Here at West Midlands ACAMH we’d like to extend a warm welcome to all of you who have an interest in children and young people’s mental health and psychological wellbeing. Whether you are a psychiatrist, psychologist, teacher, social worker, nurse or other who supports children in a professional capacity or whether your expertise comes from caring for a young person with mental health issues, we believe ACAMH has something valuable to offer.
Through our webinars, workshops and conferences we aim to provide you with the latest research findings and information on interventions developed on evidence based principles. Our events are credited for CPD.
Our committee is active in building relationships and developing links with local organisations and groups such as Birmingham’s Mental Health Operations Board and local universities and providers of professional training. By being an integral part of the wider community involved with children’s mental health issues, we can extend ACAMH’s contribution to the understanding and management of child mental health issues to a diverse range of professionals and others. Through sharing information and best practice we aim to enable you to provide children and young people in the West Midlands with the most up-to-date and effective support around mental health issues.
I’m Sheena Ashford and I’m both a health psychologist and an educational psychologist. I spent my early years in research, mainly national initiatives around health and education. More recently I ran a school-based children’s mental health service. I’m hugely committed to improving children’s mental health through effective, evidence-based practice. Please email me at email@example.com
Reena S Sungum-Paliwal
I am a retired Consultant Child and Adolescent Psychiatrist and am proud to have been involved with ACAMH Midlands Branch for over thirty years. You can also help with the advancement of child and adolescent mental health by joining the ACAMH Midlands Branch. We would love to welcome you on board.
Hi! I’m Pete Maguire, consultant clinical psychologist, also educational and child psychologist, and teacher. I have worked in services for babies, infants, children and young persons for more than fifty years, having served in almost every area of provision for children, including senior management and leading clinical roles in CAMHS and other services.
ACAMH is a great resource for all who have at heart children’s mental health, wellbeing, development, and also the growth of knowledge and understanding through research. We welcome your interest in our local and national committee and activities.
I have had a career in supporting children and families with special educational needs and disability. The work has been focussed on the identification, assessment and provision of needs. My work has also led me to establish a Social Work Practice Education Unit.
I champion a rights based approach for disabled children and young people and I am a member of the Council for Disabled Children’s Special Education Consortium.
We’d like our committee to represent a diverse range of experiences and views. We’re keen to encourage members to consider volunteering for the committee – there are no entry requirements apart from enthusiasm! If you’d like more information about what’s involved, please contact Sheena Ashford. Email: firstname.lastname@example.org
As a committee member you’ll receive free membership to ACAMH, free attendance at Branch events, plus the potential to attend the ACAMH National Conference free of charge.
Some of the benefits of joining the committee are:
Free ACAMH membership
Free attendance at Branch events
Opportunities to attend the ACAMH National Conference for free
Professional networking opportunities
Up to date information on current issues, challenges, and opportunities in different areas of children’s mental health
Les Lawrence, Chair, Children’s Quarter Board, Birmingham ‘To what extent will positive mental health, economic and emotional wellbeing of families, and children and young people, be considered in the re-opening of schools?’
This was a live webinar recorded on Wednesday 8 July 2020 for ACAMH West Midlands Branch as part of the ‘Return to school: the impact of COVID’.
Les LawrenceLes Lawrence is the Chair of the Children’s Quarter Board. Children’s Quarter is a co-operative of groups committed to creating inclusive opportunities for children, young people and their families, currently socially isolated by their experience of being disabled, or of mental ill-health or of any other reason. Former roles include; Heart of England NHS FT Chair, Royal Orthopaedic Hospital NHS Trust Chair, and Birmingham City Councillor – serving as Cabinet Member for CYP and families for 8 years. Les also served as the Chair of the CYP Board of the LGA.
This presentation is based around a series of national surveys, studies and reports and, in addition, the specific work in Birmingham by the Mental Health and Emotional Well-being Steering Group, which has members from health, mental health services, local authority, which includes, of course, education, social care, public health, NGOs and charities, and is part of the Birmingham Education Partnership. I would like you all to keep these in your mind as we go through the presentation.
Mental health has always been a subject that dare not speak its name for a very long time, but is now becoming a subject that is now receiving a great deal of support and consideration. But insufficient resources, irrespective of the initiative launched by the DfE and the Department of Health back in 2018.
Covid-19 will be with us for a considerable period of time, as will its consequences. Therefore there is no short-term fix in that regard. May I also suggest that we need to adopt to real-time methodology in planning, responding and adapting to circumstances as they emerge. Not easy for public services and especially governments. We need to forget boundaries and have multi-skilled teams working across sectors. Our staff are our most important resource and we need to develop their skills, capabilities and competencies to enable the real-time flexibility I’ve just stressed to occur. Also building confidence, trust and resilience back into our systems will require, at school level, may I suggest, curricular change. And in other areas practice change and cross-sectoral participation.
What I want to do is just to provide a degree of context as to what has been happening over the past few months. Around 40 per cent of adults are reluctant to venture out. A new word has being coined, coronaphobia. Around 68 per cent of non-disabled siblings are providing extra care in the household which they have not done in the past. A significant number of families, to varying and worrying degrees of emotional and mental health issues. 39 per cent of families have seen a reduction in incomes and 61 per cent of families have seen increased costs, with 21 per cent saying that they will definitely go into debt.
Parents are reporting significant increases in behavioural problems, for example, tantrums and disobedience amongst four to ten year olds. But interestingly, and conversely, less so in 11 to 16 year olds. A third of all age groups have indicated increased stress, loneliness and anxiety. And homelessness is likely to rise once rent protection is removed in August.
People in general, also, are losing trust in government, institutions and, to a lesser degree, experts. Not trusting or believing what they are being told or asked to do. In the great miasma of facts, factoids and misinformation how are parents and their children to weigh up the odds? Is it a wonder that many have opted to keep their children home and have expressed considerable concerns in returning to September despite the latest DfE guidance? In Birmingham, our Director of Public Health has coined the phrase ‘hokey-cokey world’ and that is what he thinks children and young people will be facing. The in, out, shake it all about syndrome.
Previous studies have shown that young people often get from school secure relationships, including those with teachers, build self-worth and esteem, stability, create a sense of meaning, and see that they have a purpose. Now, whilst many families, together with their children, will adjust to school restarting, a significant number will not. Some of those who will find it difficult to adjust will have identified special needs, including some with the HCPs, Child Protection Plans or Children in Need Plans. However, many will have had no previously identified need and will require considerable support initially and, in some cases, support on a long-term basis.
Over the past few months, via surveys, studies, helplines, work done, some by Kooth, a young person’s mental health charity, not only nationally but it is now working in Birmingham, together with the NCB Disabled Children’s Partnership, amongst others, have produced evidence of children and young people suffering increasingly, to varying degrees, anxiety, sadness, fear of change, depression, suicide tendencies, social isolation, or combination thereof. What this has allowed to be done is to put these attributes into characteristics.
First, the afraid to leave home. Those who have withdrawn from the social world, become disconnected, found the long period at home hard to manage, have become or show tendencies around emotionally-based school avoidance. The next three categories can be described as containing pupils with learning difficulties or have pre-existing mental health or serious health difficulties or are in low-income households without the technology. Many of these have become disaffected with school or awaiting placement due to exclusion. But one thing is very noticeable. They have become increasingly frustrated and depressed.
