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Targeted Mental Health in Schools

Project

-

Evaluation of Interventions

Edited by Mike Simons, TaMHS Project Manager and Lead Educational Psychologist

Northamptonshire TaMHS Project - Evaluation of Interventions April 2009 – March 2011 1

Northamptonshire

AcknowledgementsThanks to all involved in the TaMHS Project especially staff, pupils and

parents in the 13 project schools and their localities who conscientiously: engaged with consultation & training; implemented interventions; and

collected data.

The project schools were as follows: -

Daventry WellingboroughAbbey JuniorAshby Fields PrimaryBarby PrimaryFalconers Hill InfantFalconers Hill JuniorSt James InfantWilliam Parker Secondary

Croyland PrimaryHardwick InfantHardwick JuniorRuskin InfantRuskin JuniorWeavers School Secondary

Thanks also to all members of the multiagency Northamptonshire TaMHS Project Implementation Team, who: shaped implementation; delivered

training, consultation and support; many of whom also authored chapters in this evaluation document:

Mike Simons, TaMHS Project Manager & Lead Educational Psychologist

Jan Pawlikowski, Specialist CAMHS Advisor John Fardon, Specialist Teacher – Mental Health Kathryn Davidson, Educational Psychologist Yvonne Benson, Educational Psychologist Julia Jackson, Lead School Nurse for Mental Health Charlotte Lockyer, Senior Specialist Primary Mental Health

Practitioner Melissa Wheeler, Specialist Primary Mental Health Practitioner Georgia Adams, Specialist Teacher – Mental Health

Thanks to others who helped to steer the project:Mike Brooks, Tessa Parkinson, Mike Payne, Jenny Harris ,

Judith Cattermole, Cath Kitchen, Lucy Hardy, Suzanne Binley, Gill Walker and Paul Burnett

Finally, thanks to all who contributed to training, administration and other valuable support to the project.


Contents

Page no. Focus Author / Team Members4 Introduction Mike Simons6 Building Blocks of Provision for Building Mentally

Healthy Schools in NorthamptonshireMike Simons

7 Key Processes for Building Mentally Healthy Schools in Northamptonshire

Mike Simons

8 Ratings of Interventions by Project School Representatives

9 Section A: Locality Intervention10 Locality Mental Health Teams Mike Simons17 Section B: Multi-wave Interventions18 1-2-3 Magic – for use by staff & parents Yvonne Benson & Mike

Simons27 FRIENDS for Life Kathryn Davidson42 Massage In Schools Programme Mike Simons49 Midday Supervisor training Yvonne Benson54 Motivation training Mike Simons61 Other Mental Health Specific Training Delivered

to Whole StaffMike Simons

66 Protective behaviours training John Fardon70 Relaxation John Fardon (& Melissa

Wheeler)74 Shoebox including Wave 3 Interventions John Fardon78 Solihull Approach training for key staff

And Solihull Awareness training for whole staffMike Simons & Julia Jackson

87 Solution focused training for key staff Kathryn Davidson94 Section C: Wave 1 Pupil/parent- focused interventions95 Growing Talent for Inclusion Yvonne Benson105 Zippy’s friends Kathryn Davidson116 Section D: Wave 2 Pupil/parent- focused interventions118 Children’s Stress Management & Parenting

Seminar Workshops in Secondary SchoolsJan Pawlikowski

124 Peer Support and Peer Mentoring Mike Simons & Charlotte Lockyer

132 RESPECT Melissa Wheeler136 Section E: Wave 3 Pupil/parent- focused interventions137 Drawing and Talking John Fardon141 Emotional Health and Wellbeing Teams

(EHWBTs) in Secondary SchoolJan Pawlikowski

149 Meeting individual needs through consulting with pupils, parents and staff

Julia Jackson

154 Relate Family Counselling Mike Simons158 ASD Training for Parent Focused Workers Mike Simons162 Section F: Staff Well-being Focused Interventions 163 Headspace Mike Simons167 Worklife Support Programme for Staff Well-

beingMike Simons & Melissa Wheeler


Introduction

The current document provides the detail of each intervention used in the Northamptonshire TaMHS Project which ran from April 2009- March 2011, enabling 13 particular schools, as well as others to significantly improve their capacity to promote children’s mental health and to intervene where needs are identified, resulting in improved outcomes in terms of emotional wellbeing, attendance, behaviour, exclusion and attainment.

This document accompanies and should be read in conjunction with the ‘Northamptonshire TaMHS Overall Project Evaluation Report’, which summarises the aims, plans, implementation and evaluation of the overall project in terms of key overall outputs and outcomes.

Key Interventions

This document details the key interventions that have helped to bring about the overall key outputs and outcomes. Each chapter sits within a section related to the level or client focus of the interventions. The first section (A) has a focus on the Localities of the project schools, while the proceeding 4 sections (B-E) relate to the waves of intervention for pupils/parents. The interventions described in Section B can best be described as ‘multi-wave’ in terms of their focus, as they are usable at more than one wave of intervention, meaning as follows:

o Wave 1 – whole-school or whole class: i.e. universal / for all o Wave 2 – group / targeted: i.e. for those children who especially need additional input to

Wave 1. o Wave 3 – individual or very small group / more targeted: i.e. for those children who

need input additional to Wave 1 and Wave 2.Those pupil/parent interventions that are focused at particular Waves 1, 2 or 3 are described respectively in sections C, D & E. The last section (F) describes the evaluation of interventions relating to programmes designed to address well-being needs of staff.

Section & Chapter Structure

Within each section, a number of chapters present information about each intervention in a broadly consistently structured format in terms of:

Description of the intervention; Rationale for including the intervention as part of the project; Implementation/training regarding the intervention that was provided during the project ; Evaluation method for the intervention; Evaluation results for the intervention; Overall Impact rating by senior school staff of the intervention: on children who are

vulnerable to experiencing difficulties with Mental Health or who are already experiencing such difficulties; and on the school overall. [These ratings are summarised for all interventions on page 7 of this report].

Capacity-building aspects related to the intervention (including countywide, locality, within school staff / provision and within individual children and families;

Conclusion - in terms of the key lessons learned about the intervention to take forward; References.

Each chapter has been authored by one or more members of the project team who have taken a lead in implementation/evaluation of that intervention. These chapters are designed to provide the most relevant information to the reader about the value of these interventions from evaluative work following implementation in the project schools (and sometimes also in


other schools). This information should help enable the reader to make an informed decision about the usefulness of that intervention to their pupils, school or other organisation(s).

Building Blocks of Provision for Building Mentally Healthy Schools in Northamptonshire

Frequent reference is made to a model entitled ‘the Building Blocks of Provision for Building Mentally Healthy Schools in Northamptonshire’. This is a model which constitutes a key product of the Northamptonshire TaMHS Project as it summarises the aspects of provision that current evidence suggests are most important for all Northamptonshire schools to have available in order to promote and intervene in children’s mental health needs effectively at many levels: Essential Underpinnings, Essential Foundations, Wave 1 / Universal, Wave 2 / Targeted and Wave 3/ More Targeted levels. This model is shown on the next two pages in full alongside the Key Processes for Building Mentally Healthy Schools in Northamptonshire, which shows the main approach for schools to take for adopting these Building Blocks of provision in order to best meet the current and future needs of their school community.

Sources of Further Information and Opportunity

For further information about implementation and evaluation methods, tools and results for specific interventions in the project, that could not be included in this report due to reasons of space or delayed availability, the relevant chapter author can be contacted via Mike Simons [email protected]

Further details describing each intervention are available on the on-line version of the Northamptonshire Shoebox: see www.northamptonshire.gov.uk/shoebox .

Opportunities for training in many of the interventions and approaches presented here can be accessed via www.northamptonshire.gov.uk/tamhs .

For requesting a consultation meeting about mental health provision building in a school, or a one day’s training for whole staff regarding Solihull Approach Awareness, or any other enquiry about making use of the TaMHS Programme for a school please contact [email protected]


mailto:[email protected]

http://www.northamptonshire.gov.uk/tamhs

http://www.northamptonshire.gov.uk/shoebox


Ratings of Interventions by Project School Representatives January – March 2011

The following are the average of given ratings provided by representatives from each school that used each intervention. These ratings were provided as part of a structured interview regarding the impact of the TaMHS Project conducted between 26 th January and 21st March 2011. Comments about interventions and more details regarding these ratings including medians, modes and ranges, and the number of schools contributing to these figures are given in each relevant chapter. Other feedback from these structured interviews is given in the accompanying document, the ‘Northamptonshire TaMHS Overall Project Evaluation Report’.

Leve

l of I

nter

vent

ion

Interventions

Average ratings: “Where 10 is very highly useful and 1 is not at all useful, on a scale of 1-10, how useful do you think the following TaMHS interventions were/are......a)For children who are vulnerable to experiencing difficulties with Mental Health or who are already experiencing such difficulties

...b) Overall to the school

Mul

ti-w

ave

inte

rven

tions

1-2-3 Magic – for use by staff 6.9 6.81-2-3 Magic – for use by parents 7.4 6FRIENDS for Life 7.7 6Massage In Schools Programme 10 10Midday Supervisor training 4.7 6Motivation training 7 7.4Other Mental Health Specific Training Delivered to Whole Staff

5.3 6.8

Protective behaviours training 8.5 9Relaxation 6.6 6Shoebox Introduction 6.8 6.6Shoebox Wave 3 – effective use with individual pupils

8.3 6.4

Solihull Approach training for key staff and Solihull Awareness training for whole staff

8.3 8.4

Solution focused training for key staff 8 8Wave 1 Pupil/parent- focused interventions

Growing Talent for Inclusion 2 7Zippy’s friends 8.8 7

Wave 2 Pupil/parent

focused interventions

Children’s Stress Management 10 n/aPeer Support and Peer Mentoring 8 7.7RESPECT 5

Wave 3 Pupil/parent-

focused interventions

Drawing and Talking 9.5 7.8Emotional Health and Well-being Teams (EHWBTs) in Secondary School.

10 10

Meeting individual needs through consulting with pupils, parents and staff.

9.1 7.3

Relate Family Counselling 10 n/aTraining re ASD for Parent Focused Workers 7 6

Staff Well-being Focused Interventions

Headspace 7 9Worklife Support Programme for Staff Well-being. 6.8 5.8


Section A

Locality Intervention


Locality Mental Health Teams

By Mike Simons

Description of Locality Mental Health Teams

Locality Mental health Teams were forums at locality level where representatives from relevant locality agencies (inc schools) can come together as a team to address children’s mental health needs in the locality. The agencies invited to be involved included all those that were deemed to have a role in promoting and intervening in each locality of the project schools in both Daventry and Wellingborough localities of the schools involved. The agencies that became involved, in at least one meeting, included: ABC (Alliance for Black Children), ASD Specialist Teacher, BACIN, Children’s Centre Practitioner , CLA Specialist Teachers, Community paediatrician, Daventry Transitions worker, Educational Psychologists, Education Welfare Officer, Extended Services Co-ordinator, Faith leader, Family Centre Practitioner, LASI PSHE/SRE/Drugs Advisor, Prison, Youth and Community Worker, Prevention Through Learning Programme/U-Turn Practitioner, PSA, Relate Manager , School Nurse, Service Six, Social Worker, SNIP Parent Partnership Officer, Specialist Primary Mental Health Practitioner, Specialist Teacher for Mental Health, Time to Talk worker, Youth worker+ rep from each TaMHS school.

Rationale for Including Locality Mental Health Teams in TaMHS

In the early planning stages of the Northamptonshire TaMHS Project, it was envisaged that the within-schools work would be ‘supported by a virtual mental health multi-agency team of specialists who will operate at school cluster level within the localities’: due to the helpfulness of viewing mental health promotion and intervention systemically. Given the parallel process of the development of Local Operational Teams (LOTs) within the county council model of Area Based Working, it was deemed useful to use the work of the Locality Mental Health Teams to inform aspects of the LOT process.

Locality Mental Health Teams - Implementation

The setting-up of the TaMHS Locality Teams began in June 2009, by convening meetings with project school staff and project workers and others who were deemed to be most relevant to promoting and improving children’s mental health – enabling this group to identify others who should also be involved. This led to a series of 10 meetings for each team and work between these meetings between June 2009 and March 2011, involving staff from the agencies listed above as well as representatives from the schools.

The meetings were convened in Daventry at one of the project schools and in Wellingborough in the training room of the local education partnership – The Wellingborough Education Partnership (WEP). The two locality teams followed a parallel process. The initial meeting for each focused on information sharing about the Northamptonshire TaMHS Project and completion of evaluation forms designed to be both a baseline for the whole project (see accompanying document entitled ‘TaMHS Overall Project Evaluation Report’ for copy of the form used) and to encourage thinking and recording of such thinking about what is already in place and what is needed additionally on a locality basis to improve support to children’s mental health. Also at the initial meeting, each local agency representative was asked to complete an agency-mapping proforma (as shown below) by describing activities that are currently provided by their service, which support mental health/emotional well-being of children age 5-13 in schools or elsewhere in the local area . The aim of this exercise was principally to identify Northamptonshire TaMHS Project - Evaluation of Interventions April 2009 – March 2011

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the range of services provided by different agencies and also the actual cost of these services and the source of funding. Information in the completed proformas were collated and then distributed to all members of the locality team.

Agency Service Mapping

Name of Agency

Name of Programme delivered

Wave 1 (whole school/whole class),

Wave 2 (group work) or Wave 3 Individual session/therapy?

Brief description of what the service or programme delivers

Who provides this within your agency?

I.e.: Which staff

Cost of delivery of service

i.e.: Staff time, materials etc

Who currently funds this service?

i.e.: NCC/PCT/School/Community

At the second meetings in September/October 2009, the collated results of the baseline evaluation were shared, discussed and explored and an exercise conducted to prioritise the subsequent work of the forum, which would be explicitly different to that of the developing Local Operational Teams, and so avoid wasted resources through duplication. This exercise set the priorities for the subsequent activities of the team within and beyond meetings until the ‘evaluation and next-steps’ phase which began in November 2010.


Evaluation & Evaluation Results for Locality Mental Health Teams

Evaluation of the work of the Locality Mental Health Teams can be construed in terms of the issues and needed resources identified and then the activities or outputs that occurred during the project; and assessment by team members of the value of these activities. The aspect of evaluation by the team of the impact of the combination of the locality work and the work within schools is detailed in the accompanying document.

In terms of the identified priorities in both areas, these were highlighted [in italics] by team members and acted-upon as follows: -

A reduction in ‘fire-fighting’ and hence, providing earlier intervention more effectively: including use of the Northamptonshire Shoebox. Effective early intervention was regarded as key focus on all aspects of the TaMHS work and it was considered useful to support team members in effective use of the Shoebox. This was achieved through John Fardon, Specialist Teacher for Mental Health providing an overview, presenting a case-example and facilitating group activity for using the Shoebox.

Ensuring clear and easy access to and delivery of service to meet needs: including a pathway for ADHD. Since an ADHD pathway was a countywide priority of workstream of the CAMHS Partnership, it was felt that it would be helpful to work on general access to local services rather than a specific ADHD pathway.

Increase Staff Knowledge and Understanding. This aspect was a focus of the TaMHS project through much of the work directly with schools as well as through the Locality Mental Health Team. During an end-of-meeting problem-solving discussion, a specific need to increase knowledge and understanding about supporting children and parents who have experienced bereavement. The flexibility of the Locality Mental Health Team approach meant that such training input by the Child and Adolescent Bereavement Service Co-ordinator could be accessed and provided to team members. Furthermore, in terms of embedding and refreshing the large amount of training being accessed through the TaMHS project, it was important to identify means of keeping such learning alive. This led to a trainee educational psychologist, Will Cross, being tasked by the TaMHS Project Team with researching best practice and sharing this with the Locality Mental Health Teams. The result was a comprehensive literature review with examples of best practice, including the use of Solution Focused Reflecting Teams (SFRT), to both elicit useful support to work on an issue and through doing so to be reminded of previous learning that can be applied. This led to experiential learning within the teams of the SFRT process, with guidelines for members to be able to use in a variety of forums.

Developing a local services directory – and one that includes referral criteria. This was prioritised as a useful activity for the Locality Mental Health Team, enabling completion and collation of information about functions of agencies represented. There was further sharing of information by team members of other local services, which have since been collated in the Daventry area.

Increasing access to consultancy from key services. By members of the Locality Team meeting regularly, such consultancy would be made more available.

Supporting staff well-being. For school staff this was being made available through TaMHS access to the Work Life Support programme. The Locality Mental Health


Team would however, provide support to one another and encourage supportive consultation which would aid staff-wellbeing

Training for PSAs and other parent-focused workers in supporting children who have ASDs. This was prioritised as a useful activity, which because of its in-depth nature, was sought from relevant professionals and became a TaMHS 2-day course which is described separately within the ‘TaMHS Evaluation of Interventions Report’.

Clarifying the ‘parent support’ maze – including defining roles, how to engage parents from earliest opportunity (by class-teachers/form-tutors) & develop shared parenting resources between/among schools. One positive (though delayed) outcome could be parents more willing to engage in CAF process when needed. This was prioritised for work of both teams: in terms of drawing together information about parent support, including the work of Relate, parent participation, evidence-based parent programmes and encouraging team members to share access to their resources. For some aspects, like best practice in general parent engagement, there was opportunity only to sign-post to relevant agencies to access specific input to whole school staff.

Facilitating consistent SEAL/PHSE delivery. While this was regarded as very important work, there were other agencies focused on such work and therefore, to provide additionality, it was decided to prioritise other aspects.

Better links with feeder-schools for transition to secondary schools. Through meeting together cross-phase, greater links were enabled between infant, junior, primary and secondary schools: which led to useful shared understanding about other phase’s provision, as well as holistic and purposeful discussion about families whose children are in different schools and may therefore, ordinarily access a different home-focused worker.


The activities of the Local Mental Health Teams were evaluated by members in both teams as follows: -

Respondents Daventry Wellingborough Total

School Based 5 6 11

Other Agency 6 2 8

Total 11 8 19

They rated the activities in terms of:

‘the value of each of 18 listed outputs by the TaMHS Locality Team as having been of help to members of the children’s workforce in directly or indirectly meeting the needs of children in the locality who are vulnerable to mental health difficulties or those who already have significant difficulties related to their mental health’.

The rating scale used was 1 (Not helpful at all) – 10 (Highly helpful).

The members’ of the both Daventry and Wellingborough teams overall average ratings were as shown below, with the five most valued aspects shown in bold-type. Discounting the activities focused on ‘providing information’: about sources of training re Parent engagement & parent participation, which were brief and provided input only about, rather than actual training input, each aspect was rated on average at least at 7.5 with ten aspects between 8.0 and 8.6.


Ratings for TaMHS Locality Team Outputs June 2009 – November 2010

1. Building a TaMHS Locality Team and developing work together, including the sharing of strengths and resources over the course of 7 minuted meetings.

2. Base-lining perceptions of the success at meeting mental health needs in terms of the majority of children; children who are vulnerable to Emotional Wellbeing/Mental Health difficulties; and those children who have more significant Emotional Wellbeing/Mental Health needs; and how well supported are the parents of children in each of these categories.

3. Feeding back analysis of the base-lining.

4. Setting priorities for the work of the TaMHS Locality Team.*

5. Mapping of Local agencies and sharing this info.

6. Sharing knowledge of and actual Parent- focused provision in locality including that provided by schools and others.

7. 1-2-3 Magic training provided for Parent-focused workers in locality.

8. ASD training for Parent-focused workers in locality and beyond.*

9. Input offered re Parent Engagement best practice from SN-IP

10. Introduction to Parent Participation esp. in decision making in schools.

11. Overview of evidence-based Parenting programmes.

12. Overview of the work of Relate.

13. Northamptonshire Shoebox overview and sharing of real practice.

14. Summarising research findings into sustainability and embedding of learned skills

15. Experiential learning of a researched method of sustainability and embedding of learned skills, and solution finding.

16. Bereavement – how to support children who are bereaved.*

17. Overall: support from specialist mental health focused workers and networking to share approaches, knowledge and skills.*

18. Work of the locality team has linked into specific work in each TaMHS school, and other TaMHS training input to provide a systemic perspective re mental health provision.*

When asked about how Locality Mental Health Teams have enabled children’s mental health to be better supported, responses from team members identified 6 key aspects, related to knowledge, communication and access to services: -Northamptonshire TaMHS Project - Evaluation of Interventions April 2009 – March 2011

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8.0

8.0

7.7

8.4

8.2

7.8

8.0

8.5

6.0

7.8

8.2

7.9

8.1

7.8

7.5

8.59

8.61

8.47

* 5 Highest rated aspects in bold

• More widespread specialist knowledge and awareness by staff through training.• Improved knowledge of external agencies.• Better communications between agencies.• Better access to specific services including groups to support family around the child –

as identified through PSA/Mental Health Workers. Parent Support Advisor input for parents & families.

• Better access to specialist mental health workers for advice and consultation.• Better access to a variety of services with good support networks.

Capacity Building for Locality Mental Health TeamsAs shown by the evaluation of the Local Mental Health Team work, school staff and representatives who attended have gained in capacity in terms of their increased knowledge, awareness, communication and access to other services. They have also gained some tools to keep such and other learning alive and to embed this learning further.

Since the key aspects that were valued from such activity have been teased-out through this evaluation, it provides a useful foundation for those involved in the team to bring such thinking and approaches to bear in existing forums, including LOTs, education partnerships and school clusters. This is the case within project areas, but also within all other areas of Northamptonshire, especially as each of the project implementation team workers were involved in the Locality Mental Health Teams, and can thus use that experience to share such practice within their substantive posts around the county. From feedback about ‘next steps’ in the final Locality Mental Health Team meetings and at the TaMHS conferences where this work was presented at a workshop, it was felt that given the absence of area-focused TaMHS project workers hereafter, that it would be best to enable existing forums to provide such input, rather than set-up additional forums, with the additional time-demands that this would require for all involved.

Finally, the aspects of work that were prioritised during the project, are likely to be ones that are common to other geographical areas, hence this work has informed the Building Blocks model for building Mentally Healthy Schools.

Conclusion from Results of Locality Mental Health Team Evaluation

Given the high ratings given to majority of the Locality Mental Health Team activities, the indication is that the: existence of the team, the establishing the remit and the work of the teams fulfilled valuable functions especially in relation to improving knowledge, communication and access to services. The value of consultation with co-workers is amply shown by the high value placed on ‘setting priorities for the work of the TaMHS Locality Team’, enabling members of the team to have joint-ownership of the objectives and hence, also of the work to achieve these. Also, the value of content for training was identified through the highly valuing of the ASD training and bereavement training. Furthermore, results indicate that systemic and holistic work are seen as valuable, in terms of explicitly linking work within schools to work at locality level through a combination of specialist support and networking: suggesting that indeed: ‘The whole is greater than the sum of the parts. Such learning can be applied in localities elsewhere in Northamptonshire.


Section B

Multi- Wave Interventions


1-2-3 Magic

By Yvonne Benson and Mike Simons

Description of 1-2-3 Magic

According to ‘1-2-3 Magic’ the job of parenting consists of 3 tasks:

1. Controlling obnoxious behaviour (arguing, whining, fighting, tantrums)

2. Encouraging good behaviour (going to bed, homework, eating)

3. Strengthening your relationship with your child (praise, active listening, shared fun)

The programme was devised by the Clinical Psychologist Thomas Phelan, Ph.D. parent of a son with ADHD and is a behavioural management programme for parents and other carers- including teachers - of young children up to 12 years of age. The ‘1-2-3 Magic’ parenting programme explores parent-child relationships and the purpose of children’s behaviour including sibling rivalry, conflict and tantrums. It shows how applying the rules of ‘1-2-3 Magic’ can make a positive difference to these relationships.

The ‘1-2-3 Magic’ programme aims to provide simple, clear strategies, such as time-out and rewards, to reduce the negative and conflicted patterns of interaction between parent and child. It provides examples of positive and negative parenting practices and practical suggestions for overcoming difficulties caused by children’s behaviour. The key elements for parents emphasise clear and calm communication outlining expectations for their child’s behaviour and how to further develop and promote better relationships with their child.

Focusing on the three tasks of parenting as stated above, behaviours are divided into those the parent wants their child to stop such as whingeing, fighting and defiance and those the parent wants their child to start, such as paying attention and being polite. Strategies that can be used by parents include stop techniques which involve several stages before going into a ‘Time-Out’; while start techniques involve all the positive reinforcements that are familiar to most parents e.g. shared fun.

Rationale for 1-2-3 Magic Awareness Sessions

A common factor thought to be one of the causes of behavioural difficulties in children is any difficulties in the parent–child relationship (Kendziora and O’Leary, 1993). Further research undertaken by Cummings and Davies (1994) highlighted how emotional negativity in parenting and problems in child management can contribute to the behavioural and emotional problems in children, which can in the long term result in conduct or oppositional disorder and other mental health difficulties for the child. In turn these increasingly difficult behaviours raise further parental negativity and continue this negative cycle for family relationships and future outcomes for the child. Kendziora and O’Leary (1993) noted that because of the impact this negative cycle has not just for families but society as a whole, the main focus and input for children’s mental health should be on improving parenting and parental practices. It is important to support parents to feel more confident and have greater self efficacy about themselves and their own style of parenting.

Over the past five years, there has been an increase in key policies (ECM, Early Intervention) for promoting children’s emotional wellbeing through focusing on parenting interventions. Good, effective, positive parenting, is advocated by policy makers and practitioners to be a key element in supporting and enabling children and their families to have good long term mental health outcomes. A variety of behaviourally oriented individual and group-based parent Northamptonshire TaMHS Project - Evaluation of Interventions April 2009 – March 2011

18

programmes have been developed (Cunningham et al., 1995; Webster-Stratton et al., 1989 etc.) Behavioural orientated programmes focus on changing parental attitudes to affect parenting through the development of skills and self control to impact on their children’s compliance and behaviour. Gottlieb et al (1995) report that programmes that focus on changing parental behaviour have a more profound and lasting effect on children’s behaviour and so their longer term mental health, than those which focus solely on changing parents’ attitudes. Bradley et al (2003) found that in an evaluation study of the behaviourally orientated parenting programme ‘1-2-3 Magic’, undertaken in four brief sessions with parents of 3-4 year olds, parents reported more positive parental behaviour and significant changes in their child’s behaviour that continued in a one year follow-up to the study. Bloomfield and Kendall in a more recent study (2007) also found that ‘1-2-3 Magic’ is effective in terms of improving parenting self-efficacy. Parents who are confident in their parenting skills are more likely to be able to nurture and support the emotional wellbeing development of their children.

The rationale for including ‘1-2-3 Magic’ in the TaMHS project came from exploring how to support schools with their parental links and continue the development of positive mental health with their families outside of the school day. The ‘1-2-3 Magic’ programme is widely advocated by Specialist CAMHS when working with parents and so was proposed as a useful, practical programme that schools could easily utilise.

Provision of Awareness Raising Sessions and ImplementationTwo one-day 1-2-3 Magic Awareness Raising sessions took place in Northamptonshire in January 2010, led by Julie Harrison formerly from the British Red Cross ADHD Project and at that time working as a Family Support Worker for Briar Hill Family Resource Centre. Members of staff from the TaMHS schools attended in each of their local areas - Wellingborough and Daventry. Materials and resources linked to ‘1-2-3 Magic’ were made available and participants were given the opportunity to discuss the programme with a parent who used 1-2-3 Magic in the home environment and further explore how they may employ the techniques and strategies within their schools. The sessions focused on:

The key elements of the 1-2-3 Magic programme. Techniques that can be useful for families who have children with ADHD. The structure of the programme. The importance of communication and language in ‘1-2-3 Magic’.

The awareness sessions were provided at the Wellingborough Education Partnership training room on the 5th of January 2010 for 18 participants and again at St James’ Infant School in Daventry on the 12th of January for 14 participants. Participants included Educational Psychologists, Specialist Primary Mental Health Practitioners, a BACIN Family Link Worker, Family Centre Workers, Family Support Workers and members of staff from TaMHS schools, mainly those who have a specific role in supporting parents.

TaMHS Evaluation

Evaluation of the awareness raising sessions was carried out using a questionnaire which focused on participants rating their knowledge and skills regarding the learning objectives of the session before and after on a scale of 1-6 (1 not at all, 6 very much). Ratings for the presentation and relevance (1- poor and 6 excellent) were requested along with any comments about the sessions.

The learning objectives for both sessions are listed below:

1. I understand the key elements of the 1-2-3 Magic programme2. I understand how the techniques can be effective with ADHD families


3. I understand the basic principles of the programme- structure, routine, clarity of language etc.

4. I feel confident enough to apply the 1-2-3 Magic techniques to my work

There was a plan also to evaluate the impact of using the ‘1-2-3 Magic’ Programme with families using pre, post and post + 3 months measures of the parent version of the Strengths and Difficulties Questionnaire (SDQ). However, few of the participants of the training were able to provide any of this information to the project staff, for a variety of reasons, especially due to difficulties obtaining completion of these questionnaires by parents.

Evaluation Results from the 1-2-3 Magic Awareness Sessions held at Wellingborough Partnership January 5th 2010 and St James Infant School January 12th 2010

The graph below shows the average rating scales of all participants in both Daventry and Wellingborough training cohorts, before and after in relation to the learning objectives.

Scores for the presentation, resources and relevance were very positive with an average score from the participants of 5.3, 5.5 and 5.5 respectively.

A sample of the comments from the participants on both courses included:

Fantastic course learnt a lot and looking forward in trying it out. Very informative, interested, really enjoyed. Hope to put this into practice. I know of '1-2-3 Magic' and have watched the DVD, but seeing it being done and given

more information and handouts are useful. Lots of info, particularly on ADHD, which I needed. Tutor was passionate and inspiring

in her subject. This will be a very useful tool to share with families. Very personable and professional presentation with clear examples for implementation. Very engaging presenter which kept me focused and interested. Lots of examples of

how approach used successfully. Very interesting course. Explanation of real life scenarios. Putting strategies into practise - hearing benefits and problems.


Feedback at follow-up sessions

A month following the sessions, meetings were set-up with groups of schools in each locality and facilitated by an Educational Psychologist to discuss how they had implemented or were hoping to utilise the information regarding ‘1-2-3 Magic’ from the sessions. The information below summarises some of the feedback from these sessions:

At that point in time there were 21 families in the Wellingborough and Daventry areas who were receiving 1-2-3 Magic support in some form through their school.

One school reported how successful the approach had been having been introduced into their year 4 and 5 classrooms as a whole class approach. The children helped to ‘own‘ the problem as they were involved in the process of listing ‘STOP’ and ‘START’ behaviours e.g. wandering round, shouting out. Difficulties included several children needing ‘time out’ space at one time and letting go of the idea for the teachers that ‘time out’ is a punishment. Previously it had taken some children 1-3 hours to calm down, following the approach this had reduced to 5-10 minutes (following ‘time-out’). One child recognising they had had an argument with their parent and needed to calm down asked to use the ‘chill out’ zone on entering school.

Parent of one child diagnosed with ADHD found support through school. One secondary school had discussions/coaching with their SEN Learning Support

Assistants. Rather than using ‘1-2-3 Magic’ as a whole school approach, they were using this within ‘isolation’/’time-outs’ with about 4/5 individual children.

Outcome Evaluation

One school’s, (Ruskin Infant) Parent Support Advisor (PSA) was able to share data with project team members for both Pre and Post intervention SDQs for 4 families, with whom she had specifically used ‘1-2-3 Magic’.

From the results of the Pre and Post SDQ assessments, three out of the 4 children’s presentations improved in ‘Total Difficulties’ scores, to the extent that they changed categories (according to the assessment tool guidance), 2 children’s scores changed from ‘Abnormal’ to ‘Borderline’ and one changed from ‘Abnormal’ to ‘Normal’. The only child whose ‘Total Difficulties’ score did not change, already had a score within the ‘Normal’ range, according to the assessment tool guidance. The shifts between ‘Total Difficulties’ scores and resulting categories (provided in SDQ guidance) pre and post ’1-2-3 Magic’ are as shown in the graph and tables below.


Pre -Total Difficulties

Post- Total Difficulties

Shift in Total Difficulties

Family 1 21 12 9 Family 2 20 15 5Family 3 24 16 8Family 4 11 11 0Average 19 13.5 5.5

SDQ Categories for ‘Total Difficulties’

Pre -Total Difficultie

sPost- Total Difficulties

Levels of Categories Shifted

Family 1 Abnormal Normal 2Family 2 Abnormal Borderline 1Family 3 Abnormal Borderline 1Family 4 Normal Normal 0

In terms of the difference between pre- and post SDQ assessment on aspects reflected by the sub-scales in this assessment tool, the greatest positive difference related to Conduct Problems, which positively shifted by the greatest amount for each of the 4 families. Also there are positive effects for 3 of the 4 families on ratings for Hyperactivity, Emotional Symptoms and also Pro-social skills. The average shifts in ratings of these sub-scaled aspects and the total across the 4 families are shown in the graph below – with all but Peer Problems’ showing a positive shift. For Peer-Problems, there was no change in ratings for 3 out of 4 families with one family reporting a slight negative shift.


In terms of the parents’ rating of impact of the difficulties by completing the second part of the SDQ called the “Impact Supplement”, there was a decrease of impact in all 4 cases – with 2 of them by an especially significant extent. This positive decrease was mainly accounted for by the change in the extent that difficulties were placing a 'Burden on your family as a whole': moving from pre: “A great deal” to post: '”only a little”' for two of the children. This same shift extent for these 2 children occurred also for “impact on the child's friendships”. Furthermore, there was a positive impact on 'Leisure Activities' for all four families. The overall impact pre and post and the sizes of the shift for each family and as an average are shown in the graph below.

According to the PSA who worked with these families using ‘1-2-3 Magic’, she commented that it seemed especially helpful to the children’s emotional well-being by it enabling the provision of consistency for them when they behave inappropriately and giving them clear boundaries to try to adhere to. She identified that is worked well in combination with other interventions that were available at about the same time through TaMHS and through other


provision. For one child, the combination of ‘1-2-3 Magic’, Zippy’s Friends’ (see elsewhere in this report) and accessing Wrap Around (the school’s after-school provision) seemed to be important for improved family functioning and improved mental health for the child. In terms of recommending it for use with other families, she highlighted the need for families to be able to stick to the process for 1-2-3 Magic to then enable family members to get on better with each other.

Overall Impact Ratings of 1-2-3 Magic

" Where 10 is very highly useful and 1 is not at all useful, on a scale of 1-10, how useful do you think the following TaMHS interventions were/are

Overall Impact Ratings of 1-2-3 Magic for use by parents, according to senior staff from 8 project schools

Average Median Mode Range

a)For children who are vulnerable to experiencing difficulties with Mental Health or who are already experiencing such difficulties

7.4 8 8 5 to 8

b) Overall to the school 6 5 5 5 to 8


Overall Impact Ratings of 1-2-3 Magic for use by school staff, according to senior staff from 7 project schools



6.9 7 8 5 to 8

b) Overall to the school 6.8 7 7 5 to 8

Comments made alongside these ratings identified that within school 1-2-3 Magic worked well with individual children due to shared language and shared approach building on what already existed. One school representative commented that due to there being many children with issues re behaviour, 1-2-3 Magic is very helpful overall. In terms of use by parents, overall rating comments included that some parents have found it useful: but others less so, as they seemed not able to take approach on: depending on organisation and motivation of the parents. But that when parents engage well and take on 1-2-3 Magic, individual children seem to benefit.

Capacity Building

The 1-2-3 Magic Awareness sessions has built the capacity for staff in parental linked roles within the TaMHS linked schools in terms of the knowledge and skills in using the 1-2-3 Magic Programme. From the follow up meetings, schools were reporting a variety of ways they were utilising the programme and information from the awareness sessions to support children and their families. Capacity was also built through the attendance of Educational Psychologists and


Specialist Primary Mental Health Practitioners at the initial 1-2-3 Magic awareness raising sessions to use in their roles when working with parents or schools. Further sessions could be offered to other schools possibly through clusters. Feedback from the TaMHS mainstreaming conference showed that 83 participants indicated they would like to receive further information about the programme and 12 of these participants indicated they would be likely to purchase further sessions/training if funding was available in schools. Further capacity-building could usefully take place by commissioning ADDISS (the ‘1-2-3 Magic’ Licence Holder in UK) to train appropriate staff in Northamptonshire to deliver the programme to parents and to train appropriate staff to deliver training to school staff. This will need to be considered alongside other parent training and school behaviour management approaches.

Conclusion

As shown by the both the qualitative and quantitative results from the ‘1-2-3 Magic’ training and implementation, ‘1-2-3 Magic’ can be helpful to families who are able to implement this within their families, in combination with other school based input; and ‘1-2-3 Magic’ also has been shown to be of use to school staff in schools for setting and enforcing boundaries for behaviour.

The key lessons learned in the Northamptonshire TaMHS Project about ‘1-2-3 Magic’ to take forward include:-

Indications are that ‘1-2-3 Magic’ can be introduced successfully into Northamptonshire schools with a positive impact on children who are vulnerable to experiencing difficulties with Mental Health or who are already experiencing such difficulties, and on the school overall.

In particular, children benefit in terms of increased compliance with behavioural boundaries and parents benefit from using a framework for being more confident in their approach to boundary setting, and hence, increase positive behaviour of their children and reduction in impact of emotional and behavioural difficulties.

