Welcome Public Forum For Education (PFE) - 16 November 2016

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Welcome Public Forum For Education (PFE) - 16 November 2016
Welcome
Public Forum
For Education (PFE)
16 November 2016

Children’s Mental Health Issues

  Department of Children’s Services
Welcome Public Forum For Education (PFE) - 16 November 2016
Mental Health
  and Wellbeing
  in Schools
  Dr Sarah Exall
  Specialty Registrar in Public
  Health

  Department of Public Health
Acknowledgements:
Clare Offer
Mark Vaughan
Welcome Public Forum For Education (PFE) - 16 November 2016
Contents
• Background

• What is the local need?

• What do children tell us?

• What is the national context?

• What is happening locally?
Welcome Public Forum For Education (PFE) - 16 November 2016
Background
• Nationally, around 1 in 10 children aged
  between 5 and 15 have a mental health
  disorder. 25% of children with mental
  health disorders in 2005 had the same
  disorder 3 years later.

• Many more children will experience
  emotional or behavioural difficulties.
Welcome Public Forum For Education (PFE) - 16 November 2016
• Risk factors for emotional and behavioural
  difficulties in children include problems with
  parenting and family functioning, parental mental
  health, and socioeconomic disadvantage.

• Bullying in childhood is strongly associated with
  poor emotional wellbeing and future mental health
  difficulties.

• NICE guidelines and national evidence support the
  promotion of children’s emotional and social well
  being, particularly in schools.
Welcome Public Forum For Education (PFE) - 16 November 2016
What is the local need?
Welcome Public Forum For Education (PFE) - 16 November 2016
• It is estimated that there are currently just under
  8,500 children aged between 5 and 15 with
  diagnosable mental health disorders in Bradford

• The rate of mental illness among children rises as
  they get older

• Children in the most deprived wards in Bradford show
  poor levels of social and emotional development
  when they start school, which is associated with
  poorer social, emotional and mental health outcomes
  later in childhood
Welcome Public Forum For Education (PFE) - 16 November 2016
Primary classroom   Secondary classroom
Welcome Public Forum For Education (PFE) - 16 November 2016
Self Harm
• Bradford’s rate of admission for self-harm among young
  people aged 10 to 24 is 373.7/ 100,000

• Nationally, rates of admission range from 82.4 to
  1,152.4/100,000.

• In Bradford, there are an average of 240 admissions
  relating to self harm in 0-19 year olds each year.
Welcome Public Forum For Education (PFE) - 16 November 2016
What do children tell us?

Images: NHS photo library, www.sesamestreet.org;
www.bbc.co.uk; Microsoft clipart; www.shutterstock.com
National strategy and policy
What is happening locally?
• Support is provided at school level by school
  nurses, VCS, pastoral workers, school
  counsellors, youth workers

• Education is provided for the children’s
  workforce and can be accessed by teachers
  and other staff working with children and
  young people
Future in Mind:
Children and
Young People’s
Transformation
Plan (2015-2020)
7 work streams:

1.   Schools engagement
2.   Crisis care
3.   Single point of access
4.   Eating disorders
5.   Caring for the most vulnerable
6.   Developing the workforce
7.   Accountability and transparency
Aims of the Schools Engagement
workstream:
•ensure that children and families receive care
at the earliest possible opportunity
•promote resilience for children and young
people
•support schools to identify children and young
people at risk of mental health issues
•provide support for low level need in schools
and develop clear access routes offering
choice, with easy access to appointments
•develop a culture in schools which does not
stigmatise mental distress or ill-health
How this will be achieved:

•increasing the number of Primary Mental Health
Workers

•developing a Mental Health Champion role for
each school

•developing a mental health in schools pathway
Useful links
• https://jsna.bradford.gov.uk/documents/Health%20Needs%20As
  sessments/Mental%20Health%20Needs%20Assessment/Menta
  l%20Health,%20Emotional%20and%20Social%20Wellbeing%2
  0in%20Children%202015.pdf

• https://jsna.bradford.gov.uk/documents/home/Children%20and
  %20Young%20Peoples%20Lifestyle%20Survey%202013%20­
  %20SUMMARY.pdf

• https://www.bradford.gov.uk/media/3030/
  cyptransformationplanbradfordfutureinmind.pdf
Thank you
• Any questions?
Sarah.Exall@bradford.gov.uk
Mark.Vaughan@bradford.nhs.uk
Mental Health Matters
in Bradford:
Addressing Self Harm
in Schools