The happier at home. Those have enjoyed a secure and safe environment at home, have found their learning has been enhanced because the kind of distraction and avoidance of trouble has been removed. They do not want to return to school.
The re-engaged. Those who have found large classes difficult, were at risk of permanent exclusion, but often they have continued their education but have found that small group working, one-to-one support has seen their behaviour improve. Adopt a more positive view of education. They do not want to return to normal in terms of how their school is.
Interestingly, in Birmingham, Kooth found that black, Asian and minority ethnic families have been hardest hit, with family relationships often highlighted. And interestingly, across all the age groups, irrespective of their background, more females than males coming forward to discuss their individual circumstances. Further, many have also expressed a view homeschooling may have the unintended consequence of challenging the parent-child relationship, especially where the parent is juggling work from home with the homeschooling role. I’ve included two quotes from mothers, which I think exemplify the situations faced with which support will required going forward, as it’s known as pressure cooker families.
The conditions created by Covid-19 have increased the likelihood that both stressers and vulnerability will increase at a time when the protective services we normally rely on have been weakened and families have reduced social support and connections to rely on. Young people with digital access are spending more time using social media and online resources.
I seem to… Sorry about that, I seem to have rolled past. Let me just go back.
Right. Sorry about that. Added to this, children may be receiving less protection within their home if their parents are overburdened and standards of supervision have fallen. Many may be susceptible to grooming if they feel lonely or uncared for. And almost certainly they will have reduced access to protection from trusted adults outside the home.
Though child and domestic abuse concerns have seen helplines busier, it has become more problematic to both refer cases or have the ability to assist by gaining access to the home or to provide a safe refuge to support the young person or family members subject to the abusive environment. The most recent report indicates that calls to the UK’s National Domestic Abuse Helpline have reportedly risen by 66 per cent during lockdown and visits to its website increased by 950 per cent. Demand for beds in refuges has also rocketed. Witnessing domestic violence as a child can have a huge impact on their future and their mental health. Phone interventions can never compensate for home visiting.
This will have created issues for schools, especially when a number of these young people return to school. And one has to wonder whether the social care will have the ability to cope with the increased workload and whether they will be able to support the young people on their return to school. The latest report from the School’s Commissioner makes specific reference to the urgent need for local agencies, Councils, schools, youth workers and police to focus resources on adolescents at risk of becoming invisible to services or who have gone missing under lockdown. This group are easy prey to criminal gangs and abuse, as well as extremely high risk of becoming not in education, employment or training, NEET, or being excluded. It is essential that they are supported to recover from the crisis and have a way of getting back into education, training or work
To address this, the Department for Education, schools, local authorities, police forces and Safeguarding Partnerships need to work together to identify, track, support and ultimately re-engage this vulnerable group. And parents should be supported not fined for this.
The mitigations indicated on this slide are being undertaken to a greater or less degree across Birmingham. But I want to concentrate for a moment is what is happening in Birmingham. Now, bereavement counselling in Birmingham, of course, had to be adaptive in its approach to enable the various religious, cultural and ethnicity dimensions to be considered. And it is being provided equally to both families, young people and school staff, ’cause one forgets that often school staff have themselves lost members of their nearest and dearest.
Work has also been undertaken to identify as many young carers as possible, both those who have had long-term responsibilities and those, because of the pandemic, who have become involved in increased caring responsibilities. This is being done so as to provide support to those young people on an ongoing basis. But equally, and in parallel, to support those parents who are self-isolating and, or especially clinically vulnerable. And also often those young people are looking after other youngsters, other siblings who have special needs. All of this additional support is to ensure that those young carers are fully re-engaged in their education. Unfortunately, this is a situation unlikely to change to any great extent from September, irrespective of government guidance, given the low levels of trust, confidence and resilience currently experienced by individuals or in their communities. Sorry about that.
One group of concern are those who exhibit emotionally-based school avoidance tendencies. Their reluctance to attend school becomes entrenched due to emotional factors. Can I emphasise the use of the word ‘avoidance’, not refusal, as these youngsters often want to go to school but simply feel as though they cannot and are often not in control of their feelings.
In Birmingham, to assist in identifying those in this group, determine the intervention and support requirements, the signs of safety and well-being framework and early help assessment tools are being developed. This work will be undertaken with well-being leads and practitioners in and across schools. This is in addition to supporting schools in their universal approaches with wider statutory and community partners.
Further work has been ongoing to develop a governance and governing board toolkit with regards to positive mental health and emotional well-being, to assist governing boards to meet the duty test and covers such areas as physical, emotional and positive mental health and well-being, protection from harm and neglect, ensures that mental health and well-being represent an integral part of strategic and operational practice, ensure consultation on this issue with the whole school community and it is seen as a collective responsibility. It also wants the impact of all this to be assessed, so that defined outcomes can be determined and improvements and the process refined, as appropriate.
The next two slides indicate how, around the country and in Birmingham, techniques are being developed and lessons learned to begin to encourage children and young people back to school, not only over the last few weeks but for the anticipated return in September. And this is in conjunction with the programme of catch-up tutoring and the associated monies. These initiatives, practices and techniques have and are being discussed, communicated, adapted and developed, depending on the circumstances identified and are being faced in real-time.
One particular aspect that has been given a lot of consideration has been behaviour, given that the emotional well-being of many returning pupils will be at differing levels, together with the parental anxiety levels that themselves will need to be addressed, and the application of traditional behaviour policies which could give rise to a potential explosion in exclusions. Therefore we have to ask, should the punitive zero-tolerance practices be replaced by restorative practices based on consequences? Unfortunately, the Secretary of State implies fines should be levied for non-attendance. Many head teachers feel that this is inappropriate, at least in the autumn term, if not for at least two terms thereafter. Equally, to what extent should schools be allowed to flex the curriculum to encourage the rediscovery of the love and joy of learning, be more open to using the vocational, technical and arts routes to engage, encourage exploration and appreciation of self and each other, rather than just returning to the academic, exam-driven environments? The worry being that young people will find it difficult to re-engage, become distracted and therefore start to not attend, increasing the numbers who may well need to be excluded in the traditional sense.
In Birmingham, work is also being undertaken to support the professional development of school staff in dealing with the consequences of the pandemic. Also to provide consultation opportunities for both school staff and parents to ensure that parents have the confidence and the resilience to allow their youngsters to come back into school and to understand that the environment will be safe, for example. Also to assist [inaudible – 0:18:56-0:18:59]
schools are being encouraged to identify members of staff with additional training to enable them to be ones who can be approached, for example, by anxious pupils, or can assist in providing a safe place where a young person can go if needed or to identify and even assist where whole family support is required.
What has also become noticeable as schools have moved to post-pandemic working is the way, depending on the methodologies used, the ease of transition that has been achieved, irrespective of the type of community served. Many of those who have tried a top-down approach, treating staff, for example, without reference to their levels of vulnerabilities, have faced considerable logistical difficulties. Similarly, depending on the level of communication with families in the wider community, this has often had a direct effect on the levels of participation. Those schools which have utilised an holistic approach have seen increased participation at every level, with many in the wider community assisting as well.