Key aspects for making implementation of ‘1-2-3 Magic’ successful for use at home or school include the readiness, motivation and capacity of the parent(s) or staff to make use of the framework and techniques.

Capacity needs to be further built for further implementation of ‘1-2-3 Magic’ in Northamptonshire schools, and the detailed results above need to be taken into account.

Further evaluation of the impact of ‘1-2-3 Magic’ locally would be beneficial for ensuring its efficacy.

Because of the indications of the importance to children’s mental health of ‘1-2-3 Magic’, it has been included in the Building Blocks of Provision for Building Mentally Healthy Schools in Northamptonshire at the Wave 3 focus for use by parents and as a Wave 1 Whole School Behaviour Management Approach, as a recommended provision for all schools.


References

Phelan T. 1-2-3 Magic: Effective discipline for children. 3rd ed. Child management Inc.; 2004.

Bradley SJ, Jadaa D, Brody J, Landy S, Tallett S, Watson W, et al. Brief psychoeducational parenting program: An evaluation and 1-year follow-up. Journal of the American Academy of Child and Adolescent Psychiatry 2003; 42(10):1171-1178.

Bloomfield, L. & Kendall, S. Audit as evidence: The effectiveness on parenting self-efficacy of ‘123 Magic’ programmes in one community.

Bloomfield L, Kendall S. Testing a parenting programme evaluation tool as a pre- and post-course measure of parenting self-efficacy. Journal of Advanced Nursing 2007; 60(5):487-493.


FRIENDS for Life

By Kathryn Davidson

Description of FRIENDS for Life

FRIENDS for Life (FRIENDS) is a 10 session programme which has been designed to prevent, and provide early intervention for, anxiety and depression. It is based upon the same theoretical model as Cognitive Behavioural Therapy, looking at how the mind, body and behaviour interact to influence our experience of anxiety. The activities are purposeful in their aim to increase children’s skills in managing anxiety, yet they are presented in a friendly, engaging manner. The sessions develop core emotional literacy skills through fun activities which are appealing to the age group the materials are designed for. By raising pupil’s skills in a number of areas, such as; identifying and managing their own feelings, helping them to find ways to relax, supporting them in exploring solutions and developing plans to overcome difficulties, encouraging young people to reward themselves when they have done well and working to raise their self confidence they are supported in managing life’s everyday knocks and hurdles. Sequences of activities throughout the sessions reinforce the core messages so that the skills are embedded within a young person’s coping strategies to enable them to manage difficulties more effectively. In this way, one of the aims of the programme is to raise young people’s levels of ‘resilience’. Resilience is defined as a person’s ability to ‘bounce back’ following a difficult event. High levels of resilience are seen as supportive in preventing the onset of mental health difficulties.

The programme is clearly set out with easy to follow lesson plans for each session (1.5 – 2 hours for each lesson). The sessions need to be delivered as part of the whole programme, but FRIENDS for Life can be delivered in a flexible way, either as whole class sessions, as a small group programme or as individual therapy sessions. However, it is widely recommended that the programme is used on a whole class, universal basis. In this way all pupils learn the skills and develop their knowledge and confidence together, they can then model strategies for each other and keep the ideas ‘alive’. The programme uses a wholly positive approach to teaching new skills and seeks to enhance skills that pupils already have. In this way, all pupils can benefit, they can support each other in the use of their new skills and they can provide effective support networks for each other as they grow up.

FRIENDS was developed in Australia by Dr Paula Barrett, a clinical psychologist who is now working as an Associate Professor with the Postgraduate Clinical Program at Griffith University in Brisbane. The materials have expanded over the years and now include a Key Stage 2/3 programme ‘FRIENDS for Life: For Children’, a Key Stage 3 / 4 programme called ‘FRIENDS for Life: For Youth’ and Key Stage 1 materials called ‘Fun Friends’. Further details can be found on friendsprograms.com. The programme has been well received on an international level. It is currently being implemented in at least 12 countries. The World Health Organisation (WHO) endorse FRIENDS (for Children and for Youth) as a well researched programme that may be used to enhance emotional resilience and prevent the onset of mental health problems (‘Prevention of Mental Disorders, WHO, 2004). In the current TaMHS project we have focused mainly on the Key Stage 2 and 3 materials ‘FRIENDS for Life: For Children’.


http://friendsprograms.com/

Rationale for Including FRIENDS in TaMHS Project

International and National Research

FRIENDS was initially designed to teach children skills and techniques to cope with and manage anxiety. Research has shown that there has been an increase in the number of young people experiencing difficulties with anxiety. A study by Costello et al. 2003 looked at the frequency of mental health difficulties in children and adolescents aged between 9 and 16 in America. The study of 1420 young people found that by the age of 16, 36% of children were identified as having a recognised mental health disorder and health problem. In the UK it would appear that around 10% of children aged 5 – 15 are diagnosed with a mental health difficulty, with around 4% experiencing difficulties with anxiety and depression (Meltzer et. al. The Office for National Statistics, 2000). Therefore, there is growing interest in finding materials that will teach young people core skills and reduce levels of anxiety. FRIENDS is supported by a strong research base that shows it is effective in reducing anxiety levels in children and young people.

Early research showed that up to 80% of children who were assessed as being ‘clinically anxious’ improved to being rated within the ‘average’ range following implementation of the programme (e.g. Barrett et. al., 1996). A further study found that FRIENDS was successful in reducing anxiety rates among 7 – 14 year olds who had been found to have ‘mild to moderate’ anxiety disorders and in preventing the onset of a disorder in children who had shown early features of an anxiety disorder before beginning the FRIENDS intervention (Dadds, 1997).

The benefits of the programme have been shown to be sustainable with children continuing to show no signs of an anxiety disorder 6 years after completing the sessions (Barrett et. al, 2001, Lowry-Webster et al, 2003). The programme appears to be equally effective whether it is run by a teacher or a psychologist (Barrett and Turner, 2001). Furthermore, research found that children who did not show concerning levels of anxiety when originally tested also benefited from the programme and demonstrated improvements in resiliency measures when they had completed all the FRIENDS sessions. Children have also been shown to be more socially competent and to use more positive coping strategies after taking part in FRIENDS (Conradt and Essau, 2003). Furthermore, there is evidence of increased levels of self esteem when FRIENDS is taught to whole class groups of 10 year old children (Stallard et. al, 2005) which are maintained a year after the programme has finished (Stallard et el 2007).

A study by Lock et al al. (2003) explored differences in the effectiveness of the approach between varying year groups. 336 9 – 10 year olds and 401 14 – 16 year olds completed the FRIENDS programmed. Results showed that the younger group of children achieved the greatest changes in anxiety symptoms, suggesting that early intervention may be more helpful than later involvement with the programme.

More recently (2010) Liddle and Macmillan asked teachers from 2 primary and 2 secondary schools to select pupils who they considered to have high anxiety and low mood and low self esteem. After completing the FRIENDS sessions pupils showed improvements in anxiety (measured by the Spence Children’s Anxiety Scales) and low mood (measured by Children’s Depression Inventory) which were statistically significant and all benefits were sustained at a four-month follow up evaluation. There were also increases in self esteem (as measured by the Culture-free Self Esteem Questionnaire) which were maintained at the four-month follow up.

Amidst all the positive evidence to indicate FRIENDS as a successful approach to prevent, and learn how to manage feelings of, anxiety, it would also appear to be an enjoyable programme. In 2010 Stallard comments that out of 1413 pupils who had completed the


FRIENDS programme, 81% said it was ‘fun’, 67% felt they had learned new skills and 69% would recommend it to a friend.

All the above evidence, coupled with Katherine Weare’s extensive review of ‘what works’ in effective approaches to promote mental health and wellbeing in schools (see Table 1) suggest that FRIENDS provides a robust and helpful way of preventing mental health difficulties and promoting emotional wellbeing within our schools.

Table 1 - The Key Ingredients of Effective Approaches to Promote Mental Health and Wellbeing in Schools

Initiation and Experience of FRIENDS in Northamptonshire Schools Prior to the TaMHS Project

In January 2008 a one day training course was run in Northamptonshire by Lincolnshire Educational Psychology Service in order to train 8 EPs, alongside 2 representatives from each pilot project school, a Specialist Teacher-Mental Health and teachers from the Looked After Children’s Team. This enabled educational psychologists (EPs) to support 3 schools in the implementation and evaluation of the intervention.

The successful pilot project found that teachers and students enjoyed the programme. Students said they would recommend FRIENDS to other schools. Feedback from focus group discussions showed that children as young as Year 3 could talk fluently about their thoughts, linking them with their feelings and behaviour. Parents were appreciative and said that they wished something similar had been in place when they were at school. Emotional Literacy scores (as measured by the Emotional Literacy Checklist) improved following the intervention, both when used in small group and whole class situations. Overall, FRIENDS taught an effective range of skills in an accessible manner. Children were able to apply the skills to a range of situations. The skills learned could easily be cross-referenced to the 5 core areas of the SEAL curriculum.

The pilot project resulted in further interest being expressed by a wider range of EPs in the programme. In September 2008 an approved trainer from the Pathways agency in Australia was invited to Northamptonshire to provide a 2 day course to train a number of EPs to be trainers for FRIENDS. Since 2008, six 1 day training courses have been run for teachers in schools to enable them to deliver the programme. Staff in approximately 40 schools across the


The Key Ingredients of Effective Approaches to Promote Mental Health and Wellbeing in Schools:

Evidence based Balance universal, targeted and indicated Whole school Skill development Peer led work Integrated across schools Active methodologies Supportive culture and environment Effective partnerships – parents and community and agencies High quality implementation (e.g. explicit guidelines, possibly

manualised) Leadership and staff development

K. Weare, 2011

county as well as county specialist Teachers of the Deaf have accessed the training. EPs have also delivered several ‘taster’ workshop sessions to encourage members of school staff and professional colleagues to explore the intervention further.

Implementation of Training and Provision of FRIENDS in TaMHS Project

All 9 of the eligible (KS2/3) TaMHS project schools were invited to send two members of staff to attend a one day training session. Support was then provided to the schools through consultation with TaMHS EPs and free resources to assist the initial implementation of the programme. TaMHS EPs also offered to run parent workshops to inform parents about the programme.

On completion of the programme schools were asked by their link TaMHS EP to consider how / if the intervention would be built in to curriculum planning in future years.

9 TaMHS schools have sent staff on the1 day training programme. 6 TaMHS schools have completed 1 full implementation of the programme, 1 is still in the process of running the programme. So far, 2 schools have implemented FRIENDS as part of a whole class curriculum and 5 have delivered the programme to small groups of students. 6 of the 7 schools who have already worked with the programme have made provision to run FRIENDS again in 2010-2011 and to maintain it on an annual basis.

Extent of parent involvement

In 4 schools parents were invited to attend workshops where the FRIENDS programme would be introduced by a TaMHS EP and one of the members of staff who would be running the programme. Attendance at the sessions was poor, but feedback from parents who attended was positive. In three schools one introductory session was arranged. At School A, parents of 3 pupils attended, a secondary school (WPS) had parents for 5 pupils in attendance and the final primary school was supported by the attendance of parents of 3 pupils to the session. At School C (Hardwick) the EP ran 3 sessions, an introduction, a mid-way review and a final session including a presentation by the children. 3 parents attended the first session, 1 came to the middle session and 20 came to the final presentation.


Table 2 - FRIENDS in TaMHS Schools 2009-2010

School Received Training?

Run programme?Whole class or small group?

Method of selection if small group

Who delivered programme?

Is programme running again this year?(2010-2011)

FHJSA

Yes Whole class – Year 5

N/A Teacher providing PPA cover for Class Teacher

Yes

CroylandB

Yes 2 small groups of 8

Low scores on EL Checklist and referral from school staff

HLTA from nurture class and Parent Support Advisor

Yes

HardwickC

Yes Whole Class – Year 5

N/A Class Teacher Yes

WeaversD

Yes Small groups Referral by from/subject tutor and/or pastoral staff

HLTA (Higher Level Teaching Assistant)

Possibly, but with a new name as there was confusion amongst staff and students thinking that it was an intervention to develop friendship skills

Barby Yes NoAbbey Junior

Yes Small groups Teacher selection

Teaching Assistant who is also Assistant SENCO

Yes

Ashby Fields

Yes Small groups Teacher selection

Learning Support Assistant

Yes

WPS Yes Small groups, Years 7 , 8 and 9

PASS data and discussion with Inclusion team and Heads of Year

TAs 2 TAs ran a group each, they also supported each other and ran the first small group jointly

Yes

Ruskin Yes No


Evaluation

As there is a broad evidence base indicating the proven benefits to students in reducing feelings of anxiety, we decided to explore the ‘skill building’ elements of FRIENDS further. We used the Emotional Literacy (EL) Checklist before and after the FRIENDS programme to look for an increase in children’s emotional literacy skills as a result of the intervention. The Emotional Literacy Checklist includes a pupil self-report checklist as well as a parent and teacher checklist for significant adults to provide their views regarding a young person’s levels of emotional literacy. The teacher’s and parent’s ratings can be further analysed into sub-scale areas looking at ‘self-awareness’, ‘self-regulation’, ‘motivation’, ‘empathy’ and ‘social skills’. Quantitative data is available for 4 Schools (Appendix 1).

Evaluation Results

Summary of Evaluation Results from Quantitative Data

Although varying types and amounts of data are available for analysis, overall the results indicate that the FRIENDS programme has a positive effect on pupils’ development of Emotional Literacy (EL) Skills, as rated by the pupils themselves. In one school there was a significant improvement in pupil rated emotional literacy skills. The school (School A) ran the programme as a whole class intervention for a class with identified social, behavioural and emotional needs. Results showed that 14 out of the 19 pupils for whom a comparison was possible showed gains in their self-reported emotional literacy skills following the FRIENDS programme. Another school (School D) showed similar levels of progress but with smaller numbers of pupils, running small group sessions with 4 pupils. A third school ran slightly larger small group sessions and results also indicate a trend towards increased emotional literacy skills. In all three of the schools where pupil EL Checklists were completed (37 pupils altogether), 14 pupils (37%) moved up one clear category rating (where categories are identified as well below average, below average, average, above average, well above average) and 4 (10%) moved up two category ratings. Only 3 pupils dropped down category ratings, but 2 of the 3 jumped down two whole levels of category rating. It would therefore appear that FRIENDS is a helpful intervention to be run in both primary and secondary schools. At present the results suggest a more positive effect when the intervention is run as a whole class programme rather than a small group intervention package in primary schools.

Parents and teachers also perceive increases in emotional literacy skills with parents from one school (School B) identifying considerably more progress than school staff (a significant increase of 10.6 points in the average EL score given by parents following the FRIENDS programme compared to an increase of 2.3 points in the average EL score given by teachers to pupils following the intervention). In School B the 6 parents’ checklists available for analysis indicated progress for every child who had completed the programme.

Where a control group was possible (School C), teachers perceived that pupils with a high level of need made progress with their emotional literacy skills in the FRIENDS group whereas emotional literacy skills were perceived to decrease for pupils with similar levels of need in the control group. There was statistically significant difference in the scores given to pupils by teachers in the control and the intervention group.


Graph 1

A Line Graph to Show Differences in Average EL Scores Rated by Pupils Before and After FRIENDS

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A Line Graph to Show Average EL Scores Given by Parents to their Children Before and After the FRIENDS programme

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A Line Graph to Show Differences in Average EL Scores Given by School Staff to Pupils Before and After the FRIENDS programme

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Summary of Evaluation Results from Qualitative Data

Two forms of qualitative data have been gathered. Firstly views of pupils have been sought through focus group discussions. Secondly, views of staff involved in delivering the programme have been gathered through completion of a qualitative assessment questionnaire.

The focus groups designed to gather pupil’s views were led by an educational psychologist. They involved a small group of pupils who had completed the programme. The children were asked 8 questions to elicit their views. Table 3 displays their responses and any emerging themes to the 8 questions.

Table 3 – Focus Group responses indicating pupil’s views with regard to the FRIENDS for Life programme. Common responses are listed first with the number of comments made around that particular theme noted next to the response e.g. [3] = 3 responses within the theme.

Focus Group Question

School C

Hardwick

Group consisted of 6 pupils – 3 boys and 3 girls

School A

FHJS December 2010 (4months after the end of the programme).

6 pupils – 3 boys and 3 girls

What has been fun, what have you enjoyed?

Expressing / understanding our feelings [4] e.g. “helping me have less temper – both at home and at school”

Colouring in [2] Doing assembly

Coping Step Plan [2] Moving the tables and sitting

where we wanted Being allowed to talk to

friends Drawing Learning how to calm down Writing in the book like it was


Relaxation lessons You don’t have to do so

much work How the work encourages

you to get on with other children

a diary Thinking about your feelings Talking about feelings with

other people Being able to say “I like my

brother” Getting tips on roller-skating The T shirt activity on p.46

What have you found out about yourself?

Better ways to cope with problems [4] e.g. “learning how to control ourselves more such as laughing at silly things and not getting angry / upset”, “if people be bad, we tell the teacher”

That we have choices [2] Getting more confident and

laughing more [2] We can be ourselves We trust each other more

That I can use the coping step plan for lots of things e.g. getting braces [2]

That I’m more of a confident person than a lonely person [2]

I hate being angry Ways to calm down that I still

use That I’m more of a calm

person than an angry person That I am confident

What has been helpful – at school?

- at home?

Knowing how to reward ourselves when we have done something good [5]

Calming down

To relax To walk away from my

brother when he annoys me People are there for you

The group felt the following comments applied to both home and school:

To change our unhelpful thoughts

Not to stress out at someone It helps to write down

positive thoughts, writing it down helps you remember [3]

More specifically at home, the group commented:

I discuss my feelings more and fight less with my sister

I know how I feel and talk more to my brother at home

Has the programme helped you to understand other people?

When we lay down [2] Making more friends [2] Learn to accept that others

don’t like you ‘cause everyone different it was funny and useful help you in different ways

I talk to people more [3] I made new friends Trust people Good to think about role

models Write it down if you’re

worried about something You’ll always have your


friendsWhat mark out of 10 would you give the programme for how useful and enjoyable you found it

Girls – 6 , 10 , 10

Boys – 9, 9, 10

Average = 9

Girls – 10, 10, 10

Boys – 10, 10 , 6

What would have made it better – one more up the scale?

Moving around a bit more We got bored and fidgeted

sometimes A word search on ‘feelings’

would be good Monkey bully

More drawing More sharing with friends More ‘calm down’ activities More time sent on it, so

lessons are not rushed Do it again Go back and fill in the

missing bits from the book More drama More fun

Would you recommend it to others?

Yes [5] e.g. “ yes ‘cause really fun”, “could make it for everyone – every single year”

Yes x6 Year 5 is a good year to do it It’s brilliant – hope we can do

it again Schools around the world

should do it It would be good for disabled

people / people with problems

It would be good for everyone

Other comments? Carry on all the good work Our teacher was great and explained everything really well

Qualitative feedback was also gained through a structured interview in School B completed by an educational psychologist and the teaching assistant and parent support advisor who were in the process of running the FRIENDS programme. The interview took place before the programme had finished. In School C the programme was evaluated as part of preparation for a presentation regarding FRIENDS on the Northamptonshire TaMHS conferences in January 2011.

Numbers in brackets indicate the numbers of responses that identified the specific theme e.g. [2] would mean comments from two members of staff about the benefit

Strengths identified by staff include:

Easy to follow manual [2] Easy to adapt to fit the needs of the class Great activities that are easy to follow and enjoyable for the children. The idea of ‘helpful’ and ‘unhelpful’ thoughts was main highlight for pupils (and staff) in one

school. It was useful beyond the session – e.g. girl who was not looking forward to going fishing with her Dad, as last time, something bad had happened at home, and so she was


worried that something bad might happen again. However, she decided that she needed to think about the things she would be enjoying when fishing, which helped her.

Highlight was ‘Relaxation’ [2], which has led to the introduction of Relax Kids to the group from one school

Helpful to recap at beginning of next session by asking children to explain what they learned last week, and how they might have used the learning at school or at home – showing whether or not that they have learned the new knowledge and skills and so build on this in the current session.

Children say that they use the learning at home. Homework tasks were a real asset and strengthened the link with parents Learning about what makes us stressed? The football shirts activity was very popular, helping children to identify their own support

network in different situations Learning with the children, sharing ideas with them and exploring new ways of thinking /

looking at things was very powerful and empowering Short stories and the exercise of breaking down parts of a story into’ thoughts’ and’

feelings’. Activities that involved moving. Creative exercises.

Staff were also asked to comment on ways in which the programme could be improved. They noted that:

It was helpful to be flexible with time allotted to sessions. Initial sessions tended to take 1.5 – 2 hours, later sessions fitted into an hour – 1.5 hour session.

It is important to allocate dedicated, uninterrupted time for the sessions Some of the language in the workbook is inappropriate and was questioned by pupils.

E.g. page 37: “...let’s find-out how silly this thought is”. Better to use ‘unhelpful’ otherwise children feel insulted for having similar thoughts.

In one school, staff felt that 1 pupil ‘outgrew’ the programme and one was put-off by amount of words in workbook.

In one school children found it hard to grasp and generate their own ‘Coping-step plan’ Time-pressure made this harder.

Homework tasks were hard to set and monitor for a small group, rather than a whole class expectation.

In School C the class teacher commented on benefits she had noticed for the children in her class. She found that children:

Were more resilient Applied their new learning through FRIENDS to difficult situations they were facing Dealt with conflict and managed resolutions more appropriately Showed improved confidence Showed improved social skills


Overall, according to qualitative evaluation it would appear that pupils value the programme. They enjoy the sessions and learn helpful skills that they are able to transfer to real life situations. 11 out of 12 pupils who shared their views in focus groups would recommend the programme to others.

Teaching staff comment that the materials are easy to use and include a number of valuable sessions such as ‘helpful/unhelpful thoughts’ and ‘relaxation’. It has been helpful to recap learning at the beginning of each session and ensure sufficient, dedicated time is allowed for each session. One teacher found it particularly helpful to learn ‘alongside’ her class and explore ideas thoroughly with them, sharing her own thoughts and feelings as appropriate. The teacher in School C wholeheartedly recommended the programme to colleagues and noted many benefits for her students.

Overall Impact Ratings for FRIENDS for LIFE

" Where 10 is very highly useful and 1 is not at all useful, on a scale of 1-10, how useful do you think the following TaMHS interventions were/are:

Overall Impact Ratings of FRIENDS for LIFE according to senior staff from 6 project schools



7.7 7.5 8 6 to10


Capacity Building

Within the Northamptonshire Educational Psychology Service a group of EPs are trained to be trainers in FRIENDS. To date 6 one day courses have been run and approximately 40 schools have accessed the training.

A TaMHS conference was held in January 2011 where a workshop was delivered to introduce FRIENDS to staff from new schools across Northamptonshire. Feedback from the workshop was very positive with many schools expressing an interest in implementing FRIENDS. A one day training event is scheduled for May 2011 to enable more schools to establish FRIENDS within their curriculum. Schools that have currently run the programme may be able to offer support as partner schools for the intervention and staff attending the one day training course will be offered a follow up session with an EP to plan the implementation of the intervention in their school.

Conclusion

The key lessons learned in the Northamptonshire TaMHS Project about FRIENDS to take forward include:-

Indications are that FRIENDS can be introduced successfully into Northamptonshire schools with a positive impact on children who are vulnerable to experiencing


difficulties with Mental Health or who are already experiencing such difficulties, and to an extent on the school overall.

In particular, as well as the well-proven reduced feelings of anxiety, FRIENDS enables children to benefit in terms of improved emotional literacy skills and learning helpful skills that are able to transfer to real-life situations. Hence, arguably their mental health and resilience is improved. They enjoy and value the programme.

Key aspects for making implementation of FRIENDS successful include: allocating dedicated time for sessions that are not over-ridden by other competing time demands; staff choosing from the menu to tasks carefully that suit their class and so make best use of time available; and implementing the programme with a whole class for maximum impact.

Capacity has been built for further implementation of FRIENDS in Northamptonshire schools, and the detailed results above need to be taken into account in implementation in schools.

Because of the indications of the importance to children’s mental health of FRIENDS, that it has been included in the Building Blocks of Provision for Building Mentally Healthy Schools in Northamptonshire at the Wave 1 / Universal focus, as a recommended provision for all schools with a KS2/ or KS3, as shown below: -

References


Barrett, P.M., Dadds, M.R., Rapee, R.M. (1996) ‘Family Treatment of Childhood Anxiety: A Controlled Trial’ Journal of Consulting and Clinical Psychology, 64, pp.333 – 342

Barrett, P.M. Duffy, A.L., Dadds, M.R. and Rapee, R.M. (2001) ‘Cognitive-behavioural treatment of anxiety disorders in children: Long-Term (6 year) follow up’ Journal of Consulting and Clinical Psychology, 69 pp.135-141

Barrett, Farrell, Ollendick and Dadds (2006) ‘Long-term outcomes of an Australian universal prevention trial of anxiety and depression symptoms in children and youth: An evaluation of the FRIENDS programme’ Journal of Clinical Child and Adolescent Psychology, 35 (3).

Barratt and Turner (2001) ‘Prevention of anxiety symptoms in primary school children: Preliminary results from a universal school based trial’ British Journal of Clinical Psychology 40 pp 399-410

Conradt and Essau (2003) ‘Feasibility and efficacy of the FRIENDS program for the prevention of anxiety in children’ Paper presented at 24th International Conference: Stress and Anxiety Research Society Lisbon

Costello, Mustillo, Erkanli, Keeler and Angold (2003) ‘Prevalence and development of Psychiatric Disorders in Children and Adolescence’. American Medical Association

Dadds, Spence, Holland, Barratt and Laurens (1997) ‘Prevention and early intervention for anxiety disorders: A controlled trial’ Journal of Consulting and Clinical Psychology 65 pp 627 - 635

Gallegos, (2008) ‘Preventing Childhood Anxiety and Depression: testing the Effectiveness of a School-Based Program in México’ Dissertation submitted to The University of Texas at Austin in partial fulfilment of requirements for the Degree of Doctor of Philosophy

Liddle, I. and Macmillan, S. (2010) “Evaluating the FRIENDS programme in a Scottish setting” in Educational Psychology in Practice, Vol.26, No.1, pp 53-67

Lock and Barrett (2003) ‘A Longitudinal Study of Developmental Differences in Universal Preventive Intervention for Child Anxiety’ Behaviour Change 20 pp183-199

Lowry- Webster, Barrett and Dadds, (2001) ‘A universal prevention trial of anxiety and depressive symptomatology in childhood: Preliminary data from an Australian study’ Behaviour Change 18 pp 36-50

Lowry- Webster, Barrett and Lock (2003) ‘A universal prevention trial of anxiety symptomatology during childhood: Results at one year follow up’ Behaviour Change, 20 (1) pp25-43

Meltzer, Gatward, Goodman and Ford (2000). The Office for National Statistics ‘The Mental Health of Children and Adolescents in Great Britain’

Stallard (2010) ‘Mental Health Prevention in UK Classrooms: The FRIENDS anxiety prevention programme’ in Emotional and Behavioural Difficulties, Vol.15, No. 1 pp 23 - 35


Stallard, Simpson, Anderson, Carter, Osborn and Bush (2005) ‘An Evaluation of the FRIENDS programme: a cognitive behaviour therapy intervention to promote emotional resilience’. Published online by group.bmj.com. Archives of Disease in Childhood 90 pp 1016 - 1019

Stallard, Simpson, Anderson and Goddard (2008) ‘The FRIENDS emotional health prevention programme: 12 month follow up of a universal UK school based trial’. European Child and Adolescent Psychiatry 17 pp 282 - 289

Stallard, Simpson, Anderson, Hibbert and Osborn (2007) ‘The FRIENDS emotional health programme: Initial findings from a school-based project’ Child and Adolescent Mental Health, 12 (1) pp 32 – 37

Wadell, Godderis, Hua, McEwan and Wong (2004) ‘Preventing and Treating Anxiety Disorders in Children and Youth: A Research report prepared for the British Columbia Ministry of Children and Family Development’. The University of British Columbia

Weare, K (2011) ‘Promoting Mental Health and Wellbeing in Schools: An Evidence Based Approach’. A PowerPoint presentation given at the Northamptonshire TaMHS conferences

World Health Organisation, (2004) ‘Prevention of Mental Disorders. Effective Interventions and Policy Options. Summary Report’.


Massage in Schools Programme (MISP)

By Mike Simons

Description of MISP

Rationale for Including MISP in TaMHS

MISP was included in the project as a result of consultation with one of the project schools, Ruskin Infant School, which had been involved in a process to achieve Anti-bullying Accreditation. Through this accreditation process, consultation with all the school’s stakeholders had identified MISP as helpful for the school to include in their provision, which would be likely to improve social relationships and therefore also provide a preventative approach to bullying at the school.

As described in the MISP Manual for Instructors (2007) the theory behind the usefulness of Massage is that it stimulates the activity of the vagus nerve [one of the 12 cranial nerves], which slows down and relaxes the central nervous system, which in turn slows the heart rate and blood pressure and the release of stress hormones, such as cortisol. It is suggested that changes in EEG patterns also indicate increased relaxation and attentiveness, and so that classroom performance should improve. Also, it is suggested that the increase in serotonin and dopamine levels due to massage improves mood state. The Touch Research Institute’s database reportedly lists dozens of clinical trials demonstrating that a wide range of conditions can be improved by touch therapy, including childhood behaviour problems, mental health, anxiety and sleeplessness. Research also reports that massage increases levels of the hormone oxytocin, which reduces stress and can encourage social bonding. Rats deprived of oxytocin make poor parents and their offspring fail to thrive. Observers report increased social cohesion among classes that participate in the Massage in Schools Programme. The current research in MISP is summarised on the MISP website E.g. Trower (2004) controlled study in primary school demonstrated improved concentration and social functioning according to teacher perceptions; and children taught routines to families.

Motivation for MISP by the Headteacher and a range of stakeholders, including parents at the school combined with anecdotal evidence of the effectiveness of MISP from several schools both nationally and in Northamptonshire (e.g. Studfall Junior School, Corby), combined with MISP being judged to fit well with other key aspect of evidence based or evidence informed provision including the Solihull Approach, Solution Focused Approach and Relaxation (all described elsewhere in this report) led to agreement that the approach was worth trialling as part of a set of interventions that could be evaluated in terms of outcomes. The TaMHS project presented a useful opportunity to evaluate the usefulness of the approach in terms of providing Northamptonshire TaMHS Project - Evaluation of Interventions April 2009 – March 2011

42

The Massage in Schools Programme (MISP) is a Wave 1/universal clothed, child-to-child massage programme aimed at school children aged 4-12. The programme was created in the early 1990s by Mia Elmsäter from Sweden and Canadian, Sylvie Hetu, as a result of their Infant Massage training and practice and motivation for all children to experience frequent positive, nurturing touch. Through the programme a back, neck, head and arm massage is given by the children, to each other, with their permission in a 10-15 minutes daily routine. The MISP website provides further details about the intervention: http://www.massageinschools.com

http://www.massageinschools.com/

staffing and resources to enable effective evaluation of the approach and hence, help identify whether MISP is worthy of further investment in Northamptonshire.

Provision of Training and Implementation in MISP

In order for the school to be able to implement MISP, the services of Joy Allibone, a local external accredited provider of massage instruction was employed and funded by TaMHS. A combination of the Massage Instructor, Headteacher and TaMHS lead Educational Psychologist/ Project Manager planned a gradual introduction of MISP into the school via the training of staff, modelling approach with children and then coaching and observing staff using the approach all within a framework of evaluation that included intervention and control classes and evaluative feedback from staff, pupils and parents. Following this main evaluative phase, it was planned that within 12 months, all appropriate teachers and teaching assistants in the school would be trained by the MISP instructor to the extent that they were independent in day-to-day MISP implementation and all children in all 6 classes in the two-form entry school would be benefiting from this approach. This plan was put into action in January 2010 and reviewed at approximately 3-monthly intervals. By January 2011, all (approx 180) children at Ruskin Infant School were engaged in MISP led by their school staff independently of external providers.

Evaluation of MISP in TaMHS Project

Evaluations were conducted at a number of levels. Teachers completed baseline Insight Primary Self-esteem questionnaires for all pupils in YR and Y1 involved in intervention and same-age control classes before and 6 weeks after the intervention started. Parents were also asked to complete before and after intervention questionnaires using the Strengths and Difficulties Questionnaire (SDQ) for both Y1 and YR classes. In order to measure lasting effect, it was agreed that to avoid over-burdening staff, questionnaires would be completed again 6 months later only for the 6-8 children who were regarded as most vulnerable – i.e. those eligible for free school-meals. Data was also collected from children directly about their friendships and their experience about massage. Information from parents was also sought in conjunction with their questionnaire completion. Finally, staff were interviewed about their perception of the MISP experience.

Evaluation Results

Teacher Perceptions of Pupils Self-esteem

While the YR teachers identified no change in self-esteem for their children in both control and intervention groups, a one tailed T-Test comparison of the differences between pre and post results of Y1 teacher reported self-esteem, according to their completion of the Insight Primary Self-esteem Indicator, indicates a significant difference (p<0.001) between the changes in self-esteem of the Y1 class of pupils experiencing MISP compared with those not receiving MISP in the control class. The total average self-esteem for MISP and control class over time is shown in the graph below.


Comparing MISP Intervention Y1 Class and Y1 Control Class – Insight Primary: Self-esteem Indicator

Six months later, comparisons of self-esteem both between MISP and control classes and between MISP class current and previous scores was problematic for three main reasons: 6-month data was available only for children identified as vulnerable, and some had not accessed the intervention due to being on part-time time-tables; due to the passage of time, children had a different teacher making comparisons with previous data less reliable; and the children in the Y1 control classes had experienced Zippy’s Friends intervention from March to July, which may confound the results. However, bearing in mind these limitations, the results for the vulnerable pupils are as follows: -

For Y1, pupils deemed vulnerable by teaching staff, a Mann-Whitney test comparison of pre-MISP vs. 6 months later identified no significant difference between MISP and control group. The vulnerable group of 4 pupils within the Y1 MISP class gained an average of 0.8 self-esteem points per pupil compared with 7 points per pupil for the group of 7 vulnerable pupils in the Y1 control class. It was suggested that the control class may well have improved due to the Zippy’s Friends intervention (see relevant chapter elsewhere in this report).

For 14 YR pupils deemed vulnerable by teaching staff, a Mann-Whitney test comparison of pre-MISP vs. 6 months later identified a positive significant difference (p<0.01) between MISP and control group. The vulnerable group of 7 pupils within the YR MISP class gained an average of over 33 self-esteem points per pupil compared with only 8 points per pupil for the group of 7 vulnerable pupils in the YR control class.

Pupil Perceptions

The MISP Instructor introduced the Friendship Circles evaluation tool that gauges children’s perception of their relationship with others by engaging children in identifying which children in their class are their ‘best friends’, ‘friends’, or ‘sometimes your friend’. Compared with baseline taken in Jan 2010 prior to MISP being introduced, after 5 weeks of engaging in MISP, the Y1 children identified a higher number of named children in each of the friendship categories: increasing respectively by an average of 1.75, 1.1 and 0.4 friends. This indicates that children who have experienced MISP perceive that they have a greater number of friendships than Northamptonshire TaMHS Project - Evaluation of Interventions April 2009 – March 2011

44

previously – suggesting improved social relationships in the class. It would have been further informative to use the Friendship Circles for the control class and also over an extended time period.

When asked, children made many positive comments about their experience of MISP, such as liking “all of them [the strokes]” and reporting that “massage is very good, all the rain, sun, clouds... are all good”, referring to specific strokes designed to mimic the weather. Some children indicated particular sensitivity to touch such as “I don’t like it when it is hard” or not liking “the tickly feeling” associated with particular strokes.

Not all children reported enjoying massage. One boy commented: ““I don’t like it, it makes me sleepy”. For children who were not keen, they were encouraged to try-out massage: but in keeping with the ethos and the core purpose of MISP being to aid relaxation, there was no requirement of any child to engage in MISP at any time.

School Staff General Perceptions

After 3 months of MISP, teachers and teaching assistants involved in delivering MISP were asked in a focus group for their perceptions of changes. A main change identified was that the children presented as calmer and more relaxed both during and after massage and that this was especially noticeable and useful when a massage session was run just after lunch i.e. following a time that was far less structured and that promoted higher levels of activity. Staff also identified that children had improved friendships and that there was a greater sense of the class being a team. Staff also identified that generally boys seemed to apply the massage strokes more skilfully than the girls. A sense of the value placed on MISP was provided by a comment agreed by a focus group of staff, that “it would have been better if the control class had been involved in massage and got the same benefits”.

In Autumn 2010, as new staff and children were introduced to MISP, two children in 2 different classes who are regarded as vulnerable to mental health difficulties were selected for observation and comment by their classteachers in. While one child quickly took part and took an active role in the massage, the other was described as ‘a little nervous and worried’ at the beginning. After 6 weeks, both children had begun to interact with other children more and the one who had been reticent was described as ‘loving massage now’. Commenting on the whole


class, one classteacher observer identified that after 6 weeks, the “whole class are receptive to the massage and are beginning to show signs of improvement with their attitude to each other”. Another pupil who was regarded as vulnerable and tended to be inappropriately over-affectionate with other children, prior to the introduction of MISP, seemed to improve his sense of personal space after experiencing massage.Concerns were expressed by two teachers that during the learning phase of MISP, 30 minutes of each school day was taken out of the curriculum for massage i.e. 2.5 hours per week. This reflects the pressure felt by teachers to progress through the academic aspects of the KS1 curriculum. It is interesting to note that despite this time used for massage over several weeks before being reduced to 10-15 mins, the following year, these pupils who had been in Y1 are predicted to achieve the best end of KS1 results the school has had during the Headteacher’s 9 year tenure.

