Transcript Supporting mental health, positive behaviour and well being

Policy perspectives on behaviour
and well-being and implications for
research informed practice within
schools.
Brahm Norwich
Graduate School of Education,
University of Exeter
Overview
• key changes in policy - implications for school
based practices.
• Importance of focus on mental health and
well-being
• schools contribution including school based
research to improve practice
Key points about child and adolescent
mental health (CAMHS)
• 1 in 10 diagnosed MH disorder
• 1 in 7 less severe problems
• No up to date information last survey ten years
ago. (HoC Select Health Ctee, 2014)
• Focus on early CAMHS intervention urged by
Select Ctee.
• Health and Well Being Boards at LA level now
hold public health funds
• Battle to access CAMHS – bridging gap between
inpatient and community services
SEN Policy and legislative changes
• 13 years since significant legislative change
• Children and Families Act , 2014 – new Code
of practice
• mental health - first time one of the
dimensions of SEN: ‘Social Emotional and
Mental Health’
Labour Government 1997-2010
• many initiatives from early commitment to
social inclusion and inclusive education.
• BUT SEN and inclusion policies less important
than the standards agenda
• uncertainty and ambivalence about inclusion:
due to adoption of a market oriented /
parental preference-based system
Conservative policy development
• Conservative Party policy during Labour
period:
– SEN over-identified
– Inclusion: ideology that ‘failed a generation of
special needs children’
• Conservative 2010 election manifesto:
promised end to ‘bias to inclusion’
• phrase used in the SEN Green Paper
Green Paper: Support and aspiration: a new
approach to special educational needs
• ‘radically different system’
• better life outcomes for children and young
people.
• giving parents more confidence and
• transferring power to front-line professionals and
local communities.
Green Paper key elements
• new approach to identifying SEN: single
assessment process and for Education, Care and
Health Plans (EHC plans),
• increased integration of education, social care
and health service commissioning,
• a Local Offer of all services,
• parents having an option for a personal budget,
• giving parents a real choice of schools,
• greater independence in the assessment of
children’s needs
What overlooked
• Not address unresolved issues from Labour period.
– defining inclusion in a clear and realistic way
(House of Commons, 2006),
– linking the SEN and disability legislative systems
– reconciling inclusivity with parental preference
– continued value of statutory assessment for
Statement not questioned: despite critique of
Statements and alternative suggestion for parents
to opt into statutory process
• little detailed longer-term vision of how the SEN /
disability provision was inter-connected with and
dependent on the wider education service.
What was radically new
• proposals not “radically new”
• extending, integrating and tightening up existing principles and
practices.
– EHC Plans an extension of the Statement covering wider age
range of 0-25.
– Parents already involved in the assessment process and
– Some parents already had access to personal budgets.
• ‘radically new’ was in the wider education system:
– governance of schools: Academies and Free schools
– accountability system,
– funding model for SEN and the strong moves to a user-led model
SEN Pathfinders
• Green Paper very general - how work through by
Pathfinder LAs.
• Legislation went through before outcomes reported:
only a process evaluation
• Pathfinders were extended for a year and await
outcomes report.
• Evaluation: general feedback positive
– key worker role established: a single point of contact.
– personal profiles for families and young people to express
themselves
– person-centred planning approaches had been adopted.
Challenges
• development of outcomes-based plans challenging.
• limited progress over implementing some key
principles,
– involving children and young people and
– multi-agency involvement.
• involving health service professionals led to incomplete plans.
• How to balance of demands from core health work and Pathfinder
demands.
– Key workers/coordinators were also unclear about their
degrees of freedom within the planning process
• quality assurance and review process for EHC Plans insufficiently
developed.
Scale and focus of trials
• Independent Panel of Special Education Advice (IPSEA)
study:
• 28 of the 31 authorities questionnaire data
• 1507 EHC Plans for children / young people.