Dr Philippa Grace
Specialist Senior Educational
Psychologist     16/11/16

  Department of Children’s Services
Mental Health in Schools
Strategy Group: Aiming to
 • Deliver a core offer across
   Bradford schools
 • Harness and maximise existing resources
 • Respond to local needs
 • Build on evidence based practice and pilot
   and quality assure new initiatives

 Department of Children’s Services
Mental Health Matters: Core
Principles
• Increase knowledge and reduce
  shame, stigma and secrecy
• Normalise emotional distress
• Deliver support where children,
  young people and parents say it
  works best

Department of Children’s Services
Mental Health Matters!
• Self harm policy and recording
  protocol
• Mental Health Awareness Raising
  Assemblies
• Mental Health Information Hubs
  in Secondary Schools
• Getting Through Tough Times
  leaflets for secondary aged
  pupils
• Mental Health Matters
  Conference

Department of Children’s Services
The self harm protocol policy
means……

• Vulnerable pupils receive
  appropriate support from
  confident staff
• There is a consistent approach to
  responding to pupils who self
  harm, and in monitoring self
  harm in school

Department of Children’s Services
This protocol policy
provides…..
• a structure for school staff,
• using good practice guidelines from the
  National CAMHS guidance on self harm
• reassurance to staff, and identifies
  relevant information, and where
  appropriate onward referrals
The Core Message
• The best prevention for self harm
  in young people is to have
  people who they can talk to and
  who will take them seriously

• National CAMHS guidance p 10

Department of Children’s Services
What is Self Harm?
• ‘Self harm happens when
  someone hurts or harms
  themselves….
• Since we cannot answer the
  question definitively of what
  counts as ‘deliberate’ we define
  self harm as ‘what happens when
  someone hurts or harms
  themselves

Department of Children’s Services
How Common is
Self Harm?
• 10-15% of 11-15 year olds Lancet
  2012
• 20% of 11-15 year olds WHO 2013
• 18.8% of 11-15 year olds
  diagnosed with depression
• 9.4% of 11-15 year olds
  diagnosed with anxiety
• 7.5% of 5-10 year olds with
  conduct/ hyperkinetic disorder

Department of Children’s Services
Young people
explain the self harm to…
• Punish themselves
• Relieve tension or stress
• Communicate their distress to other
  people
• Take control when they feel powerless
• Make themselves feel real, if they feel
  numb and remote from the world
• Nurture themselves, through caring for
  the wounds
The cycle of self harm
Negative emotions

Tension

Self harm act

Positive effects ( endorphins and tension
released)

Negative effects
A continuum
 of self harm
‘it is most helpful to consider
self harm as a continuum from behaviour
which has a strong suicidal intent ( e.g.
some overdoses) to behaviour which is
intended to help the young person to stay
alive.’

•Coleman 2004
Myths and Stereotypes
• Self harm is manipulative?
• It is a form of revenge?
• It’s attention seeking?
• It’s a cultish teen behaviour?
• It’s a failed suicide attempt and the person
  should be placed on suicide watch?
• Evidence of a borderline personality
  disorder?
Safeguarding and
confidentiality
• Young people anonymously
  report a much higher rate of self
  harm ….from this we can infer
  the importance of confidentiality
  and the wish to control their own
  situation….
• ‘those young people who spoke
  to an adult said that once they
  had done this all decision
  making and control were taken
  from them’ Truth Hurts 2008