Also, many schools, as part of this approach, have sought to ensure that young people are included in the decisions involving their well-being, have listened to their views and worked with them to design policies that, for example, promote good behaviour and discipline. Equally important, by building social and emotional skills into the learning life of the school, resilience, structure and confidence can be rediscovered, developed and entrenched in young people.
The last comment in this regard, each school is very different and no one-size-fits-all approach will ever be sufficient. It does require the flexibility of approach I suggested at the beginning.
Some final thoughts. Many of the issues that I have raised could, I suggest, a few years ago have been addressed through facilities that we once had. I’m sure many of you can remember Children Centres, the Family Nursery Hub in many communities. Professional help on hand, often with a youth unit for excluded young people. Can you remember Extended Schools which used to have wraparound care, from breakfast to tea with homework clubs? And I’m sure many of you can remember the numerous youth centres which were available to engage and to ensure that youngsters had activities that were appropriate to their age. Almost all of this has been stripped away through austerity, leaving services stretched and schools often having to pick up the pieces. Should we be seeking to reintroduce?
Budgets are stretched. Needs will be greater, as will the support required. But will it be available at the point it is most needed? Yes, services are being brought back in, especially in the health service, but do they have the level of provision, do they have the resources and the staff to be able to provide that support at the point it is most needed? One thing that we will have to do, I would suggest, is to change working practices. We will have to pool more resources. We will have to create multi-skilled teams of professionals. But above all, to address the changed environments, it must be recognised that there has to be a programme of investment in services for families, children and young people.
Roy Broadfield ‘Parental Engagement, home learning and educating in an unprecedented landscape…’ This was a live webinar recorded on Wednesday 8 July 2020 for ACAMH West Midlands Branch as part of the ‘Return to school: the impact of COVID’.
Roy Broadfield B.Ed. (Hons), Founder and National Consultant, Impact in Learning, has worked in education for 24 years as a teacher, senior leader, lecturer and consultant. He developed the Impact in Learning Programme, now run in over 400 schools in 14 authorities, which supports parents to help bring about attainment benefits for pupils through accelerated learning. Roy’s has worked with a number of government departments, including Communities and Local Government and the REACH programme, which aims to improve education for black boys and young black men.
Good morning. I’m Roy. Thank you for inviting me to speak. If I can just explain that I’ve been a teacher now for 27 years, a senior leader in schools, a national consultant. I’m currently working as a lecturer in education at University College, Birmingham. Been a schools advisor in several authorities, including several authorities in London. I’m a maths specialist teacher and also a specialist leader in education. So that’s my background in teaching.
Thinking about the situation for schools and educating children during lockdown. I’m a lecturer in education. We have PGCE students and teacher apprentice students at our university. I was working happily with those until this lockdown situation came. And obviously they were halfway through their course in learning to be teachers. I was also delivering my impact workshops to families and to parents to help them to understand children’s learning and the way in which the curriculum works now. So we do that in schools with groups of parents in the school, bringing them in. So obviously all those impact workshops during lockdown had to go on hold, and we had to find new ways of working to get our teacher trainees, who were only halfway through their course, to finish their course and to work in a different way.
As they were working in different ways, and our teacher apprentices are school-based, so they were continuing to work through the lockdown situation. And as they were working, it was interesting to me to find out what was happening, because I was hearing from parents and from teachers and from teacher trainees about the challenges that were had in order to deliver and continue to deliver learning during lockdown. So I requested some information from them. Now I did a little bit of non-academic research, and I have to point out that the views that come out of this are my own. So it wasn’t really a university-led project. It was just out of my own personal interest. And what I did was I used reputable social media education pages to ask for information about education during lockdown. And I put out some questionnaires to our students as well, made some phone calls to parents I knew. And got responses to these requests for information from 70 teachers, 24 teacher apprentices or trainee teachers and 60 parents, who gave me information about what they felt was happening during lockdown. It gave me some really interesting insights.
So in terms of teachers, they realised that there was this sudden expectation for teachers to deliver lessons online using various platforms. In one case, one teacher said to me that they were being asked in their school to use nine different platforms to deliver the different aspects of learning in phonics, maths and so on. So there’s a massive expectation there for teachers to very quickly learn to do that. They also had to ensure that all the children could access the work. There were children with no internet access, children with very limited resources at home, children with no resources, often in deprived areas, for using manipulatives for maths, for instance, and all that kind of stuff. So the schools were expected to ensure that that work could be accessed.
They had to support parents to deliver the learning. Parents kept saying to me, I’m not a teacher. I’m suddenly expected to be a teacher. And schools had to find ways of helping to deliver that learning with the parents. There were a number of parents and families who disengaged immediately. Some schools said that after lockdown they didn’t have any response from parents for two to three weeks. And so they had to chase them. They had to check that those children were okay, they had to check on vulnerable children, particularly, and make sure that those families were coping, and wondering why there was no communication being made with the school when homework was being set. And they had a duty of care to check on vulnerable families.
There were some communication issues. Some families were… They were unable to communicate with those families. And a lot of families found that the schools were difficult to communicate with as well, at the same time. And during all of this, the schools were continuing, obviously, to teach and be in school and teach the children of key workers in school.
And the parents’ point of view. There was a lot of talk about the quality of support and resources and how that varied from school to school. So there was no parity. A lot of parents were complaining that the school down the road are getting so much more help than we are and vice versa. Some felt that the level of support from school was amazing, others felt that they’d totally been left totally on their own to deal with how to teach, what to teach and given very little support from their schools.
A lack of devices in the home was particularly problematic. If you imagine two parents both working from home, as was the case in a lot of households, with the only two devices that they had, and then school saying, with your three children we’re delivering live lessons this week. So every morning at ten o’clock we need every one of your children to be online and your class teacher will deliver maths and English for a couple of hours. That led to real problems with that lack of devices. I know the government stepped in and tried to promote schools to purchase devices for those families, but that in itself was delayed and led to some issues as well. A lot of parents said this to me that they were at a loss of how to deliver learning. Again, this thing, I’m not a teacher, kept coming up. Everything has changed since we were at school and we just don’t know how you deliver the curriculum now, which is an ongoing issue for parents.
So the overall emerging patterns that came out of this were that live lessons are impractical and unpopular for the reasons that I mentioned before, particularly the access to those live lessons. People having to be in the same place at the same time as the teacher delivering those live lessons made it incredibly difficult. However, the most popular thing was class teachings that were informal, where teachers came online in a Zoom meeting or similar. The children of one class all got together, they talked about, with their teacher, so show-and-tell about what they’d been doing. And that was really popular with parents and teachers alike.
A really interesting observation that was made by parents, teachers and some of the children that I spoke to, my nieces and nephews, for instance, on the telephone, was that seeing and hearing the teacher on-screen was the most positive boost for children’s well-being. Lots of parents saying to me that their children didn’t engage in homework when it was sent by e-mail or didn’t engage in homework when it was just online, accessed via the school website. But the minute they saw and heard their teacher on-screen, it re motivated them and much more homework was done as a result of that.
And the other thing that really came out was parents need to be shown how to support learning at home. We can’t expect them to just teach the kids things that we send to them because, as they keep telling me, we’re not teachers.
