Policy perspectives on behaviour and well-being and implications for research informed practice within schools. Brahm Norwich Graduate School of Education, University of Exeter

Overview key changes in policy - implications for school based practices. Importance of focus on mental health and well-being schools contribution including school based research to improve practice

Key points about child and adolescent mental health (CAMHS) 1 in 10 diagnosed MH disorder 1 in 7 less severe problems No up to date information last survey ten years ago. (HoC Select Health Ctee, 2014) Focus on early CAMHS intervention urged by Select Ctee. Health and Well Being Boards at LA level now hold public health funds Battle to access CAMHS – bridging gap between inpatient and community services

SEN Policy and legislative changes 13 years since significant legislative change Children and Families Act , 2014 – new Code of practice mental health - first time one of the dimensions of SEN: ‘Social Emotional and Mental Health’

Labour Government 1997-2010 many initiatives from early commitment to social inclusion and inclusive education. BUT SEN and inclusion policies less important than the standards agenda uncertainty and ambivalence about inclusion: due to adoption of a market oriented / parental preference-based system

Conservative policy development Conservative Party policy during Labour period: SEN over-identified Inclusion: ideology that ‘failed a generation of special needs children’ Conservative 2010 election manifesto: promised end to ‘bias to inclusion’ phrase used in the SEN Green Paper

Green Paper: Support and aspiration: a new approach to special educational needs ‘radically different system’ better life outcomes for children and young people. giving parents more confidence and transferring power to front-line professionals and local communities.

Green Paper key elements new approach to identifying SEN: single assessment process and for Education, Care and Health Plans (EHC plans), increased integration of education, social care and health service commissioning, a Local Offer of all services, parents having an option for a personal budget, giving parents a real choice of schools, greater independence in the assessment of children’s needs

What overlooked Not address unresolved issues from Labour period. defining inclusion in a clear and realistic way (House of Commons, 2006), linking the SEN and disability legislative systems reconciling inclusivity with parental preference continued value of statutory assessment for Statement not questioned: despite critique of Statements and alternative suggestion for parents to opt into statutory process little detailed longer-term vision of how the SEN / disability provision was inter-connected with and dependent on the wider education service.

What was radically new proposals not “radically new” extending, integrating and tightening up existing principles and practices. EHC Plans an extension of the Statement covering wider age range of 0-25. Parents already involved in the assessment process and Some parents already had access to personal budgets. ‘radically new’ was in the wider education system: governance of schools: Academies and Free schools accountability system, funding model for SEN and the strong moves to a user-led model

SEN Pathfinders Green Paper very general - how work through by Pathfinder LAs. Legislation went through before outcomes reported: only a process evaluation Pathfinders were extended for a year and await outcomes report. Evaluation: general feedback positive key worker role established: a single point of contact. personal profiles for families and young people to express themselves person-centred planning approaches had been adopted.

Challenges development of outcomes-based plans challenging. limited progress over implementing some key principles, involving children and young people and multi-agency involvement. involving health service professionals led to incomplete plans. How to balance of demands from core health work and Pathfinder demands. Key workers/coordinators were also unclear about their degrees of freedom within the planning process quality assurance and review process for EHC Plans insufficiently developed.

Scale and focus of trials Independent Panel of Special Education Advice (IPSEA) study: 28 of the 31 authorities questionnaire data 1507 EHC Plans for children / young people. Only 17% early years and 11% FE only 36% were undergoing statutory assessment for first time; almost two-thirds had prior Statements For 25 authorities: 280 personal budgets completed, 143 involving direct payments and only 27% did not cover transport and equipment. Raises questions about how extensively the proposed changes had been trialled.

Children and Families Act (CFA) 2014 the participation of children, their parents and young people in decision making the early identification of children and young people’s needs and early intervention to support them greater choice and control for young people and parents over support collaboration between education, health and social care services to provide support high quality provision to meet the needs of children and young people with special educational needs (SEN)

Code of Practice: person-centred planning (PCP) focuses on the individual enables parents, children and young people to express their views, wishes and feelings and be involved in decisions easy for them to understand and highlight their strengths and capabilities enables them to communicate their achievements, interests and desired outcomes tailors support to their needs and minimise demands on the family brings together relevant professionals to deliver an outcomes-focused and co-ordinated plan

PCP issues new system adopts and extends current principles and practices and changes their terms of reference Makes principles sound ‘new’: first 2 SEN Codes of Practice were person-centred without ‘person-centred’ label. communication and partnership with parents and pupils to person-centred Statements to EHC Plans

