Emotional Well-being and Mental Health Support
For Children & Young People in Schools
National CAMHS Support Service
October 2006
Emotional Well-being and Mental Health Toolkit
Forward by John Shears and Sarah Young
In recent years schools have reported much higher levels of challenging behaviour from children and young people as well as
a marked increase in stress, depression, anxiety and self harm often leading to worrying behaviour and an inability to learn.
With the ‘Every Child Matters’ agenda now firmly in place and the additional responsibilities that this places on schools, there
is often from them a cry for help, advice and support. Schools feel themselves in the frontline of tackling the emotional needs
and mental health of the young and can feel quite anxious and isolated.
In response to the schools’ needs a toolkit was produced in Bristol with the aim of providing support and advice. The intention
was to help schools meet both general and specific demands from young people. It has a section that outlines strategies and
resources that are available in Bristol to meet the general needs of children as well as ideas and sources to help produce an
emotionally strong school. Its second section examines approaches needed for children who show higher levels of concern
and who do not respond to early intervention. It is a useful reference point for contacts and advice from a wide range of
agencies and supporting bodies who can work with the school. A further section describes how the specialist Child and
Adolescent Mental Health Service in Bristol works and how to access it in order to tackle the more severe problems. This
Bristol specific material is further supported by a series of background annexes and wider reading.
The aim of the toolkit is not to produce a lengthy tome but to provide additional information, resources and signposts which
will give schools confidence in the already good work that many of them do to support the emotional health of the young. The
toolkit is Bristol specific but could be a useful template that can be customised for other localities. It can provide clues about
how schools and communities tackle the mental health of the young and it is hoped that by referring to it other areas might
wish to develop their own toolkit. While there is much to admire in the finished product, it is organic and something that needs
to be continually modified if it is to be of value. The greatest success of the work in many ways is not in fact the final
document but the process involved in its production. A true multi agency team representing CAMHS, the Local Authority,
Healthy Schools and Schools, and facilitated by CSIP was able to work together very constructively. The lesson for smaller
areas than Bristol is to bring together key players and provide time for them to work in partnership. In this way a useful
document is produced and more importantly cultural barriers are broken down and people genuinely work together for the
good of the child. We would like to express our thanks for the support and exemplary partnership working of colleagues in
Bristol who have developed this piece of work.
2
One way to use this toolkit – a guide to CAMHS and Children's Partnerships from the National CAMHS
Support Service
1. Start: by getting agreement from the partnership to do this piece of work and
2. Then get a small group together
2.1. the Healthy Schools lead for the partnership
2.2. The Extended Schools Local Authority lead
2.3. a primary mental health worker
2.4. a representative of specialist CAMHS
2.5. an education representative from Children’s Services/Children's Trust
2.6. a schools lead – teacher or head teacher – who is interested in children and young people’s mental health
2.7. and a few representatives of age specific and ethnicity specific organisations – such as Connexions, local
voluntary organisations, early years and family support
2.8. young people and carers representatives
3. Create a partnership toolkit:
3.1. strip out the Bristol-centric information from the boxes, acknowledge sourcing from Bristol but remove logo
3.2. put information in that relates to the whole of your partnership area
3.3. This process is likely to take some time as each member of the group will have to think about the
organisations they know of for the relevant parts of the toolkit
4. Partnership agreement and validation: Take it back/circulate to your CAMHS partnership for comment, review and
agreement. At this point you will have a fairly high level document, if you are in a large shire county or a big city. It
will not be a document which reflects the needs and resources of a local school cluster unless you are in a small
unitary authority. This should not be a problem – see below.
5. Local engagement: The next task is to engage a school cluster/extended school community. This can be a difficult
process as there are varying degrees of enthusiasm, time and capacity about truly wanting to find out what local
social emotional and psychological support there is for troubled young people. Again set up a small working group
comprising
5.1. the local Healthy Schools and Extended schools leads
5.2. the local primary mental health worker
3
5.3. if possible a GP or health visitor
5.4. a youth worker
5.5. and key staff from the school cluster who offer emotional and psychological support to the children in their
care
5.6. children and young people
6. Local completion: Go back to the blank box version of the toolkit and, using your partnership kit as a source
document, try to identify with the school community who and where the individuals and services are who can offer
support. This will include liaison with the local CAMHS team, youth services, early years, connexions, youth
offending, voluntary, church, police and other sectors for that community. This should be a task which young
people in the school help with because they may have ideas about where help is to be found which will not occur
to adults. It may even be a project for part of a class or year group in their PHSE curriculum. and they might
usefully debate the award of stars to those services and resources which they think or have found most helpful. It
will be particularly important to reflect on the needs of minorities (BME, gay and lesbian, learning disabled or
socially excluded) in doing this.
7. Feedback: At the end of this process you should have a group of people in the local school community who will
have a shared idea of the resources open to them and what is needed in order to access them. However it will be
necessary to disseminate the completed toolkit through the school community and also to use it to identify what
ought to be there and is missing. Feedback should then go back – from staff, children and young people, and
parents – to the CAMHS partnership group to enable these needs to be identified and addressed in continuing
development of services.
8. Revalidation: It is suggested that after a year the information will need to be re-validated locally and at partnership
level. The task should is an administrative one and will involve contacting local networks to ensure that the
information is still correct before re-circulating it to the partnership.
9. At the time of writing (April 2006) this work is about to be piloted. We are looking to receive feedback on the use of
the toolkit in and beyond Bristol’s boundaries and have attached a feedback form for schools to complete at the
end of the first year of using it. Schools should feed back to their Healthy Schools Coordinators or CAMHS
Partnerships who are asked to pass the forms on to the NCSS (see form at Annexe 4 for email contact).
