Social Emotional Mental Health (SEMH) and Alternative Provision in Education

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In this In Conversation podcast, we are joined by the President of PRUsAP, Sarah Johnson. Sarah also advises the Department for Education for Alternative Provision and is the Director of Pheonix Education Consultancy. Sarah published two books in Autumn 2023 focusing on social, emotional, and mental health (SEMH) which are part of the series ‘All about SEMH’.

Discussion points include:

  • The definition of SEMH and what Alternative Provisions are like in the UK.
  • The challenges children with SEMH needs may face in the classroom environment.
  • How equipped is mainstream education to support SEMH needs of children.
  • Current message to policymakers on the provision of education for SEMH children.
  • An overview of Sarah’s upcoming books and how might teachers use them.

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Sarah Johnson
Sarah Johnson

For nearly two decades, Sarah Johnson has been dedicated to fostering positive change in the lives of marginalised children, shaping a career that spans various facets of the educational landscape. As the author of ‘All About SEMH’ guides for primary and secondary teachers, and “Behaving Together: A Teacher’s Guide to Nurturing Behaviour,” Sarah brings a wealth of practical insights derived from extensive experience.

Throughout her roles as a teacher and senior leader, Sarah has navigated diverse educational settings, including primary and secondary schools, psychiatric in-patient services, pupil referral units, hospitals, and specialized resource provisions for children with speech, communication, and language needs. She has served as the Head of Behavior and Inclusion for a London Borough, actively participating in MARAC (Multi-Agency Risk Assessment Conference) and MASCE panels (The Multi-Agency Child Exploitation and Contextual Safeguarding).

In the educational sector, Sarah occupies strategic positions, contributing significantly to policy decisions that impact the future of education. As a member of the Department for Education’s Alternative Provision stakeholder group and the President of PRUsAP, a national organisation, Sarah underscores her commitment to enhancing educational provision and outcomes for pupils in Alternative Provision settings. Additionally, she serves as a Trustee for Skylark Partnerships and Teams Education Trust, and her role as a School Improvement Partner reflects her dedication to elevating educational standards and practices with a strategic focus. (Bio from Pheonix Education)


[00:00:01.449] Jo Carlowe: Hello, welcome to the Papers Podcast series for the Association for Child and Adolescent Mental Health, or ACAMH for short. I’m Jo Carlowe, a Freelance Journalist with a specialism in psychology. Today, I’m interviewing Sarah Johnson. Sarah is the President of PRUsAP, which represents the Alternative Provision sector of education in the UK. Sarah also advises the Department for Education for Alternative Provision. She is the Director of Phoenix Education Consultancy, which creates resources for Teachers, and she has two books coming out this autumn focusing on social, emotional and mental health. These are part of a book series, “All About SEMH,” which will be the focus of this podcast.

If you’re a fan of our In Conversation series, please subscribe on your preferred streaming platform, let us know how we did, with a rating or review, and do share with friends and colleagues.

Sarah, welcome, nice to meet you. I have only mentioned some of what you do. Can you give us a fuller introduction about yourself?

[00:01:05.060] Sarah Johnson: I, essentially, work with the children that are most marginalised in society. So, they might be, for example, children that are displaced by war and conflict, refugees, children that might be displaced due to domestic violence, into hotels, children vulnerable to exclusion, and again, I use that in the very broad way. So, exclusion in terms of being permanently excluded from school, or it might be children with medical needs that makes it difficult for them to attend school. And that could be anything from anorexia nervosa, cancer, anxiety, depression, or even just recovering from an operation. And that’s something that I really want to look at different approaches to support children being included in school and to benefit from the education system. So, I come very much from a children’s rights perspective about it’s their right to be in education and receiving an education.

[00:01:54.430] Jo Carlowe: Fantastic, thank you. What prompted your interest in the Alternative Provision sector of education and your focus on children and young people with social, emotional and mental health needs?