PCP practices origins in social care and health of people with learning disabilities use in the SEN field very limited Corrigan (2014) - small scale study, suggested facilitators and barriers to the effective use of PCP: skill level and availability of lead staff, level of training and ongoing supervision provided to lead staff, strength of relationships and collaborative skills within the group, ability of all members to attend throughout the process, quality of communication between settings and agencies, ability to elicit the genuine voice of the child or young person, degree to which PCP approaches were compromised by funding issues

PCP risks Some practitioners report that some reviews are not genuinely person-centred. when a single inflexible approach is adopted regardless of the identified needs of the child or young person and their family. for example, need to be adapted for a young person exhibiting highly avoidant attachment strategies or someone who has experienced severe relational trauma

Inter-service collaboration CFA duties on local authorities to ensure ‘that services work together where this promotes children and young people’s wellbeing or improves the quality of special educational provision’ (Section 25 CFA). Local authorities and health bodies required to plan and commission education, health and social care services jointly for children and young people with SEN or disabilities (Section 26 CFA). Key developments in 3rd SEND Code of Practice compared to the two previous ones is detail about how inter-service collaboration is to work. done in some detail in 22 pages

Inter-professional collaboration How are local authorities to integrate educational provision … with health and social care provision? Different multi-agency groups are unique with own socio-political context, objectives, working processes, internal dynamics and external pressures. Townsley et al (2004) found there were persistent multiple barriers to communication focus of meetings was often found to be multi-agency structures rather than improved outcomes for young people and their families.

Successful multi-agency working Eaton (2010) review of successful multi-agency – summarised in terms of Strong leadership with a clear vision and a drive to get things done, Well-managed conflicts and the absence of ‘a competitive blame culture’, Opportunities for joint training, Time for reflective learning

Eco-systemic model of multi-agency working (Eaton 2010) System level Group focus Micros: Ethical consideration Shared terminology and language: challenging and clarifying language used to define CYP needs and context Roles Clearly defined roles and responsibilities: differentiated, shared core skills and domain specific expertise Meso: Positive team-oriented attitudes, such as respect, trust , flexibility. Exo: Wider pressures Adequate budgetary, staff and time resources, common lines of accountability Macro: Philosophical context Shared goals, values and beliefs about interventions, case priorities, appropriate settings Chrono: Patterns of working over time Absence of negative robotic thinking in group working patterns

Social, Emotional and Mental Health Replaces Behavioural, Social and Emotional Needs described in the following manner: ‘Children and young people may experience a wide range of social and emotional difficulties… These behaviours may reflect underlying mental health difficulties … [or] disorders such as ADD, ADHD or attachment disorder.’ (Section 6.32)

SEMH category: issues behaviour difficulty no longer seen as a special educational need: but never was in previous Codes either Underlying category changes: removal SA and introducing SEMH is policy of reducing the number of pupils identified as having SEN (high incidence SEN, like MLD) new SEMH category no different from the previous BESD one: No clear process for specifying the thresholds for identifying such difficulties. problem with BESD category was its ambiguity and diverse use, problem persists with the new Code.

language of psychiatric disorder ‘these behaviours may reflect underlying mental health difficulties … [or] disorders’ (COP, 2014) CoP: no reference to social context in SEMH definition continuing issues about reliability and validity of psychiatric diagnoses. educational significance of impairments / difficulties need to be seen in functional and contextual terms. Crucial point : the gap between general diagnostic categories and the particular individual characteristics and context of children in educational terms. why term ‘special educational needs’ was originally introduced Not all children identified, for example, as ADHD, have the same educational needs; other personal and contextual factors are also important to understand individual cases.

The need for an interactive model of mental health relevant to education interactive model recognises the interaction of child and environmental factors in a developmental context bio-psycho-social model that integrates medical and social models (Cooper and Jacobs, 2011; Hollenweger, 2011) WHO’s child / young person’s International Classification of Functioning (ICF)

Targeted Mental Health Support (TaMHS) national initiative children aged 5–13 at risk of developing mental health problems by March 2011 3000 schools involved in delivering TaMHS projects. national review Wolpert et al (2013)

TaMHS review: factors and issues Location: - School based MH services promotes inter-agency collaboration and increased access to these services Language: - significant barrier to effective, integrated provision - absence of a common language across mental health and education services - exacerbated by differences in philosophy and working practice between agencies, Ownership: - dilemma about targeted provision: - balancing the need for implementation fidelity (by MH professionals) with the need for school ownership, embedded practice and reduced costs. Scope: educational policy encourages balance between universal, preventive provision and supplementary targeted programmes for at-risk pupils, little evidence to inform this position

