WORKING WITH CHILDREN AND YOUNG PEOPLE WITH SEMH NEEDS

1. WORKING WITH CHILDREN AND YOUNG PEOPLE WITH SEMH NEEDS SENCO Network spring 2019

2. Aims for the Session • Look at legislation to help us define SEMH and how school can support the wellbeing of CYP. • Explore how ecological systems theory can help us to assess SEMH at different levels. • Suggest a selection of baseline assessment tools to help measure progress relating to SEMH. • Suggest a selection of interventions to support SEMH in schools.

3. SEND CoP: SEMH • Persistent disruptive or withdrawn behaviours do not necessarily mean that a child or YP has SEN. There should be assessment to determine whether there are any causal factors (e.g., LDs, communication or mental health needs etc.). • Events such as bullying and bereavement can lead to LDs or wider mental health difficulties. Can impact on wellbeing and this can sometimes be severe. Schools should make provision for child’s short term needs in order to prevent problems escalating. • Where there are long lasting difficulties schools should consider whether the child might have SEN. (6.21/6.22)

4. SEMH • SEMH is one of the four broad areas that should be planned for. • Identification to work out what action the school needs to take. • Difficulties may include: • Becoming withdrawn or isolated • Displaying challenging, disruptive or disturbing behaviour • These behaviours may reflect underlying mental health difficulties (e.g., anxiety, depression, self-harm, substance misuse, eating disorders or somatic symptoms). Other C&YP may have disorders such as ADHD or attachment disorder. • Schools should have clear processes to support C&YP, including how they will manage the effect of any disruptive behaviour so it does not adversely affect others.

5. DfE - Mental Health and Behaviour in Schools (2018) • Teachers are ideally placed to promote child mental health from an early stage and identify and respond appropriately to early indications of mental health needs. They need clear systems and processes in place for identifying possible mental health needs, including routes to escalate and refer on to specialist services. • Consistent whole school approach. • Behaviour policy. • Graduated response.

6. DfE- Mental Health and Behaviour in Schools - Nov 2018 • School staff cannot act as mental health experts and should not try to diagnose conditions. However, they should ensure they have clear systems and processes in place for identifying possible mental health problems, including routes to escalate and clear referral and accountability systems. • They also need to be aware of their duties under the Equality Act 2010, recognising that some mental health issues will meet the definition of disability.

7. DfE - Mental Health and Behaviour in Schools - Nov 2018 • When schools suspect a pupil has a mental health problem, they should use the graduated response process (assess – plan – do – review) to put support in place. There are a number of identification and measurement tools, such as the Strengths and Difficulties Questionnaire (SDQ) and Boxall Profile, which can support this process.

8. The school role in supporting and promoting mental health and wellbeing • Prevention: creating a safe and calm environment where mental health problems are less likely, improving the mental health and wellbeing of the whole school population, and equipping pupils to be resilient so that they can manage the normal stress of life effectively. This will include teaching pupils about mental wellbeing through the curriculum and reinforcing this teaching through school activities and ethos; • Identification: recognising emerging issues as early and accurately as possible; • Early support: helping pupils to access evidence based early support and interventions; and • Access to specialist support: working effectively with external agencies to provide swift access or referrals to specialist support and treatment.

9. Behaviour Policy • Relational over behaviourist • Behaviourist approaches can work for the majority of CYP but are not successful for all. • Being fair isn’t about everybody getting the same but about everyone getting what they • Behaviour is a form of communication • Taking a non-judgemental, curious and empathic attitude towards behaviour • Focus on feelings that might drive certain behaviour, rather than behaviour itself • Putting relationships first • Maintaining clear boundaries and explanations around behaviour • Not all behaviours are a matter of ‘choice’ • Behaviour must always be viewed systemically and within the context of important relationships • Encouraging parental engagement and involvement

10. Mental health issues - NHS (page 11) • Phobias, anxiety and depression • Conduct disorders • Hyperkinetic disorders • Developmental Disorders • Attachment Disorders • Trauma disorders • MH Problems such as eating disorders

11. Ecological Approach

12. Ecological approach Think about a child you work with who has SEMH needs. Q1) What do you think are the environmental factors (e.g. family, community, learning environment) that contribute to their SEMH needs? Q2) What do you think are the individual factors that contribute to their SEMH needs?

13. Ecological Systems Approach • Opens up new possibilities for supporting young people indirectly. • Not just the responsibility of the child to change. • Second order change is powerful and sustainable.

14. What are the skills you already have? • Observation- Time sampling/event sampling/ naturalistic- mesosystem • Eliciting the child’s view- child at the centre- microsystem • Partnership with parents- part of the mesosystem • Planning/ provision mapping/SMART Targets

15. The Ice Berg Behaviour Thoughts Feelings

16. Activity: Draw your own iceberg • In threes or fours, think about a child that someone in the group knows well and describe the behaviours clearly. • As a group, work out and note what thoughts might accompany the behaviours. Then do the same for emotions. • Think about environmental factors that impact all of the above. • How might you use some of this information to establish a baseline and inform planning- can you set any SMART targets or outcomes?

17. Cognitive Behavioural Approaches • Explores core beliefs (e.g. I am not able to achieve at school). • How do these core beliefs affect thoughts, feelings and behaviour? • How can we adapt our thoughts to challenge our core beliefs and turn them into something more positive?

18. Emotion Coaching • Teaches adults how to engage with children in heightened emotional states. • Ecosystemic: Acknowledges the role of adults in lessening, maintaining or exacerbating the emotional states of children. • 5-Step Approach • 1. Becoming aware of the child's emotions • 2. Recognising the emotion as an opportunity for  •     intimacy and teaching • 3. Listening empathetically, validating the child's •     feelings • 4. Helping the child find words to label the  •     emotion • 5. Setting limits and explore strategies to solve the •     problem at hand.