[00:02:04.799] Sarah Johnson: I love that question, because obviously, there’s a thousand different reasons in which I work in the Alternative Provision sector, and I suppose, essentially, I really valued my education when I was younger, incredibly valued it, really enjoyed it. I come from a particularly traumatic background in terms of my own upbringing and school was my safe place. It was a place that I felt nurtured, I had really good relationships with my Teachers, and, actually, I was able to access education in a fairly easy way, not that all children can. And I suppose I wanted to support those children that found it really difficult and where, actually, school might not have been a safe place for them, and how do we, kind of, incorporate that?

And I really enjoy working with children in that sector, they’re brilliant. They’re vibrant, they’re exciting, they’re engaging, and it – working with those children just gives me an energy, which I know is not a very good answer, but I just love it. I love doing it, and I’ve worked in classes of 30 children, for example, and I might only see those children once a week, when I’m teaching citizenship, for example. I much preferred it in the PRU and AP sector, where you could actually build relationships with children, you could find out more about how they learned, what they enjoyed learning and looking at, kind of, innovative ways of – and creative ways of really engaging them. And it was challenging, I enjoyed that challenge.

[00:03:21.260] Jo Carlowe: It’s a wonderful answer. I want to take a step back. So, before we go further into the details, I want to go back to basics to find out what SEMH encompasses. What exactly is SEMH?

[00:03:32.030] Sarah Johnson: If you asked a thousand different people, they would probably give you a thousand different responses, and we all have social, emotional, mental health needs, absolutely. So, we all want to feel safe, nurtured and secure in the relationships and environment that we’re in. Children that might have social and emotional difficulties often express themselves in ways that can be quite difficult within the classroom or schooling setting, or they may not even get to that classroom setting in the first place. So, those are the children, for example, that might have emotional-based school avoidance, anxiety, depression and so on, but also, you might have children in the classroom that you may be aware of their – some of their difficulties regarding self-harm, for example, the use of drugs and alcohol or eating disorders, and so on.

And it’s such a broad term, “social, emotional, mental health, and I think one thing that the SEND Code of Practice does is it divides different needs into communication, interaction, physical, sensory and so on. But actually, we know that those tidy groups are a lot more complex than that. We know, for example, that children with social, emotional, mental health needs might have particular difficulties with their expressive, or their receptive, language. They might have challenges with having their meaning conveyed and understood, and that might not be because of their emotional regulation, per se, but it might be their ability to be able to express themselves and to be understood.

Social, emotional, mental health is a tiny facet of a individual and child’s life that can have a fundamental impact on how they engage with others around either individually, classroom or socially. And that’s why I really wanted to focus on that, because I think if children feel safe, nurtured, then they’re able to learn, and when they don’t have that, it’s really difficult for them.

[00:05:21.139] Jo Carlowe: Hmmm. So, staying with some of those challenges that you’ve talked about, how does that impact SEMH children, specifically in the classroom, and how does this change as they shift from primary into secondary education?

[00:05:34.220] Sarah Johnson: I think primary has some benefits in terms of the way that it’s set up. In that primary schools you often have one Teacher. You may have another Teacher that covers, for example, or a high-level Teaching Assistant. Generally speaking, throughout the week, you’ll have one Teacher, you will be in one classroom, so there’s less transitions and you’re able to build a relationship with your Teacher. Whereas in secondary, you have more people, you have people that might not know you. You might have people that you see just vaguely in the playground, or as you’re going from classroom to classroom. It’s more difficult to build relationships in secondary. It’s quite a big challenge.

There’s also lots of discussion where, you know, I think this is probably partially true, that primary tries to set you up as being independent, whereas secondary, there’s lots of rules and regulations about the way that you behave that are more constraining. So, I think often, as children are developing into teenagers and going through puberty, the, kind of, kicking up against those rules and wanting to be more independent, often, I think, can lead to more conflict with Teachers. I think the challenges are often around relationships, but as well as, kind of, curriculum, because actually, there are higher expectations around the way that you behave in secondary that you may not have in the same way as a primary school child. We may have higher expectations of children in secondary, but they still might not be at that, kind of, development stage where they’re able to manage those expectations.