Parent Involvement and Perceptions

Due to the need within MISP for children to actively touch other children, parent permission is required for children to engage in MISP. This proved problematic as a minority of parents were apprehensive about MISP, due principally to close association being made between nurturing touch and sexual touch. Showing parents children actually engaged in MISP in an assembly later on was helpful rather than just relying on an oral description, which increased the number of children for whom permission was given. Children, who did not have permission, were encouraged to join-in as much as they could by staying with their class and learning and practising the strokes just in the air. According to hormonal theory, such practice should benefit these children through them being present during the release through massage of the hormone oxytocin, which is thought to promote social bonding. Some parents reported that the children practised some of the strokes on other family members – which was regarded positively by these parents.

Although parents were asked and encouraged to complete the parent version of the Strengths and Difficulties Questionnaires (SDQ), before and after MISP had been introduced, there were insufficient responses to compare intervention and control classes for either YR or Y1. However, there were sufficient respondents from the YR MISP class pre and 6 weeks following the intervention to make a comparison of parent perceptions for 17 pupils. A paired-samples t-test showed no significant difference between pre and post SDQ Total-Difficulties scores (although the difference was almost significant: p=0.055). However, a comparison of the pre and post ‘conduct problems’ perception by parents showed a significant positive difference (p<0.05). Analysis of the average shifts in scores indicated positive (though not statistically significant) shifts in each of the sub-measures of the SDQ: especially in ‘conduct problems’, ‘peer problems’ and ‘pro-social’ attributes.

Capacity Building for MISP

In terms of the capacity built within the TaMHS project school that introduced MISP, all teachers and assistants within Ruskin Infant School can independently provide massage to their children, provided that they regularly consult an instructor to ensure that the accuracy and hence the quality of their strokes remains. In order to overcome the issue of new staff requiring further input from an external instructor, it is planned that two staff from Ruskin Infant School will shortly take the two-day training to qualify as instructors and hence, be able to sustain MISP in their school, provided they consult a trainer annually to ensure maintenance of the quality of their strokes and other aspects of MISP. In order to promote the mainstreaming of MISP, staff and children at Ruskin Infant School provided a workshop at the Northamptonshire TaMHS Children’s Mental Health Conferences in January 2011. This led to expressions of interest in being kept informed about training by 49


participants and 16 of them identifying that if school funds are available, they would be most likely to purchase MISP training.

Due to the benefits of the Massage in Schools Programme (MISP) being run in one of the TaMHS project schools, especially in terms of improved pupil relationships and mental health, it has been agreed that staff from other schools could have funded training for 2 staff to learn the approach and techniques. TaMHS funded training was provided to 15 schools. Having completed the training, staff are able to and expected to instruct pupils and staff across their school, and hence, to enable all children in their school to experience massage instruction frequently within an evaluative framework. Staff who attend are also required to be committed to sharing their good practice with other schools in their area, for the benefit of pupils in other schools. The popularity of this training has led to the external trainer setting-up a further training session in May 2011 with places to be funded by schools.

In terms of sustainability in publicly funded agencies, the two Specialist Teachers – Mental Health who have been closely involved in the TaMHS project in Northamptonshire will (by the time of publication of this report) have become trained as MISP Instructors for supporting schools within the county who are adopting and maintaining this approach, and for encouraging other schools to build MISP into their provision.

Finally, Joy Allibone as an Independent Instructor who provided the input to school staff for achieving the above results continues to deliver MISP with schools and is available to support schools through contact details provided in the Northamptonshire Shoebox.

Overall Impact Ratings for Massage in Schools Programme


Overall Impact Ratings of Massage in Schools Programme, according to senior staff from 1 project school



10 10 n/a n/a

b) Overall to the school 10 10 n/a n/a

Conclusion from Results of MISP Evaluation

The combination of quantitative and qualitative results from the MISP evaluation that involved teachers, support staff, parents and pupils, suggests that MISP can have a positive impact on the mental health of pupils, especially in terms of their self-esteem, friendships, pro-social skills, conduct problems and the class becoming more of a team and being calm. There is some indication of increased impact on engagement with learning, including with children who are vulnerable to mental health difficulties.The key lessons learned in the Northamptonshire TaMHS Project about MISP to take forward include:-

Strong indications are that MISP can be introduced successfully into Northamptonshire schools with a positive impact on children who are vulnerable to


experiencing difficulties with Mental Health or who are already experiencing such difficulties, and on the school overall.

In particular, children benefit in terms of their relationships with others and their being calm noticeable both at school and at home.

Key aspects for making implementation of MISP successful include enabling parents to see the intervention as a positive way of helping their child and for staff to accept that the time taken out of other curriculum aspects is worthwhile for the overall results.

Capacity has been built for further implementation of MISP in Northamptonshire schools, and the detailed results above need to be taken into account.

Because of the indications of the importance to children’s mental health of MISP, that it has been included in the Building Blocks of Provision for Building Mentally Healthy Schools in Northamptonshire at the Wave 1 / Universal focus, as a recommended provision for all schools with a KS1 &2: - as shown below: -


Midday Supervisor TrainingBy Yvonne Benson

Description of Training for Midday Supervisors

Training was provided over 2 hourly sessions to Midday Supervisors (MDSs) from an Infant and Junior school in Wellingborough by two Educational Psychologists. An initial meeting focused on outlining the TaMHS project and whether the MDSs had ideas or concerns that could be addressed to raise children’s emotional wellbeing outside at playtimes. The following issues were raised:

Feedback from Peer Mentoring questionnaires in the junior school found that the year 3 children felt most uncertain at playtimes in school.

MDSs noted that some of the children appeared bored or lonely not knowing what to do at break times.

Concerns from the MDSs included the lack of play resources/equipment that was broken and not replaced.

The limited communication/time between members of staff and MDSs regarding children’s emotional states prior to break and lunch to increase awareness of children who may need extra support was a key issue raised.

MDSs discussed that although the children enjoyed Play Buddies they tended to stop playing the games without structure and being led by an adult.

Rules were raised as a concern in that there was a need for consistency by all staff in order for children not to receive mixed messages i.e. about where they were allowed to play and with what.

The MDSs noted that they would like to know more about strategies to support children with ASD/ADHD etc.

As a result of the initial meeting it was agreed with the SENCo from the Junior School and the Deputy Head Teacher from the Infant School, that the training would include a range of materials and handouts to cover the following objectives:

The importance of rules Outlining different rewards Supporting conflict resolution Effective and positive communication Creating a friendly playground Tackling bullying A general overview of Autism

In addition to this it was also agreed at the first meeting that both schools would explore playground resources and whether they needed updating or more to be bought. Peer Mentors could team up with the playground buddies and possibly be supervised by the MDSs to play games and provide a structure. Lastly that any new rules for outside play would be introduced in assemblies to include maps signifying designated areas for equipment and resources and thus ensure consistent communication throughout the school.


Rationale for MDSs Training in TaMHS

Ofsted indicators for Wellbeing in September 2009, highlight the importance of MDSs in contributing towards the promotion of positive mental health in schools. In March 2009, the University of Hull undertook an evaluation of the training and development of MDSs in Barnsley and Warrington authorities. They found that communication between MDSs and other adults within school to be an issue and set up a mentor within the school to address concerns and to improve the communication within the school. The study showed that following training, MDSs gave a higher score for perceiving their role as important; they felt more valued and respected and had a higher level of confidence in their ability to promote positive behaviour.

MDSs training was offered to the Junior and Infant school following a GTI intervention which focused on improving the social dynamics and relationships and so learning within a year 6 classroom (see GTI chapter elsewhere in this report). Feedback from the pupils and the class teacher indicated that break times were an issue and any unresolved conflict in the playground was affecting their ability to settle back into lessons. The children noted that communication about peer conflict with the adults in charge could be difficult and that they felt their issues were not always resolved. MDSs from both schools had been unable to attend other TaMHS awareness raising sessions and it was felt by both Educational Psychologists that as break was an important period of time for the class to be developing positive relationships, that it was essential to try to engage the adults who would have most effect for supporting their emotional wellbeing at this time.

Provision of Training and Implementation

A collaborative consultation with the school’s SENCos, Deputy Head Teacher of the infant school, MDSs and TaMHS linked Educational Psychologists was set up in September 2010 to explore possible training needs of midday supervisors within their schools and the number of sessions available. An initial meeting was attended by a total of 10 MDSs at the junior school and the Educational Psychologists outlined the TaMHS project and discussed what the MDSs would like from the agreed input. The training took place in one hour sessions at the junior school and was followed up by a short questionnaire to be completed by those who attended which included the MDSs, the junior school SENCo and infant school Head Teacher. Sessions were then planned for the SENCo and Deputy Head Teacher to re-visit each area from the training and look at implications for good practice in the specific school context. The meetings were also prioritised to facilitate good communication links between MDSs and school staff.

In a third school, training on motivation and the key aspects of ‘1-2-3 Magic’ was agreed to include in two half-hour sessions with the infant school MDSs, based on what was helpful for staff from other training. This was delivered a fortnight apart by an educational psychologist and a specialist primary mental health practitioner.


TaMHS EvaluationQualitative data was collected through completion of a questionnaire following the second session of training. The information obtained from the questionnaire can be seen below:

What did you find useful from the sessions?

Clear messages heard by all Colourful, visual presentation – lots of good knowledge shared Learning about how to deal with autistic children More information was given about ASD Autistic aspects very helpful All the information was useful, especially autism Autistic talk x 2 About autistic information Bullying and autism

How will it influence your work in the future?

Will be used as a basis for future agendas How to target further input to make lunchtimes more engaging Hopefully have a better understanding so be able to help children Just carry on what I’m doing More aware in the playground I will go away and look at autism register and get to know the children Look for signs of bullying and autism

What other information would you like that could help you in your role as a Midday Supervisor?

How to motivate lunch time supervisors. What other schools do/programmes used that are effective

More history on children carried over from teachers

In the third school, completed evaluation forms were unfortunately mislaid and qualitative feedback indicated the need to have given more time to this training to help embed useful ideas. However, feedback highlighted the need for the MDSs to have more on-going support and stronger communication link with other staff – which was agreed by the headteacher, could be provided in a structured way by the PSA.

Capacity Building

The training for MDSs has built capacity for staff in 3 schools within the TaMHS project to be more aware of issues that focus on children’s emotional wellbeing in the playground. The sessions also provided the MDSs with an opportunity to raise concerns about their role and concerns with members of staff from both schools with actions being agreed to address these. Educational Psychologists are able to deliver midday supervisor training within the county upon request subject to demand and costing. It may be advantageous to explore cluster MDSs training if appropriate. The school were given resources and information in the training sessions to use as a basis for MDSs liaison and to re-visit key areas within future meetings.


Overall Impact Ratings for Midday Supervisor Training


Overall Impact Ratings of Midday Supervisor Training, according to senior staff from 3 project schools



4.7 5 n/a 3 to 6

b) Overall to the school 6 6 n/a 5 to 7

Comments made alongside these overall ratings included that for some midday supervisors this was the first training that they had experienced, underlining the importance of this staff grouping needing opportunities build-in to their job to develop their knowledge and skills and hence, also their confidence.

Conclusions

The key lessons learned in the Northamptonshire TaMHS Project about Midday Supervisor Training to take forward include:-

Indications are that Midday Supervisor Training can be introduced successfully into Northamptonshire schools with a positive impact on children who are vulnerable to experiencing difficulties with Mental Health or who are already experiencing such difficulties, and on the school overall.

In particular, children benefit in terms of

Key aspects for making implementation of Midday Supervisor Training successful include ensuring adequate time is provided to deliver and receive interactive training, that includes understanding about children’’ different development pathways and that this is part of on-going development activity for them, ideally alongside and with other staff to maximise a joined-up approach.

Capacity has been built for further implementation of Midday Supervisor Training in Northamptonshire schools, and the detailed results above need to be taken into account.

Because of the indications of the importance to children’s mental health of training for Midday Supervisors in addition to other staff, it is present in the Building Blocks of Provision for Building Mentally Healthy Schools in Northamptonshire at the Essential Underpinnings level, as a recommended part of ‘Children’s Workforce Core Competencies’ provision for all schools, as shown in the diagram below.


References

Newstead, S. The Benefits of School Playtime’ Children’s Playtimes Information Service; National Children's Bureau fact sheet No15: ‘December 2010


Training re: Motivation for Work Activities

By Mike Simons

Description of Motivation Training

Motivation can be construed as the processes involved in arousing, directing and sustaining behaviour’ (Bull 1977) or "that thing in the back of your mind that drives you, no matter what seems to be stacked against you.“ Motivation training provided through TaMHS consisted of an 80 minute workshop session summarising the key messages from up-to-date research about motivation. Drawing on a research summary and training materials devised by Leanne Toon, Educational Psychologist, CYPD, a workshop was created which explored: why the training was being delivered to staff; the meaning of motivation; early theories about motivation; possible barriers to motivation for learning; attribution theory and the impact of attributions on learning; use of feedback to pupils about their performance; and an attunement strategy for promoting a sense of competence and control regarding learning, as a key to increasing motivation for learning. The key aspects for staff to apply in their work with children to promote motivation is summarised in the final slide presented to them in the workshop: -

Specifying the focus of the training being the link between motivation and effective learning at the specific school, the workshop was entitled: ‘Helping Pupils to Be and Remain Motivated to Engage in & Complete Work Activities at X School’. The learning objectives for participants attending the workshop, were made explicit to participants as a basis for attending the training and hence, also for the evaluation of the training. The learning objectives (Los) were as follows: -LO1: ‘I understand why it is important to know and understand about motivation’. LO2: ‘I know and understand about motivation’.


LO3 ‘I know and understand research on how children are motivated to engage in and complete work activities’.

LO4: ‘I know and understand ways that I can better motivate pupils at my school.LO5: ‘I feel confident about applying knowledge, understanding and research findings about

motivation to help children learn at my school’.

Rationale for Including Motivation Training in TaMHS

It is clear from curriculum resources, such as SEAL and assessment resources such as Pupil Attitude to Self and School (PASS) that motivation is regarded as a key construct within mental health linking arousal to engagement with learning. Giving that increased learning for pupils is a key intended outcome of the TaMHS project, it is highly appropriate to ensure that schools staff are aware of updated research regarding motivation for learning and that they can apply findings of this research practically in their schools with their pupils. From analysis of the baseline PASS data for three of the schools in the project, the factor most closely related to ‘motivation to learn’, ‘Response to Curriculum’ (KS1) and ‘Response to Learning’ (KS2+) was either the lowest or 2nd lowest scoring factor for the pupils overall in the school. Consultation with school staff about the reasons for this and possible actions led to agreement for a workshop to be held for staff in each of these schools focused on how to increase motivation to learn.


The Helping Pupils to Be and Remain Motivated to Engage in & Complete Work Activities at X School’ workshop was delivered after-school at staff meetings by a TaMHS Educational Psychologist to staff from the three schools: two infant schools and one junior school between on respectively 2nd December 2009, 14th January 2010 and 24th May 2010. The number of staff participating in respective schools were: 10, 12 and 11: i.e. a total of 33 staff across the 3 schools Although it had been planned to involve also support staff in the training, almost all the staff attending were teachers in each of the 3 schools. Main barriers to support staff attending were lack of payment for attending staff meetings and child-care commitments.

TaMHS Evaluation

Evaluations were conducted at two levels.

First, evaluations were conducted by requesting that participants rate their knowledge, understanding and confidence relating to the learning objectives of the training both before and directly after the training on 1-6 scales (1 not at all – 6 very much). Ratings for presentation and relevance (1- poor – 6 excellent) were also requested– as well as comments about the value of the training.

Second, given the reasons for the specific schools being offered and taking-up the training concerned their PASS results, a comparison of pre and post PASS results was made regarding the factor: ‘Response to Curriculum’ for the two infant schools involved and ‘Response to Learning’ for the junior school. These are the factors related most closely to ‘motivation for learning’.


Results

Feedback from Workshop Participants

From immediate feedback from all 33 participants’ completion of the evaluation questionnaire, training was valued in terms of presentation (average of 4.4), relevance (average of 4.8). Staff from one of the infant schools particularly valuing the training in terms of presentation (average 4.8) and relevance (5.0). According to comments from participants, of most value was the focus on the most helpful language to use with pupils about their performance that promotes motivation (i.e. use of language that is honest and focuses on the pupil’s effort and actions; and reflects high expectation of the pupil, attributing success to him/her. Also of reported value were the opportunities for staff to discuss the research and ideas. Improvement suggestions focused only on highlighting the difficulty of motivating some children.

The ratings for the learning objectives given by staff from each of the three schools for the workshops regarding motivation were similar in magnitude to the average ratings across the three schools; and so are reported in terms of the average ratings across the three schools. The table and graph below, show the average ratings for the 33 participants across the three schools for the workshop participants of their perceptions of their existing knowledge and understanding regarding motivation before the training input (Pre) and then after the workshop (Post) with a measure of their learning in the workshop being the difference between the Pre and Post ratings (Size of Shift). Participants’ self-assessed perceptions of existing knowledge and understanding regarding motivation related to work activities were quite high, on average over 3 across all schools in 4 out of 5 of the learning objectives. The highest pre rating (4.5) was for LO1: ‘I understand why it is important to know and understand about motivation’. The lowest pre rating (2.6) was for LO3: ‘I know and understand research on how children are motivated to engage in and complete work activities’. The highest post rating (5.2) was for both LO1 and LO2: ‘I know and understand about motivation’ with the greatest shift in learning (1.8) being for LO3, concerning research and then (1.6) for LO5: ‘I feel confident about applying knowledge, understanding and research findings about motivation to help children learn at my school’.

Overall Average Ratings Across Workshops in 3 Schools (1 Not at all – 6 Very Much)

LO1 LO2 LO3 LO4 LO5 AveragePre 4.5 3.7 2.6 3.4 3 3.5Post 5.2 5.2 4.4 4.6 4.5 4.8Size of Shift 0.8 1.4 1.8 1.2 1.6 1.3

Overall Average Ratings across Workshops in 3 Schools(1 Not at all – 6 Very Much)

Changes in PASS Ratings of Motivation-Related Factors

The average PASS results related to motivation to learn, pre and post TaMHS interventions for all 3 schools who received the motivation training workshop are shown in the table and graphs below. They show an overall increase in average percentiles for the factor 'Response to Curriculum/Learning', especially for girls, an increase of 19.1%iles to 36.9%ile, compared with UK norms, according to pupil responses to the PASS on-line questionnaire who were present at school at those times. The results are based on responses across the 3 schools from 449 pupils who completed the pre-audit in June 2009 and 489 pupils who completed the same


audit in November 2010. It should be noted that given that there are two academic years between audits, about half of the children responding in the pre-audit are different to those responding in the post-audit. Hence, the measure can be thought of a more of a measure of how the school promotes motivation rather than what the pupils bring to the situation.

Response to Curriculum / Response To Learning Across 3 Schools Prior to Motivation Workshop and Prior to other TaMHS Interventions compared with these this measure

after TaMHS interventions including the Motivation workshop

COHORTPASS PERCENTILE SCORES for Response to Curriculum / Response To Learning Across 3 Schools

Pre Jun-09 Post Nov-10 ShiftOVERALL 18.8 30.6 11.8BOYS 23.7 27.8 4.2GIRLS 17.8 36.9 19.1

While the averages across the three schools show a positive trend regarding motivation, it should be noted that this overall trend across the 3 schools belies a complex and mixed picture depending on the school or particular year group and gender. Two of the schools, an infant school and a junior school showed greater gains for Response to Learning or Response to Curriculum than one of the infant schools – for reasons that are not apparent.

In terms of motivation for pupils who are more vulnerable to mental health difficulties, it is helpful to compare pre and post PASS audit results for groups of children from ethnic minorities, especially as these statistics are readily available. The number of pupils from the 3 schools in both pre and post PASS audits who were assigned to an ethnic minority are shown in the table below. As shown below, in these particular schools, these ethnic minority groupings account for 22% in the first audit and 24% in the second audit, and hence, they collectively they represent a large minority of pupils in these schools, and so the results of any changes in motivation for learning for children in ethnic minorities represent a large number of children – 118 such children at the time of the final audit.


Cohort GroupingNo. Of Pupils at Baseline PASS Audit in 3 schools

No. Of Pupils at Final PASS Audit in 3 schools

WHITE BRITISH 337 357WHITE OTHER 24 30WHITE & CARIBBEAN 23 25MIXED OTHER 12 13INDIAN 7 15BLACK CARRIBEAN 11 9BLACK AFRICAN 9 8BLACK OTHER 14 18

As shown in the table and graph below, the main benefit for pupils in terms of increased rating of Response to Curriculum’ / ‘Response To Learning’ from the TaMHS interventions including the Motivation workshop is for the pupils who are White British, in terms of starting at a low level at 5.5%ile and in the final audit having risen to 71.85ile compared with UK norms. For pupils from ethnic minorities, the greatest gain is for the group of pupils who are described as ‘Black African‘, who gain an average of 69.9 %ile points to the highest level of any ethnic group at: 85.9%ile points; then ‘White Other’, who gain 23/8%ile points; those who have mixed heritage: ‘White & Caribbean’ pupils who gain an average of 19.2%ile points; and ‘Mixed Other’ pupils who gain an average of 12.2%ile points. Three ethnic groups (representing about 42 children in the final audit) have a lower 'Response to Curriculum’ / ‘Response To Learning’ score in the final audit compared with the initial one. This decrease is the greatest (14.4%ile points) for the Indian cohort which ends up having the lowest percentile score of all represented ethnic groups at 23.5%ile compared with UK norms.

PERCENTILE SCORES BY COHORT

Average ‘Response to Curriculum’ / ‘Response To Learning’ Across 3 Schools

Pre- June '09 Post -Nov'10 ShiftWHITE BRITISH 5.5 77.3 71.8WHITE OTHER 30.6 54.3 23.8WHITE & CARIBBEAN 42.1 61.2 19.2MIXED OTHER 48.1 60.3 12.2INDIAN 37.9 23.5 -14.4BLACK CARRIBEAN 56 48.4 -7.6BLACK AFRICAN 16 85.9 69.9BLACK OTHER 42.1 30 -12.1


Capacity Building for Motivation Training

In terms of the capacity built within the three TaMHS project schools that received the motivation training, all teaching staff there can make use of the training to help all pupils there to be optimally motivated to learn. Furthermore, there is a well-developed training package that with minimal coaching, any member of the wider Educational Psychology Service could deliver to any school in Northamptonshire.

Overall Impact Ratings for Motivation Training


Overall Impact Ratings of Motivation Training, according to senior staff from 5 project schools



7 7 n/a 5 to 9



Conclusion from Results of Motivation Training Evaluation

Overall, as the training input re motivation was well received and there were gains in terms of pupil reported outcomes that relate to motivation for learning, including in groups vulnerable to mental health difficulties due to their ethnicity, there is an indication that training in motivation to learn is helpful for staff in schools, where motivation to learn is identified as an area that needs improving. Due to the other TaMHS work that was being received by all three schools, as well as other development work, it is not possible to be sure that the cause of increases in measures of motivation was the training. However, the indication is that that it was important to help staff to understand the key ways to motivate children to learn beyond those that are more obvious – especially in relation to enabling pupils to gain a sense of competence and control.

Capacity has been built for further implementation of motivation training in Northamptonshire schools, and the detailed results above need to be taken into account.

Because of the indications of the importance to children’s mental health of motivation and hence training for motivation it is present in the Building Blocks of Provision for Building Mentally Healthy Schools in Northamptonshire at the Essential Underpinnings level, as a recommended part (‘Know how to motivate and encourage children to achieve their full potential and how to empower and encourage parents and carers to do the same’) of ‘Children’s Workforce Core Competencies’ provision for all schools in, as shown in the diagram below.


Other Mental Health Specific Training Delivered to Whole Staff

By Mike Simons

Description of Other Mental Health Training Delivered to Whole StaffWhile there was a main focus in the TaMHS project on training whole staff in the Solihull Approach Awareness and there was other whole-staff training focused on Motivation the other aspects of training are summarised here. Such additional or alternative training involved two schools experiencing an ‘Introduction to Mental Health’ and one of these schools also experiencing ‘Exploring Attention in Children’. Finally, two of the schools that had already experienced Solihull Awareness Training were provided with training entitled: ‘Building on Solihull Awareness to address concerns about children experiencing Anxiety and Self-harm’.

An ‘Introduction to Mental Health’ training involved focusing staff on the key content of ‘Mental Health is Everybody’s Business’, the handbook for schools that was published by CYPP in January 2007 and written by a multiagency group, some of whom are also TaMHS project workers. The content of the training is summarised in the objectives, as: -LO1 I understand what it means to have good mental health. LO2 I know the factors which put someone at greater/lesser risk of experiencing mental health difficulties. LO3 I know how I can personally support people with mental health difficulties in my school.LO4 I know a range of ways the whole school can work together to support and prevent mental health difficulties. LO5 I have developed my knowledge and skills re children's mental health. LO6 I have developed greater confidence in my own skills in working with children's mental health.

‘Exploring Attention in Children’ consisted of the key elements that are needed for pupils to give their attention to learning in school, including motivation and learning styles. Hence, the content of the training related to the following learning objectives: -

LO1 I understand the mental process involved in 'attention'LO2 I understand how attention in children can be affected (positively and negatively)LO3 I understand the role of motivation in attentionLO4 I understand the role of 'learning styles 'in attentionLO5 I feel confident about applying knowledge, understanding and research findings about

attention to help children learn at my school

Finally, ‘Building on Solihull Awareness to address concerns about children experiencing anxiety and self-harm’ related to these 3 learning objectives: -

LO1 Being able to recognise and effectively support children who are experiencing anxiety. LO2 Being able to recognise and effectively support children who are experiencing self-

harm. LO3 I have confidence in my own skills in working with children's mental health.


Rationale for Including Other Whole Staff Mental Health Trainings in TaMHS

Reflecting the highly consultative and reactive style of delivery of the Northamptonshire TaMHS Project, identified priorities for several schools lead to agreement to include the trainings described above, with the advantage of such training being more closely identified with particular expressed needs and reflecting the current stage of the school staff’s learning journey.


While the full day’s ‘Exploring Attention in Children’ training was devised and provided to an infant school teaching staff exclusively by members of the Educational Psychology Service, the training related to 'An Introduction to Mental Health’ and ‘Building on Solihull Awareness to address concerns about children experiencing anxiety and self-harm’ was devised and provided to mainly teaching staff respectively from infant & primary and infant and junior schools in twilight sessions jointly by Educational Psychologists, Specialist Primary Mental Health Practitioners and the School Nurse Lead for Mental Health.

TaMHS Evaluation

For each of the above trainings, evaluations were conducted by requesting that participants rate their knowledge and skills relating to the learning objectives of the training both before and directly after the training on 1-6 scales (1 not at all – 6 very much).

Ratings for presentation and relevance (1- poor – 6 excellent) were also requested– as well as comments about the value of the training. Participants were asked also to identify what they had most valued from the training and about their next steps with making use of the learning, including any needs for further support.

Results of Evaluation

An ‘Introduction to Mental Health’ Training Evaluation

22 (16 primary and 6 infant) staff across the 2 schools completed evaluation sheets. According to evaluative feedback received, the average ratings for presentation and relevance were respectively 5.2 and 4.9 (on a 1-6 scale). Staff reported especially valuing the balance of presentation and activity. In terms of the learning objectives, the greatest average shift (1.8 points) from before to after the training was for ‘I know a range of ways the whole school can work together to support and prevent mental health difficulties’, closely followed by (1.5 points) ‘I know how I can personally support people with mental health difficulties in my school’. All the set objectives achieved at last an average of 1.1shift. The highest final level of learning achieved were (5.6 and 5.3) for the first two learning objectives respectively: ‘I understand what it means to have good mental health’; and ‘I know the factors which put someone at greater/lesser risk of experiencing mental health difficulties’.

From the qualitative feedback, a range of learning aspects regarding children’s mental health were identified as important, including: how to identify mental health needs; early intervention; good communication with children, parents, other staff and other professionals; having a range of provision and network of support available within and beyond school to meet needs; and knowing who to consult and where to find resources. When asked to identify what staff would focus their efforts on as a result of this training, early intervention with parents was most


commonly identified to develop relationships and useful knowledge about children and their needs and circumstances. Also, a common focus was on identified strategies and provision that staff would seek to implement with children – but also ensuring a focus on maintaining staff well-being. In terms of identifying other training needs, this mainly involved: being more aware of resources and programmes for children, parents and staff mental health; training and support networks for particular interventions or approaches; identifying how to help children with specific needs, such as those who are dyslexic, or who have experienced emotional or other abuse; and being kept up-to-date with developments in thinking and provision most appropriate for children’s mental health.

Exploring Attention in Children’ Training Evaluation

In terms of achieving the objectives, the evaluative feedback indicated that the greatest learning related to the first learning objective: ‘I understand the mental process involved in 'attention'’, where there was a shift by 1.8 points. There was also a shift greater than 1 point (at 1.2) for ‘I feel confident about applying knowledge, understanding and research findings about attention to help children learn at my school’ which was the objective most closely focused on applying the learning at the training. The final highest level of learning (4.9) was for ‘I understand the role of 'learning styles 'in attention’, where staff felt already well-informed about this area prior to the training (4.4). Both ‘Being able to recognise and effectively support children who are experiencing anxiety’ and ‘Being able to recognise and effectively support children who are experiencing self-harm’ were highly rated (both at 4.6) in terms of final learning.

In terms of qualitative feedback, most liked was the relaxed style of input, visual input and balance of theory and case-study although, more activity and was desired by one participant.

‘Building on Solihull Awareness to address concerns about children experiencing anxiety and self-harm’ Training Evaluation

Evaluative feedback for this twilight training was restricted to ratings of learning pre and post for 3 learning objectives related to anxiety, self-harm and confidence in work in relation to children’s mental health. From completed feedback by 6 participants, this training enabled an average shift of 1.2 points in ‘Being able to recognise and effectively support children who are experiencing self-harm’; and 0.3 in relation to anxiety, which was already at 3.7, at the start – staff believing that they already had achieved learning in this area, while the average final rating for ‘self-harm’ was at a lower level at 3.3. The learning objective ‘I have confidence in my own skills in working with children's mental health’ was rated as increasing to 4.1 from 3.5 at the start of the session.


Overall Impact Ratings for Other Mental Health Specific Training Delivered to Whole Staff


Overall Impact Ratings of Other Mental Health Specific Training Delivered to Whole Staff, according to senior staff from 5 project schools



5.3 5.5 n/a 1 to 10

b) Overall to the school 6.8 7 n/a 3 to 10

Capacity Building for Other Mental Health Training Delivered to Whole Staff

In terms of the capacity built within the TaMHS project schools that experienced the trainings, two whole school staff can make use of the thorough ‘Introduction to Mental Health’ training; one whole school staff can make use of Exploring Attention in Children’ training and two whole schools' staff can make use of training focused on ‘Building on Solihull Awareness to address concerns about children experiencing anxiety and self-harm’. At countywide level, these three training packages have been developed for the above training experiences and can be used for other schools countywide going forward, where there is an identified need. Judging from the range of rating responses, it will be important to adapt materials and delivery to reflect constructive feedback – especially in relation to maximising use of activities in training to develop and embed learning.

Conclusion from Results of Other Mental Health Training Delivered to Whole Staff Evaluation

According to the average evaluative feedback, the training for whole school staff involving 4 schools and three aspects of training, there were advances in learning in key objectives that relate to mental-health focused aspects of the Children’s Workforce Core Competencies (DCSF 2005). Such advances occurred especially in relation to areas identified by staff as at low levels, particularly regarding: ‘understanding the mental process involved in 'attention'’; ‘knowing a range of ways the whole school can work together to support and prevent mental health difficulties’; ‘knowing how I can personally support people with mental health difficulties in my school’; and ‘being able to recognise and effectively support children who are experiencing self-harm’. Confidence in applying knowledge, understanding and research findings about attention to help children learn at my school’, also significantly increased, when the staff experienced relevant training. Confidence increases in other aspects of mental health were of lower order but still significant.

Because of the indications of the importance to children’s mental health of aspects of Mental Health Training in addition to Solihull Approach that relate to the experiences of staff in


classrooms, this has been included in the Building Blocks of Provision for Building Mentally Healthy in terms of ‘Children’s Workforce Core Competencies’ but also in terms of providing support for children with needs in relation to their developmental pathway or experiences, as shown in the diagram below: -


Protective Behaviours

By John Fardon

Description of Protective Behaviours (PBs)

Protective Behaviours is a process that enables children, young people and adults to identify what ‘safe’ means to them, how their body tells them when they don’t feel safe and strategies to help them feel safe again. It is a multi wave intervention, enabling schools to incorporate it into whole school practice, through assemblies, class work, group work and 1:1 work for more vulnerable youngsters. It has its roots in child protection and began in the USA in the 1970’s, spreading to Australia and the UK in subsequent decades, now being used in different agencies across the country. Further information can be found at www. protectivebehaviours training.co.uk .

Rationale for Including PBs in TaMHS

Protective Behaviours has been used in Northamptonshire schools, Social Services and Voluntary agencies since the 1990s and demand for training is always high. As a county it has been used for groups of more vulnerable children in Year 7, as well as in primary and secondary school classrooms, incorporating Miss Dorothy, www.dotcomcf.org and in Specialist CAMHS group work after youngsters have been admitted to hospital following attempts of serious self harm. An article on the use of Protective Behaviours group work in Northamptonshire can be found in the Young Minds Magazine Issue No 43. It forms the basis of many of the Wave 3 interventions carried out by a Specialist Teacher for Mental Health & Emotional Wellbeing in this TaMHS project. Finally, through consultation, two of the project schools specifically requested that PBs training be provided – as senior staff recognised its value, especially in working with pupils who have additional needs concerning mental health and emotional well-being.


The equivalent of one day’s training (3 twilights) was provided to both Ruskin Infant School and Hardwick Infant and Junior Schools. This reached approximately 70 staff, both teachers and support staff in school. The training was carried out by the Specialist Teacher for Mental Health & Emotional Wellbeing, who is an accredited trainer for PBUK. It was also modelled to an individual school staff member in each of the 13 wave 3 case studies – [see Shoebox chapter in ‘Multi-wave Interventions’ section].

TaMHS Evaluation and Results

The effects of Protective Behaviours training have been very difficult to measure and in this project can only be judged by some individual comments which may include some aspect of PBs. For example, a Radio 4 programme at the end of the 1990’s, following the publication of the Young Minds article in December 1999, asked pupils how they had been affected by Protective Behaviours two years previously, several of them recounted different situations in


http://www.dotcomcf.org/

http://www.protectivebehaviourstraining.co.uk/

which they used the PB strategies to help themselves deal with bullying, anxiety and bereavement.

Evaluations of training were conducted by requesting that participants rate their knowledge and skills relating to the learning objectives of the training both before and directly after the 3 twilight sessions on 1-6 scales (1 not at all – 6 very much). Over 70 staff attended the training, but did not attend all three sessions. The immediate feedback from completion of the evaluation questionnaire demonstrated a shift in learning from an average of 2.5 baseline to almost 5 on the 1-6 scale for each objective. The average shift size was 2.5. Greatest learning shift was 3.2 for the 5th learning objective: ‘I understand the 7 PB strategies and how they can be applied.’ The highest rated final levels of knowledge/skills were for the 2nd and 3rd learning objectives: ‘I begin to recognise the inter-relationship of feelings, thinking and behaviour’ and ‘I begin to understand what feeling safe is and the recognition of early warning signs.’

When asked to name one thing that staff wanted to work on, as a result of this training a recurrent theme was helping children to develop their own ‘safe place.’ Other participants stated that they would use the PB strategies, take note of their feelings and listen more. Other participants stated the need for all staff to communicate in a fluid manner and to work on communication between home and school.

Parents of children who received Wave 3 interventions using PBs noted improvements in the confidence of their child coming to school (Y2) and the ability to deal with social situations in school (Y5). Staff noticed improvements in the ability to attend mainstream classes (Y7 and Y9) and improvement in concentration and reducing aggressive playground incidents (YR). Parents were more involved in learning about Protective Behaviours from feedback sessions at the end of the Wave 3 interventions.

Since Protective Behaviours incorporates elements of different theoretical frameworks, such as Cognitive Behavioural Therapy Approaches, Solution Focused Approaches and the use of resources promoted in schools by government initiatives, it has been difficult to evaluate as a sole intervention. The main point that differentiates Protective Behaviours from good emotional literacy or anti-bullying work is that it is a universal approach for staff, children, young people and parents and carers that can be used at many different levels. It is preventative in nature, so difficult to measure what might have happened if Protective Behaviours had not been at the core of a school or agency’s work. What would be most helpful now would be a robust piece of research to evaluate the evidence surrounding the huge variety of work using Protective Behaviours in this country. I can only end this part of the chapter with the words of a Northamptonshire Year 9 pupil interviewed on Radio 4 who said ´I would recommend Protective Behaviours all over the world, it would make it a safer and better place to be.’


