Behaviour and Discipline in Schools - Education Committee Contents


Memorandum submitted by Marlborough Family Education Service

  1.  Undiagnosed and untreated mental health problems of children or their parents have a strong negative impact on the child, their peers and teachers. The resultant behaviours in the school context impact on the experience of the whole learning community.

2.  Many families will not engage with Mental Health professionals for a variety of reasons including the universal fear of blame and stigma associated with the diagnosis of a mental health problem. In many cases, schools are left to deal with the behavioural consequences unsupported.

  3.  In 1999, The Mental Health of Children and Adolescents in Great Britain a survey carried out by the Department of Health, Social Survey Division indicated that 10% of children 5-15 years had a mental disorder; 5% had clinically significant conduct disorders; 4% were assessed to have emotional disorders—anxiety and depression—and 1% were rated as hyperactive. Furthermore, one in five children had officially recognized special educational needs. Those with a disorder were three times more likely to have special needs: 49% compared with 15%. Children with conduct disorder had the highest rate of truancy at 44%. Children with mental disorders were far more likely to live in families rated as having unhealthy functioning compared to children with no disorder. Over 50% had experienced the separation of their parents.

  4.  Teaching and support staff in schools routinely have to deal with the effects of the disruption in the classroom occasioned by such disorders. They are usually provided with little training in the identification and management of children with mental health difficulties and receive little or no supervision. In a published report, Identification and Management of pupils with Mental Health difficulties (NASUWT 2010), the following observations were made based on reports from teachers:

    (i) Teachers are often ambivalent about their ability to deal with students with mental health difficulties and would like to have a named healthcare professional who they can contact for advice. This would work as an early recognition system for the health service to identify young people who may need help, thereby supporting effective targeting of limited healthcare resources.

    (ii) Teachers would like access to professional development courses that focus on signs and symptoms. Some teachers felt that "in-class" support from a healthcare professional working alongside the teacher to give advice may be the most effective form of training.

    (iii) Teachers expressed the desire for Child & Adolescent Mental Health Services (CAMHS) to be in schools to deal directly with school referrals. There is dissatisfaction with slow and bureaucratic systems of referral.

  In our experience, school staff see existing services as remote and inaccessible with limited understanding of the pressures teachers and other school staff face as a result of the above.

  5.  At the Marlborough Family Education Service provision has been developed over the past 25 years which addresses the above needs of both families and schools.

  There are two main components of the service as it exists currently:

MARLBOROUGH FAMILY EDUCATION CENTRE (MFEC)

  Young people in schools who are at risk of permanent exclusion can be referred to an intensive programme delivered away from the school site at the Marlborough Family Service. They attend with a parent or other adult from the family along with up to nine other families and work together with a team of staff who are all trained teachers and systemic psychotherapists on the behaviours which are jeopardising their school placements and which may also be disrupting family life. The principle of "families helping families" is well-established within the model and reduces the stigma many families experience in working with mental health services.

The programme is delivered in eight week blocks with reviews at the end of each period. The reviews involve the young person and family, staff from the Education Centre, key school staff and other agencies, for example Social Services who may be involved in working with the family. School staff are involved in the programme on a day-to-day basis in reporting on the changes in the young person's behaviour via a target card system. Full re-integration into mainstream education is the goal of the intervention.

  All children referred to the Marlborough Family Education Centre are assessed by a Child and Adolescent Psychiatrist within their eight-week placement. As Education Centre staff are part of a team which includes social workers, psychologists and child psychotherapists, families who attend the MFEC are also afforded easier access to these and related services should they be necessary.

  As well as making use of planning, target-setting, daily feedback and regular review across agencies, the programme has developed the use of technologies to assist the process of change. Information technology and interactive whiteboards are used for presentation of material; digital technologies (both video and stills photography) is used regularly by both staff and families, in schools and in the home to provide other perspectives on the families' experience of change. The Centre won the NHS Innovations Award 2008 in the mental health category for its work on the use of physiological feedback via heart rate monitoring in measuring young people's levels of arousal. This now forms a key part of the treatment at the Centre.