[00:06:57.000] Jo Carlowe: Hmmm hmm, and what’s it like for Teachers? What are the challenges that they face with SEMH children?

[00:07:02.449] Sarah Johnson: So, I would say the first bit with Teachers is training. That actually, Teachers want to teach and want to impart knowledge and teach their subjects and they want to do it in a way that, actually, children really enjoy, I absolutely believe that, and develop. But the training they get to work with children with a whole range of different needs is so incredibly limited in many universities, not all universities, of course, that they might only get a few hours where they talk about social, emotional, mental health as a broad subject.

So, the first bit is the challenges is just by their knowledge and their training, I think, is undervalued, actually, in terms of social, emotional, mental health. And then, the other part is that the teaching profession is incredibly busy, incredibly difficult, in terms of being able to deliver and impart knowledge to 30 children, make sure they’re learning and progressing, but then you’re also having to balance children’s individual needs within that context can be very, very difficult. And the other bit is might not know that that child has social, emotional, mental health needs, that actually, you may not be aware that that child has anxiety, depression, ADHD or whatever it might be, and that you’re another cog in a, kind of, complex wheel, this child’s life. And in the busyness of school, you might miss it and not notice, and so, that’s another thing, is that you might not even realise.

So, the challenges are huge, but also, that sometimes, children with social, emotional, mental health might disrupt the learning of others and disrupt your teaching. It’s really frustrating and it can be very upsetting, and that is not necessarily the intention of the child either, but it’s a, kind of, symptom of, sometimes, quite challenging environments in terms of trying to balance the needs of all children at the same time.

[00:08:39.539] Jo Carlowe: Hmmm, and it sounds like that mainstream education isn’t necessarily equipped, then, to support social and emotional and mental health needs of children. What do you think?

[00:08:49.260] Sarah Johnson: Oh, that’s a really difficult question and it goes back to the ideas around inclusion. And I think for me, inclusion is about making sure that children receive a high quality, engaging education that helps them develop individually. Now, where that might be can be in a whole range of different places. Mainstream schools are often bigger. Some children that’s really, really difficult, and we can give them lots of strategies to be able to cope with bigger settings, but then, is that necessary and is that fair? Because actually, as you get older, you might choose to work in quieter environments, and that’s perfectly acceptable. Children probably have less choice than what we do as adults. So, for me, that’s where Alternative Provision and Pupil Referral Units come in to be able to, kind of, facilitate those smaller environments with higher staffing to pupil ratios.

[00:09:35.320] Jo Carlowe: So, of course, some SEMH children will be taught in those Alternative Provisions. Sarah, what are Alternative Provisions like in the UK?

[00:09:43.000] Sarah Johnson: They’re really broad, I think is the quick thing to say, is that they’re very, very different. I visited Alternative Provisions and Pupil Referral Units up and down the country and the only thing that unites them is that the children within them have a fragmented experience of education. But actually, some operate very similarly to schools, in that they might be quite large, have a number of different year groups, for example. They often have more opportunities around vocational and creative learning, but also, they might also be backfilling some of the education that children might not have had previously. So, there might be more focus on those, kind of, basic skills and literacy and numeracy.

But I’ve been to Alternative Provisions that operate like art schools, for example, and it’s a heavy focus on art. I’ve been to those that are really focused on construction. I would say one of the difficulties around Alternative Provision and Pupil Referral Units is that they often exist in very poor buildings. Not all of them, some of them are incredibly well resourced, but there’s still a group of Pupil Referral Units and Alternative Provision that are in old primary schools. So, when we think about things about children’s pride in the school environment, I think we need to look at that, as well, especially when children might feel dejected anyway. If they go to a place where, actually, it looks like it’s really quite a poor building, and that’s reduced their access to a curriculum, I think that’s a telling story for children. So, that would be one of the things that I would like to see different for those children, as well.