Overall Impact Ratings for Protective Behaviours Training


Overall Impact Ratings of Protective Behaviours Training, according to senior staff from 3 project schools



8.5 8.5 n/a 7 to 10


Capacity Building for PBs

Due to the TaMHS input, there are three schools where most staff have experienced the training and so have acquired knowledge about PBs and how to apply this effectively in their work for improving children’s feelings of safety and their mental health.

At present there are three Protective Behaviours trainers in Northamptonshire who are accredited by PBUK, two of them working in the Early Years sector. Capacity is limited to give the full 2 day Foundation Training course. We are currently looking at how training is carried out and considering a model that would enable training to take place in school any day of the year, providing teaching in three classes with additional staff being present and additional meetings/presentations taking place during the day, which would hopefully build staff confidence in using the process. Out of the aspects of children’s mental health provision identified at TaMHS Children’s Mental Health conferences in January 2011, Protective Behaviours was 10th in the order of priorities out of 33, with 60 schools interested in training or information. Additional network meetings could take place in localities to support staff using Protective Behaviours, a model which is successfully used with other interventions in Northamptonshire.


Conclusion from Results of PBs Evaluation

It is clear from the formal evaluations that shift in learning has enabled participants to understand the key concepts of PBs; the significance of a ‘safe place’ for children and adults, how our body lets us know when we don’t feel safe and what we can do about it. For some it was confirmation of what they had learnt previously and others it was clearly an ‘eye opener’ for themselves as well as the children they work with. It remains to be seen how effectively the schools incorporate PBs into their school ethos and practice. One of the schools is already demonstrating the benefits of using PBs alongside other interventions across the waves of intervention. .

Indications are that Protective Behaviours can be introduced successfully into Northamptonshire schools with a positive impact on: children who are vulnerable to experiencing difficulties with Mental Health or who are already experiencing such difficulties; and on the school overall.

Because of the indications of the importance to children’s mental health of Protective Behaviours, it has been included in the Building Blocks of Provision for Building Mentally Healthy Schools in Northamptonshire at the Essential Foundation level, as a recommended provision for all schools, in addition to or alternative to the Solihull Approach as shown in the diagram below: -


Relaxation – using the Relax Kids Model

By John Fardon

Description of Relaxation Teaching in Schools

Relaxation has been taught in Northamptonshire schools since 2007, using the seven points from Relax Kids; dance & movement, fun and relaxation games, stretching, massage, breathing, affirmations and visualisation. These exercises help children to release endorphins, which in turn help them to feel better about themselves and prepare them for learning in the classroom. Relax Kids relaxation exercises can be used for individuals, for groups, for whole classes and even during assembly time, taking-up only a few seconds or up to an hour.

Rationale for Including Relaxation in TaMHS

For some children who have difficulties with anxiety, anger, concentration and self esteem, relaxation helps them enormously. Relax Kids has been used as a multi-wave model, using relaxation in different sized groups and with individual children. Various research has been carried out on different aspects of relaxation: www.massageinschoolsassociation.org.uk for the effects of massage, www.relaxkids.com for a case study from Sylvester Primary School, Liverpool and various contributors to ‘Meditation in Schools’ – Calmer Classrooms Ed Erricker & Erricker 2005. All of these studies come to a universal conclusion that relaxation skills combine to produce benefits for children. Staff have spoken locally about additional benefits for teachers using these techniques, contributing to their own wellbeing.

Fenella Lindsell, the founder of Yoga Bugs (for children aged 2½ to 7) and Yoga’d Up (for children between 8 and 12), report that children who may be over-stimulated are helped through yoga postures and meditations, ‘to connect to that quiet space inside you which we all have’, arguing that ‘you can’t relax and focus your mind until you relax your body’. Provision of Training and ImplementationIn the TaMHS project, Relax Kids training was provided for half a day, attended by 11 representatives from three primary schools. The training within the TaMHS project built upon training carried out across the county for the previous three years. By 31st December 2010 over 300 professionals in Northamptonshire had been trained to use Relax Kids exercises in over 65 schools. Relaxation exercises were being used in more than half the TaMHS schools. One Infant School ensures that all their children experience relaxation exercises every week, using Relax Kids and other resources. Relaxation techniques were incorporated in some of the Wave 3 work with individual children and young people and used successfully. At the TaMHS conferences, representatives from 58 schools indicated an interest in finding out more about Relax Kids or accessing training.

There was some additional relaxation training and demonstration work carried out at an Infant and Junior School by one of the Specialist Primary Mental Health Practitioners (SPMHPs) after consultation with the Specialist Teacher for Mental Health and Emotional Wellbeing. The training was implemented in both the Junior and Infant school in collaboration with the SENCOs who devised a time table for the SPMHP to run the relaxation sessions with whole classes.

Three 25 minute sessions were offered to each class teacher; the first session was a demonstration by the SPMHP, allowing school staff to participate and be a role model for pupils. The second session ran jointly with the SPMHP and class teacher to encourage the teacher to begin to feel at ease with the techniques. The third-session was run by the teacher, with the SPMHP in a supportive/encouraging role. Northamptonshire TaMHS Project - Evaluation of Interventions April 2009 – March 2011

70

http://www.relaxkids.com/

http://www.massageinschoolsassociation.org.uk/


Outcomes from using Relax Kids exercises are purely qualitative in nature, although there is a very useful body of evidence from Sylvester Primary School, Liverpool, who used the NFER Nelson Emotional Literacy Assessment for the whole school. This evidence can be found on www.northamptonshire.gov.uk/shoebox One child with high levels of anxiety receiving a Wave 3 intervention borrowed one of the Relax Kids CDs, took it home and found it amazingly helped her two year old cousin go to sleep, when previously his mother had spent hours trying to get him to sleep. It also helped the targeted child reduce her levels of anxiety.

Evaluation of the Relax Kids training given to TaMHS schools indicate that it was highly valued in terms of presentation, relevance and shift in learning; demonstrating a shift on a scale of 1-6 from a baseline of 1 or 2, to over 5’s for each learning objective. The greatest learning shift was 3.9 for the first learning objective ‘I begin to understand about the seven points of Relax Kids.’ The highest level of learning was for the third learning objective, ‘I begin to understand the benefits of Relax Kids.’ The average shift was 3.6. The most important things that course participants stated they would like to take from the training included; the variety of activities; using the techniques to allow children to calm down; strategies to use in class; and the importance of relaxing.’

What has been learnt about the whole process of training and modelling relaxation skills to staff and pupils can be summarised in four points.

Ensure that the trainer/practitioner is completely at ease and fully understands the different elements of relaxation.Take time to introduce the techniques, modelling relaxation, not striving to teach everything in a short space of time.Guard against making assumptions about what the pupils and staff already know about emotions and relaxation.Try to have all staff supporting what we are trying to achieve, so we are not just implementing the idea of one senior member of staff. This will help to reduce ‘sabotage’ or non-participation from some members of staff in the classroom.

The four points above are specific lessons learnt from experience in two schools and are valuable to bear in mind when developing this work in schools.

There is more evidence of how Relax Kids interventions have been used with children from Northamptonshire schools who have been using the techniques learnt from earlier training sessions. At the TaMHS conferences, a Learning Mentor/Family Link Worker described how she had used Relax Kids exercises with a group of Year 6 boys with some behavioural and self-esteem issues, with positive results. She also used peer massage with targeted children from the Foundation Stage who were all having bad dreams. Parents reported much happier children who were able to sleep better, only a few days afterwards. A Headteacher reported how she used visualisations during assembly, observed by her School Improvement Partner, after play in class and organising a weekly lunchtime club from Year R to Year 6 for up to 20 children. For this Headteacher, Relax Kids has helped most with children who have self-esteem and anger management difficulties, describing the impact on those children as “fantastic!”



Overall Impact Ratings for Relaxation


Overall Impact Ratings of Relaxation, according to senior staff from 5 project schools



6.6 8 8 2 to 9


Capacity Building

From input through TaMHS, capacity to provide has been built within at least 6 schools, with a reported 350 children across 6 of these schools accessing relaxation or massage on a frequent basis in the first quarter of 2011. Capacity has also been built in the SPMHP staffing to support schools and others in developing relaxation as useful provision. In order to build capacity in the future, training could be developed by offering individual schools training on any day of the school year, working with the children alongside the teachers and support staff, and running a teacher/parent session later in the school day. In order to contribute to this way of working, Specialist Teachers for Mental Health have created a short film to share with staff in schools, clearly demonstrating the seven points and the benefits to staff and children. This should help to build confidence and capacity for most staff in one school. If one person in the school was also able to attend an additional half day training event they would be able to support relaxation skills across the school.

Conclusion from the Results

What has been important to discover about the training process in relaxation skills is that participants need to understand why relaxation is helpful for children and then to feel confident enough to use the techniques. Where confidence amongst staff is high enough, then the results are extremely positive, but when confidence is not sufficiently high, the impact on children and schools is less positive. It is also important to give time for staff to internalise the techniques and ideas about relaxation. In two of the TaMHS schools it was necessary to go into the school and demonstrate the techniques with the class, the teacher and support staff. This happened with 60 children in Year R and 20 children in Year 3. The staff then felt confident enough to use the techniques themselves and work is continuing in these schools.

Indications are that Relaxation can be introduced successfully into Northamptonshire schools with a positive impact on children who are vulnerable to experiencing difficulties with Mental Health or who are already experiencing such difficulties, and on the school overall. In particular, children benefit in terms of self-esteem / mental health.

Capacity has been built for further implementation of Relaxation in Northamptonshire schools, and the detailed results above need to be taken into account in further implementation.


Because of the indications of the importance to children’s mental health of physiological based interventions such as Relaxation, that it has been included in the Building Blocks of Provision for Building Mentally Healthy Schools in Northamptonshire at the Wave 1 / Universal level, as a recommended provision for all schools, as shown below: -


Northamptonshire Shoebox Including Wave 3 Interventions

By John Fardon

Description of Shoebox

The Northamptonshire Shoebox is a locally produced resource to support the inclusion of children and young people, where there are concerns about their social, behavioural, mental or emotional health. It was launched as a folder shortly before the TaMHS project in March 2009 and as an interactive website www.northamptonshire.gov.uk/shoebox from October 2009. 500 hard copies of the resource were distributed, mainly to schools, with accompanying training.

Rationale for Including the Northamptonshire Shoebox in TaMHS

The need for a resource for schools to access when early intervention or positive mental health interventions was becoming apparent in the county, with the reduction in numbers of specialist mental teachers from 5 to 2 in 2008, but there was still demand for intervention in the early stages and also in cases of crisis intervention. The Northamptonshire Shoebox was created to match need and enable capacity to be built in our schools. Given the usefulness of the resource for supporting schools in meeting mental health needs of their pupils at whole school, staff, class, group and individual levels, it is clearly a resource for supporting schools in meeting the TaMHS objectives, especially in terms of building capacity by enabling schools to use the resource effectively beyond the time of the TaMHS Project.


The Northamptonshire Shoebox was modelled and introduced to all 13 TaMHS schools by the Specialist Teacher for Mental Health, supported by other team members. It was introduced to 4 TaMHS schools to the whole staff and to the 13 schools with the pupil interventions over 6 x 45minute sessions. As a county there have been over 3100 hits on the shoebox web pages since it was launched. In the online survey, the chapter which has been found to be most useful is the chapter on ‘Behaviour’ (49%) and the next most popular is ‘Feelings’ (39%). The most useful online section was the ‘Documents’ page, indicated by 50% of respondents. In the training session given to Ruskin Junior School, all but one participant indicated that they would become familiar with the Shoebox and how to work more effectively in promoting children’s mental health. In addition to the website there have been approximately 80 telephone consultations from professionals requesting help or information related to mental health.

All 13 TaMHS schools were given the opportunity to receive input from the Mental Health Teacher, working with a chosen pupil who was deemed both to be vulnerable to mental health difficulties and to need an early intervention; and with a member of staff from the school, to use the Northamptonshire Shoebox and any relevant interventions for that child. The interventions took place over six half-hour sessions, with 15 minutes at the end of the session for the adults to discuss what approaches had been used and what might still be appropriate after the sessions. A preliminary and a summative meeting were held in each school with the SENCO, parents of the chosen pupil and the Specialist Teacher for Mental Health.




Outcome information on the use of the Northamptonshire Shoebox has been based on results of questionnaires, pre and post, measuring self esteem or emotional literacy. Informal interviews were also held some months after the interventions, to see whether progress had been sustained. The majority of pupils had made significant progress.

In KS1, four pupils were seen and three of them increased their self esteem, as rated by scores on Primary Insight, by 29, 31 and 35 points. For the one pupil whose scores declined, mostly in the area of personal power; the school reported a significant increase in confidence coming in to class and a huge difference in the involvement with parents after the intervention. The school had no further concerns after the intervention had taken place. One of the pupils had moved out of the Nurturing Group and had gained in confidence and improved behaviour in class. Another pupil had a CAF meeting organised after the intervention and completed a set of Drawing & Talking sessions.

In KS2 there were measures from pupils, teachers and parents, on the NFER Nelson Emotional Literacy Questionnaire (ELQ). According to teacher responses, four of the six pupils showed rises in emotional literacy. Two pupils moved from ‘below average’ to ‘average.’ One descended from ‘below average’ to ‘well below average’ and one remained at ‘below average.’ According to two parents, both pupils raised their ELQ, one mainly in motivation and one in empathy and social skills. The pupil-rated questionnaires showed a rise in 5 out of 6, with only one descending from well above average to average. One of the pupils in Year 6 showed a reduction of aggressive incidents in school to zero by the end of the summer and was seeking out help from the Learning Mentor far less than previously. For another KS2 pupil, the school were insistent upon him being chosen for this intervention, in spite of encouragement to choose a pupil who needed early intervention. The results were not positive for him and he needed more in depth intervention from specialist services, consistent with the needs identified on his statement.

For the two KS3 pupils, the most obvious changes could be measured in terms of attendance in mainstream classes. Both pupils are now full time in mainstream classes, one of them achieving this almost simultaneously with the intervention, becoming far more confident and being part of different social groupings within the school. The other pupil had been excluded several times and had an older brother who had been permanently excluded; he too is back in full time classes and attending college one day per week, with no further exclusions.

Parental involvement was part of each of these interventions, including a meeting prior to and at the end of the intervention. A mid term phone call was made to each parent and verbal feedback was positive. Two separate CAFs were organised following the intervention and one referral to Specialist CAMHS, based on high levels of anxiety measured on the Spence Anxiety Scale.


Overall Impact Ratings for Shoebox


Overall Impact Ratings of Shoebox, according to senior staff from 9 project schools



6.8 7 8 2 to 10


Additional comments by school representatives about the Shoebox identified that in some of the schools it is used regularly by staff in key roles for their direct work and for them to act as consultants to others; and that it is especially useful for vulnerable children.

Capacity Building for the Development of the Northamptonshire Shoebox

For each of the 13 schools, there is capacity built for at least one member of staff to draw on the model of the Specialist Teacher for Mental Health for using the Shoebox with an individual child. Certainly for 4 schools and for many of the others, there is the additional capacity-built of all or most of the staff having clear knowledge of the usefulness of the Shoebox and how to use this resource.

In terms of involving others schools, the simplicity of the Northamptonshire Shoebox means that the capacity building potential in schools is enormous. At present, it is possible for a number of Educational Psychologists and the two Specialist Teachers for Mental Health and Wellbeing to deliver training to staff in schools. It could be that selected members of staff (SENCOs, Inclusion Managers, Senior Staff) are trained and then able to cascade the essentials to all staff.

Links between the Northamptonshire Shoebox, training possibilities and the ‘Building Blocks for a Mentally Healthy School’ are continually being developed, alongside a new ‘Quick Guide for Adults’ to help pupils maintain positive mental health. With the roll out of TaMHS across the county we will be able to see how all the different interventions fit together to help staff in schools, which will undoubtedly be included in the ever growing contents of the Northamptonshire Shoebox. www.northamptonshire.gov.uk/shoebox



Conclusion

Reflecting on the whole Northamptonshire Shoebox training, modelling and interventions the results have been mostly positive. The extent to which any school embraces the concept of the Shoebox has been dependent on the status of the receiving adults from each school, some being able to influence other staff members in what might be helpful. Some teaching assistants may have felt unable to share their experience with other staff members. In the schools where all staff were given an opportunity through staff training, to see how the Shoebox could be used, there was definitely the intention to use it. More time is needed and more feedback from schools to evaluate the impact of this intervention.

Indications are that the Northamptonshire Shoebox can be introduced successfully into Northamptonshire schools with a positive impact on children who are vulnerable to experiencing difficulties with Mental Health or who are already experiencing such difficulties, and on the school overall. And that training and modelling of use of the Shoebox is a helpful way of capacity building within school in a way that leads to staff being more confident and capable of meeting pupils’ mental health needs before or instead of involving outside agencies.

Because of the indications of the importance to children’s mental health of staff accessing and using the Shoebox, it has been included in the Building Blocks of Provision for Building Mentally Healthy Schools in Northamptonshire at the Essential Foundations level, as a recommended provision for all schools.


Solihull Approach Training

By Mike Simons & Julia Jackson

Description of Solihull Approach Training

The Solihull Approach focuses attention on promoting the emotional well-being and mental health in infants, children, adolescents and families. The approach provides a theoretical framework for working with children, families and colleagues. It draws in theories of psychotherapy, child development, including attachment and behaviourism, and brings them together in a practical way. The model integrates the concepts of:

Containment; Reciprocity; Behaviour management.

The training enables participants to recognise how behaviour is a sign of the extent to which people (children and adults) feel understood and able to deal with their emotions at that time. For example, when feeling overwhelmed and not understood many people are likely to behave in ways that get noticed. The Solihull Approach is supported by a resource pack of materials.

Rationale for Including Solihull Approach Training in TaMHS

The Solihull Approach is a nationally recognised and locally endorsed theoretical approach to working with families and compliments other methods. Due to it’s sound evidence based, in Northamptonshire in 2007, the Children and Young People’s Partnership Board adopted the Solihull Approach training as core training for all staff in the children’s workforce and hence, there has been an on-going programme of 2-day Solihull Approach Foundation training for both the School Years and the Early Years organised by the Workforce Development Team of the county council and provided by combinations of Educational Psychologists and Specialist Primary Mental Health Practitioners. However, coverage across the county including in schools has been limited by several factors, including lack of staff resources, the fact that training cohorts need to be small (no more than 14) for the training to be effective. Hence, the TaMHS project offered an opportunity for two staff in each school to be trained in the approach, which would should provide a valuable foundation for staff to provide support for children’s mental health, especially when working with children and families who are vulnerable to mental health difficulties, and indeed at all levels of working with others. Furthermore, the TaMHS project offered an opportunity to accelerate the training roll-out focused on participants from schools. The project also offered the opportunity to develop and pilot a version of the training appropriate to training a whole school staff – a one-day training package termed locally: Solihull Approach Awareness training – as a way of providing greater likelihood that the approach will become embedded in the schools in terms of depth and breadth, more so than if just 2 staff were trained using the full 2-day Foundation course alone.


One Educational Psychologist member of the TaMHS Project Team was already an experienced accredited trainer in the Solihull Approach Foundation training and the seconded School Nurse Lead for Mental Health member of the team had become accredited to train but first sought and took opportunities to observe national trainers in their delivery of the 2-day training. This enabled both team members to co-train up to two staff from each of the 13 project schools in April-May 2010 in Solihull Approach Foundation: The School Years: in two


separate cohorts – one in Daventry, local to project schools there; and one in Wellingborough, local to schools there.

The Solihull Approach Awareness training was developed through consultation with Veronica Lawrence, Specialist Senior Educational Psychologist – Early Years. As well as being a key advocate for the Solihull Approach and it’s use in educational settings, which led to it being adopted by the county council as core training for the children’s workforce, she had piloted a full-day’s training of the Early Years version of the training with the whole staff from a local Children’s Centre, at the request of the Headteacher there, who wanted all her staff to benefit as she had done from the Foundation course. A key to such whole-staff training working in organisations such as schools, it was believed essential to ensure that some staff in the organisation had completed the Foundation training, and so could provide on-going support and resources for those who had experienced only the one-day larger-cohort version.

Given that the TaMHS baseline audit of Staff Knowledge, Skills and Confidence had helpfully identified both strengths and improvement opportunities in areas very much related to those covered in the Solihull Approach, it was decided to further tailor the Solihull Approach Awareness training for each school based on the unique results for each school. In this way, it was thought that greater engagement of staff would result, as they would have greater ownership of the content and it would meet identified needs in a more focused and explicit way. Hence, a version was developed for each school by pairs of co-trainers from the project team. Those involved in tailoring and providing the training included the accredited Solihull Approach Foundation trainers but also Educational Psychologists who had been in receipt of only the Foundation training and had experience of implementing this in their work.

Each of the 2-day Solihull Approach – School Years Foundation training was attended by 12 staff (a total of 24 over the two courses) representing 11 of the project schools and 1 school outside of the project, where 2 staff had been actively seeking spare places on a course. One of the project schools not represented had 2 senior staff who had already accessed the training; and the other not represented could not attend due to a date clash but sought and received training later-on from a set of sessions organised by the county council. Two spare spaces on the training were taken-up by two recently recruited Specialist Primary Mental Health Practitioners, one of whom was providing TaMHS input in other aspects of the project. And the final two spaces were taken by two staff who work for the Alliance for Black Children, a local resource in Wellingborough who work with children from ethnic groups who are especially vulnerable to mental health difficulties.

7 (3 Infant, 3 Junior and 1 primary) out of the 13 project schools received a tailored version of a one-day’s Solihull Approach Awareness training – mostly occurring on school’s training days, although one school chose to have these held as a series of after-school training sessions. While all 13 project schools were encouraged to access the Solihull Approach Awareness training for all of their staff, 6 schools did not engage with this due to them prioritising other mental health training for use on their limited number of training days, including: an introduction to children’s mental health; relaxation and addressing concerns about children experiencing Autistic Spectrum Difficulties (ASD), Attention Deficit Hyperactivity Disorder (ADHD). Evaluations of these trainings are written-up elsewhere in this report. For the 2 secondary schools, a combination of them having their training day content planned months in advance and them prioritising other whole-school development work over mental health development work made it not possible to arrange Solihull Approach Awareness training or other Mental Health training for their whole staff. However, one of the secondary schools by the time of publication of this report will have received Solihull Approach Awareness training for their Emotional Health and Wellbeing Team (see separate chapter in this report).


TaMHS Evaluation

For the Solihull Approach Foundation – School Years training, an established evaluation questionnaire that had been developed by the founders of the approach was used, in order to elicit participants’ perceptions of: the course’s relevance to their work; the quality of the training; the key aspects of learning; and how they plan to use their learning ‘back in the workplace’. It was decided to use this established questionnaire, as it seeks perception of the core value of the training and also so that the results could be added to those of others for the purpose of ongoing both countywide and national evaluations of the training.

For the Solihull Approach Awareness training, evaluations were conducted by requesting that participants rate their knowledge and skills relating to the learning objectives of the training both before and directly after the 1-day training on 1-6 scales (1 not at all – 6 very much). The learning objectives (L0s) were as follows: -

LO1: I begin to understand the model of the Solihull Approach. LO2: I begin to understand what containment and reciprocity mean.LO3: I begin to understand how containment and reciprocity can be applied practically in my

schoolLO4: I begin to understand the interaction between emotional development and brain

development.LO5: I have developed my knowledge and skills re children’s mental health in areas

especially highlighted in the staff knowledge, skills & confidence questionnaire. LO6: I have confidence in my own skills in working with children’s mental health.

Finally, an additional learning objective was added for two schools where staff-wellbeing had additionally been highlighted as a concern and where part of the training could usefully focus. The learning objective for this was identified as:-

LO7: I'm confident that I can manage my own mental health needs well, whether or not this involves getting help from others.

Ratings for presentation and relevance (1- poor – 6 excellent) were also requested– as well as comments about the value of the training. Participants were asked also to identify what they had most valued from the training and about their next steps with making use of the learning, including any needs for further support. Finally, qualitative evaluation was collated in the form of video and audio recordings of children and staff, reflective diaries and interviews, in order to identify the valued-added in practice of the Solihull Approach.

Results of Evaluation

Solihull Approach Foundation Training

19 participants completed evaluation sheets – unfortunately 4 of the participants out of the 24 who attended the first day were unable to attend the 2nd day of this course, and 1 participant left too early on the 2nd day to complete the evaluation. According to evaluative feedback received, 78% of respondents found the ‘relevance of this training and of the Solihull Approach to your work’ “Highly Relevant” – the remaining 22% identifying this as “Quite Useful”. ‘Presentation by the trainers’ was regarded as “Excellent” according to 63% of participants, with all but one of the rest identifying this as “Good”. The 5 key aspects of learning identified most commonly by respondents related to (listed in order of frequency): containment, reciprocity, behaviour management; importance of link between parents, attachment and early child development; and finding-out why specific behaviours occur. Participants’ responses to the question about how they will use their learning ‘back in the workplace’ were varied but many indicated: using it to improve the way that they think about and relate to children, parents


and colleagues; using the approach as a framework to reflect on situations; and sharing their new knowledge and understanding with colleagues and reflecting with them about how the Solihull Approach can be used in their school.

During one of the training activities, respondents were required to record more concrete intentions for using the approach when they returned to school. The responses identified many levels of use for the approach including for: whole-school ethos; behaviour policy; PSHE; classroom management; embedding the approach into other provision such as Nurture groups; transition; peer mentoring; early parent involvement; parent-support; managing late-arrivals to school; and individual planning for a child and family.

Finally, most respondents added further positive comments including: -

Solihull Approach Awareness Training

In total, 147 staff, mainly teachers, received the Solihull Approach Awareness training – with 108 staff completing and presenting an evaluation form, assigning an overall average rating of 3.5 for the presentation and 4.3 for relevance (on 6 point scales).

Perception by participants of meeting the learning objectives across the four sets of training are shown in the table and graph below, in terms of the average pre/baseline assessment, post- training and the shift between the two, which identifies the extent of the perceived learning that has taken place. It should be noted that LO7 was relevant to only one training cohort (40 staff) – as this specifically referred to ‘staff wellbeing’ as an objective; and LO6 refers to three out of the four training cohorts who rated their ‘confidence’ in meeting children’s mental health needs.

Meeting of Learning Objectives across 4 Training Cohorts involving staff in 7 Schools

Size/LO LO1 LO2 LO3 LO4 LO5 LO6 LO7Pre 1.4 1.3 1.3 2.1 1.9 1.9 2.7Post 4.5 4.6 4.5 4.7 4.4 4.3 4.4Shift 3.1 3.3 3.2 2.6 2.4 2.4 1.7


A very informative course, trainers with great expertise and adviceClear links back to what/how

we can take this into school

Great course and delivery

A valuable course that can be embedded through many areas. Thank you.

Very valuable two-day training which will impact on the approach for so many children in our school”.

Meeting of Learning Objectives across 4 Training Cohorts involving staff in 7 Schools

As shown in the table and graph above, the greatest shifts in learning (respectively by 3.1, 3.3 and 3.2 points) were for the first three learning objectives: -

LO1: I begin to understand the model of the Solihull Approach. LO2: I begin to understand what containment and reciprocity mean.LO3: I begin to understand how containment and reciprocity can be applied practically in my

schoolThe highest level (4.7) reached was for LO4: ‘I begin to understand the interaction between emotional development and brain development’. This was closely followed by the next highest (4.6 for LO2 and 4.5 for both LO1 & LO3) relating to beginnings of understanding regarding containment and reciprocity and how these can be applied practically in their schools. Final average ratings across all objectives were between 4.3 and 4.7. The objective with the lowest shift (1.7) related to staff-wellbeing – mainly because this had by far the highest of the pre-ratings (2.7).

Responses from participants from all 7 schools identified particular aspects of the training that were most liked, including: delivery that was accessible but not patronising; balance of use of interaction and information; mixed use of informative DVD (re early brain-development and of babies interacting) Power Point, diagrams and speaker delivery; specific applying of the Solihull Approach to concerns about anxiety and self-harm; and that the training being not too intense but delivered in a relaxed atmosphere. In some of the training sessions, a greater emphasis on interaction was identified as an improvement opportunity.

In terms of responses to the question ‘What are the most important things that you will take away from today’s awareness raising training?’ the main themes included: aspects of learning around early brain development, containment and reciprocity and impact of adult-wellbeing on child outcomes; and how they can apply these key ideas to their own perspective of situations which they can then handle differently at the level of self, colleagues, work in class and specific kinds of situation such as in addressing self-harm. When asked to: ‘Name just one thing that you want to work-on as a result of this training’, the most popular responses were: paying attention to their own feelings more and stepping back from these; more deliberately providing containment through active listening; and S.O.S. (i.e. Stop, Observe [and] Switch attention from behaviour to containment and reciprocity], which refers to Northamptonshire TaMHS Project - Evaluation of Interventions April 2009 – March 2011

82

a memorable way to refocus in a more productive way to resolve a situation where a child’s (or adult’s) behaviour is causing concern.

For ‘realistically building on this awareness raising training in order to work more effectively in promoting children’s mental health?’, out of the 108 respondents: 10 (9%) indicated that they would ‘Actively seek a place on a 2-day Solihull Foundation training course’; 31 (29%) indicated that they would ‘Make use of the expertise of staff in my school who are already trained in the Solihull Approach’; and 34 (31%) indicated that that they would ‘Apply some of these ideas in the today’s training to my work without further training’. And, referring to the Northamptonshire’s overarching children’s mental health resource, 24 (22%) indicated that they would ‘Become familiar with the Northamptonshire Shoe Box and how to make use of this’.

To the question: ‘What else do you think you need in order to help to build on today’s training in order to work more effectively in promoting children’s mental health?’, many of the 25 responses referred to making time to reflect on using the Solihull Approach in specific situations; accessing some kind of further training, being coached or reading more about the Solihull Approach and other aspects of mental health – including accessing more examples of how the approach and resources can be used in school situations.

Results of Qualitative Evaluation of Impact upon families, children, staff (at whole school and individual)

Qualitative evaluation was collated in the form of video and audio recordings of children and staff, reflective diaries and interviews. This data includes perspectives from a teaching assistant, a Headteacher and two children: identifying the use of containment, reciprocity-repair and the use of Solihull Approach overall to support relationships and so benefit children and families. The efficiency benefits to other services and organisations are also recognised within these recordings as the Headteacher in one particular school noted a significant decrease in their need for police involvement, reduced conflict resolution time in school, enhanced parent-staff and enhanced staff-staff relationships. The reduction of conflict within these relationships has maximised opportunities that can now be utilised for positive learning.

Within schools where Solihull Approach Awareness training had been completed, staff continue to use language associated with the Solihull Approach and a ‘common understanding’ dominates the ethos of those schools which have adopted this as a whole school approach. It is argued that a distinct difference is notable regarding language, reception attitude, approach to child and adult behaviour, staff wellbeing, and crises management when engaging such schools in comparison to those which have not.


Overall Impact Ratings for Solihull Approach Foundation Training – Key Staff


Overall Impact Ratings of Solihull Approach Foundation Training – Key Staff, according to senior staff from 8 project schools



9.3 9.5 10 7 to10


Comments made alongside these overall ratings included: “helpful for working with individual children. Very good. Need to develop in school”. “Helped with supporting parents”. “Found this extremely useful - still using”.

Overall Impact Ratings for Solihull Approach Foundation Awareness - Whole Staff


Overall Impact Ratings of Solihull Approach Foundation Awareness – Whole Staff, according to senior staff from 7project schools



8.3 8 8 7 to 10


Comments made alongside these overall ratings included: “Excellent - had a major impact on ways of working across the school”; and “Has provided a shared language”.


Capacity Building for Solihull Approach Training and Use

In terms of the capacity built within the TaMHS project school that introduced Solihull Approach Training, 11 schools have 2 staff newly trained in the Foundation School Years version; with the remaining 2 schools having 1 member of staff trained. In addition to this one additional school had 2 staff trained; and also 2 Specialist Primary Mental Health Practitioners have been newly trained, as have been 2 staff from a voluntary organisation focused on supporting children from ethnic minorities. All those trained are well placed to support colleagues in their schools or others with whom they work in making full use of the approach and accompanying resources. Also, a new trainer in Solihull Approach Foundation has been able to develop skills and experience in training through the TaMHS project.

140 staff in 7 schools are trained in Solihull Approach Awareness, sufficiently to use this while being supported by 2 staff in school who have been trained in the Foundation version of the course and who have a resource pack. Furthermore, other staff were able to benefit from joining these courses, including: a trainee educational psychologist, two specialist primary mental health practitioners and one specialist teacher for mental health: which has build capacity for their future work.

Furthermore, capacity has been built in terms of the development of a valued training pack for Solihull Awareness Training that is adaptable to the specific identified training needs of the school. This training has so far been delivered by 3 educational psychologists and one Lead School Nurse for Mental Health: but could be shared with other educational psychologists and specialist primary mental health practitioners for use with other schools. Furthermore, the video and audio recordings of children and staff, reflective diaries and interviews regarding the use of the Solihull Approach was presented at the TaMHS conference in January 2011 and the resulting presentation provides an additional tool to promote the benefits of the Solihull Approach ‘direct from the horses mouth’. This is an important aspect within the evaluation when considering capacity building for promotion of mental health: as the Solihull Approach provides a foundation to understanding, it facilitates a common language and way of managing tension and conflict within an organisation (be that family unit or whole school environment). A copy of this ppt. Presentation, is available via [email protected]



Conclusion from Results of Solihull Approach Training Evaluation

The combination of quantitative and qualitative results from the Solihull Approach Training evaluation that involved teachers and support staff, suggests that Solihull Approach Training and Solihull Awareness Training are highly valued and are applicable to promoting and intervening in children’s mental health on many levels, including as a framework for thinking and action for: self-care, individual pupil, parent or colleague work; group or class work; and whole-school policy and practice. This view is further emphasised by the qualitative evaluation and the overall project impact evaluation Therefore, the Solihull Approach continues to be a highly useful core approach to be promoted as a foundation for all work regarding children’s mental health in school and beyond.

Capacity has been built for further implementation of the Solihull Approach Foundation and the Solihull Approach Awareness Training in Northamptonshire schools, and the detailed results above need to be taken into account for maintaining and improving the quality of the training and support.

Because of the indications of the importance to children’s mental health of Solihull Approach that it has been included in the Building Blocks of Provision for Building Mentally Healthy Schools in Northamptonshire at the Essential Foundations level, as a recommended provision for all schools, which also links with the Solihull Approach Parent Group that is as shown below: -


Solution Focused Approaches

By Kathryn Davidson

Description of Solution Focused Approach

Solution Focused Brief Therapy (SFBT) began life in Milwaukee, America in the 1980s. The main founders of the approach were Steve de Shazer and Insoo Kim Berg. Together with a number of team members from wide ranging disciplines they worked together, united in finding helpful ways to work with people who are experiencing difficulties in their lives. The founding members of the team believed that it was unhelpful to focus mainly on the problems in a situation. Instead, the SFBT team were inspired to use methods which seemed to work, techniques which appeared to improve things and help people to make progress. In short, they switched the focus from trying to change problem behaviour to promoting solution behaviour (BRIEF documentation 2010). They made the assumption that people already had the resources to improve their lives and the role of professionals should be to remain ‘open’ to new ways of working which were infinitely respectful of the people they worked with and designed to help people to help themselves.

The main principles of the approach are to support people in making a shift from being ‘problem-focused’ to being ‘solution –focused’. This is achieved by holding a core set of beliefs when working with others:

We don’t need to fully understand the problem before we can find a solution Everyone has the strengths and resources to help themselves There will already be something that is working Change can happen in very small steps No matter how bad the problems is, it doesn’t happen all the time We can’t change the past so we should focus on the future Having a clear idea where you want to be makes it more likely that you will get there

Once the main principles of the approach are understood, it can be applied in a great many ways in a wide variety of situations. As the name suggests Solution Focused Brief Therapy originated as a method of counselling. The same ideas and techniques have since been applied to a number of different situations such as:

individual work with pupils in schools, providing ‘coaching’ rather than ‘counselling’, supervision sessions, meetings with colleagues, parents of children in schools, teaching staff, professionals larger group meetings to gain positive outcomes for all personal reflection organizational reviews, looking at what is working well and where the organization

would like to be whole school approaches to support staff and pupils in developing high standards of

teaching and learning such as the Solution Oriented School Programme (Rees, 2005 in Hobbs, 2006)


Rationale for Including Solution Focused Approach in TaMHS

The SFBT approach emerged through developing a better understanding of what seemed to work in counselling situations with people. It is therefore no surprise that several studies have found good outcomes for people following use of the approach in therapeutic settings. A summary of a range of studies is available from BRIEF www.brief.org.uk that show that the approach is found to be helpful and only a small number of sessions are needed to be effective (e.g. around 4 sessions). Some of the measurable outcomes include a reduction in reoffending rates for people who had been in prison (Sebord and Ukin 1997), reduced measures of depression amongst people experiencing difficulties with substance abuse (Smock et. al., 2008), increased scores on measures of parenting skills (Zimmerman et. al, 1996) and higher return to work rates (Cockburn, 1997). Many of the studies conducted to date have had fairly small sample sizes, but several have used control groups to compare outcomes of different approaches. In 2000 Gingerich and Eisengart reviewed 15 controlled studies of Solution Focused Brief Therapy (SFBT). Their review concluded that there is preliminary support for the efficacy of SFBT, but further research needs to be undertaken.