TaMHS review: factors and issues Timing: - impact of TaMHS interventions more for primary children - amplified by differences between primary and secondary - place greater emphasis on the relation between children’s mental health and academic attainment may help to lessen primary-secondary difference Evidence-based practice: - engagement in using / developing evidence-based practice was disappointing in schools, - lack of awareness of evidence-based materials and a lack of access to the appropriate training and materials. - Australian ‘Kidsmatter’ programme: guide to over seventy evidence-based interventions, - recent UK MindEd web based learning programme https://www.minded.org.uk/

Mental health and behaviour in schools Departmental advice for school staff In order to help their pupils succeed, schools have a role to play in supporting them to be resilient and mentally healthy.. Where severe problems occur schools should expect the child to get support elsewhere as well, Schools should ensure that pupils and their families participate as fully as possible in decisions Schools can use the Strengths and Difficulties Questionnaire (SDQ) to help them judge whether individual pupils might be suffering from a diagnosable mental health problem MindEd, a free online training tool There are things that schools can do – including for all their pupils, for those showing early signs of problems and for families exposed to several risk factors – to intervene early and strengthen resilience, Schools can influence the health services that are commissioned locally through their local Health and Wellbeing Board • There are national organisations offering materials, help and advice. Schools should look at what provision is available locally

Risk and protective factors for child and adolescent mental health (DFE, 2014) In child In family In school In community

In school *Bullying • Discrimination RISK FACTORS Protective factors *Bullying • Discrimination • Breakdown in or lack of positive friendships • Deviant peer influences • Peer pressure • Poor pupil to teacher relationships * Clear policies on behaviour and bullying • ‘Open-door’ policy for children to raise problems • A whole-school approach to promoting good mental health • Positive classroom management • A sense of belonging • Positive peer influences

Wave / tier 3: specialist Wave / tier 2: targeted Wave / tier 1: Quality first / universal

Universal provision Health Select Ctee CAMHS Report 2014: Mandatory module in ITT on MH and for CPD (section 210) Difficult to ensure that all schools use tools DFE guidance and MindEd website Role for Ofsted and tension between standards agenda and wider well-being ones Example of universal public health intervention – protective factor ‘Supporting Teachers And childRen in Schools’ (STARS) project evaluating the Incredible Years Teacher Classroom Management (TCM) intervention. TCM: 6 day training course to groups of 8–12 teachers. STARS trial aims to improve children’s behaviour, attainment and wellbeing, reduce teachers’ stress and improve self-efficacy.

Targeted interventions Supporting teacher problem solving approaches Teacher Support Teams (Creese, Norwich, Daniels) Collaborative groups (Hanko) Circles of Adults; Teacher Coaching; Collaborative Problem-Solving Groups Staff Sharing Scheme. Bennet and Monsen (2011) review EPIP

Lesson Study: universal and targeted approach to integrating cognitive and social/emotional aspects into teaching LS as practice-based research / inquiry Distinctiveness study of lesson (pedagogic focus) For and by teachers focus on learning / learners Case pupils (UK version) research oriented (RQ :how improve learning of ?) Research lesson collaborative LS team involved at each stage (lesson observation by team) enables inter-disciplinary collaboration reflective practitioner use of craft and research informed knowledge

Lesson Study logic

How adapt LS to researching lessons with pupils with SEMH difficulties Research lesson goals – both subject based, e.g. maths, and about learning behaviours (emotions, relationships etc.) LS team to include class teachers and those with specialist knowledge, e.g. SENCo, specialist teacher, Edpsych and/or MH worker use research-based knowledge about emotional / behaviour functioning in lesson review/planning , e.g. self regulating strategies

Concluding comments Crucial importance: whole school policies and practices – senior management commitment to broader achievement and well-being Current ‘standards’ agenda undermines this commitment Important things schools and teachers can do Practice-based research – inter-professional, collaborative & research evidence informed, e.g. LS MUCH WORTH DOING AND CAN BE DONE

References Norwich, B. & Eaton, A. (2014): The new special educational needs(SEN) legislation in England and implications for services for children and young people with social, emotional and behavioural difficulties, Emotional and Behavioural Difficulties, DOI: 10.1080/13632752.2014.989056 Norwich, B and Jones J. (2013/4) Lesson Study: making a difference to teaching pupils with learning difficulties. London: Continuum Publishers. Ylonen, A. and Norwich, B. (2012) ‘Using Lesson Study to develop teaching approaches for secondary school pupils with moderate learning difficulties: teachers’ concepts, attitudes and pedagogic strategies’, in European Journal of Special Needs Education, Vol. 27 (3): 301-317

MindEd web based learning programme https://www.minded.org.uk/ Web sources: LS for Assessment: http://elac.ex.ac.uk/lessonstudymld/page.php?id=171 Department for Education, Advanced training materials for SEN, Lesson Study, available at: http://www.education.gov.uk/lamb/module2/M02U09.html# MindEd web based learning programme https://www.minded.org.uk/