 

Secondly, challenge negative thoughts indirectly through questioning. Instead of reassuring the young person that nothing bad will happen, ask them things like ‘what has happened in this situation before?’ This can help them to challenge any negative thoughts.

 

Thirdly, help the young person think through what they learned about their fears and about themselves. Did their fears come to true? Did they cope? Help the young person rate their anxiety on a scale of 1-5 or 1-10.

 

 

Wave 3

Where a child may need further support beyond what the school can provide, we seek specialist advice and or a referral to an external agency.

 

Specialist help

Where the needs of the child are such that more specialist help is required, we discuss this with parents and the routes available to seek outside the school setting.

 

Social, Emotional and Mental Health needs’ (SEMH) is an overarching term for children and young people who show difficulties in one or more of the following:

 

• managing their emotions
• social interaction
• mental health

 

These difficulties may be displayed through them becoming withdrawn or isolated, as well as through challenging behaviour.

 

For some children difficulties in their emotional and social development can mean that they need additional and different provision in their school in order to achieve. It is important that they are able to form and maintain healthy relationships and fully engage in the learning opportunities provided.

 

In some circumstances, a referral to the GP or Emotional Well-being and Mental Health Service may be appropriate or the Local Authority's Family Innovation Fund.

 

www.nelft.nhs.uk/services-ewmhs

https://www.nelft.nhs.uk/services-ewmhs

 

In the first instance, EWMHS will look to promote the use of early intervention services, which may include psycho-education, talking therapies, mentoring or support as recommended within the National Institute of Clinical Excellence Guidelines. There are other resources available that can provide a range of supportive interventions. This support includes digital and online resources for example websites and Apps.  These are freely available and may be accessed via the NELFT EWMHS web resource at:

 

https://mindfresh.nelft.nhs.uk/ 

 

 

Routes for referrals

 

1. Direct referral  to a local service e.g. Emotional Well-being and Mental Health Service or Kids Inspire.

 

2. Indirectly, through Essex County Council’s Early Help and the Family Innovation Fund

 

3.Essex County Council’s Children and Families Hub which provides:

 

• advice and guidance to the public and professionals looking for support at levels 2 and 3 (Additional and Intensive as set out in the Essex Effective Support Windscreen).

 

• a referral pathway to request for support from Family Solutions  (level 3 Intensive Support on the Effective Support Windscreen).

 

• a referral pathway for any safeguarding concerns at level 4  (Specialist support on the Effective Support Windscreen).

 

Types of Specialist Support

 

There is a wide range of therapeutic services for children and young people who have experienced trauma, traumatic bereavement, abuse and neglect that may be available through external agencies

 

• Systemic Family Therapy
• Mentalization based treatment for families, children and adolescents
• Trauma- Focused Cognitive Behavioural Therapy (TFCBT) 
• Eye Movement Desensitization and Reprocessing (EMDR)
• Multi family therapy
• Play Therapy
• Child and Adolescent Psychotherapy
• Interpersonal Psychotherapy for Adolescents (IPT-A)
• Family Based Interpersonal Psychotherapy (FB-IPT)
• Short Term Psychoanalytic Psychotherapy (STPP)

 

 

NHS App library

https://www.nhs.uk/apps-library/

 

We have a list of other website links below which families can access for advice and support.

 

Where concerns are such that we feel the child is at risk of immediate harm, our Child Protection procedures are followed.

 

If a parent is concerned about a child’s well-being, they should feel at ease to discuss this with an adult at the school. This could be the class teacher in the first, the pastoral leader/Family Support Worker or the head teacher.

 

If a child has received a diagnosis of a mental health issue, or is receiving support either through Emotional Well-being Health Service or another organisation, we will consider drawing up an Individual Care Plan. This plan should involve the pupil, parents, and relevant professionals.

 

Above all, promoting good mental health and well-being in schools relies on every member of staff playing their part. Every interaction between a child and a staff member is significant and can shape a child’s thinking or hold a part of the jigsaw that could support a struggling child to move forward.