[00:11:10.930] Jo Carlowe: Sarah, you advise the Department of Education for Alternative Provision and the Ministry of Justice for Secure Schools, and you supported on the SEND and AP green paper. What is your current message to policymakers in relation to the provision of education for SEMH children?

[00:11:27.079] Sarah Johnson: So, I’m going to respond a little bit to the recent news about contracts being issued to reduce Educational Health Care Plans for children. I think that the first reduction for Educational Health Care Plans is likely to be children with social, emotional, mental health needs, because it is an easier argument to reduce support for children with ADHD, rather than children with cerebral palsy, for example. I’m really worried about that, and I think when you start trying to put targets on not supporting children, on not giving them their statutory access to education, you’re on very dangerous ground.

My, kind of, top thing would be that actually, we stop looking at cutting costs and we start looking at how do we meet the needs of the children that are in our communities? And that is the biggest thing. The irony is, in the long run, it will reduce costs, because if we’re meeting children’s needs now, we won’t be trying to support them when things have gone terribly wrong for those children in the future. So, for me, it’s don’t issue contracts around reducing costs, but actually, look at how can that money be best spent to make sure that children in our communities get the support that they need? Whether or not they’ve got social, emotional, mental health needs, whether or not they’ve got physical health needs, whatever it might be, that we support them early on.

And the other bit, I think you might’ve said only one thing, but you know what? I’m going to dominate this, early intervention. Getting it right in the early years is crucial. We have to have value and love for our early years practitioner, who work so hard working with the youngest children, who might exhibit quite difficult and challenging behaviour and needs. I think we need to make sure that we are investing in their professional development as staff, but also, that we’re investing in really powerful children’s centres, which is part and central to the community.

In the old days, we would call it Sure Start Centres, and for me, they are a fantastic model of bringing the community together, but also, educating parents and carers around how best do we interact with our children to make sure that they develop in the best way that we can?

[00:13:29.940] Jo Carlowe: You mentioned earlier about, sort of, infrastructure, really, both the poor buildings for – in Alternative Provision. Have you got any thoughts about that and about resourcing?

[00:13:39.230] Sarah Johnson: I think there needs to be a overhaul around how we fund Alternative Provision, and that we have long-term planning, rather than short-term reactionary planning. So, what we look at is our population, our demographics. We look at our increasing numbers of children in the community and how do we best meet their needs? And that costs money, buildings cost money, and we know at the moment that there’s different things happening nationally around buildings being closed for schools in terms of concrete and so on. That we need to make sure that we have an investment in buildings to be able to enhance the curriculum for children in Pupil Referral Units and Alternative Provision and not to prevent access to exciting opportunities that are vocational and engaging, as well. And that’s a wider issue across schools across the UK, unfortunately.

[00:14:26.660] Jo Carlowe: Sarah, as described in the intro, you have two books coming out. These are, “All About SEMH: A Practical Guide for Primary Teachers,” and “All About SEMH: A Practical Guide for Secondary Teachers.” Can you give us an overview? What do the books comprise and how might Teachers use them?

[00:14:43.510] Sarah Johnson: Both books are essentially a handbook for Teachers, but I think they would be equally useful for SENCos and Teaching Assistants around a range of different profile needs or diagnosable conditions and how they might support children. So, one of the things that I thought, as I said – sort of, mentioned earlier, is that there’s a lack of training or there’s a broad brush approach to training. So, instead, with the “Practical Guide for Primary Teachers,” you can open the book up, it will tell you about a range of different difficulties and challenges and so on.

So, for example, you could turn to one page and find out about anxiety or attachment disorder, self-harm, managing emotions, tic disorders, and so on. And you can literally just dip into it and go, “I’ve got a kid in my class, and I’m really worried about the way they manage emotions.” You can find out a little bit more about it in terms of, what does that look like? What does that mean? How might a child be diagnosed with it, if it’s a particular condition? And then, it’s divided into, “Okay, what can I do to help that child? What can I do practically to support them?”