• Only 17% early years and 11% FE
• only 36% were undergoing statutory assessment for first
time; almost two-thirds had prior Statements
• For 25 authorities: 280 personal budgets completed, 143
involving direct payments and only 27% did not cover
transport and equipment.
• Raises questions about how extensively the proposed
changes had been trialled.
Children and Families Act (CFA) 2014
1. the participation of children, their parents and young
people in decision making
2. the early identification of children and young
people’s needs and early intervention to support
them
3. greater choice and control for young people and
parents over support
4. collaboration between education, health and social
care services to provide support
5. high quality provision to meet the needs of children
and young people with special educational needs
(SEN)
Code of Practice:
person-centred planning (PCP)
• focuses on the individual
• enables parents, children and young people to express
their views, wishes and feelings and be involved in
decisions
• easy for them to understand and highlight their
strengths and capabilities
• enables them to communicate their achievements,
interests and desired outcomes
• tailors support to their needs and minimise demands
on the family
• brings together relevant professionals to deliver an
outcomes-focused and co-ordinated plan
PCP issues
• new system adopts and extends current
principles and practices and changes their
terms of reference
• Makes principles sound ‘new’:
– first 2 SEN Codes of Practice were person-centred
without ‘person-centred’ label.
– communication and partnership with parents and
pupils to person-centred
– Statements to EHC Plans
PCP practices
• origins in social care and health of people with learning disabilities
• use in the SEN field very limited
• Corrigan (2014) - small scale study, suggested facilitators and barriers to
the effective use of PCP:
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skill level and availability of lead staff,
level of training and ongoing supervision provided to lead staff,
strength of relationships and collaborative skills within the group,
ability of all members to attend throughout the process,
quality of communication between settings and agencies,
ability to elicit the genuine voice of the child or young person,
degree to which PCP approaches were compromised by funding issues
PCP risks
• Some practitioners report that some reviews
are not genuinely person-centred.
• when a single inflexible approach is adopted
regardless of the identified needs of the child
or young person and their family.
– for example, need to be adapted for a young
person exhibiting highly avoidant attachment
strategies or someone who has experienced
severe relational trauma
Inter-service collaboration
• CFA duties on local authorities to ensure
– ‘that services work together where this promotes children
and young people’s wellbeing or improves the quality of
special educational provision’ (Section 25 CFA).
• Local authorities and health bodies required to plan
and commission education, health and social care
services jointly for children and young people with SEN
or disabilities (Section 26 CFA).
• Key developments in 3rd SEND Code of Practice
compared to the two previous ones is detail about how
inter-service collaboration is to work.
• done in some detail in 22 pages
Inter-professional collaboration
• How are local authorities to integrate educational
provision … with health and social care provision?
• Different multi-agency groups are unique with
own socio-political context, objectives, working
processes, internal dynamics and external
pressures.
• Townsley et al (2004) found there were persistent
multiple barriers to communication
– focus of meetings was often found to be multi-agency
structures rather than improved outcomes for young
people and their families.
Successful multi-agency working
• Eaton (2010) review of successful multiagency – summarised in terms of
– Strong leadership with a clear vision and a drive to
get things done,
– Well-managed conflicts and the absence of ‘a
competitive blame culture’,
– Opportunities for joint training,
– Time for reflective learning
Eco-systemic model of multi-agency working
(Eaton 2010)
System level
Group focus
Micros:
Ethical
consideration
Shared terminology and language: challenging and clarifying
language used to define CYP needs and context
Roles
Clearly defined roles and responsibilities: differentiated, shared core
skills and domain specific expertise
Meso:
Positive team-oriented attitudes, such as respect, trust , flexibility.