So what has worked well? So I contacted my teacher apprentices and said to them what’s worked well with you? And Chris is one of our teacher apprentices at a Birmingham school, and he said that he’d been sending homework out two or three weeks and getting very little response so had to take a new approach. And one thing that worked really well for him was this idea of asking children to teach your parents something that we’ve already learned. So he would give them the stimulus and just say, teach your parents something that we’ve learned in science. Teach your parents something that we’ve learned in English. And this particular homework that was set was teach your parents what we know about the parts of a plant. And teach your parents what we know about the reproductive system in flowering plants. And this was one child’s response. Actually took her parent outside, found a flowering plant, broke it up and had this artistic approach to demonstrating what she knew. And the parent learnt alongside. And the feedback came from homework being photographed and sent back into school. And that was shared with all the other children as an example of what you can do. We all know that when you teach somebody else something that you know, it reinforces the teaching for yourself as well. So that was really a popular way of delivering homework to children.
Another one of our teacher apprentices, Jodie, works in Victoria Special School in Birmingham. And she realised that the complex curriculum that they teach in special schools was going to be really challenging for parents to deliver at home. So what Jodie did, as a trainee teacher, let’s not forget, she’s not an experienced teacher of many years. Well, she created her own web pages on the school’s website for her children and parents to access at home, where she described the prime areas of learning and development, and then gave examples of the sort of things that she would be teaching on their topic of ‘The Great Outdoors’ this term.
What was lovely about this was that a lot of those little examples around the edges had links to short videos, videos of her, YouTube videos, stories and so on, and activities that the parents could take part in at home with their child. And then the parents would take part in these activities. And the way in which they fed that homework back was that they would upload photographs on a page, again that Jodi created, for home learning photos, where the children would take photographs, their parents would take photographs of the children being engaged in those activities, and they’d be uploaded. And it gave them a talking point as well when they met together with their class teacher to talk about the photographs and the things that they’d been doing, which was a really successful way of delivering that.
So as an SLE, I’ve been working with supporting St. Patrick’s Catholic Primary School in Coventry. And this is the teacher that I’m working with there, Elise*. And Elise* and I were working on home learning ideas for the children that were inspiring and motivating and accessible to them. Now, we had to bear in mind the things that had come out of that little bit of informal research that I’d done. Parents need instruction. It’s no good just sending them a worksheet and saying get your child to do this. The parents need instruction, they need some support, they need to see how it’s done. We know that what motivates children most is seeing the teacher on-screen. And we realised that no live events could really be accessed by all children.
So videoing short videos with the teacher on-screen and instructing the parents was going to be really popular. So Elise* contacted her IT team, she found out there was some Apple Mac software where we could merge her image with some instructional video that we could share with the children and the parents. And the plan is to send these home for every year group. Now, I have to tell you that this little video that I’m about to show… it’s a short video… is a little bit jumpy when we’ve got a large Zoom audience, but I just hope you get the gist of that merging some instructions for parents with the teacher being on-screen, which is so very important. And I’ll just play that short video now.
Video presentation: Hello. Good morning, everybody. It’s Miss Biggins here and I welcome you to our addition presentation for Year Four. And we have our addition column here and our calculation on the left-hand-side. And our calculation today is 3232 add 1053. Now, it’s really important that we use our place value today. So that’s why we’ve got the grid next to us so we can see where they need to go. So, we have got 3000 which is represented by three ten-pound notes, 200, which is represented by two-pound coins. Three tens, which is three ten-pence pieces, and two ones which are represented by our one pennies there. Now, working in coins today. It doesn’t matter if you haven’t got coins at home. We’re going to use whatever you have. So you might have counters like we have at school or you could just have little pieces of paper, as long as they’re all the same size or you’ve coloured them the same. So remember…
Roy: Okay. Can I just ask someone to just come onto mike and let me know was the sound okay on that video? Did that..?
Participant: Yes, that was fine, Roy. It was a bit jumpy but the sound is absolutely fine.
Roy: Thank you very much. Thank you. Great. So that was one version of instructing with parents with the teacher on-screen. And so then, when we have this blended learning situation, which is likely to occur in September, this is what we’re working on delivering to every single year group from that school. Sorry, I’ll jump back.
So despite all the hard work and efforts by parents and teachers, and despite everyone working really hard to ensure that children were continuing to learn at home, there have been lots of news reports from health professionals and the national press about this mental health crisis that’s likely to come as a result of the lockdown situation. We all know that mental health, childhood mental health issues, were already a concern way before this came into play. Young Minds, for instance, talking about the number of five to 15 year olds experiencing anxiety and depression increasing by 48 per cent between 2004 and ’17. And Action for Children discussing how one in eight five to nineteen year olds had at least one mental disorder when they were assessed in 2017. And The Children’s Society, going right back to 2008, pointing out that 70 per cent of children and adolescents with mental health issues not receiving appropriate interventions sufficiently early enough. So we know that mental health issues were already a concern. If we see this mental health.org.uk, going back to 2018, this organisation was very concerned that the test-driven, narrow curriculum was having an impact on the well-being of some children and were campaigning for a more broad and balanced curriculum to be had. And then lockdown came, when we know that that would have impacted upon many of those children.
So what does that mean in the present circumstances? Well, the best piece of evidence that I could find of a bit of research done, one study was from the University of Oxford where they followed more than 10,000 parents for one month during lockdown in their co-space survey. And what they did was they questioned the parents of children and adolescents, and they questioned the adolescents themselves, and they were particularly interested in finding out about the emotional difficulties, behavioural difficulties and restless and attention difficulties that children may have experienced during lockdown.
Particularly concerning here is, if we look at the first row, these are parents reporting on children at primary age. Their emotional behaviour and restlessness all increased when they were locked down at home over that one-month period. If we look at adolescents, when parents reported about them, they said that their emotional difficulties decreased, there was no change in their behavioural difficulties, but their restlessness and attention difficulties increased. However, the adolescents, when they self-reported, felt that there was no change. So it’s really interesting to see the perspective there between parents and what the adolescents thought themselves.
Something that came as a little bit of a surprise for me was that children with special educational needs and disabilities and those who’d already been recognised as having mental health difficulties, because they were locked down with families at home, their emotional difficulties on the whole actually decreased and there was no change in their behavioural difficulties and in their restlessness and attention difficulties.
And as Liz pointed out, I think the real concern here, looking at this, is being prepared for when these children go back to school and what that means for schools. We hear a lot now about schools talking about a recovery curriculum. And what is it that we need to prepare and what is it that we need to get ready when these children return to school in those situations?
I noticed online, again, a reputable Twitter site, which asked the question about children who had started to return to school. And the overwhelming consensus by teachers and head teachers was that children have come back in displaying no real problems on the whole. A head teacher in Birmingham pointed out to me that a lot of the children have come back well into her school, they’ve been fine. But it would really be context-driven depending upon the experiences that children have had. But she pointed out that children in Handsworth in Birmingham are amazingly resilient and she feels that they’ve come back in incredibly well, and that looks very promising for the future.