A number of informative and inspiring books have been published regarding SFBT. Many of the books provide case study examples to show the effectiveness of the approach, often taking a situation which is perceived to be ‘stuck’ and providing examples of enlightening questioning styles that help the person to begin to see things differently and make progress. Some books (e.g. Ajmal and Rees, 2001) focus on ways in which the Solution Focused counselling techniques can be applied successfully within an educational context.

Franklin et al looked at the effectiveness of Solution-Focused Therapy with Children in a school setting in America in 2001. The research followed 7 case studies, evaluating pupils’ scores on the Conners' Teacher Rating Scales. Observations were taken to inform the Conners’ Rating Scale during a ‘baseline’ phase and during the intervention phase when the children were receiving SFBT sessions from doctoral students with at least 3 years experience in clinical practice. Results showed that there was progress with 5 out of the 7 cases, indicating that SFBT may be effective in supporting pupils with a range of behaviour difficulties.

In 2002 King and Kellock published a study exploring the benefits of Educational Psychologists providing intensive, short term counselling using Solution-Focused approaches to children and their families. Parental questionnaires that were completed after the sessions had finished indicated that 67% of families (18 families in total) felt that the problem had either ‘ended’ or ‘improved a lot’ following the intervention. 94% of the families would recommend the approach to someone experiencing a similar situation.

An unpublished study undertaken by the Northamptonshire EPS (2005-2007) looked at the effects of Solution Focused Coaching which was provided for 18 cases which were perceived to be ‘stuck’ by the school and the link Educational Psychologist. The pupils were aged between Year 2 – Year 11. Of 8 the pupils who completed evaluation questionnaires 5 rated the coaching as either ‘very helpful’ or ‘extremely helpful’ with the remaining 3 pupils valuing it as ‘fairly helpful’. Teachers tended to agree. Of the 15 teachers who completed the final evaluation questionnaire 7 rated the coaching as either ‘very helpful or extremely helpful’ and all of the 6 parents who responded agreed with this judgement. Furthermore, when asked if the current situation had improved following the coaching 5 of the 6 parents stated that it was ‘much better’, 7 of the 15 teachers and 5 of the 7 pupils who answered the question rated it as either ‘much better’ or ‘a little bit better’. This suggests that Solution Focused coaching may be helpful in moving forward some situations/ cases that appear to be ‘stuck’.


http://www.brief.org.uk/

As described above, solution focused approaches have been found to be helpful in a wide range of situations, helping people experiencing very unique difficulties and valuing the varying elements and strengths in each situation. It has been used to help young people in schools experiencing difficulties with anxiety, with friendship issues, with poor reading skills, with social and behavioural difficulties. Each case study is rich in its exploration of the different facets of every situation. However, there have also been some studies seeking to evaluate SF approaches as a specific approach towards helping an identified issue. For example, in 2003 Young and Holdorf studied the impact of using Solution Focused Brief Therapy in tackling bullying in schools. They implemented SF therapy predominantly in individual sessions, but also occasionally as part of a support group approach for cases which requested support via an anti-bullying helpline. Out of 92 pupils, 92% felt that their situation had improved to the point where further support was no longer needed following the SF intervention. The report concludes that SF approaches in individual casework and in support groups are effective strategies that work quickly when a pupil needs help in a bullying situation.

Initiation of programme in Northamptonshire TaMHS Schools

There is a long history of enthusiasm for Solution Focused Approaches within the Northamptonshire Educational Psychology Service. The TaMHS project (Targeting Mental Health in Schools) provided a new opportunity to introduce the techniques more broadly as a helpful way to promote mental health in a variety of settings.

A one day introduction to solution focused approaches was planned and delivered in November 2010 by two Northamptonshire Educational Psychologists and a Specialist Teacher - Mental Health. A third Educational Psychologist and a second Mental Health Teacher attended the day in order to begin to build a larger team of trainers and to support the trainers in providing feedback to participants. Immediately following the day’s course Solution Focused letters were sent to all participants, thanking them for their contributions, providing individual feedback from the day and acting as a reminder of the areas that they identified that they wanted to work on as recorded on their evaluation forms. It was hoped that, in addition to their actual content, these letters would act as a good working example, illustrating techniques shared on the day, and giving participants a personal experience of being in receipt of such a letter- perhaps adding some encouragement to try this in their own work.

The intention of the course was to provide a ’taste’ of Solution Focused approaches, supported by some initial techniques. Details were provided of further training if participants wanted to pursue the approach further and a reference list was also made available. Participants were encouraged to try out some ideas to see the value in the approach in the hope that they would be inspired to attend further training.

To provide follow on support to participants, a consultation session has been arranged 3 – 4 months after the training day. Each school / organisation who attended the training will be visited by a named Educational Psychologist and/ or Mental Health Teacher to review the training, consider techniques that have been applied and to consider next steps. A further twilight interest group meeting has also been arranged 6 months after the initial training for participants to share their experiences, consider ways of supporting each other and make plans for the future.

20 participants attended the training in November 2010. Table 1 illustrates the professional roles represented at the training day.


Table 1 – Professional roles of participants at ‘Introduction to Solution Focused Approaches’ training day, November 2010.

Professional Role Number attendingTeacher (including SENCOs and Heads of Year in secondary schools)

6

Teaching Assistant 5Head Teacher 1Parent Support advisor / Family Link Worker

4

Specialist Primary Health Care Practitioner

1

SENCO for Complementary Education for the county

1

Mental Health Teacher 1Educational Psychologist 1

Evaluation Results from Quantitative Data

At the end of the training day we collected 19 evaluation forms from participants. The evaluation form had two main aims, firstly to provide feedback regarding the effectiveness of the training and secondly to provide a thinking aid to participants in planning their use of the approach and considering their next developmental steps in this area (available from the author).

To evaluate the effectiveness of the training day participants were asked to rate their knowledge / confidence in 4 key areas before and after the training, where 1 would represent ‘not at all’ and 6 would represent ‘very much’.

Table 2 – Participants’ responses to rating questions on the evaluation form

Learning Objective Average response before the

training

Average responses after the training

Difference

I understand the difference between a solution focused and a problem focused approach

2.18 5.589 +3.41

I have an idea of the main techniques of solution focused practice

1.35 5.12 +3.78

I have begun to think about how solution focused methods could be useful to me in my work

1.76 5.29 +3.53

I know where I can access further information, support and training

1.705 5.18 +3.47

Table 2 shows that participants had gained knowledge and understanding in various areas as a result of the training day. On average course attendees felt they made at least 3 points Northamptonshire TaMHS Project - Evaluation of Interventions April 2009 – March 2011

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progress in their ratings of the statements by the end of the day. Two participants did not mark a final position against the statements; therefore it was not possible to include their ratings.

Participants were also asked to rate the presentation and relevance of the day between 1 and 6, where 1 = poor and 6 = excellent. 17 participants responded to each question. Average responses show that participants rated the presentation at 5.59 and the relevance of the subject at 5.76.

Evaluation Results from Qualitative Data

Analysis of the comments made on the evaluation forms shows that participants appreciated a range of factors of the training. Areas that were listed under aspects of the training that attendees liked were:Video [7]Relevant and useful [6]The positive, non-judgmental approach [4]Different presenters [3]Enjoyable [3]Handout [2]Real case studies [2]Opportunity to practice the strategies [2]Easy to understandInformativeResources Cementing my skillsRelaxed, friendly atmosphere

Two participants made suggestions to improve the training. One requested “More examples with teenage range” and one said she “would love to delve deeper – more training please!”

Additionally, two participants independently contacted me after the training session to comment on the usefulness of the techniques to their work and to share examples where they had already been able to put it into practice.

Overall Impact Ratings for Solution Focused Training


Overall Impact Ratings of Solution Focused Training, according to senior staff from 3 project schools



8 8 n/a 7 to 9


Comments made alongside these overall ratings included that since the training, the approach, structure and techniques have been used for working with individual children, parents and with


[Numbers in brackets indicate the number of responses referring to each aspect of the training. Where no number is given only one response was made].

other staff focused on meeting holistic needs of children of most concern; and also by staff in personal lives.


Capacity Building

In the county there are a number of psychologists with an interest in SFBT who have completed introductory training and use the techniques in their work. We have resources for a one day training course and a framework for follow up support that could be repeated. Three Educational Psychologists and two Mental Health Teachers would be able to provide the training without further guidance. Further Educational Psychologists would be able to contribute if there was sufficient demand for more training. There is also now the possibility of participants providing some support for each other in their use and maintenance of the skills.

Conclusion

The key lessons learned in the Northamptonshire TaMHS Project about a Solution Focused Approach to take forward include:-

There are strong indications that a Solution Focused Approach can be introduced successfully into Northamptonshire schools with a positive impact on children who are vulnerable to experiencing difficulties with Mental Health or who are already experiencing such difficulties, and on the school overall.

Key aspects for making implementation of a Solution Focused Approach successful include continuing to show the practical and relevant use of the approach to work with parents and children of a variety of ages.

Capacity has been built for further implementation of a Solution Focused Approach in Northamptonshire schools, and the detailed results above need to be taken into account.

Because of the indications of the importance to children’s mental health of a Solution Focused Approach, it has been included in the Building Blocks of Provision for Building Mentally Healthy Schools in Northamptonshire at the Essential Foundations level, as a recommended provision for all schools, as shown below.


References

Ajmal and Rees, 2001 ‘Solution Focused Thinking in Schools’. BT Press

Cockburn (1997) ‘Solution-focused Therapy and Psychosocial Adjustment to Orthopaedic rehabilitation in a Work Hardening Programme’ Journal of Occupational Rehabilitation 7 (2) pp 97-106

Franklin, Biever, Moore, Clemons and Scamardo (2001) ‘The Effectiveness of Solution-Focused therapy with Children in a School Setting’. Research on Social Work Practice

Gingerich and Eisengart (2000) ‘Solution-Focused Brief Therapy: A Review of the Outcome Research’ in Family Process Vol. 39, Issue 4 pp477-498

Hobbs, C (2006) ‘The Solution Oriented School Programme: Drawing on the strengths of staff and pupils to build solutions towards inclusive schools’. A paper presented at the European Conference of Educational Research, University of Geneva, September 2006

King, E and Kellock, I (2002) ‘Creating a Solution-Focused Counselling Team’ in Educational Psychology in Practice, vol. 18, no.2, pp103-111

Sebord and Ukin (1997) Journal of Collaborative Therapies

Young, S. and Holdorf, G. (2003) ‘Using Solution Focused Brief Therapy in Individual Referrals for Bullying’ in Educational Psychology in Practice, Vol.19, No. 4 pp. 272 – 282

Zimmerman, Jacobsen, MacIntyre and Watson (1996) ‘Solution Focused Parenting Groups: An Empirical Study’ Journal of Family Therapy 19 (2) pp. 159-172


Section C

Wave 1 Pupil/Parent-Focused

Interventions


G r o w I n g

Talent Growing Talents for Inclusion (GTI)

By Yvonne Benson

Description of GTI

GTI is a whole-class intervention which promotes emotional wellbeing through the development of positive and collaborative peer relationships using solution focused and appreciative inquiry approaches. One of the critical factors for GTI is the involvement of the children and adults as collaborative partners in working towards a changed future. Involving the children in this way empowers them to feel a part of and own the process themselves. Skills or strengths that are already happening within a classroom are identified and these ‘talents’ are nurtured through a cycle of teaching, modelling, experiential learning, reflection and celebration of their development. This culminates in a final combined class led project that revisits and reinforces their talents and focuses on further developing peer collaboration and appreciation of each other. The project celebrates their progress and success towards more collaborative and positive relationships and so a more able conducive learning environment. The Growing Talents for Inclusion programme was devised in Northamptonshire by Marian Keenaghan, Senior Educational Psychologist and Mary Doveston, Senior Lecturer in Special Education, University of Northampton. The approach was developed from practitioner research which focused on assisting schools with a significant proportion of individual referrals for children and young people with social, emotional and behavioural needs. Seventeen GTI projects have been taking place in Northamptonshire since 2002 where the social dynamics within a class have been identified as barriers to their learning involving whole classes from year 3 to year 8.

The GTI process is based on principles and approaches of: Appreciative Inquiry Solution Focused Brief Therapy Collaborative Consultation Co-researching with students

Appreciative Inquiry and Solution Focused ApproachesThe Appreciative Inquiry Process uses a 4-D cycle- the Discovery, Dream, Design and Destiny phases (Cooperrider & Srivasta 1987), as follows.

Discovery and Dream phase - Starting out and Meeting the ClassAn initial collaborative consultation is held with the school to describe the process and identify the ‘talents’ – skills - to be developed with the class teacher. A miracle question is employed for envisioning and exploring preferred futures and class teachers visualise how they would like the class to be. This stems from the thinking that envisioning the future helps to make it happen- ‘the future we anticipate is the future we create’ (Bagshawe 2003). Scaling as used in solution focused approaches is employed throughout the process to measure progress towards the ‘talents’.The class meet the GTI practitioners. At present this is mainly Educational Psychologists.Feedback from observations of the class includes appreciative language to acknowledge, describe and amplify the strengths and observed behaviours already being displayed by the class. This process supports the children to become familiar with what they are already doing well in order to repeat those desired behaviours and successes.A process of data gathering is undertaken – a social inclusion survey is used to identify which children may be socially vulnerable or rejected and to assess the dynamics within the classroom. Children’s views are sought regarding the talents and to what extent these are Northamptonshire TaMHS Project - Evaluation of Interventions April 2009 – March 2011

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already being displayed by their peers in the classroom. This ensures that everyone is consulted. Again solution focused rating scales are used to discuss what is already going well in the class and how things could be improved.The GTI practitioners feedback ‘findings’ from the interviews to the class and clarify the next steps of ‘talent building’.

Design phase – ‘co-constructing the future’The Class Teacher describes the ‘problem’ in positive terms to the children - how they would like their class to be - and invites them to be partners with the Class Teacher to work towards a different future. The involvement of the children supports them to feel a part of the process of change and so be co-researchers in a different future along with the Class Teacher.

Destiny Phase – Innovating ‘what will be’.At this point in GTI, the class begin to work towards developing their ‘talents’ through cooperative and fun activities providing skill development.

Skill building consists of approximately 6 sessions and involves fun activities to develop and fan (nurture and increase) the ‘talents’. These sessions are structured using a developmental approach to promoting co-operative skills and follow the cycle of teach, model, practise, reflect and celebrate. Children work in groups/pairs and are mixed up so that they have a chance to work with everyone. The children practise and reflect on their performance during the sessions and along with the adults available, describe what they have observed using appreciative language. Each session follows a similar format: introduction, reflection on the previous session using photographs/video, skill building and focusing on the future.

The Class Project further develops cooperative skills and provides the class with an event or common purpose to work towards and gives a sense of community and ownership. The children are taught how to brain storm and democratically decide on a project that will involve everyone. The project utilises the children’s strengths and ‘talents’ that have been identified and provides a further opportunity to practise their skills. The project is then planned, organised and carried out by pupils and is followed by a celebration of their involvement in GTI.

Rationale for including GTI in TaMHS

Children who present with social emotional behavioural difficulties are at a greater risk of mental health difficulties and underachieving academically. Early developmental psychopathology is linked to higher rates of later anti-social behaviour and mental health difficulties, Meltzer (2000). Government policy - the ECM agenda (2003) and more recently ‘Early Intervention, the next steps’ (2010) - has recognised that prevention or early intervention to address and reduce these difficulties in school can promote greater positive mental health and emotional wellbeing later in life and into adulthood. The raising of emotional literacy as an issue to be taught and focused on within the curriculum has been promoted through the PSHE framework and the introduction of SEAL (social emotional aspects of learning). GTI links in with other initiatives such as SEAL, values education and Circle Time through focusing on the importance of supportive relationships for children’s positive mental health. Broffenbrenner’s (1979) ecological theory of child development suggests that a child’s network of supportive and close relationships can be key to their cognitive, physical, social development. If a child is unable to access affirmation they may be more likely to seek out and display inappropriate attitudes, activities and become disaffected in their learning and relationships generally. Claxton (2005) noted the need to focus on the development of constructive, positive relationships to secure increased good mental health outcomes for children and young people in the long term. Blum and Libbey (2004) proposed that having a feeling of connectedness and


a sense of belonging is a critical factor for a child’s positive mental health and school success. Establishing more positive peer relationships can reduce negative and challenging behaviour as the child feels a greater connectedness to their class community, Saponshevic (1994). Positive peer relationships are linked to higher school attendance and engagement with learning and may reduce a child’s possibility of dropping out of secondary school. GTI interventions focus on these relationships and the social dynamics within a classroom to support the development of a more positive sense of peer and school connectedness that can impact on a child’s emotional wellbeing. However unlike universal programmes that support peer relationships, GTI aims to support more collaborative positive classroom dynamics and can be tailored to address each class’s individual needs and social barriers to learning

The importance of the GTI intervention as a whole class activity rather than a small group intervention is raised by DuPaul and Ecker (1994) who noted that social skills taught in isolation or out of context of where the difficulties occur will have little impact on the problem. This suggests that peer relationships especially for more isolated and vulnerable children, need to be developed through a structured and positive environment within their own class rather than removing them. The process aims to support these more socially isolated and vulnerable children through developing the supportive and connectedness skills of the rest of the class. This is likely to have more of an effect for the children than practising the skills in an unrelated environment and therefore reducing their ability to generalise any knowledge gained. The effects of developing more collaborative social skills and relationships through a GTI intervention therefore can have a positive impact for the whole class and not just those identified as vulnerable.

Developing the ‘talents’ or skill building activities include collaborative learning opportunities in paired or in groups allowing children to work with and get to know each other. Azmitiu (1988) noted the positive benefits of paired or group activities that can promote cognitive development due to the breadth and depth of discussions children may have during problem solving tasks. Children are able to access invaluable insights from how their peers approach problems and increase their own range of skills and knowledge in these areas. As the children work collaboratively with different partners and groups in GTI, they engage in activities together, engaging in cooperative working and developing appreciative, reflective feedback skills that focuses on their shared learning towards mutual goals. These co-operative activities in GTI, support the development of more positive relationships as they provide structured activities with high appeal to the children involved. They provide fun opportunities for children to learn with those they may not choose to work with in a different lesson and as a result discover positive reasons for liking them, Hill (1985).

The importance of the class project is not just to celebrate the ending of the GTI intervention but as Roseth, Johnson and Johnson (2008) proposed, working towards and achieving a mutual goal can result in more positive views of those children involved for each other. The children take on responsibilities and work in groups to make the project of their choosing happen and as a result of this collaborative process develop a ‘can do’ attitude. The actions that contribute towards the success of the group and the project are recognised and celebrated by the children thus creating a greater sense of community, belongingness that will support their engagement in learning.

Provision and Implementation of the GTI Intervention

From the core proposal of interventions, one junior school involved in the TaMHS project identified the social dynamics of their Year 6 class as being a barrier to their learning. Through an initial consultation with TaMHS linked Educational Psychologists and the school’s SENCo


and Class Teacher, it was decided that the class may benefit from a GTI intervention. A collaborative consultation with the school’s SENCo and class teacher and two TaMHS linked Educational Psychologists was set up in January 2010 to outline the intervention and the set up of the programme.

Extent of parent involvement/outcomesParental letters outlining the process and seeking permission were sent to parents before the GTI intervention to gain permission. As can be seen from the return of the Emotional Literacy checklists, 16 forms were returned pre GTI but only 9 returned following the intervention of which 6 could be used for comparison purposes. Those used showed an increase in average ratings for those 6 children following GTI as perceived by parents.

Evaluation Results

Quantitative data was collected through the NFER Emotional Literacy Checklist which both pupils and parents were requested to complete. All the individuals in the class were interviewed separately by an Educational Psychologist before and after the project. The interview consisted of the children feeding back how they rated themselves as a class on a scale of 0-10 in being able to treat their classroom as a learning environment, where 0 - is not at all and 10 is very good. The ratings were compiled and averaged and input into a chart as shown below. This was fed back to the whole class to reflect on their progress.

How did we rate ourselves as being able to treat our classroom as a learning environment?

The above increase on the rating scale represents a 17% increase in the overall average rating by the children following the project.

The children were also asked in both - before and after GTI - interviews, whether their peers displayed each talent -as identified - in the classroom using a ‘1’ to describe where they were able to display the talent most of the time to 0 where they very rarely displayed the talent. The feedback was input into an excel spreadsheet and then given a percentage rating to construct the talents chart as seen below.


How did we rate our class for the talents to be developed?

As can be seen from the graph, the children’s ratings for their peers in displaying each talent increased following the project. The greatest increase was perceived by the children to be in the talent of ‘being a good team player’. This showed an increase of 22% in positive ratings.

GTI Social Inclusion Survey ‘Work Habits’ ResultsEach child completed a social inclusion survey during a whole class session with their class teacher before and after the GTI intervention. The question for the social inclusion survey asked was:‘Who helps you to have good work habits?’ The children had to rate each individual in their class with a number. They were given a choice of 4 answers 1- not at all, 2- sometimes, 3- definitely and ?- don’t know. Who helps you to have good work habits?

Girls = 9, Boys = 17, total = 26The results reflect an overall decrease in ‘?’s as the children worked within groups or pairs of children who they wouldn’t normally work with showing greater social awareness of each other. There is also a decrease in 3s and 2s whilst an overall increase in 1s.This would appear to suggest that the children felt that they perceived others as not helping them to develop good work habits. It may also be that as the children became more aware of the ‘talents’ and need to develop good work habits and that as they had new opportunities to work with peers they had never worked with before, they were more able to make a judgement on who they felt modelled good work habits.Northamptonshire TaMHS Project - Evaluation of Interventions April 2009 – March 2011

100

These results do not correspond with the information gathered through individual interviews with children and the ratings scales of being able to ‘treat the classroom as a working environment’. This may be as a result of the children reflecting that they themselves needed to develop good work habits and become more independent - not relying on others - and this was reflected by some of the feedback during the focus group session. There may have been some confusion with the children completing a number of questionnaires on the same day which required ‘1’ for an increase in the displaying of talents which conflicted with the required response for this questionnaire.

Emotional Literacy Results: feedback from pupil checklists

Summary

The above graph shows a positive shift in the emotional literacy scores from the children’s completed checklists and highlights that the children’s perceptions of their emotional literacy having improved following the GTI intervention.

Emotional Literacy Results: Feedback from parental checklist

Pre – January 2010. 16 checklists returnedPost July 2010. 9 checklists returned. 2 incomplete, 1 returned where no ‘pre’ checklists available. Therefore there were 6 parental checklists to provide a comparative analysis.


SummaryThe above graph shows again a positive shift in the parent’s perceptions of their child’s emotional literacy following the GTI intervention. Qualitative data was collected through semi-structured interviews with individuals within the class before and after the project, a focus group made up of pupils from the GTI project class and a questionnaire sent to the class teacher following the GTI intervention.

Themes that emerged from pupil’s comments from final interviewsQuestion 1: What did you enjoy most?Theme FrequencyActivities linked to skill development 21Class project 2All of it- GTI 1Not doing work 1

Question 2: What has got better?Comment FrequencyMore concentration/independence/trying our best

26

Being good team players ( a supply teacher commented on it) more cooperation/know each other a lot better

8

Respecting classroom and resources more 8We are calming down more (when we line up and come in)

7

We are listening to our teacher more 6Whole class (it’s a better class to be in now) 3More spiritual 1

Differences the class noticed following the project: (examples)


Qualitative Feedback from the class teacher (questionnaire)

Questions ResponseWhat were your first impressions of GTI?

I wasn`t sure how the “talents” fitted in at first with the initial questionnaire, but as we concentrated on a different talent each week, it became clear.

How clear was its purpose at the beginning?

I wasn`t fully sure what the project entailed, but hoped it would be working on social skills. I think we were in a strange situation because I had already had the class for a term before the project started. I think it would have been more effective if it was at the start of a year when the children and teacher don`t know each other.

What are the main assets/components of GTI?

I thought the activities were very good. The way they concentrated on one of the talents each time focused us all on the fact that they could make the right choices in that area. This gave good opportunities for praise and for the children to feel positive. The photos and feedback from the last session were good as they reinforced good behaviour and choices

In what ways was GTI beneficial to your class and to yourself as a teacher?

I got ideas for PSHE activities which I would like to try with my next class. The identification of areas to target – skills for success identified – activities to try out the skills and reinforcing the skills is a formula which I will use.The class enjoyed the activities and felt success for that session. They got a lot out of organising the final project as it was a real life activity.

How could it be improved?

I think the children were sitting for too long at the beginning of the session. Perhaps the giving out of the badges and the compliments could be a bit quicker each time.

Would you run it again? What support would you need?

Yes I would. Don`t think I would need any support. Now I have seen it run successfully, I feel confident to give it a try!

Other comments Thank you very much. The children have really enjoyed your visits and it has made them focus more on the talents and break down their choices in behaviour and see how they can behave and perform as a group. Thank you for all the ideas

Overall Impact Ratings for Growing Talent for Inclusion


Overall Impact Ratings of Growing Talent for Inclusion, according to senior staff from 1 project school



2 2 n/a n/a

b) Overall to the school 7 7 n/a n/a


Comments made alongside these overall ratings included that the class teacher involved in the project has subsequently shared ideas with other staff who seek them for their classes. Hence GTI has been beneficial overall to the school.

Capacity Building

As outlined in the class teacher feedback, the teacher felt comfortable to run the programme again independently, having been fully involved in the process will incorporate some of the ideas into their PSHE time the following year. Activities and materials are currently being used by another class within the school and being shared with other staff.

To promote the further use of GTI within the county a workshop was run at the TaMHS mainstreaming conference in January 2011. 34 participants indicated they would like to be kept informed about training for GTI and 9 participants identified that if there were funds available that they would be interested in purchasing a GTI intervention.

There are currently 2 GTI projects running in Northamptonshire schools outside of TaMHS and eight Educational Psychologists who have successfully run GTI projects in recent years.

Schools who wish to find out more or engage in a GTI intervention in the county should contact their link EP or Marian Keenaghan Senior Educational Psychologist/Mary Doveston Senior Lecturer Northampton University. More information can be found on the Shoebox website.

Conclusion

The overall conclusion from both the quantitative and qualitative data suggests that GTI has a positive impact on the mental health of the children involved in the intervention through focusing on reducing the barriers to their learning and improving the social dynamics with a classroom. These improvements may impact in the long term on their sense of connectedness to school and each other, their engagement with learning and so reduce the possibility of dropping out of secondary school later in life.

Hence, indications are that GTI can be introduced successfully into Northamptonshire schools with a positive impact on children who are vulnerable to experiencing difficulties with Mental Health or who are already experiencing such difficulties, and on the school overall, with capacity built within the school.

While GTI has clearly an approach that is beneficial for the mental health of children and the school overall and could be useful to any school for children of an appropriate age, it has not been included in the Building Blocks of Provision for Building Mentally Healthy Schools in Northamptonshire as a recommended provision for all schools due to it being deemed as more appropriate for schools who have particular classes where relationships and dynamics are particularly problematic. Hence, within the TaMHS Programme, GTI can been seen as a recommended approach for use with schools who have a particular class that meets this criteria as a bespoke intervention or new approach within the ‘Key Processes..’ model below.


References

DOVESTON, M and KEENAGHAN, M (2006a) Improving classroom dynamics to support students’ learning and social inclusion: a collaborative approach. Support for Learning, 21,1, 5-11.DOVESTON, M and KEENAGHAN, M (2006b) Growing Talent for Inclusion: an appreciative Inquiry into classroom dynamics. JORSEN,6,3,153-165DOVESTON, M and KEENAGHAN, M (2009) Improving group dynamics to support learning and social inclusion : developing and enhancing CPD tutor capacity. SEN R&D Awards T34736. Manchester TDA.DOVESTON, M and KEENAGHAN, M (2010) Teachers and Educational Psychologists working together: what can we learn? Support for Learning, 25, 3, 131-136.MCGRATH, H & NOBLE, T. (2010) Supporting positive pupil relationships: Research to practice. Educational & Child Psychology Vol. 27 No.1MCLAUGHLIN, C. & CLARKE, B (2010) Relational Matters: A review of the impact of school experience on mental health in adolescence. Educational & Child Psychology Vol. 27 No.1MURRAY-HARVEY, R. (2010) Relationship influences on students’ academic achievement, psychological health and well-being at school Educational & Child Psychology Vol. 27 No.1


Zippy’s Friends

By Kathryn Davidson

Description of Zippy’s Friends

Zippy’s Friends is a comprehensive programme designed to promote mental health and wellbeing with pupils aged between 5 and 7 years. The aim of the intervention is to help children to learn better ways to cope with everyday problems. The programme provides straightforward materials and lesson plans to cover 24 weekly whole class sessions, each lasting approximately 45 – 50 minutes. The themes and content of the programme are linked together through a story which is appealing and appropriate to pupils in Key Stage 1. The sessions each focus on a certain aspect of the story, encouraging children to consider ways that characters can cope in the story before considering and developing their own coping skills.

The intervention is clearly structured and benefits from a progressive richness and complexity of skills and themes, where earlier ideas are reinforced and used as starting points for further sessions. It is therefore important that the programme is taught in its entirety. The 24 sessions are divided into 6 modules covering the topics – Feelings, Communication, Making and Breaking Relationships, Conflict Resolution, Dealing with Loss and Change and We Cope. New ideas are introduced using examples that would be familiar to most children aged 5 -7 years. Children are encouraged to evaluate the storyline and ways of coping with a wide range of situations before being encouraged to reflect on their own skills / solutions, benefiting from sharing ideas with peers and learning strategies to help them to decide if a ‘solution’ to a problem is a helpful or an unhelpful one. In this way their skills are enhanced on many levels and in many ways , for example their social and emotional skills, their speaking and listening skills, their ability to consider other views, their ability to analyse and evaluate suggestions and ways in which they can create and use a support network in a range of situations.

The programme was developed over a period of 7 years with the aim of increasing the coping skills, mental health and emotional wellbeing of young children. Monkeviciene et.al (2006) quote studies which have shown that “the use of effective coping skills can help to overcome the negative effects of stressful life events”. Zippy’s Friends therefore seeks to extend the range of coping skills that children can employ. Drawing on further research into coping led by Segal (1983) and Lazarus and Folkman (1984), Zippy’s Friends has been designed to help children to find their own coping styles, rather than endorsing one particular approach. It recognizes that a variety of coping strategies can be helpful and that good coping skills can vary between individuals and situations.

Zippy’s Friends works by developing children’s repertoire of coping skills and their ability to adapt those coping skills to various situations. It integrates a range of skills including teaching problem solving skills, enhancing social skills and improving emotional understanding alongside clear messages about finding ways to ‘cope’ with everyday stresses and more complex situations. Crucially, as Monkeviciene points out “Zippy’s Friends does not tell children what to do, nor does it indicate what is right or wrong. Instead, it encourages children to explore and think for themselves”.

The programme is published and managed by a UK based charity called Partnership for Children (www.partnershipforchildren.org.uk). Partnership for Children has successfully introduced Zippy’s Friends to many countries worldwide (currently 19 different countries) as well as a growing number of counties in the UK.


http://www.partnershipforchildren.org.uk/

In order to run Zippy’s Friends in a school the teacher who will be delivering the sessions needs to attend a one day training course run by Partnership For Children, or one of their approved trainers, and purchase the core materials (a set of posters, Teacher’s Notes, lesson plans for each module etc.) and consider which additional resources may be helpful to them. The county’s Zippy’s Friends Coordinator would then liaise with the school with regard to further support that might be helpful. It would be expected that one observation of a session and follow up consultation with a Zippy’s Friends trainer would be planned as a supportive measure and to ensure fidelity to the programme. Further support could be arranged through interest groups or links being established with a partner school.

Rationale for Including Zippy’s Friends in TaMHS Project

To date there have been three large scale studies of Zippy’s Friends, 2 conducted in Denmark and Lithuania by Mishara and Ystgaard (2006) and Monkeviciene, Mishara and Dufour (2006) and 1 in Ireland by Clarke and Barry (2010). Holmes and Faupel also evaluated the intervention in Southampton Schools between 2003 and 2006.

Mishara and Ystgaard studied 322 children in Danish schools and 314 in Lithuanian Schools who were undertaking the programme. They compared their performance with children in control classes in both countries (110 children in Denmark and 104 children in Lithuania). The short term effects of Zippy’s Friends were very positive. Pupils who had received the programme used significantly more positive coping strategies (as measured by the Schoolagers Coping Strategies Inventory) and displayed significant improvements in social skills (as measured by the Social Skills Questionnaire, Student and Teacher Forms, Elementary Level) than control groups. Pupils who had received Zippy’s Friends showed higher increases in scores in the core social skill areas of ‘assertion’, ‘self-control’, ‘empathy’ and ‘cooperation’ than pupils in the control group.

To measure coping strategies Mishara and Ystgaard interviewed children using the Schoolagers Coping Strategies Inventory. They looked at ‘how often the strategy was used’ and ‘how helpful the strategy had been’ and found a significant improvement in strategies used by children who had received Zippy’s Friends when compared to control groups. Further analysis was undertaken by asking teachers to observe children and note coping strategies used. While there were some inconsistencies across countries in the number of observations that were carried out, results do suggest that in Denmark there was a significant increase in the number of coping strategies used by children who had completed the Zippy’s Friends programme, as observed by their teachers. Further analysis of the performance of the children in Lithuania also showed decreases in externalizing and hyperactive behaviours following the intervention.

Monkeviciene, Mishara and Dufour (2006) focused on exploring the benefits of Zippy’s Friends in supporting children transferring from Kindergarten to Elementary School in Lithuania (aged between 7 and 9 years). The study followed 140 children who had received Zippy’s Friends as part of their class curriculum the previous year. Monkeviciene et al compared the children’s transition into school with a control group of 106 children. They found that the children who had completed the Zippy’s Friends programme in their previous school year, adapted to school life better than the control group. Results showed that the Zippy’s Friends children had fewer problems with self-regulation, learning and discipline and they used significantly more different coping strategies than children in the control group. The coping strategies used were rated as appropriate to the situation. In general, results show that the children who had studied the Zippy’s Friends programme scored higher in behavioural and emotional adaptation to school and had more positive reactions to the new school environment.In 2008 Zippy’s Friends was introduced as a Social, Personal and Health Education intervention into 42 schools that had been designated as ‘disadvantaged’ primary schools in Northamptonshire TaMHS Project - Evaluation of Interventions April 2009 – March 2011

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the West of Ireland. Clarke and Barry studied the progress of the pupils and assigned students into intervention groups (523 pupils in total) and control groups (207 pupils in total). They found that Zippy’s Friends had a significant positive effect on children’s emotional literacy skills (as measured by the Emotional Literacy Checklist). Teachers also observed improvements in children’s social skills, verbal communication skills and their ability to manage their feelings and relationships with each other. Children in the Zippy’s Friends groups had a wider range of vocabulary for articulating their feelings than children in the control groups.

Further results from the Clarke and Barry 2010 study show that children seemed to increase their repertoire of coping skills following the programme and their coping skills were aimed at directly addressing the problem. Teachers commented that they had a greater awareness of the children’s wellbeing which helped their relationship to flourish with the children. Teachers felt that there should be a ‘whole school awareness’ of the programme to assist in a whole school approach to handling situations and to reinforce children’s skills in a range of settings. A summary of the findings published on the Partnership for Children website notes that 77% of teachers who took part in the study felt that Zippy’s Friends also had a beneficial impact on children’s academic achievement.

In Southampton Zippy’s Friends was introduced as part of a wellbeing initiative in 2003. In total 54 classes ran the intervention between 2003 and 2006. Results from a study of 59 pupils (23 in the control group and 36 in the experimental group where teachers in each class had been asked to select two pupils in their class who they considered to be within the average range for ability and emotional development) show a general increase in Emotional Literacy skills (as measured by the Emotional Literacy Checklist), with trends emerging for higher scores in ‘self awareness’ and ‘motivation’ in pupils, as rated by teachers following the intervention. Parent’s responses on the Strengths and Difficulties Questionnaire (SDQ) showed a positive shift in the average scores for children following the intervention. Both children in the control and experimental groups made gains in the number of simple and complex feelings words they used, showing an increase in emotional vocabulary. The children in the Zippy’s Friends groups made more progress than peers in the control groups. Finally, children in the Zippy’s Friends groups made significant improvement in their performance on the Child Role Play Measure, a test which asks children what they would do in a range of situations and provides a score for the coping strategy they suggest. This finding implies that the children had a wider repertoire of coping skills to draw on following the intervention and a better ability to decide which approach might be most effective in different situations.

Provision of Training and Implementation of Zippy’s Friends in TaMHS Project

Zippy’s Friends was initially introduced into Northamptonshire in a formal way in February 2010 when Partnership For Children ran a one day training course for 2 members of staff from 6 schools and 13 members of the Educational Psychology Service. At the first training day schools were invited to attend who were part of the TaMHS project. At the end of the training day the schools were sufficiently trained and resourced to run the programme in their schools and the Educational Psychologists were trained to be trainers in the programme.

