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
disordersanxiety and depressionand 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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