So my heart sank, when we consider everything that we heard from Les and some of the things that I’ve just mentioned to you, when I saw this news headline on the 29th of June which said that, in order for children to catch up on all that learning that they’ve lost in the last few months of being locked down, that schools may need to cut the curriculum and focus only on maths and English for a year in order for them to catch up. And it was really disappointing and quite depressing to see that information being put out there by the Secretary of State for Education. However, my heart was raised again three days later when this headline came out. Where Gavin Williamson said we understand it will put additional pressures on teachers, but the curriculum must be full, broad and balanced, which echoes the new Ofsted framework, which says that inspections will be there to ensure that children receive a full, broad and balanced curriculum when inspections take place from September onwards.
So what do we need to do to ensure that we have that broad and balanced curriculum? I think there’s a great opportunity here. Eckhart Tolle the philosopher talks about out of adversity comes opportunity, and I think we need to take that opportunity. Never before have we been in such a situation where we can take what we know and have such an opening for change. Sir Ken Robinson has said for a long time that there’s a need to teach differently, that the task of education is not to teach subjects but to teach students, to teach children. And this was echoed recently in a Times Educational Supplement article by Liz Robinson who said that school leaders need to be aware of the three H’s and make sure that we’re teaching to the three H’s when children arrive in this new world that awaits education. That we need to be teaching children for their head, which is all the academic subjects, but we also must be teaching equally to their hearts, which is social and emotional subjects. And we also need to be teaching to their hands, which is the creative, creativity and problem-solving.
One way that I… Another example that I saw of this was the Excelsior Academy Trust in Birmingham who are promoting a programme called Agents of Hope, where they’ve taken 14 children’s storybooks and written lesson plans for each of those storybooks. And the lesson plans that they are hoping to teach, obviously as a PS [inaudible – 0:18:41[
we’re getting children to talk about those things that have concerned and worried them. The books explore ideas such as sadness, worry, loss, bereavement and loneliness. And those lesson plans are available to all schools free of charge if you e-mail Andrew Moffat at the school, and his e-mails are displayed there on the screen. And they’re hoping that a PSHE approach will help children to talk about those experiences that they’ve had.
So the DFE very recently said that there will be [inaudible – 0:19:15] to teach for mental well-being and released a document in June 2020, part of the Health Education Lessons in School for both primary and secondary. And this sign-posted schools to the NHS Five Steps to Mental Wellness page and encouraged teachers to deliver education that includes these things. So connecting with other people, being physically active, learning new skills, giving to others and paying attention to the present moment through mindfulness.
So why mindfulness? Well, mindfulness is growing in popularity in schools. There are several programmes available. Mindfulness in Schools project, the Headspace for Kids project, Mind Up was created by Goldie Hawn, the actress, and is working in a lot of schools internationally. And the reason for this coming out into schools now, being more and more popular, is that there’s now lots of scientific evidence that breathing exercises and sense awareness exercises are known now to reduce anxiety, to increase children’s resilience and to give children and adults clearer, more productive thinking.
And the photograph of the person that’s there is Chris Ludlow, who is one of our ITE lead at University College, Birmingham, is a published author in the field of children’s mindfulness and has created the Thought Bubbles website, which you can see an image of there. And just to give us a taster of what the sort of thing that we’re suggesting children are experiencing in part of their recovery from all of this, I asked Chris if he would lead us, just to finish off with, in a very short mindfulness exercise. And I’m going to hand over to Chris in order for us to experience that now.
Video presentation: Good afternoon, everyone. And welcome to just a really short mindful breathing exercise. Okay. So first of all, it’s just really important that we’re nice and comfortable, whether we’re sitting down, sitting down on a chair or the floor. Just nice and comfortable. So just take a moment just to get yourself really comfortable. Okay, so when we are comfortable, okay, sitting up nice and straight with lots of air in the lungs. Really, really important. Okay. And then just really slowly taking a few deep breaths. So it’s in through the nose and out through the mouth. In through the nose. And out through the mouth. And as you’re doing this, you can count slowly up to five as you breathe in and then as you breathe out down from five back to one.
Okay, now just gently and slowly, on your next out-breath just close the eyes. And just take a moment. Let your breath return to normal. And just listen carefully to everything that you can hear around you. And then just focus on the breath. The in-breath. And then the out-breath. Just thinking about the in-breath as our stomach goes a little bit harder and the out-breath, as we gently relax. Just take a moment to focus on your breath. And then gently open the eyes.
I hope you enjoyed that. And it’s just something that you can do at any point in the day when you’ve got a spare moment just to re-energise yourself and refocus yourself. Thank you.
Roy: And just in summary, I feel inspired. I feel we have a unique opportunity to work together to create this educational approach that will effectively prepare children to lead valuable, productive lives, where all their talents and interests are nurtured. Thank you very much.
ACAMH members can now receive a CPD certificate for watching this recorded lecture. Simply email email@example.com with the day and time you watch it, so we can check the analytics, and we’ll email you your certificate.
Tamsin Ford is Professor of Child and Adolescent Psychiatry at the Cambridge University. She is an internationally renowned Child Psychiatric Epidemiologist who researches the organisation, delivery, and effectiveness of services and interventions for children and young people’s mental health.
She completed her core training in psychiatry on the Royal London Hospital Training rotation and at the Bethlem and Maudsley Hospitals and she completed her PhD at the Institute of Psychiatry, Kings College London. She moved to Exeter in 2007, leading a group of researchers whose work focuses on the effectiveness of services and interventions to support mental health and well-being of children and young people. She was an Editor for ACAMH’s journal CAMH six years, stepping down as lead editor in June 2014.
She recently moved to the University of Cambridge. Tamsin’s research covers the full range of psychopathology and agencies, practitioners and interventions that relate to the mental health of children and young people. Every interaction with a child presents an opportunity to intervene to improve their developmental trajectory. Her work has direct relevance to policy, commissioning and practice.
So, my name is Tamsin Ford. I’m a Child and Adolescent Psychiatrist by background and I’m currently working for Cambridge University. I’m unusual as an academic, in that I did all my clinical training, post-graduate training, before stepping sideways and getting involved in research. So, I worked for 10 years for the NHS full-time and over the past, sort of, well probably decade, if not slightly longer, the interface between mental health and education has become an increasing research preoccupation of mine because children who struggle with their mental health can have a big impact on schools and, likewise, schools can have a big impact on children’s mental health.
My background as a researcher is epidemiology, which means quantify, well, I think people, you know, I don’t have to explain it quite so much now after three months of Covid. I do communicable and non-communicable diseases epidemiology. So, mental health epidemiology. But epidemiology is the quantification of who has problems, what are the risk and protective factors, how those change over times and it’s, kind of, the basic science that underpins public health approaches. And that’s the kind of direction that my work takes.
We have had a series of very large internationally excellent surveys in the UK that we should be really proud of. We perhaps should have had more of them. The adults have been surveyed every five years initially and then every seven years, but the most recent of these surveys involved over nine thousand children between the ages of 2 and 19 and took place in 2017. This showed that of school-age and going up to 19. So, school and college one in eight young people had a diagnosable mental health condition that was impairing their ability to function. And, in fact, 1 in 20 met criteria for two or more conditions and they were more impaired. So, it’s well worth bearing that in mind.
This study was unusual in that it actually went down to the age of two. So these are the first national level data we have for poor mental health in pre-schoolers. And that suggested about 1 in 20 have a diagnosable mental health condition at that point. Now, the question we were answering for government was how many children out there needs services? So, that’s why I’m talking about diagnosable mental health conditions. I’ll come back to that point later. Now, I hope you’ll be able to see my mouse.