CASE STUDY

    A child and his legal guardian had turned up late every day during the 3 weeks they had attended the Education Centre to the frustration of other families. A joint plan was created with the families to record their morning routine and their cycle journey to the Centre using a digital video camera to try to identify why. The next day the child and guardian bounced into the Centre on time. On review of the tape in the group the management of conflict within the family was established as the principal reason for the lateness. It was then possible to move to a discussion of new strategies to manage conflict and improve punctuality. Without the use of digital technology it would have taken much longer for this information to emerge.

EARLY INTERVENTION

  A team of eight Early Intervention Workers (EIW) deliver mental health services directly in schools. The team comprises members with a range of professional backgrounds: teaching, family therapy, clinical psychology, psychiatric nursing, art therapy. Each school in Westminster can call on a named team member.

EIWs work alongside school staff in the identification of mental health difficulties in young people in schools. Treatment is also delivered in school through:

    (i) Family Groups: the EIW and a named member of the school staff jointly convene a weekly session for referred young people and parents. Specific behavioural targets are devised collaboratively between the parents, teachers, other professionals and the child so that a focused intervention can be created that is relevant and useful to all parties. Progress is reviewed weekly in the group and every six weeks with other professionals. The location in school enables families to engage more easily with mental health services. It also allows them to acknowledge the link between emotional well-being and their children's learning. Working in group settings increases the number of families who gain access to services and improves cost-effectiveness.

    (ii) Individual family work with young people and their parents. This takes place independently of, and sometimes as a precursor to joining a Family Group.

  The role of the EIW is central to a family's access to more intensive or specialist mental health services and referrals to the MFEC are made through this channel as well as those to psychiatry or child psychotherapy. The EIW also plays a bridging role when a young person returns to school. Membership of a Family Group acts as a support in the process of re-integration into mainstream education.

  Close collaboration between school staff and EIWs has enabled the development of a body of mental health awareness and expertise in schools. Staff feel more confident in the identification and management, with support, of mental health difficulties displayed by young people in schools. Regular training courses and consultation and supervision groups delivered by EIWs to school staff have consolidated this.

CASE STUDY

    The Special Needs Co-ordinator in school made a referral for Katja and her son Wilaf aged 11. Wilaf was experiencing ongoing difficulties in making friends in school. Disputes were increasingly ending up in violence. Katja was resistant at first to involvement with mental health services but agreed to meet with the school's EIW. A series of meetings was arranged as a result of her growing ease with the process. She disclosed in time that she was suffering increasing difficulties in managing Wilaf at home. He would fly into rages and was physically challenging to her. She admitted she was frightened that in time he would assault her. Some improvements took place in their relationship but Katja remained convinced that there was something seriously mentally wrong with Wilaf. The EIW arranged a prompt child psychiatry appointment for them which did not lead to a diagnosis of Wilaf's mental illness. This helped Katja locate the difficulties in the relationship between them. Family work continued in school with Katja assuming more of the responsibility for change. Wilaf has since made a successful transfer to secondary school.

      6.  A number of key themes have repeatedly presented themselves during the period of developing our service over the past 25 years. Some of these correspond with key themes identified in the Department of Health publication New Horizons: Towards a shared vision for mental health (2009) and bear repeating. In the development of a strategy to effectively manage behaviour and discipline in schools and to enlist the support and co-operation of mental health services in achieving this:

      (i) Services must be accessible and prompt in their response.

      (ii) Efforts should be made to reduce the stigma young people and families experience as a result of involvement with mental health services.

      (iii) The importance of agencies working together must be stressed.

      (iv) Value for money is paramount.

      (v) Preventative work and early intervention should be seen as money-saving in the long-run.

      (vi) Services should champion innovative practice.

      (vii) Schools should be able to use services which are flexible and can be tailored to their specific needs.

    September 2010




 
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