Inclusion - Going strong

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Identifying an increase in the numbers of children experiencing mental health and well-being problems has urged staff at Elmwood Infants and Nursery School in Croydon, south London, to introduce targeted support and interventions.

‘Our school is in an area of social deprivation and many families are struggling with all the difficulties that this brings. Children are three times more likely to develop mental health problems if they live in poverty and we have many families in that position,’ says assistant head for inclusion Helen Walsh, who is now the school’s designated mental health lead.

‘We have lots of children who are struggling emotionally or presenting with challenging behaviour. Often when we look at the cause, we find a range of difficulties, from what the child is dealing with at home to adverse childhood trauma.’

Nine per cent of the school’s 412 children are currently identified as having social and emotional mental health problems, not counting a large number of children classed as ‘vulnerable’.

‘We see the full gamut of problems here and realised that we have not always had a lot in place to support the children and their parents,’ says Ms Walsh. ‘It is very difficult for children to access special mental health support outside school – there is an 18-month waiting list for CAMHS services – so we needed to look at what we can do in school to support children while they wait for more specialist support.’

ROLE

Elmwood identifies its role in supporting the mental health and well-being of children as:

Prevention To create an ethos, environment and curriculum that builds resilience, ensures children are able to manage times of change and stress and nurtures positive mental health and well-being

Identification To understand what mental health needs are and recognise any emerging issues

Early support To provide evidence-based interventions for children identified with needs

Access to specialist support To work with outside agencies for children identified with high needs.

The school has a policy outlining what risk factors to look for and the procedures for staff to follow if they suspect that a child is experiencing mental health difficulties. Among the risk factors that staff are alert to, and make some children more likely to experience problems, are long-term illness, having a parent with a mental health problem, death and loss, loss of friendships, family breakdown and bullying.

They also understand the factors that protect children from adversity – such as self-esteem, communication and problem-solving skills, a sense of worth and belonging and emotional literacy.

The Boxall Profile and Strengths and Difficulties Questionnaires are used to asses children thought to be at risk of mental health and well-being problems to provide a picture of where their needs are.

KEY SKILLS

‘While we do not teach explicitly about mental health conditions in the EYFS or KS1, we can promote skills, knowledge, understanding and language that will enable children to adopt healthy thoughts, behaviours and strategies to seek appropriate and timely support in the future,’ explains Ms Walsh.

‘We can support children in developing their resilience and emotional well-being from an early age by incorporating key skills across the curriculum.’

These include:

• good communication skills
• good problem-solving skills
• healthy coping skills, including responses to moments of crisis
• the knowledge, skills and confidence to seek help.
  

INITIATIVES

Initiatives to support the children in these key skills are:

Mental Health Cluster Group

Elmwood joined the Children and Young People Cluster Group pilot, run by South West London Health and Care Partnership, in September, aimed at establishing a mental health support team to enhance the delivery of targeted support for children identified with mild to moderate mental health conditions in school settings.

As part of the pilot, two staff members will train as mental health first-aiders and the school will receive the support of a qualified mental health team, including a mental health key worker for a day every fortnight. ‘This access to qualified support will be invaluable while our highest-need children wait to be referred to CAMHS for assessment,’ says Ms Walsh.

Emotional Literacy Support Assistants (ELSAs)

Two of Elmwood’s staff have undergone ELSA training, an educational psychology-led intervention which covers areas such as social skills, emotions, bereavement, social stories and therapeutic stories, anger management, self-esteem and counselling skills.

ELSAs provide emotional support through establishing relationships with children and providing a reflective space to share thoughts and feelings. ELSAs use basic counselling skills – active listening, problem clarification, open questions, thinking aloud, verbal and non-verbal prompts – to guide conversations.

Children who are presenting as unhappy or upset, struggling to manage their emotions, identified by their teacher or parents as being withdrawn or displaying challenging behaviour are targeted for one-to-one sessions with an ELSA for around 20 minutes once or twice a week.

‘They are able to provide special time where the child can receive targeted support, such as recognising and talking about their own emotions, simple anger management techniques and time to relax, play games and talk in a non-threatening environment,’ explains Ms Walsh. ‘Children can use the strategies they have learned, but know they can talk to their ELSA if they are finding things difficult.’

The school is considering training more staff in this approach because of its success and the continued demand from children.

Nurture groups

Children displaying needs similar to those targeted by the ELSAs but who could benefit from longer, group intervention are invited to attend nurture groups. Groups of around eight children attend the nurture groups for two afternoons a week, often for a school year.

The nurture group is a combination of a school and home environment with consistent adults there to support interactions, such as modelling co-operation and leading activities around emotional literacy. Each session is uniform and predictable so children feel secure.

‘There aims to be a family feel with children continuing their learning linked to the class themes but gaining more support while also learning how to cope with anxiety, follow instructions, build friendships or learn social skills,’ says Ms Walsh. ‘The children always have snack time at the end and take it in turns to lay the table and tidy away. They get to eat together, chat and share their news.’

Social skills group

This group was recently launched in response to the ELSAs and nurture groups running at full capacity. They are run by a teaching assistant and operate two afternoons a week targeting mainly children who have been identified as having difficulties with social skills, such as turn-taking or initiating play, displaying high levels of anxiety or difficulties developing friendships. Activities include role play around social situations, and discussing emotions and responses.

‘The groups are run by a familiar adult so the children feel more comfortable to talk. We notice that after being involved, children develop more confidence to become involved in games, to contribute during class and to be silly if they are unusually passive,’ says Ms Walsh. ‘They know it’s OK to have fun and to laugh, which is so good to see.’

Lunchtime friendship club

‘The playground can be a scary place for children who have social skills difficulties, are experiencing difficulties at home or who have EAL. Then there are children with behavioural difficulties who, when there is unfocused play, tend to play-fight, which can spiral, and those who have medical conditions, such as sickle cell anaemia or severe asthma, who can struggle outside,’ says Ms Walsh.

The group has been established to give around 15 to 20 children each day a ‘secure’ place to go during the lunch hour. It is led by a learning mentor who sets up a variety of toys and games along with role-play and small-world play opportunities. Children deemed as vulnerable are given a ‘free pass’ to attend whenever they choose, while others are occasionally signposted to the group along with being encouraged to attend other lunchtime activities, such as reading sessions or the health and fitness club, and children are also randomly selected so that it is inclusive.

MENTAL HEALTH: A DEFINITION

‘Mental health is defined as a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his own community’ World Health Organization

FURTHER INFORMATION

• Mental health and well-being provision in schools, www.gov.uk/government/publications/mental-health-and-wellbeing-provision-in-schools
• www.elsanetwork.org