So, in 1999 and 2004 there were previous surveys, which because they were done using as close as we could do it, the same methodology. In fact quite a lot of the same team. We’re able to compare across time and what you can see is a deterioration in people’s mental health, in young people’s mental health. The slightly odd age range of 5 to 15 year olds is because that’s the age range in the first survey. So, we have to take the conditions we didn’t study first time round out and we have to take the age range that we’re stuck with. I think, actually, the size of the increase was much smaller than many people thought and you can see it’s there for both boys and girls.
If we look at the type of mental health condition, you can see that the increase is almost completely explained by an increase in emotional difficulties. So, anxiety and depression at clinical levels. And, again, that changes evident in both boys and girls. The prevalence of…or the proportion of young people who meet diagnostic criteria for a mental health condition increases with age, which is not a new finding but it gives us confidence in our findings that it’s there.
And there are differences in the age pattern between boys and girls with there being more boys than girls in preschoolers and primary school-aged youngsters who are struggling. Pretty much even stevens at secondary, and then the switch to girls struggling much more than boys in the later teenage years.
And, in fact, when you look at the type of mental health conditions, now remember that young people can have more than one mental health condition and actually by the time you get to the young people who are seen in Child and Adolescent Mental Health Services, more of them will have two or more conditions than will only have one condition.
So, about a fifth of those who meet diagnostic criteria in previous surveys have comorbidity in the general population. But it’s more like two-thirds once you get to clinics. And you can see in the younger children, it’s primarily behavioral problems and less common disorders in this group will be neuro developmental disorder. So, autism, ADHD, that kind of problem.
Whereas you get a switch to emotional disorders rocketing up in older teenagers, and that’s particularly amongst young women, which I’ll come to later. And by the time you get to the older teenage years, the less common disorders, actually, are more likely to be eating disorders. So, anorexia and bulimia.
The data are not widely available from this survey, which I think is a real problem. But there was led by ONS some analysis of background characteristics of the young person, their family and the neighborhood in relation to having a disorder. We could do this for having any disorder, or having anxiety and depression combined, or a behavior disorder. The other conditions, there are too few of them, to be able to do this kind of analysis.
Where I’ve written something in green, that factor changes with age. So, amongst primary school-aged children, boys were more likely to have particularly behavior disorders. Where I’ve written something in purple, it’s because it keeps cropping up. So, you’ll see poor parental mental health is something that predicts having a disorder, or is associated with having a disorder. Remember both the background characteristics and meeting diagnostic criteria were measured at the same time. But, socio-economic hardship is in there too.
And then there are shifting patterns by the number of children. Now the fact there’s only poor parental mental health related to emotional disorder, I suspect is because there are fewer numbers at this age and there is an issue with what we call statistical power. It doesn’t mean to say that other things aren’t important. It’s just that we don’t have enough to be able to tease out the relationship.
And then this is the same for the secondary school age groups. They didn’t do it. They didn’t do this analysis for the older children. Where you’ll see that for emotional disorder, you’re more likely to be a girl. For behavior disorder, you’re more likely to be a boy. And again socio-economic status is in there and poor mental health across the border.
Now, I think and with the previous surveys I’ve done analysis that have demonstrated this. The relationship between poor mental health in young people and in parents is resprical. So, it works both ways. But there is an implication in that when young people are treated by one service that might be in a different trust, or indeed second, you know, not even secondary care for many adults with poor mental health. But something we could do that might really help young people is to make sure that their parents who have poor mental health get the support that they need.
When I was training as a child physchiatrist, I had many social conversations when, you know, people found out what I did, that usually went along the lines of children, “don’t need a psychiatrist.” Well, I think I’ve just shown you some data, actually, that they may not need a psychiatrist, but they certainly need skilled mental health professionals.
And they need other professionals who work in their circle to be skilled at detecting mental health problems and plugging them into support. When I argued that people would then say, “Oh, but they grow out of it.” But when you look at the data, actually, they don’t. I put quotes around persistence in the title of this slide because actually the 99 survey and the 2004 survey will repeat it three years later. And this mirrors what was found in the very first…one of the first psychiatric epidemiological studies, actually, let alone to do with children.
The Isle of Wight study that Michael Rutter led in the early 1970s. When you go back to the same sample taking youngsters who met diagnostic criteria at baseline. About half of them meet diagnostic criteria three years down the line. We have a little bit of data between those time points, but they’re at, kind of, one year intervals. And, actually, these youngsters SDQ scores, most of them don’t come back into the normal range.
They may decline and I imagine inbetween that people are flipping in and out of that diagnostic boundary. What predicted baseline to having a disorder the second time around at follow up with these factors? So, you’ll see that disruptive…the more externalising problems are more persistent. That’s a very common finding. Peer relationships seem very important. They’re there for ADHD, they’re there for conduct disorder, there also there for anxiety disorder. So, markers of socio-economic status pop up for conduct disorder and for depression and for anxiety.
Now, some of these, also, are associated with having these problems in the first place but it’s not necessarily that what precipitates or predicts a problem. It’s, also, what predicts its persistence and it may be children coming from those backgrounds who need to work particularly hard. So, for example for ADHD, if they also have a neurodevelopmental disorder then perhaps we need to be working particularly hard to help them manage their symptoms of ADHD.
But as many of you know, and I’m getting the sense of quite a lot of people who work within education on this call. There is not such a distinct dividing line between children who meet diagnostic criteria and children who don’t. And, in fact, this is a problem for the whole of medicine. So, there’s lots of fuzziness around when you call wheezing asthma.
If you end up on ITU regularly every time you have a cold, then there’s no doubt you have reactive airways, and I think most people agree, yes, you have asthma. But there will be lots of people in the population who never seek help, who get wheezy when they exercise. For example, blood glucose. We put a dividing line and say at this point you’re called a diabetic. But, actually, the risk of having raised blood glucose increases with each level, it doesn’t suddenly shoot up.
So, it’s not something that’s unique to Mental Health Services. But what you see here is the self-report on the SDQ total difficulty scale, and it’s beautifully normal distribution like height, weight. Most youngsters are in the middle, a very few are absolutely thriving and, in fact, our scale doesn’t quite, you know, there’s a missing bit there. It doesn’t quite cover it all and then, you know, there are some who are doing really badly. The scale goes up to 40. So, very high scores are very rare.
This is the parents and this is the teacher. Now, as an epidemiologist the fact that they are asked exactly the same questions and these curves are very different, I find fascinating. Indeed, the only difference between the parent and the teacher SDQ is the P and the T on the top left-hand of the form. The questions are exactly the same.
The blue arrows indicate the cut point and that we don’t have a distinct population above the cut point and I think clinicians don’t just count problems or count difficulties when they’re making a diagnosis or formulating the predicament that a young person who’s come to them is in. And, in fact, what makes the difference about whether or not you think this is a clinically relevant problem is as with the rest of medicine things that relate to the child’s predisposition, so family history, their family context, their own characteristics, like, you know, how is their level of intelligence, do they have any physical health problems and also their school context can make a big positive or negative difference.