Department of Children’s Services
Good reasons for early
intervention
• Early intervention may tackle
  the cause of the emotional pain,
  or offer alternative ways of coping
• Some people may want to stop self
  harming, but they need advice and/ or
  encouragement
• Early intervention can prevent
  escalation
How can we help our
children through tough
times?
•   Normalise feelings of despair
•   Teach and / or model coping skills
•   Improve the situation
•   Teach strategies to reduce tension
•   Identify positive and physical activities
•   Teach / model self talk – rehearse this
•   Promote belonging and sense of
    connectedness
Alternatives to
self harm
Self harm websites usually have lots of
 ideas about alternatives to self harm. These
   include:
• Clenching ice cubes ( make them with fake blood)
• Draw red lines on your skin
• Elastic bands on wrist
• Harmless pain – eating a chilli
Looking at these together reduces shame and
   increases sharing and the feeling of being
   understood
When you find out about self harm
• Do                        • Don’t
• Make sure they are safe   • Tell them to stop
• Remove possible           • Encourage them to
  equipment                   carry on
• Listen                    • Rush to tell parents –
• Show concern                take care!
• Debrief with colleagues   • Show fear, revulsion or
  and report                  panic
                            • Deal with it alone
                            • Feel responsible
Managing Self Harm
in School
Protocol for responding to
self harm in schools:
•Brief overview
•Key components
•Resources
•Onward referrals
Future in Mind:Mental Health
Champions in Every School
Support to deliver evidence based
interventions in schools
Training and supervision for school staff
Developing and delivering
psychoeducational resources for school
staff
References
• National CAMHS Support Service
• ‘Self Harm in Children and Young People
  Handbook 2011
• Royal College of Psychiatrists Self Harm
  fact sheets
• www.psych.ox.ac.uk/news/new-guide-for­
  parents-who-are-coping-with-their­
  child2019s-self-harm-2018you-are-not­
  alone2019
• Dealing with Self Injury Young Minds
Thank You

Dr Philippa Grace
Specialist Senior EP
(Mental Health)
philippa.grace@bradford.gov.uk
Rhian Beynon,
   Team Manager
Adoption and Fostering

      Jamie Gutch
Assistant Headteacher
Ilkley Grammar School
Children’s Mental Health and the
      neurobiology of stress
The Triune Brain

       Reason
          Relate
            Regulate
The Executive Functions

• emotional regulation   • reflection
• inhibition
                         • concentration
• empathy
                         • self-awareness
• planning
• decision making        • rationalising panic
Fight or Flight
• The Lower brain deals with survival and is 40 times faster than
  our rational brain
• The lower brain receives sensory information first and
  responds to perceived danger by activating our stress response
  system.
• It has memory templates for things that are safe and things that
  are dangerous.
• New experiences are initially categorised as potentially �
  dangerous. �
• Children who have experienced attachment-related traumas �
  are very easily triggered into a powerful dysregulated state. �
Stress Response
Dissociation
• Reduction of Heart rate
• Disconnect from self or environment
• Memory Gaps
• Compliance
• Lack of Individuation
• Fainting
A child who has experienced abuse,
neglect and loss is likely to have
deeply embedded beliefs, such as …..

• The world is a dangerous and frightening place
• I cannot trust anyone
• I must take control of my own survival
• I am never certain of the motives of others
• Food and comfort are in short supply
Life on Planet Shame
• It was all my fault
• I am a bad child
• I am a loser
• I am rubbish
• I am unlovable
• I don’t deserve to be cared for
• I don’t deserve good times
• People will hurt me
• People will abandon me
Shame – Be Alert
• Shame is ‘I am a bad child’ not ‘I am a good child who �
  made a mistake’ �
• Shame is toxic
• A child in shame learns nothing from an experience, it �
  only confirms to them they are bad �
• Social Learning Theory only works if the child trusts the
  motivations of the caregiver.
• Is my response going to increase or decrease feelings of
  shame?
Feeding the monster
• Shaming – red traffic lights, sad faces, dark clouds �
  reinforce the child’s self view �
• Excluding – denying good times and positive experiences �
• Taking things away – reinforcing old lessons
• Rewards and praise – may clash with the child’s inner �
  narrative �
• Control battles – trauma will usually win
Surprising the monster with P.A.C.E
• Playfulness – fun, relaxed, lightness, non critical, �
  enjoyment, humour, soft tone. �
• Acceptance – You’re ok, feelings are valid, I accept your �
  sadness/anger/fear (not behaviour) �
• Curiosity – Non-judgemental, I wonder…, I’m interested,
  reflection, I want to understand.
• Empathy – I feel your pain, I’m here with you, You are �
  not alone, I can handle your distress. �
The Three ‘R’s

       Reason
          Repair/Relate
             Regulate
Freeze
           Working with students with �
Attachment difficulties and the practical implications �
         for decision-making in schools �

                A work in progress by
                    Jamie Gutch �
Jamie Gutch �
•Arrived at IGS in Jan 2015 and joined the Leadership team in
a T&L role….