Despite there being less than 24 weeks before the end of the academic school year 2009 – 2010, 4 schools decided that the intervention was too important to miss a cohort of children and so they began the programme straight away. Two interest groups were run by Educational Psychologists (EPs) who had attended the training to provide support, 1 operated in the South of the county and 1 in the North of the county. Schools were offered the possibility of an EP


visiting one of the sessions to observe the lesson. Two schools in the North of the county accepted the support.

In September 2010, two further training days were run by Northamptonshire EPs who were trained as Zippy’s Friends trainers (one in Wellingborough and one in Daventry). The trainers were supported by 2 core members of the Partnership For Children organisation in order to maintain the integrity of the training programme, to provide support to the trainers in order to develop their skills further so that they might then support others and to ensure best quality delivery of the materials and activities.

Between 1 and 2 members of staff from 14 schools attended the training alongside 9 further members of the Educational Psychology Service, 2 Specialist Teachers for Mental Health, 2 Specialist Teachers for Looked After Children and 2 BACIN Teachers. School staff who attended the training were given the core set of materials to enable them to begin the intervention in their school. The arrangement for receiving the free materials requested that the schools act as ‘partner’ or ‘lead’ schools to support colleagues who may be beginning to implement the programme following further training next academic year.

Evaluation forms from the training suggest that schools planned to begin Zippy’s Friends during the autumn/ winter term 2010. Each school would be visited by a trained EP or Specialist Teacher for Mental Health who would observe a session and offer consultation on the implementation of the programme. Schools in the North of the county area requested an interest group meeting to talk with each other and share their views and experiences so far. A meeting subsequently took place in February 2011.

The EPs who attended the Autumn term 2010 training were invited to attend a further session to be trained as trainers in order to support the ‘roll-out’ of the programme to all Northamptonshire schools. There are currently 22 EPs or Trainee EPs and 2 Specialist Teachers for Mental Health who will be able to provide Zippy’s Friends training from September 2011.


Evaluation of Zippy’s Friends in Northamptonshire

Table 1 indicates the engagement levels for Zippy’s Friends in Northamptonshire schools between February 2010 and December 2010.

Number of Schools

Number of schools running the intervention

Number of children receiving the intervention

Number of EPs trained

Spring / Summer 2010

6 received the training

4 4 whole class groups

13

Autumn/ Winter2010

14 received training

20 21 whole class groups

9

Of the 4 schools who ran the Zippy’s Friends programme in the Spring /Summer 2010, 3 schools collected data from the class who received the Zippy’s Friends sessions (the intervention group) and a control group (a parallel class who continued with their normal PHSE curriculum). 2 schools were able to collect data from parents of children in the intervention and control group and teachers from all 3 schools were able to complete checklists to measure the self esteem of the 7 or 8 most vulnerable pupils in the class.

Table 2 – Range of Quantitative Data Returned by Schools during the Project Phase of TaMHS to Evaluate Zippy’s Friends

School Insight Self Esteem Parent SDQExperimental Control Experimental Control

(A) N = 8 N = 8 N= 5 (B) N=7

(N = 7 + 3 months)

N = 0(N = 6 + 3 months)

(C) N = 8 N = 7 N= 2N = number of questionnaires returned

Two quantitative measures were used to gain an understanding of any improvement in the children’s self esteem as perceived by their class teacher (using the Insight Primary Self-Esteem checklist) and any progress in core areas of their emotional skills and behaviour as rated by their parents (using the Strengths and Difficulties Questionnaire, SDQ). Results from the analysis of the SDQ are discussed in Section f).

The Insight Primary Self Esteem checklist provides an overall indication of a pupil’s level of self-esteem. The overall score can then be broken into three core components – sense of self ( “having a good idea about who you are….accepting [your] strengths and limitations” , Morris, p. 5), sense of belonging ( “how comfortable you are about being in relationships with other people….it also involves having good friendship-making skills and an open, tolerant attitude towards other people” Morris, p. 5) and sense of personal power ( “your inner knowledge of your ability to have an impact on the world around you”, Morris, p.5). The checklist can be completed by the young person themselves working with a teaching professional, or, a teacher can complete it, giving their perspective of the child’s self-esteem. The checklist consists of 36 statements which can be rated as true ‘most of the time’, ‘quite often’, ‘occasionally’ or ‘almost never’. It is designed to be used with pupils at primary school (4 – 11 years).


The Strengths and Difficulties Questionnaire (SDQ) provides information across a range of categories e.g. emotional skills, pro-social behaviour, conduct issues, hyperactivity and difficulties with peers. It can be used as a screening tool to identify vulnerable children, or, as in this study, a method of measuring progress before and after an intervention. In the current study parents were asked to complete the SDQ before and after the intervention to ascertain parent’s perceptions of any changes following the intervention.

A range of qualitative data has been gathered including: structured interviews with two teachers regarding the intervention; completion of a qualitative evaluation questionnaire by 1 teacher; a session run by an Educational Psychologist to gain pupils’ views in two schools; evaluation of the programme at ‘interest group’ meetings led by EPs; and observation of a Zippy’s Friends session in 2 schools by an Educational Psychologist.

Evaluation Results from Quantitative Data

Overall it would appear that pupils in all three Zippy’s Friends classes made gains in their levels of self esteem, as rated by their class teachers using the Insight Self Esteem Indicator. Results for vulnerable pupils in School A showed a significant increase in levels of self esteem (p < 0.05). In the Zippy’s Friends classes in all 3 schools, out of the 23 pupils selected as being among the most vulnerable in their class, 15 pupils remained in the same descriptive category (e.g. high, good, vulnerable or very low) as before the intervention, 5 pupils (21%) moved up one category description and 3 (13%) made a jump of two category bandings. In two schools pupils from the Zippy’s Friends classes made more progress with their self esteem than pupils in the Control groups (in one case the difference between the two groups was statistically significant). The school that was able to provide data at the three month follow up stage showed that, although self esteem was rated lower than it had been immediately following the intervention, some progress appeared to have been maintained and clear discrepancies existed between the control group and the children who had received Zippy’s Friends.

Graph 1

A Line Graph to Show Progress in Insight Self Esteem Scores Given to Vulnerable Pupils in Each Class by ClassTeachers Before and After Zippy's

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School ASchool BSchool C

In School A parents of 5 of the children identified as being the most vulnerable in the class completed the SDQ before and after the Zippy’s Friends programme. In general there was little variation in their scores before and after the intervention. Overall SDQ scores (without the prosocial measure) remained the same for 3 pupils, 1 pupil gained 2 points and 1 pupil lost a point. All scores, both before and after the intervention fell within the ‘Normal’ range.


In School C, the SDQ was completed by 2 parents of children who had been identified by the teachers as vulnerable before and after the intervention. Both pupils were in the Zippy’s Friends receiving class. Both pupils showed progress following the intervention. Pupil 1 seemed to make progress with her emotional symptoms and hyperactivity score (moving from a ‘borderline’ to a ‘normal’ score for hyperactivity). Her overall score moved from ‘abnormal’ to ‘borderline’. Pupil 2 also made progress in hyperactivity, moving from an ‘abnormal’ to a ‘normal’ score. His emotional symptoms and peer problems scores improved, moving from ‘borderline’ to ‘normal’ scores. However his overall score remained in the ‘abnormal’ range both before and after the programme. Both pupils appeared to experience more conduct problems following the intervention (Pupil 2 remained in the ‘abnormal’ category and Pupil1 moved from ‘normal’ to ‘abnormal’).

Evaluation Results from Qualitative Data

Pupils Views re Zippy’s Friends

An Educational Psychologist met with 24 children in a Year 1 class in School B and 25 children in a Year 1/2 class in School C. When asked ‘does Zippy’s Friends help you? Tell me a number between 1 and 10 where 1 is no help at all and 10 is helps me a lot’, children in School C all responded “10” with the exception of 3 pupils who gave it a 5, 7 and 9 respectively. In School B the children were asked a slightly different question – ‘do you like learning about Zippy’s Friends? Tell me a number between 1 and 10 where 1 means you don’t like it at all, 10 means you like it a lot and 5 means it is ok’. Out of 24 children, 16 rated it as 10, 2 gave it a 9 – 10 rating, 2 said 9 and 1 child each gave it a rating of 8, 5, 2 and 1. Overall it would therefore seem that children like learning about Zippy and they find the programme helpful.

Children in both classes were then asked ‘How does Zippy’s Friends help you?’ There are several themes that emerge from the children’s responses, as displayed in Table 3.

Table 3. Themes that emerged from children’s comments when asked

‘How does Zippy’s Friends help you?’.

Rank order

Theme Example

1 To know how to cope with bullying [4]

“when you are bullied you can tell somebody”

2 To talk to someone if you have a problem [3]

“talk to my friends when I’m angry”

2 To know a ‘helpful’ thing to do [3] “it helps me learn so I don’t hurt other people _ I just think about Zippy- and just say…and walk off”“when I think about it on the playground”

4 To keep friends [2][N] = number of responses linked to the theme out of a possible 17 comments


Staff Views re Zippy’s Friends

Staff evaluation of the programme is equally positive. Teachers who have delivered Zippy’s Friends comment that they have seen clear and marked changes in children’s social and emotional skills throughout the programme. Two types of qualitative feedback have been sought from staff delivering the programme. A summative questionnaire was completed by staff from 3 schools at the end of the programme. 5 schools have also attended interest group meetings where comments were recorded regarding Zippy’s Friends.

Strengths of the programme that have been identified by staff include: Progress in children’s ability to “use more feelings words to describe their moods and

understand that the feelings are not ‘right or wrong’ they are just feelings” Progress in children’s ability to manage problems they face in every day situations e.g.

in the playground. Their social problem solving / solution finding skills improve. They are applying the skills well, sometimes with a reminder such as “what would Zippy do?”

Progress in children’s ability to resolve conflict after falling-out with friends. Children seem to have adopted the strategy to ‘talk about it’ and are using it independently and successfully

Progress in children’s ability to share thoughts and feelings. Even children who were initially reluctant to join in became more comfortable over the series of sessions and participated fully as the programme continued

Excellent stories – with good continuity and progression through each module. Children related well to the characters in the story

Children engage well with the programme and enjoy the activities. Some teachers report enjoying it too!

Easy to use materials with minimal preparation, good structure and order of sessions Good pace of work set Easy for children of all abilities to access The programme helps teachers to gain a greater understanding of the children and it

can bring teachers and pupils closer together Evaluation sheets are really helpful allowing children to reflect on their feelings and

giving staff an insight into children’s responses Module 5 – Saying Goodbye – Changes and Coping with Death, Learning from Change

and Loss. Issues covered more thoroughly than in SEAL. Children are able to talk about losses and parents can talk to teachers about issues affecting their children more easily

In general there has been a motivating sense of enthusiasm emanating from staff teaching the programme, for example, one teacher commented “Zippy’s Friends is fantastic and I would recommend it is used in every Year 2 class. All the children loved Zippy and enjoyed the sessions” Other comments have included “One of the best interventions ever introduced. You really get to know your class and help them develop lifelong coping strategies”, “it is invaluable” and “As a parent, I would want my child to experience Zippy’s friends to enable him to cope with life’s challenges”.

School staff considered limitations and areas for improvement for the programme. They said: Activities can sometimes be repetitive. It can be helpful to include role play rather than

some of the reading activities Feedback sheets can be too rigid and may benefit from a more creative approach Some sessions appear shorter than others (notably sessions 2 and 3 in each module),

but the time required often depends on the relevance of the issue to the children It is helpful for the class teacher to run the sessions so that ideas can be reinforced and

applied to situations throughout the week Helpful for children to sit on chairs rather than the floor due to the length of time some of

the discussions/ activities takeNorthamptonshire TaMHS Project - Evaluation of Interventions April 2009 – March 2011

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It will be important to follow up and build on their learning in future years Advice may be helpful from professionals on ways to deal with children/ parents who

might become very upset when death is covered in the programme It can be difficult to implement the programme without first going on the one day training

course

Observations of Zippy’s Friends sessions have been carried out by Educational Psychologists in 3 schools for consideration as part of the evaluative process. Further observations have been conducted with a separate focus of providing support for the school in implementing Zippy’s Friends. Observation records indicate some themes across the observations.

Core themes include: Children are very engaged in the sessions Children seem relaxed and able to participate in discussions, even when the focus is on

more negative emotions Children seem to find the activities fun – they appear to be relevant and appropriate for

the age range Children are benefitting socially, emotionally and in thinking about what to do when

problems arise It is helpful when teachers accept and praise answers given by the children, showing

that all ideas are worth considering. This seems instrumental in motivating children to make lots of suggestions

It is helpful when a clear outline of the session and objectives to be learned is given. Bringing in the children’s own experiences helped to bring the ideas being taught to life

and gave the learning points greater meaning for the children Higher level thinking skills are encouraged when considering whether strategies are

helpful / unhelpful and how they may be used in different situations A high level of reinforcement of learning points helped the children to understand the

ideas and apply them to their own situations It is helpful to follow the published teachers’ notes very closely in terms of structure and

content of the session to preserve fidelity to the programme. The rules are very helpful, especially revising children’s understanding of them at the

beginning of each session Vulnerable children are able to access the activities alongside peers It may be helpful to consider working in smaller groups, including paired work

throughout the session to maximize the engagement of all the children and reduce ‘whole class listening’ time

The A4 size pictures may be a little small to use as a visual aid for the whole class. It may be beneficial to make use of the images available on the resource CD to project them onto a large screen

Class displays can be very helpful in emphasising key themes and serving as a memory aid for children

Evaluation activities at the end of the sessions are valued and staff follow up on any concerns raised


Overall Impact Ratings for Zippy’s Friends


Overall Impact Ratings of Zippy’s Friends, according to senior staff from 4 project schools



8.8 9 10 7 to 10


A comment made by a Headteacher alongside these overall ratings included that Zippy’s Friends was effective with the vulnerable group of pupils within the whole class.

Capacity Building for Zippy’s Friends

All 4 schools that ran Zippy’s Friends in Spring/Summer 2010 have built the programme into their PHSE curriculum for Key Stage 1 and continue to deliver the intervention during the 2010-2011 academic year. One particular school re-wrote their entire PHSE policy around the themes in Zippy’s Friends, to introduce children to the key concepts in a cyclical manner as they progress through the school to help them to maximize the benefits of the Zippy’s Friends programme.

Each school currently trained in Zippy’s Friends has agreed to support colleagues with the approach and become a ‘partner’ school to provide an additional means of liaison, expertise, experience and support to staff embarking on the programme for the first time.

The Northamptonshire EPS (Educational Psychology Service) currently has 22 EPs and 2 Specialist Teachers for Mental Health trained to deliver Zippy’s Friends training to school staff and others. The implementation of Zippy’s Friends in the county is managed by a County Coordinator, Mike Simons, Lead TaMHS Educational Psychologist in consultation with Partnership for Children. Activities to ensure effective roll out of the intervention include:

1. November 2010 – Easter 2011, Zippy’s Friends – trained EPs and Specialist Teachers for Mental Health visiting nominated school staff who have undertaken initial training to provide support and observe a session.

2. TaMHS conference workshop in January 2011 was run by Kathryn Davidson, TaMHS Educational Psychologist summarising Zippy’s Friends and its benefits. Of all interventions presented at the conference, Zippy’s Friends was the training/intervention identified by 48 participants as most likely to be purchased by their school. Zippy’s Friends was the top rated training/intervention identified in this way.

3. Zippy’s Friends will be among a range of interventions recommended to schools by their TaMHS link EP. Arrangements for accessing training / materials will be clarified for schools during the Summer Term 2011.

4. Trained Zippy’s Friends EPs and Specialist Teachers for Mental Health will meet together to support each other to be trainers and to develop courses to be run in the Autumn Term 2011.


5. It is planned that 4 one day courses will be run across the county for school staff to attend to become trained in Zippy’s Friends in Autumn 2011.

6. Each school attending the courses run in autumn 2011 will be linked with a partner school. They will receive a visit from a Zippy’s Friends trained EP to observe a session and to discuss the intervention. They will also all be invited to interest group meetings.

7. Roll out of the programme, quality assurance and maintenance of fidelity of the intervention will be managed by the Zippy’s Friends county-wide coordinator

Conclusion

There is compelling evidence that Zippy’s Friends can be introduced successfully into Northamptonshire schools with a positive impact on children who are vulnerable to experiencing difficulties with Mental Health or who are already experiencing such difficulties, and on the school overall.

In particular, children benefit in terms of their self-esteem and coping skills. School staff find the programme accessible and straightforward to deliver and report marked changes in their pupils’ social and emotional skills, which they attribute to the programme. Key aspects for making implementation of Zippy’s Friends successful include ensuring that staff who deliver the programme first experience the 1-day training and that they engage in follow-up support activities.

Capacity has been built for further implementation of Zippy’s Friends in more Northamptonshire schools in a way that is sustainable and promotes fidelity to the programme. Because of the evidence of the importance to children’s mental health of Zippy’s Friends, this programme has been included in the Building Blocks of Provision for Building Mentally Healthy Schools in Northamptonshire at the Wave 1 / Universal level, as a recommended provision for all schools with KS1 pupils, as shown below.


References:

Clarke, A.M. and Barry, M.M. ‘An evaluation of the Zippy’s Friends emotional wellbeing programme for primary schools in Ireland’. Health Promotion Research Centre, NUI Galway

Holmes and Faupel (2004-2005) ‘Zippy’s Friends: Southampton Evaluation Report’. Southampton Psychology Service

Mishara, B. L. and Ystgaard, M. (2006) ‘Effectiveness of a mental health promotion program to improve coping skills in young children: Zippy’s Friends’ Early Childhood Research Quarterly 21 110 – 123

Monkeviciene, O., Mishara, B.L. and Dufour, S. (2006) ‘Effects of the Zippy’s Friends Programme on Children’s Coping Abilities During the Transition from Kindergarten to Elementary School’ Early Childhood Education Journal, vol.34, No.1. pp. 53 - 60

Morris, E. (2002) “Insight Primary Assessing and Developing Self-Esteem” GL Assessment

Wills, J. (2010) ‘A Systematic Review of the Zippy’s Friends Programme’. An unpublished Evidence-Based Practice Review Report for the UCL Doctorate in Educational and Child Psychology Course


Section D


Interventions


Children’s Stress Management & Parenting Seminar Workshops in Secondary Schools

By Jan Pawlikowski

Description of the Workshops Delivered

There were three workshops requested for in addition to the development of Emotional Health and Wellbeing Teams in secondary schools under the TaMHS Project. These workshops were wave 2 interventions identified through the interim review of the needs assessment and end of year evaluation.

One secondary school had established a parent ‘drop in’ support group (not a TaMHS initiative) and requested TaMHS support to deliver two workshops on Practical Parenting Strategies to address behaviour management of children.

The other secondary school identified a group of young people who were experiencing relationship and personal difficulties which were predisposing them to stress related underperformance in school.

The workshops delivered were:-

1. An overview of the ‘Systematic Training in Effective Parenting’ programme developed by Don Dinkmeyer and Gary McKay, America 1996

2. An overview of the ‘1-2-3 Magic’ parenting approach developed by Thomas Phelan

3. ‘Stress Management’ for Students developed by Jan Pawlikowski Northampton CAMHS.

Rationale for Including the Workshops in TaMHS

The TaMHS project needed to include delivering interventions to groups of young people and involve parents or carers.

The workshops were Wave 2 interventions based on tried and tested approaches.


Outline of sessions on Practical Parenting Strategies based on Systematic Training for Effective Parenting and 1-2-3 Magic

Sessions were held at Weavers School on Thursday 30th September 2010 and Thursday 25th November 2010 9.30 am to 11 am.

Aims of the Sessions:

To deliver an overview of the two approaches as presented within the authors publications via prepared PowerPoint presentations.

To explore with the group of parents the relevance of the approaches and applying these in practice.

To facilitate group discussion and participation through the encouragement of supportive advice shared within the group.


Gather feedback for TaMHS evaluation purposes at the end of the sessions

Outline of Session on Stress Management

This session was held at William Parker School on Thursday 17 June 2010, 9.30 am to 11.00 am.

Aims of Session: To explore the nature of stress and its effects and consequences using a cognitive

behavioural framework to help understand and explore ways of coping. Open question to explore what difficulties young people have today which can cause

them to feel stressed. The group brainstormed ideas which were fed back to include statements such as

‘teachers who are unreasonable’, ‘the pressure of homework and pending exams in the future’, ‘family issues concerning disagreements with parents and coping with younger siblings who demand attention’. Other concerns were related to school and social situations such as arguing with friends and falling out with them, being bullied and being pressured or persuaded to conform to certain things.

What affect does all this have on us as individuals? Feedback was that it affects sleep. They feel worried and low. Other comments

received were that it could cause self harming or eating disorders, aggressive behaviour and misusing substances.

Introduced the CBT model using a triangle to indicate thoughts, feelings and behaviours and the group explored the difference between feeling in a calm and happy frame of mind when things are going well as compared to when people experience stress and its affects. The feed back was that when you are not under stress your thoughts are clear, your feelings are in check and your behaviour is composed as against when under stress thoughts being distorted, exaggerated, you devalue your opinion of yourself, you worry, you can feel sad and angry and scared, and behaviours could result in habits, aggressiveness, lacking in concentration etc.

Explored how stressful symptoms affect us biologically/physically using the outline of a human being. We explored the effects it has on our senses, nervous and muscular, and respiratory system such as high blood pressure, increase/decrease in respiration, muscle cramps, tension, nausea, headaches etc.

The group began to focus a lot on how this communicates to other non-verbally that there may be something wrong or others misinterpreting a problem and perhaps thinking that someone may be angry with them when in fact they are feeling sad.

We explored as a group ways to help manage these symptoms referring back to the CBT triangle and the body diagram.

Feed back came as: trying to relax, going for walks, releasing tension through sport and talking to someone whether this be a friend, member of the family or teacher.

Introduced relaxation technique to help relieve the physical symptoms of stress and then this in turn helping some of the psychological effects through muscle tension techniques and breathing techniques which the group did as a whole and gave feed back.

End of session was completing a questionnaire. Results are described below.


TaMHS Evaluation

Overview of Systematic Training for Effective Parenting (STEP)

Questionnaire Questions re STEP Questionnaire Responses from 5 Parents

On scale of 1-10 please give your opinion of the facilities

Average = 9.2Range = 7 to 9

On scale of 1-10 please give your opinion of delivery and handouts

Average = 9.6Range = 8 to 10

Did the session meet your expectations? Yes = 4To some extent = 1

Which part of the session did you find most useful and why?

Behaviour, that’s what I need most help with.The strategies.Talking with others.All of it.

Which part of the session did you find least useful and why?

None = 2.N/A

Was the session: Too short = 0Too long = 0About right = 5

On scale of 1-10 please give your overall opinion of the session

Average = 9.2Range = 8 to10

Comments

It was very interesting and made me think and have more knowledge about what strategies that can be used with certain behaviours.Very friendly and relaxed.Very friendly and well informed.

Overview of the 1-2-3 Magic Approach

Questionnaire questions re 1-2-3 Magic Approach Questionnaire responses from 4 parents

On scale of 1-10 please give your opinion of the facilities:


On scale of 1-10 please give your opinion of delivery and handouts:


Did the session meet your expectations? Yes = 2Somewhat = 1To some extent = 1

Which part of the session did you find most useful and why?

Identifying together what start and stop behaviours to tryChoosing no more than 3 problems to work on


Talking about each others' problems.Which part of the session did you find least useful and why?

None = 3N/A

Was the session? Too short = 0Too long = 0About right = 4

On scale of 1 – 10 what was your overall opinion of the session?


Comments

It was interesting but it needs to be applied in the right way to get the most out of using it.I’ve been taught before and it was good to go through it again. I enjoyed it

Questionnaire re Session on Stress Management:

1. Before the session, did you have any understanding of ways to cope with stress? Please rate this with an X and now the session is complete, do you feel you have gained some insight into how you can cope, please rate this with a √.

2. Before the session, do you consider yourself to be someone who has some resilience at coping with stress and how is your resilience now following the session?


3. How would you rate this session? If it was repeated to other young people, do you think it would be helpful?

4. What did you find most useful about this session? Tensing your muscles then relaxing them to relieve stress. (x 2) How to deal with being stressed. (x 3) The triangle was useful; it helped me think about what I go through and how I

cope. The exercises to calm you down. (x 3) Something to help you in an argument/fight.

5. What else could we cover in this session if were to repeat it for other young people?

It was really helpful talking about stress and there was nothing else I needed to know.

How to solve different types of problems, when we are stressed like ‘problems in our head’ when go to sleep.

Results

Generally most of the feedback was positive. The results were taken at the end of each training session and it would have been

interesting to gather any impact the sessions would have made in the long term through a follow up evaluation, but time did not allow for this.

Overall Impact Ratings for Stress Management for Children


Overall Impact Ratings of Stress Management for Children, according to senior staff from 1 project school



10 10 n/a n/a

b) Overall to the school n/a n/a n/a n/a


Capacity Building for Delivering Ongoing Workshops

These workshops were derived from a perceived need identified by the schools at a particular time within the TaMHS project. Future workshops would be best delivered at the time of need for maximum congruency. However capacity to do this may not be sufficiently available at these times but should be actioned and diarised in.

A series of workshops; a minimum of three, would provide an overall package, allow for continuity and development of an overall theme.

Workshops need to allow at least half a day to set up, deliver and for debriefing on top of the time needed to research, prepare presentations and provide handouts.

Consideration needs to be given to how to support schools themselves to deliver such workshops and so be less reliant on outside agencies to do such direct work.

Conclusion

Delivering bespoke seminars or workshops to students and parents or carers provides opportunities for them to receive information and guidance on applying strategies at improving relationships and personal care. This would serve to promote wellbeing and resilience.

The outcomes all mentioned the value of working in a group situation and being able to discuss and share experiences.

The outcomes also suggested ideas for ongoing workshops, perhaps a series of workshops done with the same group over a period should be considered next time.

Indications are that workshops for parent and children can be introduced successfully into Northamptonshire schools with a positive impact on parents and children who are vulnerable to experiencing difficulties with Mental Health

It will be important to enable such workshops to be provided by school staff to maximise capacity-building.

Such workshops for parents and children need to build on and complement the support to enable schools to deliver the Building Blocks for Building Mentally Healthy Schools in Northamptonshire that is described elsewhere for working with both parents and children.


Peer Support and Peer Mentoring

By Mike Simons & Charlotte Lockyer

Description of the Intervention

As part of the Northamptonshire TaMHS project Peer support and peer mentoring was identified as a wave 2 intervention that would benefit a number of young people. Peer support in primary schools is fast becoming a powerful tool for social inclusion. Peer support encourages older students to support their younger peers through both personal development and school related problems. This is proving a valuable contribution to the emotional and social well being of pupils and fits in well along side such programmes as Every Child Matters and SEAL.

Sue Mackintosh-regional support agency co-coordinator, national peer mentoring pilot 2006-2008 comments: -

“Peer mentoring is proving to be an effective and sustainable way of tackling attainment – as well as some more difficult issues such as behavior, bullying, language and attendance…. The feedback, enthusiasm and commitment we are getting from both students and teachers is outstanding… the results speak for themselves.”

The Mentoring and Befriending Foundation (MBF) (see www.mandbf.org.uk) is the national strategic body for mentoring and befriending, offering support to practitioners and organisations throughout the country. They define mentoring as ‘a voluntary, mutually beneficial and purposeful relationship in which an individual gives time to support another to enable them to make changes in their life’. Reflecting the lower level of complexity for younger children to mentor others, the generic term used for children in primary schools who have a mentoring role with others is ‘peer supporter’.

Training in Northamptonshire was provided by a representative from MBF in March 2010. The training was held over 2 days: 1 for infant, junior & primary schools and 1 for secondary schools. The training was open to all TaMHS schools and other schools who expressed an interest for them to be able to run peer support or mentoring programmes. The training was also aimed at members of the TaMHS Project team and other staff within their organisations, for them to be able to cascade training to other schools and to effectively support any school that was running a peer support or peer mentoring programme. Finally, due to the requirement to involve voluntary sector partners in the TaMHS Project, Service Six www. servicesix .co.uk – a countywide youth service provider that works with 10 -25 year olds in Northamptonshire, was recruited to enable two of their support workers to experience the training, and then become involved in training of children and young people to be peer supporters and mentors respectively.


http://www.servicesix.co.uk/

http://www.mandbf.org.uk/

Participants in Primary Peer Support Training in March 2010

Participants in Primary Peer Mentoring Training in March 2010

8 Teachers (many in management roles) & 5 support staff from 7 TaMHS Schools (3 Infant, 2 junior & 2 primary)

3 Teachers in Management roles from the 2 Secondary TaMHS Project Schools

2 Teachers from 1 primary school from beyond the project

11 Staff from 6 Secondary schools beyond the TaMHS Project

4 Specialist Primary Mental Health Practitioners

7 Specialist Primary Mental Health Practitioners

6 Educational Psychologists 7 Educational Psychologists2 Service 6 Support workers 2 Service 6 Support workers1 Lead School Nurse – Mental Health

Evaluation of Primary Peer Support Training for Staff

In terms of self-evaluation of 25 participants’ progress (out of 27 who attended) in developing knowledge and understanding, related to the learning objectives, there was an average shift of 3.0 points on a scale of 1 (not at all) to 6 (very much) from 1.5 – 4.5.

Learning Objectives Average Starting point

Average Finish point

Average Shift

I have a clear awareness of the processes of setting up a primary peer supporter programme.

1.4 4.5 3.1

I have a clear understanding of the role of a primary peer supporter.

1.8 4.8 3.0

I have a clear understanding how to recruit and train primary peer supporters.

1.4 4.5 3.1

I have identified a sound structural framework in order to promote sustainability for a primary peer support programme.

1.2 3.8 2.6

I have a clear understanding of the importance of monitoring and evaluating a primary peer supporter programme.

2.0 4.8 2.8

I am clear about next steps needed for me and my school (or other organisation) to help set-up and running a primary peer supporter programme.

1.3 4.7 3.6

AVERAGE 1.5 4.5 3.0

Hence, the training was well received in terms of meeting the learning objectives. Also from qualitative responses, there was clear indication that positive use of the training was intended to be made by school – based participants, as indicated in the summary responses to the questions below from the school-based participants.


Next Steps Questions for Primary Peer Support

Summary of Next Steps Responses from School-based participants

How and when do you intend to use 'Primary Peer Support' Training that you received today?

Imminent discussion with senior managers and other school staff, to be considered as part of a review of pastoral or PSHE support and to link to or improve current system of use of young leaders / playground buddies.

What kinds of support from Specialist Primary Mental Health Practitioners, Educational Psychologists, Service Six or others, do you think would be most helpful in developing peer support in your school?

Presentation to staff, Help in setting-up - initial discussion re planning, organisation and evaluation and monitoring including a help-line. Organisation of support network meetings and 'celebration' events. Peer Supporter supervision sessions.

What else might be needed to build on this training for maximum benefit to you, your school and children with whom you work?

Time, money, resources, network meetings for sharing good practice; and accreditation.

Representatives from outside agencies also responded to these ‘next’ step questions from their perspective. Their responses were complementary to those of the school representatives – i.e. intending to provide support, including linked schools for generic work, and further training, in the ways suggested by school representatives.

Evaluation of ‘Setting-up and Running a Secondary Peer Mentor Programme’ Training for Staff

In terms of self-evaluation of 23 participants’ progress (out of 30 who attended) in developing knowledge and understanding, related to the learning objectives, there was an average shift of 2.9 points on a scale of 1 (not at all) to 6 (very much) from 1.8 – 4.7.


Learning Objectives Average Starting point

Average Finish point

Average Shift

I have a clear awareness of the processes of setting up a secondary peer mentor programme.

1.6 4.8 3.2

I have a clear understanding of the role of a secondary peer mentor.

1.9 5.3 3.4

I have a clear understanding of how the peer mentor role can contribute to the overall support strategy in secondary schools.

1.6 4.6 3.0

I have a clear understanding how to recruit and train secondary peer mentors.

2.0 5.0 3.0

I have identified a sound structural framework in order to promote sustainability for a secondary peer mentoring programme.

1.6 4.1 2.5

I have a clear understanding of the importance of monitoring and evaluating a secondary peer mentor programme.

1.7 5.1 3.4

I am clear about next steps needed for me and my school (or other organisation) to help set-up and running a secondary peer mentor programme.

1.7 4.3 2.6

AVERAGE 1.8 4.7 2.9

Next Steps Questions for Secondary Peer Mentoring

Summary of Next Steps Responses from School-based participants

How and when do you intend to use Secondary Peer Mentoring Training that you received today?

Immediate discussion with senior managers and other school staff; use with vertical tutoring; start to plan and organise; shore up and build on systems already in place; focus support SEN students and those disaffected; publicise through web and newsletter; and attending network meetings.

What kinds of support from Specialist Primary Mental Health Practitioners, Educational Psychologists, Service Six or others, do you think would be most helpful in developing peer support in your school?

Liaison; general guidance and specific guidance for difficult or complex scenarios inc safeguarding issues; and training for Peer Mentors inc role-play. .

What else might be needed to build on this training for maximum benefit to you, your school and children with whom you work?

How to actually train peer mentors – situations, case-studies and responses that could be used; staff to help train Peer Mentors, with an existing Peer Mentor assisting; regular attendance at network meetings, workshops & additional training; links to other schools who are running successful peer mentoring schemes; greater training on setting up and providing sustainability; and accreditation.


Representatives from outside agencies also responded to these ‘next’ step questions from their perspective. Their responses were complementary to those of the school representatives – i.e. intending to provide support, including linked schools for generic work, and further training, in the ways suggested by school representatives.

Following on from the training a steering group was identified to include Specialist primary mental Health Practitioners, Educational Psychologist, and Service Six. This team also offered dates for the schools trained to meet to share ideas and gain support. These meetings were well attended initially and looked at the setting up of programmes within the TaMHS schools but attendance then declined. TaMHS staff trained in peer mentoring and support offered open access for consultation.

Outcome Data

From the information available 1 infant school, 2 primaries and the 2 secondary schools have implemented the scheme into their schools. The nature of the programme means that each school has been able to adapt the programme to meet their own identified needs. Parents were informed that this was taking place within the schools but not included in the evaluation process. Anecdotally parents have commented to staff that they have been pleased with the support to mentors and mentees.

One school, Hardwick Junior has provided data, as requested, following 3 months of a peer supporting scheme. The scheme involved the SENCO and an LSA who had participated in the MBF training providing training and co-ordination for 7 pupils (of whom 6 went on to take the role of peer supporters) using a bespoke version of the MBF ‘Lean on Me’ training materials.

The data requested of all participating schools and provided so far by just Hardwick Junior school included feedback from peer supportees, supporters and staff involved in the peer support scheme. The data was gathered using a set of questionnaires provided by Jan Pawlikowski, Specialist CAMHS advisor. The feedback from the staff identified that the scheme at Hardwick Junior School Adequately addresses the emotional and wellbeing needs of pupils at a 9 on a scale of 1-10.

Peer Supportee Feedback

Peer Supportee Ratings at Hardwick Junior School Rating from 1 – 10 (1 being No and 10

being Yes)

Average from 6 Supportee Responses

Range from 6 Supportee Responses

This helped me with my problems 6.8 5 to 9

It was good to have a peer supporter 8.3 5 to 9


In terms of aspects of life that the ‘Peer Supporters can help me with’, all 6 agreed with three out of the four aspects presented in the questionnaire: Friendships, Confidence and Problems – but not Lessons – reflecting the focus of the particular emotional and social focused peer supporter scheme in place at the school. Additionally, there were comments by the supportees indicating the value of the supporters ‘playing with me when I’m lonely’ and highlighting that sometimes it is important to have an adult to talk to, rather than a peer supporter.

Peer Supporter Feedback

Peer Supporter Ratings at Hardwick Junior School Rating from 1 – 10 (1 being Poor/No and

10 being Excellent/Yes)

Average from 6 Supporter

Responses

Range from 6 Supporter Responses

The training sessions for becoming a peer mentor/support worker was...

8.5 7 to 9

I enjoy being a peer mentor/support worker: 7.5 6 to 9

Being a peer mentor/support worker has helped me understand others more

9.8 9 to 10

Being a peer mentor/support worker helps me to understand my own problems

5.2 2 to 8

I got enough help to be a better peer mentor/support worker

10 n/a

Hence, the Peer Supporters at Hardwick Junior School indicated that their training and support had been towards the excellent end of the poor-excellent spectrum and that this had enabled them at an ‘excellent’ level to be a better peer mentor/support worker and to understand others more. The enjoyment of peer support work was mixed depending on the supporter but all were higher than 5 on the 10 point scale of ‘No’ to ‘Yes’. Finally, there was a very mixed perception of whether ‘Being a peer mentor/support worker helps me to understand my own problems’, from 2 to 8 on the 10 point scale of ‘No’ to ‘Yes’.