And the difference is with the Primary and the Secondary Teachers, is that what I’ve tried to look at is needs and conditions and so on that would present more frequently in primary school, for example. So, in the primary school you might have foetal alcohol syndrome, for example. Whereas in secondary school, you have bipolar disorder being spoken about. So, there’s bits there that might be helpful for both, but actually, I’ve geared towards the things that you might more frequently see in secondary or – and/or in primary.

And what it looks at, as well, it tries to look at evidence-base about what has been found helpful within the classroom setting. So, it’s not just random ideas that might be useful. What I’ve tried to do is come from a very Teacher perspective. So, I’m a, you know, I’m a qualified Teacher, so what I’ve tried to look at is how do we impart information about clinical needs, for example, in a way that is accessible and then, can be understood from a practical perspective in the classroom?

[00:16:39.700] Jo Carlowe: Brilliant, and as you’ve just said, the book includes practical strategies and adaptations that can be used in every classroom. Can you give us a flavour, mo – are there a couple of tips you could share with us, just one or two examples?

[00:16:50.910] Sarah Johnson: So, I – you know, I’m going to open my book – oh, I love this page. Actually, it’s obviously a page that I’ve loved, because I’ve opened it up and I’ve, obviously, flicked through this case.

[00:16:59.949] Jo Carlowe: You have fallen to that page, yeah.

[00:17:01.120 ] Sarah Johnson: Yeah, fallen to that page. So, every section – and one thing that I hadn’t mentioned, actually, every section I have sense checked with somebody who has either got that need or condition, has a child who has that need or condition, and so on. And that was really important to me, because if you’re talking about someone’s child, I think it’s really important that we aren’t just professional, but we’re also thoughtful and caring.

So, the ‘Anxiety’ section, for example, tells you what anxiety is. Then, it looks at, “What is an anxiety disorder?” and it goes into detail about “emotionally based school avoidance,” and “social anxiety disorder,” but then, it gives “Interventions and Strategies.” So, it’s got “Anxiety disorder Tool 1: Explicitly teach worries, anxiety and responses to threat,” and then, it’s got some images, for example, of – and I love this image, of a different response to a bee. So, it’s talking about the idea of threat and how people might respond differently to threats. Now, one person is feeding the bee honey, whilst another person is running away from that bee.

And the idea of those pictures is it becomes an opportunity to talk to children about that people might think and experience fear and threat differently. It gives different case studies that you can use with children directly to explicitly teach. So, for example, it narrates and illustrates ideas of fight, flight and freeze, and the Illustrator has drawn honey badgers, for example, are really notoriously violent and aggressive. So, you’ve got a case study of a honey badger and how they deal with threat, but also, an elephant shrew, who runs away really fast, and there’s another image there, or freeze and the idea of fainting goats. So, when fainting goats hear a noise, they stop, they fall to the floor and faint, essentially.

So, these are just, kind of, fun, interesting ways to depersonalise issues around anxiety, but to, kind of, promote conversations with children. So, Teachers will be able to open that up and go, “Oh, that’s quite interesting, I can share this with the children that I work with and have discussions.” And I, obviously, love that page because who doesn’t want a picture of a fainting goat and an elephant shrew in their book, along with a violent honey badger? But it’s a, kind of, fun, interesting way of talking about really serious issues and not in a way that is untruthful, either, but going, “We all experience these feelings, but some people experience them in a more extreme way than others.” And then, depersonalising it through the use of animals, I think is – that was my daughter’s suggestion. So, she was the one that suggested some of those animals, as well.

You know, I could pick that up and go, “You’ve got a child with anxiety. Maybe you can think about this.” “Oh, you have a child with foetal alcohol syndrome. Okay, well, actually, they might be struggling with their concept of time. How about this resource?” And when I open these books, I’m so happy with the fact that I think they’ll be really practically used.

[00:19:48.450] Jo Carlowe: In the book you talk about the difference between children’s behaviour at home and at school. Can you elaborate on this? What might Teachers typically see that parents don’t, and vice versa?