Exo:
Wider pressures Adequate budgetary, staff and time resources, common lines of
accountability
Macro:
Philosophical
context
Chrono:
Patterns of
working over
time
Shared goals, values and beliefs about interventions, case priorities,
appropriate settings
Absence of negative robotic thinking in group working patterns
Social, Emotional and Mental Health
• Replaces Behavioural, Social and Emotional
Needs
• described in the following manner:
• ‘Children and young people may experience a
wide range of social and emotional
difficulties… These behaviours may reflect
underlying mental health difficulties … [or]
disorders such as ADD, ADHD or attachment
disorder.’ (Section 6.32)
SEMH category: issues
• behaviour difficulty no longer seen as a special educational
need:
– but never was in previous Codes either
• Underlying category changes: removal SA and introducing
SEMH is policy of reducing the number of pupils identified
as having SEN (high incidence SEN, like MLD)
• new SEMH category no different from the previous BESD
one:
– No clear process for specifying the thresholds for identifying
such difficulties.
– problem with BESD category was its ambiguity and diverse use,
– problem persists with the new Code.
language of psychiatric disorder
• ‘these behaviours may reflect underlying mental health difficulties … [or]
disorders’ (COP, 2014)
• CoP: no reference to social context in SEMH definition
• continuing issues about reliability and validity of psychiatric diagnoses.
• educational significance of impairments / difficulties need to be seen in
functional and contextual terms.
• Crucial point : the gap between general diagnostic categories and the
particular individual characteristics and context of children in educational
terms.
• why term ‘special educational needs’ was originally introduced
• Not all children identified, for example, as ADHD, have the same
educational needs;
– other personal and contextual factors are also important to
understand individual cases.
The need for an interactive model of
mental health relevant to education
• interactive model recognises the interaction of
child and environmental factors in a
developmental context
• bio-psycho-social model that integrates
medical and social models (Cooper and
Jacobs, 2011; Hollenweger, 2011)
• WHO’s child / young person’s International
Classification of Functioning (ICF)
Targeted Mental Health Support
(TaMHS) national initiative
• children aged 5–13 at risk of developing
mental health problems
• by March 2011 3000 schools involved in
delivering TaMHS projects.
• national review Wolpert et al (2013)
TaMHS review: factors and issues
•
•
•
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Location:
- School based MH services promotes inter-agency collaboration and
increased access to these services
Language:
- significant barrier to effective, integrated provision - absence of a
common language across mental health and education services
- exacerbated by differences in philosophy and working practice between
agencies,
Ownership:
- dilemma about targeted provision:
- balancing the need for implementation fidelity (by MH professionals) with
the need for school ownership, embedded practice and reduced costs.
Scope:
- educational policy encourages balance between universal, preventive
provision and supplementary targeted programmes for at-risk pupils,
- little evidence to inform this position
TaMHS review: factors and issues
• Timing:
- impact of TaMHS interventions more for primary children
- amplified by differences between primary and secondary
- place greater emphasis on the relation between children’s
mental health and academic attainment may help to lessen
primary-secondary difference
• Evidence-based practice:
- engagement in using / developing evidence-based practice
was disappointing in schools,
- lack of awareness of evidence-based materials and a lack of
access to the appropriate training and materials.
- Australian ‘Kidsmatter’ programme: guide to over seventy
evidence-based interventions,
- recent UK MindEd web based learning programme
https://www.minded.org.uk/
Mental health and behaviour in schools
Departmental advice for school staff
• In order to help their pupils succeed, schools have a role to play in
supporting them to be resilient and mentally healthy..
• Where severe problems occur schools should expect the child to get
support elsewhere as well,
• Schools should ensure that pupils and their families participate as fully as
possible in decisions
• Schools can use the Strengths and Difficulties Questionnaire (SDQ) to help
them judge whether individual pupils might be suffering from a
diagnosable mental health problem
• MindEd, a free online training tool
• There are things that schools can do – including for all their pupils, for
those showing early signs of problems and for families exposed to several
risk factors – to intervene early and strengthen resilience,
• Schools can influence the health services that are commissioned locally
through their local Health and Wellbeing Board •
• There are national organisations offering materials, help and advice.