And it’s those things will make a difference between a child whose scoring above the cut point, but you think no they’re not impaired and I wouldn’t count that as a disorder against a child who may be scoring below the cut point, but, actually, is really struggling to function and to do what they have to do.
But that said there are lots of people who will argue that if we get public mental health approaches in terms of prevention and mental health promotion right, maybe we can shift the curve. I think the other thing these graphs tell me is that teachers are reticent in reporting problems. And this ties in with the research I’ve got. They will tell you a problem is there if they’re absolutely sure, but they’re cautious, which means we should listen to them as mental health practitioners.
So that’s where we were before lockdown, and I think there’s…I’m sure you may well have been approached to complete them. I’m sure you’ve seen them going around the internet, there are, you know, people have talked about an epidemic of mental health and other monitoring scales that have gone round. We really lack high-quality data on children.
So, I had a conversation with people at the London School of Hygiene who are doing all the modeling saying where can we get some data on children? We have very little that has baseline samples and the problem with these convenience samples that go out via Facebook or Twitter, or snowball by word of mouth is that they’re often filled in by healthy volunteers. And they’re often filled in by people who are worried.
They’re not a carefully selected sample frame and you don’t know who you haven’t got. You don’t know who saw the post on Twitter or Facebook and didn’t click and do the survey and you’ve obviously excluded anybody who isn’t online. That said, things like the coast based study has given us lots of really useful information. They’ve got a fantastic website and they can tell you about some of the things that young people and parents are worried about.
What the data from previous epidemics suggests is that anxiety depression and for those that have been really badly ill, or traumatically retrieved, trauma are the things that we should be looking for. I think in terms of going back to school, Cathy Cresswell and Polly Waite have asked teenagers and parents of young children, “What are the worries about this?” And they’ve come back. There’s a lots of teenagers who are really worried about being behind at school.
They’re really missing their friends. So, you know, I would encourage anybody who’s interested in that to put co-space into Google and go and get the details of that study and they’re going back, they’re doing waves every month and initially it was every week, but we don’t know if we’ve got the same people each week.
And because of the fact that it’s a convenience sample, because it had to be, we don’t know what it tells us about prevalence. Because we don’t know who the sample is and we don’t have baseline data. The nearest we’ve got to baseline data yet in the UK is two studies, only one of which has any teenagers in it. And it’s this one which is available as a pre-printice coming out in Lancet Psychiatry. So, this is data from April 2020. In a panel of adults from age 16 at the baseline who have been filling in this survey and they’ve been involved between six and nine waves collected over the last five years.
And amongst that group, young people did come up as having more psychological distress. As did women, particularly young women, and also those in adverse circumstances. Now, that last one is boring because actually we’re about to see a lot more people take a financial hit and there is a strong association between debt and poor mental health. I should say that, actually, this gradual deterioration in mental health over the last five years was there for everybody. But in these groups, the deterioration in mental health accelerated and did so significantly.
The other survey used the aspect survey, but the average age of those people is now 28. So, it’s not children. They are beginning to follow their children, but it’s not a systematic sample and they didn’t in April. They didn’t get any data from the children, and also data from a survey in Scotland called, ‘Generation Scotland’, they’re in their 50s. So, it tells you about the parents. It doesn’t tell us about the children.
So, what about going back to school? Well, if children’s mental health is deteriorating and it might well be, we should be worried. This is an association with parent report on the total difficulties questionnaire, and being excluded from school three years later. And what you can see is the more children who are struggling, there are increased exclusions in school.
Now, that’s a story about schools struggling to contain young people and the coast space study is talking about more parents complaining about behavioral disturbances in primary school children. That has implications for schools and for parents and I should say this work was done. The photograph of the young woman in the right-hand corner is Claire Parker, who was my PhD student at the time she did this work. And she’s now a clinical psychologist in Exeter.
We also looked from Baseline in 2004, amongst the children who had a mental health condition that was either recognised by a parent or teacher or both, or not recognised. And what we showed was adjusting for all these different background factors, and sadly the children who have learning disabilities who are facing adversity, you know, all these factors are raised amongst youngsters who are excluded if you look at government statistics.
But having accounted for them statistically and looking forward to 2007, two to four times the number of exclusions. And, in fact, we detected a bi-directional relationship. It works both ways. So, the youngsters who didn’t meet diagnostic criteria, three years later one who’d had an exclusion, three years later were more likely to meet diagnostic criteria. And often there problems are long-standing.
So, this is data from the Asbach Cohort, and what you’re looking at here is SDQ scores, okay, collected at these ages. So, between age 3 and 16. This graph is girls and this graph is boys, and the blue line is children who hadn’t been excluded by age eight, and the red line is children who had. Now, there were very few of these and probably too few girls to study, and the lines don’t look that different.
But the actual estimate could be anywhere on that line, and you’re seeing very big lines and bigger than the boys because there were fewer girls and that’s just a statistical artifact. But what you see with the boys is they come in with slightly raised SDQ scores at three, and, actually, they stay raised all the way up to the…you know, so we can see these young lads coming. That means we should be able to intervene and some of them may need specialist provision. But let’s make that about meeting their needs.
This is the same data. So, again blue is no exclusion, red is exclusion. And these are girls and these are boys, and this is for exclusion by age 16. And what you can see here is we have a picture of deteriorating mental health amongst those who are excluded. So, thinking about mental health, you know, schools sometimes have to exclude pupils for people’s safety, but, actually, it should be a wake-up call to think about mental health issues.
Attendance is associated with, particularly, emotional disorders. So, this is data from the 2004 survey. This was completed by Katie Finnings, this analysis. She’s also done a fantastic series of systematic reviews where she’s reviewed all the literature. And one of which is in the ACAMH Journal of Child and Adolescent Mental Health on anxiety disorders.
There’s one in the Journal of Affective Disorders about depression and one about to be submitted on the, kind of, softer concept of emotional difficulties. But what you see here is, red is secondary schools and blue is primary. And there’s a very strong association with depression. I think the difference by age is that they’re very, very few primary school children who actually meet formal criteria for the depression.
Then we’ve got emotional difficulties and you can see it’s amongst the slightly raised STQ score on the emotional difficulties subscale. It’s not that different. But once you get to high and very high, you get the populations moving apart. That’s related for any absence, and this is for unauthorised absence. And one of the surprising findings, when you think of the old concept of school refusal being related to emotional difficulties and truanting being related to behavior, is actually, we found a stronger relationship between unauthorised absence.
So, this works at an early stage of preparation. There is a hint when we look backwards and forwards of a bi-directional relationship in this sample, but we haven’t managed to replicate it in a primary school sample that used a trial run by the Manchester Education Faculty.
What we did show there was that youngsters who had emotional difficulties were more likely to have poor attendance going forwards. We didn’t find it the other way around, but I think the take-home message is if you have children who are not attending and particularly if it’s a change in attendance, have a think about emotional difficulties, anxiety or depression because they may, you know, it’s difficult to know what’s going on in someone else’s head and emotional difficulties are difficult to pick up in the school context.
I think particularly vulnerable groups to consider as schools go back for all of us working in relation to children. Those with pre-existing mental health conditions have had the most amazing… we’ve all had to adjust massively, but that is going to be harder if you have a pre-existing mental health condition.