[00:20:00.120] Sarah Johnson: So, this comes down to my practice as being a Teacher, and I remember saying to a parent, “They’re not like that at school.” And she phoned me up the next day and her daughter was kicking, screaming, shouting, and it was such a different, alien experience to what I see of that child within the classroom environment, who was very calm and very collected and so on. We often find that children might mask some of their challenging behaviour at school. They might be able to keep it in, and then, when they get home, which is, for them, a safe environment, it might explode, and it might be really difficult for that parent and carer to deal with.

But also, there are different rules at school and at home. There’s some things that a child might be able to do at home, they can’t do at school. Conversely, it might be, you know, there’s complaints about that child running around, not sitting, not concentrating, but actually, within the home environment, that’s perfectly appropriate. But it’s not seen as appropriate within a schooling environment, for lots of different reasons. I would say that it’s – there’s different demands in each environment, home and school. So, it’s no wonder that children are going to respond differently to that.

And I think what’s really important is that we believe in the other person’s experiences. So, when a parent tells us, “Actually, this is not like it at home,” is that we also learn what things has that parent done within the home environment that means that that child is able to be calm or is able to express themselves in a particular way? What can we learn, as Teachers, to be able to bring that in, as well as what can we do to support parents, to support them when things are really difficult at home? And having that mutual relationship of collaboration.

[00:21:33.789] Jo Carlowe: Great. Sarah, is there anything else in the book that you would like to highlight?

[00:21:39.240] Sarah Johnson: I think I mentioned at the beginning that whilst it says, “A Practical Guide for Primary Teachers,” or “Secondary Teachers,” depending on which book you pick up, I think it’s a really helpful resource for SENCos, Teaching Assistants and probably Educational Psychologists, as well, and possibly parents and carers, because I think it gives a different approach that they might find useful. Actually, I think it’s broader than just “A Practical Guide for Secondary Teachers.” I think it would be really helpful for SENCos and so on to pick this book up and have a look, as well as Specialist Advisory Teachers, as well, in the local authority.

[00:22:13.910] Jo Carlowe: Is there anything else in the pipeline for you that you would like to mention?

[00:22:17.840] Sarah Johnson: So, one of the things that people may or may not know about me is that I have four children, but three are under the age of two. So, I am tired, but saying that, my daughters have recently been – my twin daughters have been recently diagnosed with cerebral palsy, and I’m wondering about whether or not actually what might be helpful is resources to support parents around what does that diagnosis mean and what can you do within a home environment?

But the other thing is, I’m also researching at the moment, is the impact of social media on the school community, and I’m talking people in USA, Canada, Australia, England and so on, around what do they do within that school environment to support children’s digital citizenship? And it might be that I’m looking at providing, sort of, further resources and information for that.

[00:23:09.140] Jo Carlowe: And finally, Sarah, what is your take home message for those listening to our conversation?

[00:23:14.590] Sarah Johnson: I always use this phrase, and I think it’s a really important one, and it’s not even my phrase. It’s by Dr. Navina Evans, who works in East London. And we were really stuck with how to support a child, and we kept on doing the same things over and over again, and nothing really was changing, and Dr. Navina Evans said, “How can we think about this differently?” And to me, that is such a powerful question. So, that’s what I want your take home to be, is that we can get really stuck in children’s behaviour, or in our rigid approaches, and I think that question of just taking a step back, “How can I think about this differently?” is the most empowering question that I’ve ever been asked by anyone. And she probably said that to me about 15 years ago. That is one of the most important questions we can ask ourselves.

[00:23:57.580] Jo Carlowe: Sarah, thank you so much. For more details on Sarah Johnson, please visit the ACAMH website,, and Twitter @acamh. ACAMH is spelt A-C-A-M-H, and don’t forget to follow us on your preferred streaming platform, let us know if you enjoy the podcast, with a rating or review, and do share with friends and colleagues.

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