Schools should look at what provision is available locally
Risk and protective factors for child and
adolescent mental health
(DFE, 2014)
FACTORS
In child
In family
In school
In community
RISK
PROTECTIVE
In school
RISK FACTORS
Protective factors
*Bullying
• Discrimination
• Breakdown in or lack of
positive friendships
• Deviant peer influences
• Peer pressure
• Poor pupil to teacher
relationships
* Clear policies on behaviour
and bullying
• ‘Open-door’ policy for
children to raise problems
• A whole-school approach
to promoting good mental
health
• Positive classroom
management
• A sense of belonging
• Positive peer influences
Wave / tier
3: specialist
Wave / tier 2:
targeted
Wave / tier 1: Quality first /
universal
Universal provision
• Health Select Ctee CAMHS Report 2014:
– Mandatory module in ITT on MH and for CPD (section 210)
– Difficult to ensure that all schools use tools DFE guidance and MindEd
website
• Role for Ofsted and tension between standards agenda and wider wellbeing ones
• Example of universal public health intervention – protective factor
– ‘Supporting Teachers And childRen in Schools’ (STARS) project
– evaluating the Incredible Years Teacher Classroom Management (TCM)
intervention.
– TCM: 6 day training course to groups of 8–12 teachers.
– STARS trial aims to improve children’s behaviour, attainment and
wellbeing, reduce teachers’ stress and improve self-efficacy.
Targeted interventions
Supporting teacher problem solving approaches
• Teacher Support Teams (Creese, Norwich,
Daniels)
• Collaborative groups (Hanko)
• Circles of Adults;
• Teacher Coaching;
• Collaborative Problem-Solving Groups
• Staff Sharing Scheme.
• Bennet and Monsen (2011) review EPIP
Lesson Study: universal and targeted approach to
integrating cognitive and social/emotional aspects into
teaching
LS as practice-based research / inquiry
Distinctiveness
• study of lesson (pedagogic focus)
– For and by teachers
• focus on learning / learners
– Case pupils (UK version)
• research oriented (RQ :how improve learning of ?)
– Research lesson
•
collaborative
– LS team involved at each stage (lesson observation by team)
– enables inter-disciplinary collaboration
•
reflective practitioner
– use of craft and research informed knowledge
Lesson Study logic
How adapt LS to researching lessons
with pupils with SEMH difficulties
• Research lesson goals – both subject based, e.g.
maths, and about learning behaviours (emotions,
relationships etc.)
• LS team to include class teachers and those with
specialist knowledge, e.g. SENCo, specialist
teacher, Edpsych and/or MH worker
• use research-based knowledge about emotional
/ behaviour functioning in lesson review/planning
, e.g. self regulating strategies
Concluding comments
• Crucial importance: whole school policies and
practices – senior management commitment to
broader achievement and well-being
• Current ‘standards’ agenda undermines this
commitment
• Important things schools and teachers can do
• Practice-based research – inter-professional,
collaborative & research evidence informed, e.g.
LS
• MUCH WORTH DOING AND CAN BE DONE
References
•
Norwich, B. & Eaton, A. (2014): The new special educational needs(SEN)
legislation in England and implications for services for children and young
people with social, emotional and behavioural difficulties, Emotional and
Behavioural Difficulties, DOI: 10.1080/13632752.2014.989056
•
Norwich, B and Jones J. (2013/4) Lesson Study: making a difference to
teaching pupils with learning difficulties. London: Continuum Publishers.
•
Ylonen, A. and Norwich, B. (2012) ‘Using Lesson Study to develop teaching
approaches for secondary school pupils with moderate learning difficulties:
teachers’ concepts, attitudes and pedagogic strategies’, in European
Journal of Special Needs Education, Vol. 27 (3): 301-317
Web sources:
LS for Assessment:
http://elac.ex.ac.uk/lessonstudymld/page.php?id=171
Department for Education, Advanced training materials
for SEN, Lesson Study, available at:
– http://www.education.gov.uk/lamb/module2/M0
2U09.html#
MindEd web based learning programme
https://www.minded.org.uk/