Data collection from other schools has proved difficult. The data that has been gathered looked at evaluation from peer mentors / supporters, peer mentees and school staff. Peer mentors enjoyed the training and felt it helped them to understand others better. They all scored highly that they felt that they got enough help and support in the role. Young people who had been mentored felt that it was a positive experience and that they talked about issues with friendships, worries and confidence rather than academic issues. Staff said that they liked the training resources and felt that it addressed the emotional and wellbeing needs of pupils.In terms of things that could have been improved was mainly around the training of mentors. Some schools choose to have Service Six staff to deliver the training. This did not work as well as they had hoped due to them not engaging with the young people at an age-appropriate level. The overall feedback has been good. It has allowed staff to be able to deal with more difficult issues and mentors have felt valued and rewarded in the role.


Overall Impact Ratings for Peer Mentoring/Support


Overall Impact Ratings of Peer Mentoring/Support, according to senior staff from 3 project schools



8 8 n/a 7 to 9


Capacity Building

Capacity has been built in up to 8 schools with infant, junior or primary age pupils and up to 8 schools of secondary age pupils. In terms of moving forward, schools that have had a positive experience have offered their support to other schools. 7 SPMHPs, 10 EPs and 1 Lead School Nurse – Mental Health have been enabled to offer training, consultation and support around setting up and monitoring programmes. The Service Six staff who received the initial training from MBF and participated in delivering training have since left this organisation and hence, are not able to be involved in further capacity-building.

Conclusion

Indications are that Peer Support and Peer Mentoring can be introduced successfully into Northamptonshire schools with a positive impact on children who are vulnerable to experiencing difficulties with Mental Health or who are already experiencing such difficulties, and on the school overall. In particular, children benefit in terms of helping them with their problems and having someone for them. Key aspects for making implementation of Peer Support and Peer Mentoring successful include ensuring that thorough training, support and supervision are provided to those in a helping role. It will be important to continue to gather evaluative information in order to enable these interventions to be made most effective in schools where schemes are already running and to ensure that best practice is shared with schools that plan to develop Peer Support or Peer Mentoring provision. Capacity has been built for further implementation of Peer Support and Peer Mentoring in Northamptonshire schools, and the detailed results above need to be taken into account. Because of the indications of the importance to children’s mental health of Peer Support and Peer Mentoring, that it has been included in the Building Blocks of Provision for Building Mentally Healthy Schools in Northamptonshire at the Wave 2 / Targeted level as a recommended provision for all schools, as shown below.


RESPECT

By Melissa Wheeler

Description of RESPECT Group Programme

RESPECT is a group programme that was devised by a local Specialist Primary Mental Health Practitioner (SPMHP), Jackie Hancock. It is a Cognitive Behaviour Therapy (CBT) based programme that is intended to be run in schools, of any phase, by professionals who can facilitate a group and whose primary role is working with children and young people. The programme is designed to give children and young people the knowledge, awareness, information and language to:-

Enable them to make better informed choices about their lives. Encourage them to support each other and strengthen their identity, self confidence and

self esteem. Empower them to communicate their thoughts, wishes and feelings. Enable them to explore and understand their life experiences.

As well as ‘respect’ itself, other important learning elements of the programme are reflected by the initials in the name RESPECT: i.e. Responsibility, Esteem, Success, Pride, Experience, Confidence and Trust.

In terms of implementation, the programme is designed to be introduced to a school by a SPMHP who then, with members of school staff working alongside, run the programme together over 8 weekly sessions. Successive groups are run with increasing independence by the school staff, until they are confident to run the programme exclusively by themselves, with SPMHP input required only on an ad hoc basis when needed.

Rationale for Including RESPECT in TaMHS

Given the importance of achieving a balance of universal, targeted and more specialist provision in the TaMHS programme, it was regarded as important to include group work that was evidence-informed or evidence-based. RESPECT Group programmes had been run in several of the North of the county schools, including 4 of the TaMHS project schools, in infant, junior and secondary schools by members of the SPMHP team, with good anecdotal feedback which led to these schools seeking to continue the programme each year or more frequently. The fact that the programme was based on sound evidence-based CBT theory and practice made inclusion of the programme more appealing. It was considered by the TaMHS project team that this was a great opportunity to include RESPECT in one or more schools that had not so far accessed this, with a view to both evaluating the programme in terms of mental health outcomes and for spreading the programme more widely, including potentially in the South of the county.

Implementation of RESPECT

Given that RESPECT was already running in 4 of the TaMHS project schools, the other 9 project schools were encouraged to consider including this within their provision. Simultaneously, SPMHP colleagues who were familiar with running the programme, but who were external to the core TaMHS project team, were encouraged to use their time to support the spread and evaluation of the RESPECT programme. While several schools were keen to include RESPECT, unfortunately experienced SPMHPs were not available to introduce RESPECT. Therefore, it was agreed that for one school, whose deputy headteacher had


identified several children in his class who especially needed resilience building, it could be helpful if a TaMHS SPMHP liaised with the founder of the programme and co-ran a group with an experienced SPMHP sufficiently to introduce and run the programme herself in the TaMHS infant school.The particular group of children for whom the programme was introduced were from families who were currently having many difficulties, and it was perceived that these were having an impact on the emotional/mental health of the children. Alongside on-going attempts to engage the families in productive work, their children were engaged in the RESPECT Group programme with other children, whom had benefitted from being in a Nurture Group but appeared to need additional support due to remaining concerns about their behaviour, relationships, and self esteem or anxiety. Some of the children also needed help to manage the transition from Y2 to a junior school, and it was thought that the CBT process within the RESPECT programme would be helpful to them too.

TaMHS Evaluation Results

4 sessions were run by the TaMHS SPMHP and SENCo and supported by a Learning Support Assistant. However, it was not possible to complete the programme due to a combination of: other competing activities meaning that some sessions could not run; the SENCo needing to make herself available on an emergency basis to support other staff; and the programme beginning close to the end of the school year. These issues meant also that planned evaluations could not meaningfully take place. Although the planned works was incomplete, the SENCo reported that she had benefited from observing a SPMHP professional in practice and this had helped her growth and development as a SENCo.

Capacity Building for RESPECT

While the school has not been introduced to the full RESPECT programme, the SENCO and an LSA has experienced aspects of this to reduce the length of time needed for an SPMHP to support the school in running future groups independently. Also, through the TaMHS project, an additional SPMHP has been able to learn how to run RESPECT groups including consideration of aspects of timing, planning and experience with schools. Further engagement of members of the SPMHP team who are more experienced with RESPECT will be needed to help extend RESPECT to other schools and to provide a robust evaluation of the full programme in terms of pupil outcomes.


Overall Impact Ratings for RESPECT


Overall Impact Ratings of RESPECT, according to senior staff from 1 project school



5 5 n/a n/a


Comments provided alongside this rating exercise by a second school indicated that RESPECT had been introduced before the TaMHS Project and that this had achieved good results for children’s emotional health and well-being – which concurs with anecdotal feedback provided elsewhere.

Conclusion

Although the TaMHS Project experience of RESPECT is limited in terms of the extent of input and of beneficial results, indications are that this targeted intervention can be introduced successfully into Northamptonshire schools with a positive impact on children who are vulnerable to experiencing difficulties with Mental Health or who are already experiencing such difficulties.

Key aspects for making implementation of RESPECT successful include: - Ensuring a mix of needs in the group was important for enabling modelling and the

group to work together effectively School commitment to the group work going ahead needs to include provision of

emergency cover by staff who are not involved in the group. SPMHPs need to gain sufficient experience from working with more experienced

RESPECT practitioners prior to introducing the programme to a new school. Giving sufficient time for programmes to run, and taking account of planning time and

time for missed weeks.

Limited Capacity has been built for further implementation of RESPECT in Northamptonshire schools and work could usefully be done to address this, alongside increasing the extent of evaluative information available for this intervention, in order to enable these interventions to be made most effective in schools where schemes are already running and to ensure that best practice is shared with schools who plan to develop RESPECT provision in their school. Because of the indications of the importance to children’s mental health of RESPECT, more because of it’s CBT base and reported success in schools prior to the TaMHS Project, it has been included in the Building Blocks of Provision for Building Mentally Healthy Schools in Northamptonshire at the Wave 2 / Targeted level, as a recommended provision for all schools, as shown below.


Reference

Paul Stallard, P (2002) Think Good- Feel Good)


Section E


Interventions


Drawing and Talking

By John Fardon

Description of Drawing & Talking

Drawing & Talking is a safe, easy to learn method of working with pupils in primary, secondary and special schools, to help with underlying emotional difficulties that may be affecting their learning and behaviour. A one day training course enables a sensitive adult in school to facilitate 12 x 30 minute weekly sessions to individual pupils, during which they draw and talk. It provides a ‘safe space’ for the child to engage in drawing and talking (right and left brain activity), resulting in a series of drawings over a 12 week period. The theoretical component to the training teaches basic neurobiological theory related to trauma, how to create a safe and containing space, the importance of endings and losses, how to deal with distress and child protection issues.

Rationale for Including Drawing and Talking in TaMHS

Drawing & Talking had begun to be used in Northamptonshire schools in 2007, following a training course provided by Maria Beagley, founder of Drawing & Talking Ltd. www.drawingandtalking.com This serial drawing technique was originally developed by John Allan, Professor Emeritus of Counselling Psychology at the University of British Columbia, and described in ‘Inscapes of the Child’s World,’ John Allan, Spring Publications 1988. The technique was then developed in this country by Child Psychotherapist Michael Green. A description of this successful work can be found in the NASEN magazine ‘Special,’ Spring 2003. Maria Beagley, who was a SENCO in the London Borough of Sutton, trialled Drawing and Talking at her school with her Teaching Assistants, having followed training from Michael Green. Maria has now trained over 3000 professionals working in UK schools. The need for a simple and accessible intervention such as Drawing & Talking is highlighted by the number of pupils nationally being excluded or displaying emotional and behavioural difficulties in schools. Given anecdotal positive feedback about the usefulness of Drawing & Talking for children who are vulnerable to mental health difficulties or who have identified needs, it was agreed that it would be useful to include this intervention in the TaMHS Project, and to use the experience to evaluate its effectiveness more robustly.


Currently in Northamptonshire there have been over 130 people trained in the method. During the TaMHS project there were two training courses provided to a total of 79 professionals working in schools, including Teaching Assistants, Teachers, SENCOs, Learning Mentors and other professionals supporting schools. By the time this report has been completed, it is hoped that one of the Specialist Teachers for Mental Health and Emotional Wellbeing will have been accredited by Drawing & Talking Ltd to train others in Northamptonshire. This will undoubtedly help to meet the demand currently shown by Northamptonshire Schools, and the waiting list which arose from the most recent (2nd March 2011) training. The number of schools benefitting from this method in Northamptonshire varies according to demand, but is likely to be in excess of 40 schools and between 50 and 100 pupils during the project. Feedback has been generally very positive, including 88 participants who attended the January 2011 Northamptonshire TaMHS conferences who wished to kept informed of training and information about Drawing & Talking, proving Drawing and Talking to be the most popular intervention from the conferences.


http://www.drawingandtalking.com/


Outcome data has been mainly qualitative in nature. Consultation groups have been set up in the two TaMHS geographical areas, enabling staff who use the technique to come and share some drawings and discuss their experiences. These sessions have proved very helpful and very important to ensure support is given to maintain understanding of their training. These groups are facilitated by the Specialist Teacher for Mental Health and Emotional Wellbeing and occur three times a year.

At one primary school in Wellingborough, three children who had experienced the intervention gave Drawing & Talking a score between 9 and 10, on a scale of 0-10 of how much it helped them. One girl stated that it stopped her from feeling poorly and enabled her to talk to Mrs X, whilst another said it helped them solve problems. Staff using Drawing &Talking were asked the following questions and some of the responses are listed below:

What do you think was helpful about the intervention for the pupil’s mental health/emotional wellbeing?

He was able to relate to his picture without having to admit his problems. It has been noted that he appears considerably calmer and more considerate at home. The pupil told me: ‘the sessions have made me more sociable.’ ‘You get to draw out your feelings and talk.’ Pupil A For the child to talk in a quiet, safe, trusting environment. What do you think might have been improved about the intervention or the way it was

implemented? To have started the intervention earlier and not run out of time at the end of term. To have met Mum personally before the intervention. To have a quiet, uninterrupted workplace. I doubt if this was the correct intervention, but the time spent with him has allowed me

to think of future interventions. To know more about the background of the child I was working with. If you were to recommend this intervention for use with other pupils, what might you say

about it? Let the child do the talking. Listen without judgement. This intervention could be helpful for any child who needs some 1:1 attention and time,

not just for children who are showing more extreme behavioural issues. Take your time with the child. Can be useful, powerful, comforting when used with a child, but doesn’t seem to be

effective for every child. Consideration must be made to match the child carefully. It worked very well for a Polish boy who had very little English.

Completed questionnaires were requested from the first TaMHS-funded cohort by the Northamptonshire TaMHS Project to help gain evidence of changes in self esteem, emotional literacy and/or strengths and difficulties. Despite encouragement, to complete these before and after, too few questionnaires were returned to provide useful aggregated feedback.


Overall Impact Ratings for Drawing and Talking


Overall Impact Ratings of Drawing and Talking, according to senior staff from 8 project schools



9.5 10 10 8 to 10

b) Overall to the school 7.8 8 n/a 5 to 10

Comments made by representatives from 4 of the schools alongside these overall ratings were very positive - identifying that the intervention:-

Has led to “big changes with children who have been involved, with those children easier to manage in the classroom”

“Has really been embraced by the school”. Has been “very good for quiet children who don’t otherwise appear to have additional

needs – as it has helped them to open-up and express their hidden needs and be supported

Involved “Initial trepidation from staff, but led to some real 'light-bulb'moments”

Capacity Building for Drawing and Talking

Due to the Drawing & Talking training that has been delivered during the TaMHS project, this technique is available to be used in 37 schools where at least one member of staff has been trained. This includes two special schools – one a primary school for BESD and one a secondary school for children with learning difficulties. Also, participants have included 4 staff from BACIN and Hospital and Outreach Education to provide respectively capacity for working with pupils who are at risk of exclusion and who have identified higher level mental health needs, which have led to school absence. Also, a Specialist Teacher for Mental Health has received the training, enabling her to use the intervention with Looked After Children. Others who are more likely to make use of the intervention for the purposes of recommending the use of the intervention by others and for understanding which children might benefit from it include a Specialist Primary Mental Health Practitioner, an Educational Psychologist, a Specialist Teacher for Autistic Spectrum Difficulties and the Lead School Nurse for Mental Health.

Further capacity building in Northamptonshire schools has been considered in three ways. Firstly, consultation for Drawing and Talking practitioners in geographical areas has begun and can be built to cover more areas as more people complete their Advanced Training, enabling them to provide consultation in the areas where they work. Nine people completed their Advanced Training in February 2011. At present the consultation lasts between 60 and 90 minutes. Secondly, more training will be available from John Fardon, the Specialist Teacher for Mental Health & Emotional Wellbeing who from May 2011 is deemed by Drawing and Talking Ltd as sufficiently skilled and experienced to train representatives from individual schools or provide local area based training, possibly based on Local Operational Teams. Finally, it would be possible to organise a countywide conference for users of Drawing & Talking to share successes, consolidate and develop new skills. These aspects could usefully be monitored and evaluated with the use of a chosen and agreed evaluation tool, such as the readily available Goodman’s Strengths and Difficulties Questionnaire.


Conclusions

To summarise, the outcomes of Drawing & Talking demonstrate that it has been a positive intervention for most pupils, although maybe not the right tool for some of the children chosen. It is helpful for people using the technique to have consultation time with someone who has completed the Advanced Training, to refocus on the technique and to build on their confidence in using the technique. Time needs to be given to. Consultation with parents is helpful and needs to be encouraged.

Strong indications are that Drawing and Talking can be introduced successfully into Northamptonshire schools with a positive impact on children who are vulnerable to experiencing difficulties with Mental Health or who are already experiencing such difficulties, and on the school overall. In particular, children seem to benefit in terms of having a regular repeated protected time and space with a sensitive adult to process their own thoughts and feelings without the need to express these directly to an adult. Key aspects for making implementation of Drawing and Talking successful include: sticking closely to the process as presented in the Foundation training; giving time to plan the 12 week intervention, to ensure it can be completed; consulting with parents to ensure that they understand the intervention and therefore, have appropriate expectations about what can and can’t be shared; and regularly engaging in consultation with someone who has completed the Advanced Training, to refocus on the technique and to build on their confidence in using the technique.

Capacity has been built for further implementation of Drawing and Talking in Northamptonshire schools, and for further implementation of training for more schools.

Because of the strong indications of the importance to children’s mental health of Drawing and Talking it has been included in the Building Blocks of Provision for Building Mentally Healthy Schools in Northamptonshire at the Wave 3 / More Targeted level, as a recommended provision for all schools, a shown below: -


Emotional Health and Well-Being Teams Within Schools

By Jan Pawlikowski

NB Appendices referred to in this chapter are not part of this report due to reasons of space, but they are available from the chapter’s author or the editor of the report.

Developing a Working Model/Framework for Implementing the Teams Operations Providing foundation training and ongoing support to school staff and identified team

members. Cultivating a whole school approach and pathways to existing internal school systems

and external services.

Description of Emotional Health and Well-Being Teams in Schools

Establishing Emotional Health and Well-Being Teams in schools is a Wave 3 programme aimed to provide early intervention and easy access for young people to receive support for their emotional health and well-being needs or low to moderate mental health issues. Additional benefits will be the promotion of support and early identification of any moderate to severe or enduring mental health conditions requiring intervention from specialist services.

The framework and model to develop a school emotional health and well-being team was conceived by Jan Pawlikowski, Specialist CAMHS Practitioner, Northamptonshire CAMHS and was developed together with Alison Williams, Special Educational Needs Co-ordinator from Danetre School, Daventry which became the first school to develop an Emotional health and Well-Being Team based on the model design.

Although the framework and model was interned for implementation within secondary schools, it can be adapted for use in primary schools.

Principally an Emotional Health and Well-Being Team consists of school staff who have an interest in supporting young people with emotional health and well-being (EH&WB) difficulties, providing them with basic foundation skills training in listening to enable the use of various interventions such as problem solving, cognitive behavioural techniques and other approaches.

Team members would need to have protected time to see between two and three young people per week who could either; self-refer or be referred to the team for support. An identified team co-ordinator (typically the school SENCo) would manage the referral system, any meetings and allocation of cases to team workers. Supervision of cases would be overseen by the team co-ordinator in liaison with an external specialist practitioner assigned to the school, who would also provide termly group supervision/coaching and any additional training needs to the team. Support would also be available through the CAMHS Specialist Primary Mental Health Practitioner daily available Liaison Line outside any formally arranged supervision times.

The team operations also include the use of paper documentation such as referral forms, waiting/allocation lists, case review notes and self-rating scales to evaluate and evidence any progress made by the young people, (see appendix A4).


Rationale for Including the Development of Emotional Health and Well-Being Teams in TaMHS

Establishing Emotional Health and Well-Being Teams in schools was included in the TaMHS Project as the model had been endorsed by the Northamptonshire CAMHS Partnership, ‘Mental Health Promotion and Early Identification’ Schools Years Workstream, as a means of developing capacity within universal services and contribute to the development of Northamptonshire’s Comprehensive CAMHS Strategy. The model had successfully been implemented in Danetre School, Daventry and following a presentation at the Corby Conference in 2006 was adopted by two Excellence Clusters schools in the North of the County who adapted and implemented the model independently, building on their existing pastoral support services.

The importance of psychological well-being in children and young people for their healthy emotional, social, physical, cognitive and educational development is well recognised. Many children and young people experience some form of mental health problem or distress and it is estimated that between 10-15% of all 5-15 year olds have a diagnosable mental health disorder. The prevalence of mental health difficulties among young people impacts on education performance, participation and social development. The importance of schools to promote early identification and support for mental health issues is cited by Lister Sharpe et al 1999.

School is a major element of almost every child and young person’s life and is therefore a logical location for mental health promotion, identification and early intervention. Teachers and other educational staff are best placed to identify mental health issues early and offer support as they have already established a relationship with the child/young person and their family. While teachers and other educational staff may not have specialist training in mental health issues, their contact and work with young people will mean that they have an important role to play in mental health promotion, identification and early intervention. However to achieve this, teachers and educational staff require extra support and training in order to work effectively with young people and their families who are experiencing mental health distress. The development of an Emotional Health and Well-Being Team in school supported by Specialist CAMHS workers can provide teachers and educational staff with the necessary training and support, in order for them to work effectively with young people and their families within universal or targeted levels of need.

Developing school teams supported by external services, further promotes the whole school approach ethos and any new and existing agendas promoting child mental health such as Every Child Matters and current government white paper. The training and specialist support provided through the EH&WB Team programme, also meets some of the common core skills and competencies for the children’s workforce, as cited in every child matters (DCFS 2005). This is also outlined in the national service framework for children and maternity services (DoH 2004) standard 3; Child, Young Person and Family-Centred Services, (common core of skills, knowledge and competencies apply to staff who work with children and young people across all agencies) and Standard 9; The Mental Health and Psychological Well-being of Children and Young People (all staff working with children and young people are able to make a contribution to mental health promotion and early intervention, providing appropriate interventions and specialist referral when problems are identified).

Within Northamptonshire, the establishment of Emotional Health and Well-Being Teams in schools also promotes the development of integrated working practices as described in the Northamptonshire Partnership ‘Integrated Working Guidance’ document which outlines multi


agency interventions across four levels of need; Universal, Targeted (additional support), Targeted (specialist support) and Specialist levels of need.


Implementing the model and framework for the TaMHS Emotional Health and Well-Being Team in schools programme was set out in three phases and involved two secondary schools:-

Phase 1 – Preparing/Promoting

An initial promotional meeting was held with each school Head Teacher, SENCo and other key staff to present the model and ascertain any capacity issues for implementation. A Team Co-ordinator (commonly the school SENCo) was identified and key operations such as processing referrals and provision of meetings for the team was drafted. Potential team members were identified as those who were already working well with EH&WB needs to be invited along with any other interested staff to a meeting held within Phase 2.

A Tool Kit Guide has been designed (see appendix A1) to assist with the start of the process in setting up and EH&WB Team.

Phase 2 – Mapping/Briefing the Team

This involved a meeting with each identified team to brief them about the model and identify any of their training and support needs. To enable the promotion of the team’s identity and develop team cohesiveness, their involvement in obtaining the views of other school staff at meetings and student through the devising of a questionnaire (see appendix A2) was undertaken to be then distributed and collated ready for phase 3. The student questionnaire was passed via the Student Council for their views before disseminating. A letter to the Board of Governors was also drafted to explain the proposed team being established within the school and to obtain their feedback (see appendix A3). Ways of promoting and obtaining the views of parents and carers was also considered through parents’ evenings and newsletters. Student questionnaires typically sought to obtain the following:-

Students views about having the Emotional Health and Well-Being Team in their school. Ideas for a name to be given for the team. Ideas for what issues the team could provide support for i.e. friendships, worries,

troubles etc. Views on what students liked about school. Students’ ideas for making school a better place. Views on what makes Students feel unhappy. If a team was available for support, would anyone access this?

Phase 3 – Commencing/Implementation

Feedback from any questionnaires sent out to students and staff was collated and the results shared at a second meeting with the team. Any emerging themes were noted for possible action and to inform the team of the types of difficulties expressed by students to be addressed. This also informed any training needs.

Training sessions for the needs identified by the team at Phase 2 and from the student questionnaires were diarised along with any additional meetings to address further planning of the phased content. Supervision/support meetings were also diarised alongside any


referrals/admissions meetings with the Specialist CAMHS worker and Team Co-ordinator within school.

The typical timeline from Phase 1 through to implementing the teams Operations and fulfilling the foundation training was typically between one and two school terms. Choosing a name for the team was selected from those posed by the students in the questionnaires. (This has the potential for a prize or award to be given out to a student who has proposed the chosen name however; in the TaMHS Project the questionnaires were anonymous). The Student Council was once again involved in choosing a name and assisted towards the promotion of the launch of the team via flyers and posters within the school. A photo board of the school staff who were members of the team was also proposed.

Documentations to be used for referral and note keeping purposes was agreed on and designs sent for formatting and printing. (see appendix A4)

Whilst the team can obtain support from external specialist services over their case work this provision also helps to facilitate cases into specialist services or any other targeted service intervention, in addition to or commencing the use of CAF.

There is also potential for young people to be supported by each other should the school adopt a peer mentoring/support team modelled on the programmes developed by the Peer Mentoring and Befriending Foundation. This would enable another level of support for young people within school to function alongside the interventions offered by the Emotional Health and Well-Being Team.

TaMHS Evaluation

The evaluations for the development of the TaMHS EH&WB Teams in the two secondary schools were conducted on various levels. These included obtaining the views of students about having a team within their school and reasons they would access the service to evidence their endorsement and participation in the process. Also evaluating the individual team members levels of confidence, competence and degree of skills and knowledge both prior to and following completion of the training programmes identified (see appendixA5). Feedback from any bespoke training sessions was also obtained.

Any co-worked interventions with a specialist worker were also evaluated obtaining the views of the pupil, member of staff and parent where relevant (see appendix A6). Each session held by a team worker with a pupil was evaluated using a simple rating scale of how a student felt before and after each session.

At the end of the first school year of the team being implemented, an additional qualitative evaluation of the team was undertaken through focused interview with the team workers.

A final TaMHS ‘impact’ assessment was concluded at the end of the TaMHS project period (see appendix A7)


Evaluation Results

The outcomes from the above evaluations (see Appendix’s B1-B6)) indicate the following:

Student/Pupil Questionnaire

The combined results from both TaMHS schools showed that 572 pupils were in favour of their being an Emotional Health and Well-Being Team in their schools compared to a 112 pupils who were not in favour. 363 pupils said they would access the service, 260 pupils said they would not and 34 were unsure. (see appendix B1)

Suggested names for the team ranged from ‘Help for Every Reason’, ‘The Shrinks’ through to ‘No Worries’, ‘The Worry Busters’ and ‘Sorted’.

What was liked about school were friends, clubs, the uniform, the help and support. Ideas to make the school a better place were after school clubs, comfortable furniture,

security cameras, individual support Things that were contributing to unhappiness at school were lessons, teachers’

attitudes, bullying, theft and disrespectfulness.

Training Programme

Following foundation training on basic listening skills the trend of rating the staff’s levels of confidence, competencies, understanding of emotional health and well-being needs and being able to support young people and their parents moved significantly from ‘not at all’, ‘only a little’ and ‘somewhat’, through to ‘mostly’ and ‘very much’.

What staff valued about the training was learning about communication and the understanding of open and closed questions and reflective listening.

More time for training would have been appreciated and more opportunities to role play. For some staff it encouraged them to enrol on further training in counselling skills. Trainings delivered were on Listening Skills (to include problem solving), Psychosocial

Development (to include attachment theory, Maslow’s Hierarchy of needs and a CBT framework), Using Cognitive Behavioural (CBT) Interventions, and on ADHD. (see appendix B2)

Individual and Co-Worked Cases:- Staff, Pupil and Parent Evaluations The combined results of cases referred and seen from both schools taking part in this

programme are:- Sep 09 – July 10 Referred/seen = 210. Closed/referred on = 173. Ongoing = 47 Sep 10 – Mar 11 Referred/seen = 96. Closed/referred on = 60. Ongoing = 36 Of these; 12 cases had received co-worked support from a specialist worker and 2

cases were referred into specialist CAMHS Using the devised documentation for students to rate their wellbeing on a simple scale

from sad to happy at each session. The overall outcomes when the rating scales were used proved positive.

Samples of co worked interventions with a specialist worker were evaluated using likert rating scales for a series of up to 15 question (see appendix A6)) which the student, team worker and parent completed pre and post any intervention. Not all co-worked cases involved parents. The results indicate a trend towards the positive in most cases and for most questions especially for the student. (see appendix B3)

Out of a number of cases co-worked one was referred into Specialist CAMHS for suspected dual diagnosis of OCD and ASD and is currently undergoing specialist CAMHS assessments.

(see appendix B4) Case example outline


Emotional Health and Well-Being Team End of 1st Year Qualitative Focused Interview(see appendix B5)

The effectiveness of having established the Emotional Health and Well-Being Teams showed to improve a greater understanding and insight into how to work with young people.

It promoted the role of being a listener to young people and receiving support and coaching from a specialist practitioner promoted the acquisition of new skills.

Team workers felt more confident in working with young people and were reassured by the access to support from Specialist CAMHS Workers over any work.

The training and support received, consolidated existing skills and some new interventions were learned.

The training provided; which commenced with three workshops in listening skills and problem solving techniques and included further bespoke training in child development, understanding ADHD and cognitive behaviour approaches were mostly all rated as being ‘very much useful’.

All the training pre and post evaluations showed improved confidence and competencies and also developed insight into what to say and how to approach young people’s problems.

Receiving supervision and the opportunity to co-work cases with specialist worker were highly rated. Co-worked opportunities with the specialist worker modelled interventions to team members and encouraged them to try new things out themselves.

Limitations expressed by some team members were around lack of protected time to deliver the work or attend supervision. Additional work demands through other staff leaving or through organisational changes also affected the efficacy of fully implementing the Emotional Health and Well-Being Team objectives.

Overall Impact Rating The final TaMHS impact evaluation undertaken at the end of the TaMHS Project period

Year indicated that some of the difficulties resulting from staff changes etc. in one school had been overcome and a new intake of staff were being trained to become additional members of the Emotional Health and Well-Being Team.(see appendix B6)

Much value was being placed on having established an Emotional Health and Well-Being Team in the schools.

School staff were becoming ‘minded’ in understanding and identifying emotional health and well-being needs in young people and being able to signpost them for support.

The Emotional Health and Well-Being Team’s place within the existing school systems helped link pathways between other systems such as behaviour panels, IEPs, Pastoral Support Plans and CAFS.

Undergoing the basic training in listening skills continued to have its impact and was upheld as sustaining the team’s operations along with the ongoing support and supervision received.

Improved levels of behaviour, attainment and attendance was also being attributed to the establishment of the EH&WB Team.


Capacity Building for Emotional Health and Well-Being

Emotional Health and Well-Being Teams in schools has built capacity for staff within at least five secondary schools within Northamptonshire, two of these were under the TaMHS Project to include approximately 20 members of staff between both schools. Sustaining the work requires approximately 2 hours formal group supervision per term per school provided by a Specialist CAMHS Worker alongside any bespoke training needs which may arise amounting to between 1-2 hours of training per term or every alternate term.

Helping to develop a new team with any other schools will require intense input for the initial two terms, to provide the training and support to set up the team. The ‘Tool Kit’ can be used to guide the process along and serve as a checklist. Once a team is established, the termly supervision and bespoke training sessions should be all that is required to help sustain the teams.

Overall Impact Ratings for Emotional Health & Wellbeing Teams (EHWBTs)


Overall Impact Ratings of Emotional Health & Wellbeing Teams (EHWBTs), according to senior staff from 2 project schools



9.5 n/a n/a 9 to 10

b) Overall to the school 10 10 n/a 10

A comment made alongside these overall ratings included from one of the schools that their Emotional Health and Well-being Team is “phenomenally valuable” to the school.

Conclusion

From the immediate and follow up evaluative data, helping schools to develop their own ‘in-house’ Emotional Health and Well-Being Team proves successful provided that the framework and model can be implemented or adapted resembling that which was intended using the phased content described.

To summarise this includes; student and staff participation, structuring operations and documentation, providing training in listening skills alongside other bespoke training in child psychosocial development, using problem solving and cognitive behavioural interventions and receiving any ongoing supervisory support and training needs.

Specialist CAMHS Workers who provide support to universal and targeted services are well placed to build this capacity promoting a skilled workforce who can support young people and their families appropriately within universal and targeted settings.


Establishing EH&WB Teams can help to prevent cases being inappropriately referred into Specialist Services and help to facilitate specialist support appropriately for cases with higher levels of need.Hence, overall Indications are that an Emotional Health and Wellbeing Team can be introduced successfully into Northamptonshire schools with a positive impact on children who are vulnerable to experiencing difficulties with Mental Health or who are already experiencing such difficulties, and on the school overall.

Emotional Health and Wellbeing Team capacity has been built in two schools within the TaMHS Project. This capacity needs to be actively sustained internally in the school and externally through on-going Specialist Primary Mental Health Practitioner support. For further enabling of Emotional Health and Wellbeing Teams in Northamptonshire schools, the detailed results above need to be taken into account and consideration be given to enabling more staff from Specialist CAMHS or other outside agencies to be able to help schools to set up these EHWBTs.

Because of the strong indications of the importance to children’s mental health of an in school Emotional Health and Wellbeing Team, it has been included in the Building Blocks of Provision for Building Mentally Healthy Schools in Northamptonshire at the Wave 3 More Targeted level, as a recommended provision for all secondary schools, as shown below.


Meeting Individual Needs through Consulting with Pupils, Parents and Staff

By Julia Jackson

Description of Meeting Individual Needs through Consulting with Pupils, Parents and Staff

The description of this intervention schools at the beginning of the project was outlined at wave two/three intervention support level as containing consultation for the school support staff or Emotional Wellbeing Teams (EWBTs) and parent support staff. The framework for the TaMHS wave approach with regard to family intervention is reflective of ‘Northamptonshire’s Family and Parenting Support Framework’ (pg 8 A Strategy for Family Support and Parenting across Northamptonshire 2008-2012).

Both strategies target early identification of families needing extra support to promote wellbeing because of adverse factors affecting parenting capacity, e.g.: mental or emotional health, substance misuse, disability, living in poverty, social exclusion or abuse. TaMHS intervention benefits staff as they share the process of delivering specific parenting and relationship consultation & advice for families usually within the school setting or occasionally through a home visiting assessment and/or intervention, dependent upon complexity and severity of difficulties, or when differentiation between school and home behaviour patterns are reported. Subsequent interagency working and signposting is to: Family centres, Parenting Groups, Group work, Advocacy, Family Relationship Work, Welfare Rights advice, Short break services, services that support adopted children and young people, BACIN, SNIP, ASD groups etc .

The detail of how this support process within TaMHS would look in practice was deliberately not tightly defined and evolved into a variety of different functions.

Role of TaMHS team member in providing this input

One aspect of the role required discussion of child and family cases with school staff using a solution focused exploratory approach to elicit what the staff member felt was/were the key issues for the child/family and what their original intentions were in potential management. This facilitated a learning opportunity regarding: case management, most appropriate approach, any therapies and strategies or programmes of intervention that may be useful. Observation of the child in school or joint assessment of the child (TaMHS team worker and School staff) was sometimes required to establish a clearer perspective of the child’s needs. These sometimes subsequently necessitated joint meetings with the child or young person, mainly where cases were particularly difficult or the school staff lacked skill or confidence.

However it emerged there were many parents that wished to engage with the TaMHS process that had significant issues of their own. These were sometimes acute social crises but often presented as enduring chronic negative patterns of behaviour within the family history (and intergenerational). Such thinking and behaviour patterns were identified as the source of the child’s emotional difficulties and subsequent behaviour in school; and therefore any potential progress required a parallel change process.

The TaMHS staff provided a counselling, containing and strategy planning service (including home visits, signposting to local services, referrals or CAF as required) to the parent


(sometimes with and sometimes without the school staff*), this enabled the family to move forward; whilst also consulting with the school staff on how to work with the child individually in school. This way the process of change was uniformly supportive. These cases were possibly the most successful but very time consuming.* = Sometimes the parent would refuse to have school staff present as they discussed their personal issues; this is a significant obstacle to sustainability beyond the project phase, especially also as the Parent Support Advisory posts have been reduced. At other times the staff support was engaged with another school task and unable to join our meeting which was disappointing but a reality.

Rationale for providing this intervention as part of TaMHS

Demographically Northamptonshire has a population that is planned to grow at a faster rate than most other similar counties in England by 2020. The population of the county will increase by around 27% by 2021. (A Strategy for Family Support and Parenting across Northamptonshire 2008-2012). The profile (in 2008) of the Daventry area includes a population of 49,400 (aged 16 – 64). Within this group Incapacity Benefit (IB) & Severe Disability Allowance (SDA) numbered 1,805 Claimants (210 aged 25 -34 and 425 in the 35 -44yr age group - likely parents of children 5-13) (Department of Work and Pensions August 2008.

The entire Daventry south Northants area as a ward is not generally regarded as deprived, however Daventry itself is an anomaly of this.

Within the Daventry area, Initially seven schools engaged with this input from the SPMHP TaMHS worker (2 infant, 2 junior 2 primary and 1 secondary) throughout the period of Jan – July 2010; of these 2 primary schools continued to be predominantly supported by the Specialist Teacher - Mental Health and Educational Psychologist and one infant school was managed by a Lead SPMHP.

Four schools continued to engage intensively with support from the SPMHP TaMHS worker throughout Jan 2010 – end March 2011 (1 infant, 2 junior and 1 secondary - also incorporating those within a separate exclusion unit) and are still asking for more!

What enabled greater success for this intervention is the geographical location of three of the four schools as they shared one site (1 infant, 1 junior, 1 secondary); the internalised benefits were then able to travel with the pupil and family to the next school where staff had a similar strategy; thus becoming an local integrated pathway approach to EWB and mental health concerns.