Those who live in difficult home circumstances as, you know, we as somebody very eloquently said, “We might all be in the same storm, but we’re not in the same boat,” you know being in a nice house with a garden and your own laptop that you can link with your friends and get your lessons online, is not the same as being in a family of five or six in a three-bedroom flat with no garden and one laptop between all of you.
Some people will have had Covid adverse experiences. There is increasing evidence that infection itself, even if mild, might have central nervous system effects. Very few children have been hospitalised, thank goodness. Very few children have ended up on ITU, but trauma, post-traumatic symptoms after ITU admission is not uncommon.
Some children unfortunately will have been bereaved, and some will be in families where there is sudden financial strain. I think there is a group of children anecdotally, and we’re trying to measure it who, actually, are doing better during lockdown. And I think as I joined there was a discussion about, you know, flexibility and timing being useful for some children.
If school is a hard place for you to be. Not being at school providing home is an alright place to be, might actually be easier for you. And I think, particularly, youngsters with autism spectrum conditions may really struggle to get back into school because of the difficulties handling change, and because also what they’ll be going back to will inevitably not be quite the same and these are a group of youngsters who really struggle with that.
Those who have anxiety based difficulties attending school often struggle after half terms and holidays, let alone six months off and so I think schools and mental health services are going to need to think really carefully about how we support schools and families to make sure that those children don’t miss out more.
In terms of managing behavior, I just want to highlight the education endowment funds practitioners tools. It’s based on three systematic reviews that I was part of, and it’s got very simple practical evidence-based guidelines. I wanted to pull out this diagram from the influences on behavior. So, there are positive and negative influences that were all exposed to all the time, and there are negative and positive behaviors.
And what you hope is the bulk of pupils and children are in this quadrant with positive behaviors and lots of positive influences. But, actually, as you go through life, we all have things we have to deal with and we will all fluctuate about which quadrant your in at any particular time.
Now schools I know sometimes feel like they’re being held responsible for everything, and I think in this systematic review we highlight things that schools can marry and manage directly, and they’re in green. So, relationships in schools, both with between pupils and between pupils and teachers.
The teaching and learning environment, the school context can make a huge difference to children and young people’s well-being. And promoting positive attitudes and self-concept. All of that school can directly influence. There are some things that you can identify and maybe highlight a bit, and then there are other things that really aren’t your business to do anything other than be aware of and perhaps act on. So, sometimes they’ll be cultural clashes between home and school.
Sometimes they’ll be things in the home life that you can’t influence, but you are aware are a stress or are difficult for youngsters. So, for example, young people who are carers or young people who are perhaps having to work outside school in order to bring money into the family, for example. That, you know, is inevitably going to make them more tired, inevitably going to eat into time when they could be working.
So, I think there are six recommendations that I encourage you all to go along and check and I’ll make my slides available at the end, if people want them. I wanted to talk a bit more about this using classroom management behaviors to support good classroom behavior. But, in fact, in the trial that I did, it also promoted mental health in general, particularly for the children who are struggling.
And the program we tested was The Incredible Years Teachers Program. So, this is based on very established empirically demonstrated theory of operant conditioning. What you give attention to, you will get back too. So, trying to ignore as much of the low-level disruption as you can, but also modeling the, kind of, behaviors that you want children to produce and the importance of having warm nurturing relationships with social animals.
So, Carolyn Webster-Stratton who developed this program talks about the piggy bank of goodwill, that will make children more able to hear criticism. It’s six days over six months. So, teachers have a chance to go back and practice in their classrooms. You start from building positive relationships and being proactive and thinking about what certain children struggle with.
Training your attention on the positives, correcting things in a positive way, using incentives and then focussing on decreasing inappropriate behavior with ignoring and misdirecting, following through and then finally thinking about emotional regulation social skills and problem-solving.
So, this is a logic model and I’m going to break it down for you. And I hope you can see it clearly enough. Now, we talked about the manualised curriculum. It’s delivered in groups. The idea being that everybody in the group is an expert in their own context. This is about honing skills and, actually, teachers in our qualitative process study said actually it was very validating. This was stuff they knew, but they hadn’t thought of for a while and it allowed them to, kind of, sit back and reflect.
And that’s exactly the way it’s delivered. And the idea is it’s a safe space, it’s collaborative, the group facilitators we chose all were teachers. And their expert in the program, but they’re not, sort of, aiming to teach teachers how to be better teachers. It’s about coming up with solutions and trying them out.
So, how do we think it works? I think the teachers told us and we expected there to be an improved focus on children’s perspectives and where children are coming from. The teachers move from being reactive to being more proactive, that they felt calmer and more under control and that you then got a virtuous circle with positive impacts on the teacher, on the child and the whole class as a whole that led to shared outcomes with improved relationships and a more positive attitude to learning.
And in our trial, we showed a small but significant improvement in children’s mental health for everybody, but a larger one that was sustained over 30 months for children who struggle. Which I think in itself makes this worth doing. And, in fact, this is the program that our systematic review demonstrated increasing evidence for and a similar pattern. The impact on everyone overall is tiny, but the impact on those who struggle is bigger. And, in fact, we’re halfway through a re-application, which fortunately hasn’t been too badly disrupted by the shutdown. So, there should be more UK-based evidence.
I also wanted to talk about school-based services and counselling. So, I have a link with the charity place to be and this is…I’m sharing their outcome data. So, one of the things, and only one of the things they offer is face-to-face counselling and, so, here we have pre-counselling strengths and difficulties questionnaires from teachers and from parents, and what you see is there’s a big drop down to after the counselling’s finished that, actually, seems to be maintained over the following year by both informants. But that doesn’t give us a control group. We don’t know if those children would have just got better anyway. We’ve talked about how mental health fluctuates over time.
So, what we’ve done is compared children from place to be in red, with children from the British Child and Adolescent Mental Health survey in 2004 looking at follow-ups going out up to, actually, 2007. And what you see, we very carefully matched on as many background characteristics as we had available to us, and what you see is a similar pattern.
There is a bit of a drop in the national survey from children’s scoring about the same at baseline. But those who have counselling, it is bigger and it’s more sustained, and actually it is no longer significant after two years. But it looks like the trend goes down. It’s just our confidence intervals, because we have fewer data points become much wider.
So I wanted to highlight this amazing paper by Mark Greenberg saying that, actually, when you’re dealing with things on a whole school level or any kind of preventative approach, you’re not going to get dramatic effects like you do when you’re dealing with your measuring interventions in the clinic. But, actually, that’s because for some parts of the population, you are promoting mental health. The same program for other more vulnerable children might be preventing them slipping into a mental health condition.
And for those who are already struggling, you might be treating them. So, you’ve got all these sub-groups in there. And I think this will apply to what we’re dealing with post Covid, both in terms of learning and in terms of mental health. So, they’ll be the vast amount of the general population who will be unsettled coming back after such a big gap, as we all have been.
But many of them will be okay with the support that we can put in around them. Then there are a group of children, who because of learning problems, social problems and health problems, both mental and physical health, cannot cope in mainstream and need alternative provision. But there’s this vunerable group, which I think will be bigger because of Covid, and they’re the group that we want to really intervene to try and keep them within the mainstream school and get them over this bump. I’ve put up some useful information about mental health, and then I’ll provide some references and I’ll stop talking there. Thank you very much for your attention.