•Previously Head of Languages at Harrogate Grammar School,
G&T Co-ordinator, Pupil Premium focus. Been in education
since September 2005

•Current role (as of Sept 2015 with some twists and turns…)
   –   AHT Groups, Inclusion and Intervention
   –   LM Learning Support
   –   LM Key Stage 4
   –   LM CEIAG and Alternative Curriculum

•Key changes at IGS 2016-17
   – Move to non-teaching HOYs
   – New SENDCo in place – Beth Donkin
IGS context
• Ilkley Grammar School is a non-selective comprehensive Academy (2011)
  for 11-18 year olds.
• There are 1614 students on roll, (354 students in post 16).
• The academic profile on entry in year 7 is consistently sig. above the nat.
  ave.
• Pupil Premium funding for 127 students (7.9% of our school population).
  36 Year 7 students are PP.
• 226 students (14.0%) with SEND (below the nat. ave). This includes 208
  SEN K students and 24 with a Statement or EHCP (10 in Y7) .
• 110 teachers (31 part time) and 87 support staff
• Attendance is high and isolation, exclusion and permanent exclusion
  rates are low.
• Taking into account starting points, the overall progress of students
  exceeds ‘good’ in many areas across the curriculum including English and
  mathematics. This is supported by a significantly positive P8 score of
  +.23 in 2015, and estimated scores of at least +.3 in 2016. The percentage
  of students making 4LOP is higher than adjusted national figures in every
  subject.

But….
But…
•   We have a growing incidence of mental health issues due to..

     – Family breakdown
     – Social media
     – High expectations

•   We had 38 children who met the threshold for CAMHS last year.

•   There is a core of children and families (around 8%) who are very disengaged and
    difficult to reach precisely because they are relatively small in number. These are
    very isolated in the context of IGS due to their deprivation relative to the majority.
    A number of these are well known to the police .

•   We currently have 21 children who are LAC or who have been adopted from care.
Discovering a framework
                for
     managing children with
     attachment difficulties..

Where are we? At the start of a journey

   – Sig. increase in the number of students exhibiting symptoms of
     fight, flight or freeze.
   – A skills/training gap emerged.
   – Contacted by a number of parents of adopted children and
     began working with some key students and families. Patterns
     emerged.
   – At a CAF Nicky Poprikova offered the possibility of delivering
     CPD with her colleague Rhian Beynon.
   – CPD was attended by around 25 IGS colleagues and resonated
     deeply with our struggle to manage key students.
Challenges for (secondary) schools
• Fight : Violent behaviour – students are often physically quite big and
  are in a non-rational, dysregulated state.

• Flight : Safeguarding – on a large school site there are multiple
  ‘changeovers’ between different professionals during a school day.

(e.g. at least 26 people involved in a recent communication re provision for
                                    1 student)

• Freeze : Refusal to follow instructions leading to frequent escalation.

   (e.g. Teacher-LSA-HOY-AHT-DHT-Parent-Police)

    Adolescence is a time of huge change – mentally, physically, socially
Challenges cont.
            Personalisation V consistency �
      Parents – ‘my child doesn’t fit your behaviour policy why can’t you adapt
      what you do?’

      Students – ‘they get away with it, why can’t I?’

      Teachers – ‘I’m being inconsistent and risk being a hypocrite’

        Some of the challenges for decision-making… �
•Consistency (Implementing the Behaviour policy)
•Financial cost (Provision of expensive interventions)
•Time cost (Intensive deployment of staff, often 1:1)
•Risk management (honouring non-negotiable safeguarding responsibilities)
    – Children seem to inhabit a different reality (Memory gaps / dysregulated states)
    – Children display a lack of trust (Authority seems undermined)
Solutions that seem to be working for us…
1.    Allow sanctions to be delayed and students to ‘take 5’.

2.    Provide ‘Time in’ (freeze) and ‘Time out’ (fight/flight) cards.

3.    Explore pro-active rather than re-active interventions

4.    Plan high-quality whole school CPD on Attachment Disorder

5.    Try interventions which explore risk management

6.    Ensure Transparency re decision-making, include all stakeholders

7.    Agree safe spaces and identify key ‘trusted’ colleagues as part of a support
      plan.

8.    Always have a plan A,B,C,D,E,F,G…a creative, graduated and structured
      response which accepts that
      –    it takes a disproportionately long time to build trust
      –    interventions often won’t work
      –    rejection of intervention may not seem rational
      –    Plan H,I and J may require a move to a different setting

          It is sometimes more about doing something than doing the right thing �
« Time in » card
Y9 Alternative Curriculum
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Pro-active interventions
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