TaMHS Evaluation

In excess of 50 consultations were made with the TaMHS team worker of these 20 required observation, assessment and intervention with the TaMHS worker; and six cases required intensive and ongoing work. Several professionals meetings, two CAF’s, involvement with Education Act statutory assessment processes, two CAMHS referrals and one child protection referral emerged from engagement with these families. Also two cases were referred to the TaMHS worker from Specialist CAMHS.Results of Evaluation

The quote below is part of an email from a family whose child was referred to TaMHS for extreme behaviour and parents that were desperate and depressed (on medication). I have


worked with them (and support staff for 4 of 5 sessions). Initially it required containing and understanding of their situation via assessment and counselling (integral with Solihull Approach concepts); then using a combination of solution focused (SF), CBT and goal planning strategies they were able to integrate a different way of being with their children to promote a positive relationship and adopt consistent behaviour strategies with their children. The SF approach to self evaluating their coping capacity using scaling suggests that they have truly internalised this process. (Upon their first meeting they scored themselves a 2 out of 10 and at the end 8/9 out of 10).

“I look forward to watching all of the DVD tomorrow night and also to reading the book and also your presentation of the 1-2-3 Magic system of behaviour. By the way Mrs *** [the child’s teacher] asked [me] into the class and showed us some photos of where ****** had been playing with a group of girls which has sort of put our minds at rest and I filled **** in on everything that we talked about.I have also tried that hugging again when **** and also **** started to have a stress fit at ***** or myself and it did tend to work, so I'm definitely going to continue that system in the future and I think **** might start to use it after watching me a few more times.*** and I have both appreciated and definitely benefitted from all of your help and support over the past sessions which you've done for us and we both feel that it's greatly assisted us to understand ourselves as well as our three gorgeous boys. So hoping that the 1-2-3 Magic will just be the icing on the cake. With regards to the score on how we feel that we are able to cope I think that my score would be 8/9 out of ten but soon to be ten out of ten. That wouldn't of been capable without your very friendly, patient, caring, supportive shoulder and perspective of the person you are dealing with”.

The use of pre (before first session) and post (following last session) questionnaires did not occur with every encounter. In total there were probably 21 returns. Most of these were submitted to Specialist CAMHS for collation and not returned so I have limited data to draw on for this report. Yet the following reflects the general trend of responses received:

1. I feel confident as a parent/carer in supporting any problems my child has Range Pre = 1- 4 /10 Range post = 6 -9 /10

2. I feel supported by the school in dealing with any of my children’s problemsRange Pre = 1 – 5 Range Post = 6 -10

3. I am confident in my parenting skills to manage my child’s problemsRange Pre = 2.5 -5.5 Range Post = 5 -7

4. I have a positive relationship with my childRange Pre =2-5 Range Post = 6 -9

5. I can help my child resolve their problemsRange Pre = 1-4 Range Post = 4 -8

6. I can support my child in achieving their best at schoolRange Pre = 3 -6 Range Post = 6 -8.5

7. My child listens to meRange Pre = 1-3 Range Post = 4 -7

8. Generally speaking my child keeps to the rulesRange Pre = 1-6 Range Post = 4 -8


9. Talking to someone about my concerns helps meRange Pre = 6-7 Range Post = 7.5 -10

To summarise average staff consultation feedback To what extent was consultation considered to be effective 5/5 To what extent did consultation help develop your understanding or skills in relation to

the child 5/5 To what extent has consultation been useful in deciding what actions to take 4/5 -

comments are that some services do not exist locally or require additional funding How helpful are the notes/record of the consultation 4-5/5 How well are the interventions / actions resulting from consultations evaluated 4/5

comments are that some of these are ongoing How helpful do you think the pupil/ young person found the consultation 3-5 / 5 as some

ongoing work which requires parental attitude change first before child impact can be evaluated

How useful do you think parents found the consultation process 5/5

Overall Impact Ratings for Meeting Individual Needs through Consulting with Pupils, Parents


Overall Impact Ratings of Meeting Individual Needs through Consulting with Pupils, Parents, according to senior staff from 8 project schools



9.1 9 9 8 to 10


Overall Impact Ratings for Support for Key Staff re Individual Families


Overall Impact Ratings for Support for Key Staff re Individual Families, according to senior staff from 5 project schools



9.4 10 10 8 to 10



Comments made alongside these overall ratings included the value of observing skilled staff asking helpful questions using approaches that can support knowledge.

Capacity Building for Meeting Individual Needs through Consulting with Pupils, Parents and Staff

When school staff have been able to work alongside TaMHS workers with individual families, this has enabled capacity-building through observational learning and reflection on approaches witnessed. This is especially helpful where TaMHS staff have used particular approaches, such as Solihull Approach or Solution Focused Approach which the school staff have received training on and can then be shown its practical use with children and parents from their school.

Conclusion from Results of Meeting Individual Needs through Consulting with Pupils, Parents and Staff

Statements made by parents following personal experience of TaMHS intervention have all been positive. The most challenging aspects of the work is that it has required a significant committed change process on behalf of the parent/s. Where this has occurred in parallel with support to the child in school the child’s emotional and behavioural wellbeing has benefitted most. Where parents have been inconsistent or somewhat reluctant to change but support initiated in school the child has appeared to improve (in school) but to a lesser degree.

Overall, there are strong indications that support for Meeting Individual Needs through Consulting with Pupils, Parents and Staff through the TaMHS project has been highly valued, especially the systemic approach that enables parent and child’s needs to be considered together. Schools equipped with the Building Blocks of Provision for Building Mentally Healthy Schools in Northamptonshire are well resourced to provide such support. Joint work with representatives from external agencies such as Specialist CAMHS, Educational Psychology Service and Specialist Teachers – Mental Health can help to enable use of such provision to be maximised and embedded. However, great care needs to be taken to enable rather than replace or deskill the school-based worker – such as through making their learning an explicit goal of any individual child or family focused work.


Relate Awareness and Family Counselling

By Mike Simons

Description of Relate Awareness and Family Counselling

Relate is national charity working to promote health, respect and justice in couple and family relationships. As the country’s largest provider of relationship support, every year they help 150,000 people of all ages at a national network of 77 Centres working at 600 locations as well as by phone, online and via SMS text. Their services include relationship counselling for individuals and couples; family counselling; counselling for children and young people; as well as providing friendly and informal workshops for people at important life stages.

Relate Northamptonshire has for several years been providing counselling for children in some maintained schools. It was on the basis of this work and their current focus on developing family counselling in their services that their manager sought to include Relate work as part of the Northamptonshire TaMHS Project, which resulted in provision of workshops to inform school staff and locality workers about the work of Relate that may be helpful to families and children’s mental health in the area. It also resulted in some commissioned family counselling work in some of the TaMHS Project schools.

Rationale for Including Relate Awareness and Family Counselling in TaMHS

Since the DCSF TaMHS guidance identified that partnership work with voluntary sector organisations was essential to be included in each pathfinder project and that also family work needed to be included, it was important that a strong link was made by Northamptonshire TaMHS to an organisation locally that could achieve both these objectives. Given that Relate counsellors were already working with some schools in Northamptonshire, including one of the TaMHS schools prior to the project, with positive feedback from school staff, and that the Relate manager offered assistance to jointly steer the project, it was agreed that it would be useful to commission some work from Relate to contribute to the Northamptonshire TaMHS Project, in such a way that their interventions could be evaluated and so provide information to commissioners about the value of Relate’s work to intended mental health outcomes. Indeed, given the systemic nature of many difficulties with mental health and the limit to capacity and high thresholds of Specialist CAMHS and Social Services, an accessible local resource, such as Relate for providing expert facilitation for families was deemed likely to be a very helpful addition to the spectrum of provision for intervening in children’s mental health.

Project meetings with the local Relate manager identified that the confidential nature of their work would make it hard to build capacity beyond Relate staff, therefore, their capacity-building contribution would need to be in a different way. It was agreed that Relate would pilot some family counselling in several schools to build capacity within these families and within Relate, and with useful evaluative information helping to build future capacity in terms of which work is commissioned to support families. Secondly, it was agreed that a workshop led by a Relate counsellor would enable local school and other agency staff to understand the work of Relate and so have knowledge and understanding in staff as built-capacity.


Provision of Relate Awareness Training and Implementation of Family Counselling

Once information was provided about Relate’s policy and practice regarding supervision and safeguarding training for staff that was satisfactory for commissioning to be undertaken, Relate ran a 1¼ hour workshop in April 2010 in each area of the two sets of project schools, entitled ‘How can Relate Northamptonshire Help Improve Children’s Mental Health?’. The workshop include various sub-topics that were recorded by a TaMHS Educational Psychologist in order to circulate more widely, including these themes: scope of Relate work; Relate work specifically with children; Relate counselling quality assurance; emotional/physiological/ behavioural dynamics of counselling; criteria to consider for identifying parents who might use relate; funding; schools currently funding relate counselling time; courses for parents and professionals; and counselling availability. The learning objectives for the workshop were as follows:-

LO1 - I understand how individual counselling of pupils by Relate counsellors can be helpful. LO2 - I understand how family counselling provided by Relate can be helpful to families. LO3 - I have good overall knowledge of the work of Relate LO4 - I understand how the work of Relate can positively impact on the mental health of parents, children and families. LO5 - I know when it is appropriate to sign-post children, parents and families to Relate. LO6 - I feel confident in sign-posting children, parents and families to Relate, when appropriate.

Also, Relate began taking referrals from project schools for family counselling up to the value of £1000 in total (at the rate of £40 per session).

An additional idea of setting-up a parent group for pupils who see a Relate Counsellor was also discussed, but it was decided that such an initiative would best be followed-up outside of the TaMHS Project.


20 staff participated in the two Relate workshops. Attendance was mainly by staff in a parent-focused role such as Parent Support Advisor, Home School Support Worker and Parent Link Worker, BACIN Family Link Worker, Education Welfare Officer, and Social Worker. Staff from the Educational Psychology Service and Specialist Primary Mental Health Practitioner team also attended.

Evaluations of the workshop input were conducted by requesting that participants rate their knowledge and understanding relating to the learning objectives of the training both before and directly after the workshop, on 1-6 scales (1 not at all – 6 very much). 17 staff completed evaluation forms: 5 from the Wellingborough workshop and 12 from the Daventry one. For each learning objective there was an average rise of between 2.0 and 3.2 points comparing pre and post workshop ratings, with the greatest rise being for LO3: ‘ I have good overall knowledge of the work of Relate’, which also constituted the highest rated (5.4) final score. Four out of the six learning objectives resulted in ratings of 5.0 or more with the 2nd and 3rd

highest ratings (both 5.2) relating to objectives LO2 and LO4, respectively: ‘I understand how family counselling provided by Relate can be helpful to families’; and ‘I understand how the work of Relate can positively impact on the mental health of parents, children and families‘. While the rating of the objective related to ‘confidence’ grew by an average of 2.0 points, the average final rating for LO6 ‘I feel confident in sign-posting children, parents and families to Relate, when appropriate’ was the lowest of the final ratings, at 4.4.


In terms of Relate family counselling, by the time of the project end, 5 families had had TaMHS funded work but only one of these cases was described as ‘completed’. For this completed case, the ‘presenting problem’ was described as: ‘living in new location, step-family issues including resentment from son’. The desired outcome for this family was identified as: ‘partner and son to communicate and get along’. After 9 sessions, outcomes achieved included: ‘Mum and partner continue to reach agreement on family rules; family continue to use time-out strategy; son and partner's son fight but play together more; and school attendance increased to 95.5%’, (although unfortunately no baseline for this has been provided to the author)’. While an initial Strengths and Difficulties Questionnaire (SDQ) was requested from parents, unfortunately, this was not returned.

The other 4 cases that are yet to be completed all involve families from one other school. Here the identified issues relate to a variety of presenting issues, including: differing parenting ideas and styles causing conflict; child’s sleeping difficulties; a child exhibiting anger, violence and destructive behaviour including in school; behavioural boundaries; and parental feelings of guilt.

While there is as yet incomplete qualitative and quantitative data for the family counselling, the intervention was sufficiently valued by both the schools involved for the Headteachers there to commission further Relate family counselling in order to continue to benefit these and other families.

Overall Impact Ratings for Relate Family Counselling


Overall Impact Ratings of Relate Family Counselling, according to senior staff from 1 project school


a) For children who are vulnerable to experiencing difficulties with Mental Health or who are already experiencing such difficulties

10 10 n/a 10


A comment made alongside this rating was that the Relate counselling had been “Excellent”.

Capacity Building for Relate Work

Capacity has been built in terms of staff knowledge and understanding about the work of Relate in relation to children’s mental health in 20 staff directly as well as many others through circulation of notes from workshops.

Beyond the capacity built within the families with whom Relate has engaged in family counselling, capacity has been built through the TaMHS project in Relate itself in terms of the opportunity to put into practice training for their staff in family counselling. And for two of the schools that experienced family counselling through Relate, they are retaining such provision


through re-commissioning Relate time to continue this family counselling work beyond the TaMHS Project.

Evaluative work in relation to family counselling should be completed and communicated to commissioners to further build capacity in terms of informed decision making for whether there is further commissioning of such family counselling from Relate or other organisations.

Conclusions

There has been increased knowledge and understanding by a variety of staff in schools and in both localities about the work of Relate in relation to children’s mental health and hence, these staff can knowledgeably include Relate work as one of the options for sign-posting or engaging that will be appropriate for some families. In terms of evaluating the outcomes of the Relate family counselling, one completed case suggests that desired outcomes were achieved for the family. Further evaluative data is being sought for this case and for the 4 others that are on-going, in order to help evaluate the usefulness of family counselling provided by Relate to children’s mental health.

Anecdotally and from qualitative feedback, the work is highly valued for intervening with children who are vulnerable to experiencing difficulties with Mental Health or who are already experiencing such difficulties.


Autistic Spectrum Disorder (ASD) Training for Parent Support Advisors (PSAs) and other school staff focused on work with

parents

Description of ASD Training for PSAs et al

ASD training was provided over 2 days in consecutive weeks to home-focused workers by the Specialist Senior Educational Psychologist – ASD and members of the ASD Specialist Team. The training included use of case studies, video clips and examples of materials used in the home, to meet the following learning objectives:-

An introduction to ASD—and key ideas and understanding that parents need in order to help their children

An insight into the experience of parenting a child with ASD and the needs of other family members

Strategies and activities for helping the child to develop new skills in key areas of development

Ideas for ‘working round’ the child’s difficulties, and for preventing or managing challenging behaviour

Information about sources of support

Rationale for Including ASD Training for PSAs et al in TaMHS

Given the high prevalence (approximately 1:100) of children affected by an ASD, and the vulnerability of children with an ASD to mental health difficulties, such as anxiety and relationship issues, it is important that staff in schools have a good understanding of the needs and appropriate approaches, strategies, techniques and resources for working with children and families with ASD. While staff who work in schools have procedures to access skilled staff from the ASD Specialist Teacher team who work in collaboration with the Specialist Senior Educational Psychologist for ASD and other Educational Psychologists, PSAs and others in similar roles have less ready access to such support. Staff from TaMHS project schools who have parent focused roles, such as PSAs, Home School Support Workers (HSSWs) and Parent Link Workers (PLWs) expressed a need and desire to be able to support parents of children with ASD more effectively, as this group of parents experience higher levels of stress and difficulty than the parents of youngsters with other types of developmental difficulty Hence, ‘Training for PSAs HSSWs, PLWs etc in supporting parents who have children with ASD’ was identified as a priority in a TaMHS Mental Health Locality Team meeting and this led to the project manager engaging the ASD specialist staff identified above in providing training to the parent-focused workers who work in or with the schools in the TaMHS project and to those associated with other schools to make best use of any additional training places.


Training was provided at a venue central to the county on 16 th and 22nd June 2010 and attended by 26 participants in total, including 10 staff from TaMHS project schools (including a worker who provides PSA work for other schools too), 5 PSAs from other schools and 6 PSAs whose work covers clusters of schools and a Family Centre worker. The final 4 places were taken by 3 Specialist Primary Mental Health Practitioners and the Lead School Nurse for Mental Health. There were approximately 40 schools covered by the school-linked participants attending: including primary, secondary and all-through schools. Finally, demand for places on the training exceeded supply – as 19 staff remained on the waiting lists who have yet to access this training.


TaMHS Evaluation

Evaluations were conducted by requesting that participants rate their knowledge and skills relating to the learning objectives of the training both before and directly after the 2-day training on 1-6 scales (1 not at all – 6 very much). Ratings for presentation and relevance (1- poor – 6 excellent) were also requested– as well as comments about the value of the training.

5 months after the training, a questionnaire was emailed to all participants to seek retrospective feedback about the extent that the training has helped them to meet the challenges in supporting parents whose child may have an ASD.

Results

From immediate feedback from 21 participants’ completion of the evaluation questionnaire, training was highly valued in terms of presentation (average of 5.3), relevance (average of 5.4) and shift in learning from an average of 2-3 baseline to almost 5 on the 1-6 scale for each objective. The average shift size was 2.6. Greatest learning shift was 2.9 for the 6 th learning objective: "I know useful sources of support for parents and children where a family has a child with an ASD". The highest rated final level of knowledge/skills was for the 4th learning objective: "I know of useful strategies and activities for helping children with an ASD to develop new skills in key areas of development".

Six participants responded to the e-mailed 5-month follow-up evaluation questionnaire, which represents 29% of the school-linked participants. Average ratings on a 1-10 scale (1- Not at all to 10 – Very much) of the value of the training to each of 6 aspects were as follows, in order of most valued to least: - :

Share with parents useful sources of support for parents and children where a family has a child with an ASD (7.3).

Help parents/carers to understand key aspects about ASDs (7.2). Overall effectively support parents where their child has an ASD (7.0). Understand parents’ experience of parenting a child with an ASD and the needs of other

family members (6.7). Share with parents useful strategies and activities for helping children with an ASD to

develop new skills in key areas of development (6.5) Share with parents good ideas for ‘working round’ the child’s difficulties, and for preventing or

managing challenging behaviour, where a child has an ASD (6.5).

From the perspective of making use of the training, participants indicated that the most helpful aspects of the training had included: understanding differing levels of need within ASD spectrum; Social Stories; scheduling of daily routines; and information about support services. Being provided with case studies in the training was regarded as especially. In terms of any need for further support, each participant indicated that the training had already provided them with sufficient support and on-going access to information such as on websites. One participant summarised her thoughts about the value of the training in: “A really useful course and valuable for supporting families with ASD”.


Overall Impact Ratings for Training re ASD for Parent Focused Workers


Overall Impact Ratings of Training re ASD for Parent Focused Workers, according to senior staff from 5 project schools



7 7 n/a 4 to 10


A comments made alongside these overall ratings included that as a result of the training, staff involved are more comfortable about exploring issues with families such as in relation to concerns that a child may need an assessment due to concerns about a possible developmental disorder.

Capacity Building for ASD Training For Parent Focused Workers

The ASD training has built capacity for staff in a parent-focused role for approximately 40 schools, including 10 within the TaMHS project, in terms of knowledge and skills regarding supporting parents whose child may have an ASD. A further seven similar 2-day training sessions would be likely to build capacity in a similar way to the remaining 275 schools in the county. Capacity was also built through this training for the participating Family Centre Worker, 3 Specialist Primary Mental Health Practitioners and the Lead School Nurse for Mental Health: which should be useful in their on-going casework, where they are likely to work with parents whose child may have an ASD.

Conclusion from Results of ASD Training For Parent Focused Workers

The above immediate and 5-month follow-up evaluative data indicate that ASD training for parent-focused workers in the manner provided by the Children and Young People’s Service staff who have specialist responsibility for working with youngsters with ASD is valued and useful in their roles, without the need for further immediate support. It would seem highly appropriate for such training to be repeated to provide training to staff linked with other schools across the county – especially given the high number of staff who were on the waiting-list for the TaMHS-provided training.

Because of the vulnerability of children with ASDs to mental health difficulties and hence, indications of the importance to children’s mental health of ASD Training For Parent Focused Workers, it has been included in the Building Blocks of Provision for Building Mentally Healthy Schools in Northamptonshire at the Wave 3 More Targeted level, as a recommended provision for all schools, as shown below.


Section F

Staff Well-Being Focused

Interventions


Headteacher Wellbeing Programme: Headspace

By Mike Simons

Description of Headspace Programme

Set-up by the charity Teacher Support Network’s, Work Life Support (WLS) now known as www.educationsupportpartnership.org.uk established Headspace: a programme designed to provide Headteachers with the time and space to develop and sustain their own wellbeing and personal and professional effectiveness. This bespoke and confidential programme provides a framework within which Headteachers can explore the most effective behaviours and learn from each other, using action-learning and problem-solving techniques. Shaped entirely by the individual group of leaders, the Worklife Support facilitator focuses on the specific concerns and interests of the small group and helps to keep the sessions on track. The Headspace programme offers leaders: the resources they need to improve their resilience and work more effectively; a safe and confidential framework within which they can reflect together on the practical issues of leadership and develop robust, creative and sustainable strategies; and the chance to enhance their capacity to work in a complex, constantly changing environment, facing challenges with optimism and creativity.

Rationale for including focus on Headteacher Wellbeing in TaMHS

A focus on Head-teacher wellbeing was included in the TaMHS project as a core offer to each school due to a combination of related reasons. There are sound reasons to focus on staff-wellbeing in general for the mental health benefits indirectly to children [see section in this report on ‘Worklife Support (WLS) for Staff Wellbeing’ for further comments on this]. Also, ‘there is abundant evidence, drawn largely from studies of high performing organisations, that leadership is a highly significant variable in determining organisational success and contributing to successful schools’ (West-Burnham 2010). Given this evidence, it is vital that headteachers remain in sufficiently good mental health in order to provide leadership and containment to others – more junior staff, pupils and their parents. Unlike other staff in school and despite having a particularly demanding role, headteachers may well have no peer or senior member of staff with whom they can share the rigors and the joys that their roles provide in a way that can enable them to feel listened-to and understood and support them in their development and in generally maintaining positive mental health. Hence, early-on in the project planning, it was agreed to provide funds for any headteacher of a TaMHS school to join the Headspace Programme.

.Provision of Implementation of the Headspace Programme

Through consultations with each of the 13 TaMHS project schools’ headteachers, it was agreed that 6 of these prioritised this programme and hence, would be funded by TaMHS (£600 each) to join the programme. Headteachers from project schools who chose not to join the programme cited reasons related to workload issues rather than lack of need, and in one case, a recent positive experience of Headspace led to thinking that a break from such experience was currently more appropriate.

In order for the programme to run, a higher minimum than 6 headteachers was required. Hence, it was not until April 2010 that a sufficient number of additional school-funded Headteachers from beyond the project were recruited to enable the first of the 6 meetings (one full introductory day and 5 half-days) to be held. Since then, this group of 8 Northamptonshire Northamptonshire TaMHS Project - Evaluation of Interventions April 2009 – March 2011

164

http://www.educationsupportpartnership.org.uk/

headteachers has met termly, facilitated by Jenny Blount, from Worklife Support, with their final meeting taking place on January 26th 2011: which included a focus on evaluation from the 8 participants who attended the final session.

TaMHS Evaluation

As the effectiveness of the work is dependent on a high level of confidentiality, it was not appropriate for TaMHS project workers to join any of the meetings. Therefore, there is reliance on the evaluative feedback achieved through completion by each of the headteachers of a questionnaire designed by WLS staff, with additional items added by TaMHS staff to ensure that it meets the evaluative needs of the project. However, in the event, a different set of questions was presented to participants by the facilitator.

Results

From evaluative questions about what participants found most useful about their experience of Headspace, the key aspects identified were: time and space to reflect, discuss and share honestly with other Headteachers in a safe, comfortable and supportive environment; expert mediation & facilitation; higher-level discussion including the generation of a range of solutions and reading to address issues that others also share. Respondents emphasised the importance of the group being a ‘closed’ one (rather than open to others joining part way through) due to the importance of the built relationships and built trust between the existing group members enabling honest and open sharing, that is so valued. Participants indicated the importance of the experience being: non-judgemental, confidential, flexible, reflective, supportive and reassuring. Also, they identified that the experience was liberating for them from the everyday aspects of a busy Headteachers work, where he/she risks and/or experiences isolation. This combination of attributes was regarded by participants as excellent for their well-being. As commonly found for other self-help oriented groups, members identified the benefits of mutual support and sharing ideas and realising that others face similar difficult issues. Rather than identify particular categories of headteachers who might benefit from Headspace, the collective view was that a mix of experience and phase was helpful to all.

Reflections from participants identified that the sessions had impacted positively on their work-life balance by putting things into perspective, highlighting the importance of them looking after themselves and as one respondent identified, “building sustainable resilience” into their working lives. Another respondent identified the programme as providing a “lifeline” and another, that it had helped him/her to recognise that it was OK “not to be the perfect Headteacher” without feeling inadequate. Hence, several had identified that the programme had helped them to work more effectively, through having a healthier perspective and therefore, had resultant better well-being.

All 8 respondents indicated a desire to continue to meet in a similar way with one indicating absolutely, one indicating ‘periodically’ and one indicating ‘probably’; with 3 comments alluding to the need to find funding first.

In terms of improvement opportunities, these were identified by only three respondents, respectively indicating: that using the same work-space for each session would be better to maximise feelings of safety and trust; that more research input would be useful; and that at times, there was too much “doom and gloom”. Also, there were various other comments relating to: keeping in email contact; having more frequent meetings; having a particular focus for discussion, as well as the opportunity to bring issues; and to have a group of no bigger than the final group size of 8 participants.


Overall Impact Ratings for Headspace


Overall Impact Ratings of Headspace, according to senior staff from 4 project schools



7 7 n/a n/a


Comments made alongside these overall ratings included that Head Space has” been fantastic and impacting on whole school enabling me to put things in perspective” – with of particular value of being with “supportive colleagues in similar situation and true empathy, very supportive”, which other staff such as classteachers may also find useful.

Capacity Building for Headteacher Wellbeing

For Headteachers who have worked through the WLS Headspace Programme, they may have the capacity to sustain this work through maintaining networks of peer support that has began as part of the programme.

For making use of the WLS Programme, schools remain reliant on purchasing this from WLS. However, it is worth considering developing the role of others such as Educational Psychologists in a ‘Supportive Consultation’ role that is currently proving valuable to Parent Support Advisors (PSAs) across the county, which is currently commissioned by Extended Services. Also, it is understood that capacity is being developed by a local partnership organisation, Aspire, to provide support to leadership teams in schools provided by staff with direct experience of the headteacher role.

Conclusion from Results of WLS Headspace Programme Evaluation

The WLS Headspace Programme has been well received by Headteachers engaging with this process in terms of benefiting their wellbeing and the effectiveness of their work, despite an equivalent 3.5 full days out of the year having been taken out of their busy work lives to fully experience the Headspace programme. Given the value of such a programme to Headteachers and the importance of their role to many outcomes including the mental health and emotional well-being outcomes of their pupils, Head Teacher Wellbeing Programme has been included in the Building Blocks of Provision for Building Mentally Healthy Schools in Northamptonshire at the Essential Foundations level, as a recommended provision for all schools, as shown below.


References

West-Burnham, J (2010) School Leadership for Wellbeing, National Children’s Bureau, Highlight no. 257.


Worklife Support Programme for School Staff Well-being

By Mike Simons and Melissa Wheeler

Set-up by the charity Teacher Support Network’s, Work Life Support (WLS) now known as www.educationsupportpartnership.org.uk established a Well-Being Programme for schools, and other public sector organisations to help organisations bring about positive change and realise their potential by focusing on the wellbeing and effectiveness of all members of staff. The Well-Being programme seeks to be a positive, proactive and sustainable intervention, focusing on solutions and ideas for the future. It uses a process of self-evaluation that involves the whole staff, enabling staff members themselves to identify their organisation’s individual strengths and areas for development. Through Well-Being, everyone decides together on the best course of action through which to make constructive changes to their organisation. As part of the programme, each school receives:

an independent service that has been specifically tailored to the education context detailed training and guidance for members of the school Well-Being team an initial audit of staff wellbeing in which every member of staff is encouraged to

participate: the Well-Being survey a confidential ‘data profile’ containing the outcomes of the Well-Being survey information, support, structured guidance and practical suggestions on understanding

the data and how best to feed it back to - and involve – all staff access to a wide range of printed and electronic resources (such as guidance materials,

case studies and workshops), all based on best practice from other Well-Being organisations

Although not purchased by the TaMHS project, for an additional cost, WLS also provide an Employee Assistance Programme (EAP) to school staff which provides 24 hour per day access to: information services and telephone counselling regarding debt advice, financial guidance, legal guidance; as well as on online health and wellbeing resource and access to face-to-face counselling.

Rationale for Including focus on Staff Wellbeing in TaMHS

A focus on staff-wellbeing was included in the TaMHS project as a core offer to each school due to a combination of related reasons. Research (BirkbeckCollege in partnership with WLS (2007): see website) suggests that there are links between average teacher wellbeing in schools and pupil performance. The Solihull Approach (SA) identifies that (emotional) ‘containment’ is a core determinant of healthy minds and relationships for all. SA highlights that only when adults have sufficient emotional containment and hence, are not overwhelmed, can they usefully provide emotional containment to others, including to children and including to vulnerable children, who especially need emotional containment. Hence, it is appropriate and necessary to focus on staff wellbeing in order to provide a sound foundation for building and maintaining children’s mental health – especially for children who are vulnerable to mental health difficulties. Also appropriate to TaMHS is the focus on the health of the organisation, the school, which is viewed as critically important to the mental health of children as well as those who work for the organisation. Finally, the solution focused approach to the programme fits well with the ethos of TaMHS in Northamptonshire.


http://www.educationsupportpartnership.org.uk/

Provision of Implementation of the WLS Well-being Programme

Consultation with leaders in each of the TaMHS schools agreed that staff wellbeing was an important focus of work for both the staff and for the children with whom they worked. This led to all project schools, except for one primary and both secondary schools, agreeing to develop staff wellbeing in their schools through use of the Work Life Support programme. Through the course of the project all 10 of these schools have identified ‘volunteer’ ‘champions’ of wellbeing for their schools and paired with a member of senior leadership team have: attended a briefing provided by Work Life Support; set-up a school Well-Being team; championed use of an audit tool for use by every member of staff to identify strengths and opportunities for improving staff-wellbeing; received consultation regarding their schools’ results and resulting ways forward; fed-back results to staff and together devised an action-plan; began to implement this plan; and reviewed the process so far with other schools facilitated by WLS. At the time of writing this report, schools are at various stages in this process and at various time-points during 2011-12 will be ready to implement a final audit of staff views in order to measure progress since the initial audit and to provide a steer to further actions.

TaMHS Evaluation

At the time of writing this project evaluation report, a summative evaluation of the Work Life Support programme is not available as the intervention has yet to run its course. Northamptonshire TaMHS has commissioned Work Life Support to provide a report and consultation regarding the progress of the first wave of (8) TaMHS Schools who will be ready to re-audit following the end of the 2-year programme. Therefore, what is reported here is some of the formative information gleaned through on-going discussions with school leaders.

In terms of the process, the onus is on school leadership and well-being ‘champions’ to maintain the programme as a priority for staff involvement. Anecdotally, due to other priority aspects of TaMHS work and other externally driven priorities, such as the Improving Schools Programme (ISP) it has been easy for Staff Wellbeing to slip down the agenda. However, there have been some tangible changes made to practice in schools. The following innovations were identified at WLS reviews in response to well-being audits and action plans held in November-December 2010 involving a total of 8 of the TaMHS project schools, as well as other schools who are involved in the programme.


Positive Solutions Found Improvement OpportunitiesWell-being Programme Process

Gathering all the staff together for the feedback, paying those who were not usually in school at the time, making a real effort to encourage the staff to feel like they were one team

Creating a wellbeing team charter and negotiating with SLT as to how the team would operate in the school, how much time and resource they would be given and what their role would be

Ensuring that items on the action plan and staff wellbeing in general are regular agenda items on meetings

WB team send round an agenda and have a rota of invited guests to attend meetings

WB team allocated a one hour slot at school council meeting

Engaging staff in solution finding rather than an over-focus on identifying problems.

Getting time for genuine consultation and establishing shared meaning for this.

Need to find time to draw-up action plans to focus efforts on agreed well-being priorities.

Getting support to deliver action-plan actions rather than resources including time being used-up on other agendas.

Improving Communication in School

Creating a communication group whose specific function is to develop better lines of communication in school particularly between different staff groups. This group meets only once a term and are supposed to be a forum for passing on ideas, comments etc for staff who don’t always have the opportunity to talk together. Slight danger of it becoming a moan shop, which the team were working hard to overcome. Different representatives ensure that all information etc is circulated to their various teams afterwards.

Setting up a text messaging system across all staff to improve communications

Creating proper booking systems as a result of consultation with staff to ensure that rooms are properly booked in advance to avoid confusion and time wasting for staff and students.

Creating improved absence management roles and systems to ensure that less time is wasted by support staff chasing absent pupils.

Establishing protected time for teachers and their TA’s to meet to discuss lesson planning, pupil needs, etc

Agreeing on a three-weekly slot for the LSA’s to meet together to share ideas and concerns.


Resources and planning:

Changing the way that the school calendar is organised to enable staff to contribute to year plans.

Ensuring that the calendar is kept in the staff room to allow all staff to plan well ahead.

Changing the way that resources are stored around the school, to make it easier for staff to use them.

Providing pigeon holes for all staffImproving effective-ness of meetings:

Agendas published before the meeting Minutes provided for all meetings Timing and focus of meetings tightened to

make them more effective.

Well-being Notice Boards

Used to promote events, update staff on the action plan, and celebrate positive events and occasions.

Staff also encouraged to use it as a ‘What made you smile today?’ board’

Develop use of notice-board to include publicising discounted offers, childcare, care sharing, ironing services etc, all with a mind to improve work/life balance.

Well-being focused Activities

Running a wellbeing afternoon for all staff with a range of activities.

Staff social activities

Finding an approach to Increasing number of staff attending social activities.

One example of a specific intervention for improving staff-wellbeing arose from a consultation between a Specialist Primary Mental Health Practitioner (SPMHP) and staff from a pair of project schools. From spending time at both schools, it was clear to the SPMHP that although the staff were trying hard to meet the needs of the pupils well-being/emotional & Mental Health, staff were neglecting their own mental health needs, to the detriment of themselves and their work. Consultation with senior staff at the schools led to the setting-up of a joint-school lunchtime workshop involving a TaMHS SPMHP and commissioned worker, Joy Allibone who routinely offers well-being seminars for staff. The result was the setting-up of a calm space in school and at a time that all staff could access for at least some of the time a session of relaxation with calm music and smell, and the use of fragrance to reach all senses. Also, books and affirmations were placed on the floor in cosy blankets and pillows for staff to also read and nurturing food was also provided for staff to support staff attendance at the workshop. Finally, a hand-massage with essential oils was available from Joy Allibone.7 staff attended the workshop for at least part of the lunch-time. According to responses on 7 completed evaluation forms, the staff that attended the workshop appreciated the time for themselves and felt the benefit of the workshop and began to see the importance of their own well-being and how they can protect themselves in the future. It was agreed that it would be helpful for the workshop to be repeated to encourage more staff to attend and that it was important to make the space more welcoming and well-decorated which would be more worth-while when building work was completed that allowed such a space in school to achieve permanence. It was also regarded as important that such workshop activities were conducted as part of an over-arching staff-wellbeing strategy of which all or at least the majority of staff took ownership.


Overall Impact Ratings for Work life support for Staff Well-being


Overall Impact Ratings for Work life support for Staff Well-being, according to senior staff from project schools



6.8 7 7 6 to 7


Comments made alongside these overall ratings included

Overall Impact Ratings for Support to school staff to provide containment


Overall Impact Ratings for Support to school staff to provide containment, according to senior staff from 6 project schools



8.8 9 9 7 to 10

b) Overall to the school 7.2 7.5 9 5 to 9

Capacity Building for Staff-Wellbeing

For schools who have worked through the WLS Wellbeing Programme, they may have the capacity to sustain this work and provide advice to other schools in terms of forming Wellbeing Teams and in the process of developing and implementing well-supported action plans.

For the making use of the WLS Programme, schools remain reliant on purchasing this from WLS at costs related to the number of staff employed in the school. However, TaMHS project staff have made deliberate efforts to understand the process by attending WLS meetings and through on-going discussion with school leaders. As such, project staff are more skilled to support schools in their work on Staff Wellbeing. Building on the use of a questionnaire developed by a member of the TaMHS team prior to the project may enable more capacity by local agency staff in Northamptonshire to develop support for staff to develop their well-being.


Also, it is understood that capacity is being developed by a local partnership organisation, Aspire, to provide support to leadership teams in schools.

Conclusion from Results of WLS Staff Well-being Programme Evaluation

The WLS Well-being Programme has been well received by schools engaging with this process – especially as it raised the profile of the importance of staff well-being in both its own right but also in promoting the mental health and well-being of children. It has also generated helpful actions in schools set in a framework of staff owning the solutions.

Because of the indications of the importance to children’s mental health of a Staff Well-being Programme, that it has been included in the Building Blocks of Provision for Building Mentally Healthy Schools in Northamptonshire at the Essential Foundations level, as a recommended provision for all schools, as shown below.

References

Holmes, E (2005) Teacher Well-being: Looking after yourself and your career in the classroom by Elizabeth Holmes (published by Routledge, ISBN 0415334985)

Morris, E.K., Casey, J. (2006) Developing Emotionally Literate Staff London: Paul Chapman

Newton, C. (1995) Circle of Adults Educational Psychology in Practice, Vol.11, no 2, pp 8-14