20. Emotional Literacy Support Assistant (ELSA)

21. Environment Thoughts Cognitive Behavioural Model Behaviours Emotions Physiological Response

22. Tools to assess individual needs • A range of approaches can be considered to help identify individuals who may benefit from more targeted support • The DfE places particular emphasis on the importance of: • Effective use of data, such as a screening tool; and • Effective pastoral system in which students are well known by at least one member of staff • Screening tools should not be used in isolation

23. Observation • Describe the behaviours (e.g., what, how often, when, intensity, how long) • Are there any behaviours that occur together (e.g., certain situations, in a chain)? • What activities does the child do? How do these go? • How predictable is the routine? • Level/type of work, transitions, positive feedback, choices, communication and interaction etc. • What actions and objects are supportive or present challenges to the child? • What function do the behaviours serve? • What’s already being done to try and support the child/change the behaviour?

24. Stirling Children’s Wellbeing Scale

25. Warwick Edinburgh Mental Wellbeing Scale

26. Target Monitoring and Evaluation forms • A flexible way to evaluate outcomes of a wide range of interventions • SMART targets agreed and clearly described in consultation with staff, families and CYP • Ensures coherence and continuity across different people and settings

28. Interventions • Scaling system to elicit child voice • Cognitive Behavioural Approaches • Emotion Coaching • Solution Circles • ELSA

29. Scaling Very Not at all

30. CYP - IAPT • - IAPT- Improving Access to Psychological Therapies • - CYP-IAPT – a programme to transform CAMHS and improve clinical outcomes which works with and supports change in existing services in NHS, LA’s and the voluntary sector • CYP IAPT PRINCIPLES : • A. Participation - Ensuring services are influenced through collaboration between CYP and their families and services, • B. EBP- Services/treatments are based on best available evidence, • C. Accountability -Clients are given feedback in every session to reflect on progress towards goals set • D. Awareness -All of these become part of a long term culture within the service. • E. Accessibility- Improved access to services for families, CYP. • - Development of CYP-IAPT collaboratives to further develop training packages

31. Why Evidence Based Practice? …To stop us from doing good!!

32. WHAT IS EVIDENCE-BASED PRACTICE? • Conscientious use of current best evidence to make decisions about patient care • A problem-solving approach to clinical practice • Based on: 1. A systematic search for and appraisal of most relevant evidence to answer questions 2. One’s clinical experience and expertise 3. Patient preference and values

33. Why is Best Evidence and Evidence Based SEMH Practice Important? • Ensures CYP receive the care that fits their needs • Facilitates sound decision making and makes it more explicit • Minimises risk to the CYP so that benefits outweigh harm • Provides us with the skills and knowledge to evaluate healthcare literature and practice • Exposes gaps in knowledge and conflicts in evidence

34. Relevance of EBP to Our Practice in School Think about a pupil with SEMH needs and consider the following: • Assessment – how do you properly gather and interpret findings? • Causes of the problem – how to identify them? • Deciding what the problem is – where the symptoms/signs indicate a range of possible problems how do you decide which is most likely? • How to select and interpret tests used to identify problems and to monitor progress? • How to estimate the likely progression of a condition/illness and any likely complications? • How to select interventions that do more good than harm and that are worth the effort and cost of doing them? • How to reduce the chance of the problem reoccurring or how to promote health? • How to keep up to date; improve your skills; and work in a more effective/efficient team? • How best to understand the perceptions of individuals and groups e.g. CYP, families, parents. Adapted from Sackett et al (1997)

35. ROUTINE OUTCOME MEASURES • What are they? • Why use them? • Which ones do you already use? • Which ones should you use? • Where can you find them? https://www.corc.uk.net/

36. Key factors for successful SEMH interventions • - Relationships • - Routine Outcome Measures (ROMs) • - Goal Based Outcomes • - Session Rating scales • - Planning the end at the beginning! • -Supervision

37. Ladder of Intervention Is a guidance document that supports pupils with SEMH including those with behaviour that challenges the organisation. Emphasises the importance of a relational approach and developing positive mutually respectful relationships between adults and pupils. Signifies the importance of a whole school approach to positive emotional wellbeing.

38. Intervention Guidance Jointly developed across health, education and social care professionals Provides guidance on universal strategies and approaches, targeted intervention specialist intervention Provides information on CPD, approaches and services

39. Engagement events 5 Engagement events across the county to explore the content of each document and gather school views/feedback on the draft documents. (venue to be confirmed – letter will be issued in red bag) If you wish to attend please inform inclusiveeducation@northyorks.gov.uk

40. The SEMH Orchard- SEMH Intervention Guidance

41. SEMH PLANNING -ACTIVITY • 1. Think about a pupil who is attending your school. • 2. Consider the additional needs of the pupil • 3. Use the SEMH Orchard to help you find a pathway for that CYP. • 4. Summarise the support and intervention you would endeavour to source and/or deliver.

42. References • Mental Health and Behaviour in Schools (2018) https://www.gov.uk/government/publications/mental-health-and-behaviour-in-schools--2 • Measuring and monitoring children and young people’s mental wellbeing: a toolkit for schools and colleges https://www.annafreud.org/media/4612/mwb-toolki-final-draft-4.pdf • Supporting Mental Health in Schools and Colleges (2017) https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/634728/Supporting_Mental-health_Case_study_report.pdf