4
THE KIT
This CARE PATHWAY is a toolkit to support schools to do the right thing at the right time to produce the best
outcomes for children and young people with mental health difficulties. It should also support the general emotional
health of all children.
It has 4 elements:
An
SECTION 1
SECTION 2
SECTION 3
WORK
WITHIN
SCHOOLS
ADVICE &
SUPPORT for
those
showing
CONTINUING
CONCERN
SPECIALIST
SUPPORT &
ADVICE
Introduction
to
set the scene
PATHWAY AND REFERRAL ROUTES
It aims to be a readily available quick reference and by the nature of its subject matter cannot be totally definitive.
5
Introduction
In recent years schools have reported much higher levels of challenging behaviour from children and young people, as well as a marked
increase of stress, depression, anxiety, and self harm. With the ‘Every Child Matters’ agenda now firmly in place and the additional
responsibilities that this places on schools, there is often from them a cry for help, advice and support. Schools do feel themselves in the
front line of tackling the demands of the emotional well-being and mental health of the young. It is hoped that this toolkit will be one part
of the support needed.
As research* shows that at least 10% of all children in schools will have at some stage in their schooling a diagnosable mental health
disorder, it is crucial to provide appropriate support. At the same time at least as many young people will have lesser emotional
difficulties which require intervention and care. The mental health of children and young people depends on a wide group of
professionals successfully working together and it is hoped that this toolkit provides some strategies to assist with this process.
The toolkit is in several sections:
Section One describes the work that can be developed in schools to support the general well-being of all children and it provides links
and references to help develop an emotionally strong school and meet the general needs of children and the relatively small scale
concerns that occur from time to time.
Section Two should enable schools to seek help for pupils who are showing higher levels of concern or those for whom early
intervention has not succeeded. While it is not a definitive list of supporting bodies and agencies, it should enable the school to seek
advice and act quickly.
Section Three describes the specialist Child and Adolescent Mental Health Service in Bristol and how referral can be made when the
problems are severe and ongoing and earlier actions have not been able resolve them.
The toolkit is further developed by a series of annexes which provide additional information and may be useful background reading. Its
main purpose however is not to produce a lengthy tome but to signpost support and help give schools confidence in the very good work
that they do to support the emotional health of their students.
Our aim will be to regularly update the toolkit and constantly evaluate its usefulness as a working document so please provide us with
feedback.
* NSF Standard 9 on Children’s Mental Health, Page 6, Item 2:2. Audit Commission Report on CAMHS,
Research by Target & Fonagy ‘What Works for Whom’
CARE PATHWAY FOR CHILDREN & YOUNG PEOPLE NEEDING SUPPORT
SECTION 1 – Work Within Schools
SERVICES TO SUPPORT THE MENTAL HEALTH / EMOTIONAL WELL-BEING of ALL CHILDREN & YOUNG
PEOPLE
The school’s pastoral system enhanced by:
Further specific interventions could use:
 SEAL (Primary) programme
or
 SEBS (Secondary) programme
 Meeting with parents and offering support through
PARENTLINE PLUS
 Engaging Learning mentors
 An effective PSHE programme
 Using trained counsellors (school or voluntary sector)
 Engagement in the Healthy Schools Programme
 Peer counsellors, pupil support networks
 The Behaviour & Attendance Strategy
 The school’s educational psychologist
 Behaviour Support Services
 The school nurse
 The Educational Welfare Officer Service
The Voluntary Sector has a wealth of experience that can be utilised through, Childline, CHIPS, Samaritans and
the Directory of Bristol’s Voluntary & Community Sector Organisations (See Page 11) to name but a few
sources
Refer to annexe 2 …. For what schools can do at Tier 1
7
SECTION 1
REFERENCE SHEET
One Big Database is a central database which brings together information about services for children, young people and their parents in Bath and North
East Somerset, Bristol, South Gloucestershire and North Somerset.
Available on the Internet www.ciswest.org.uk/1bigd/
SEAL (Social and Emotional Aspects of Learning) or SEBS (Social, Emotional and Behavioural Skills)
Contact
Brigid Allen, Excellence in Cities
Address
Tel:
Email:
Bristol Education Centre, Sheridan
0117 903 1295
brigid_allen@bristol-city.gov.uk
Road, Horfield, Bristol BS7 0PU
PSHE Policy & Scheme of Work cross referenced with National Healthy Schools Programme (NHSP)
Contact
Address
Tel:
Email:
Neil Davidson, Sex & Relationships
Bristol Education Centre, Sheridan
0117 377 3218
neil_davidson@bristol-city.gov.uk
Education Consultant
Road, Horfield, Bristol BS7 0PU
Julie Coulthard, Drug Education
Consultant
Bristol Education Centre, Sheridan
Road, Horfield, Bristol BS7 0PU
0117 377 3218
julie_coulthard@bristol-city.gov.uk
Antonia Taylor, Citizenship Advisor
Bristol Education Centre, Sheridan
0117 377 3221
antonia_taylor@bristol-city.gov.uk
Road, Horfield, Bristol BS7 0PU
Healthy Schools Programme aims to help raise pupil achievement, reduce health inequalities and promote social inclusion. For more information
view www.wiredforhealth.gov.uk
Contact
Address
Tel:
Email:
Sarah Young, Healthy Schools
Bristol Directorate for Public Health,
0117 900 2216
sarah.young@bristolnorth-pct.nhs.uk
Programme Manager
King Square House, King Square,
Bristol BS2 8EE
Behaviour & Attendance Strategy – group work targeted at specific issues set up and/or supported by LEA behaviour support group.
Contact
Address
Tel:
Email:
Esther Pick-up Keller, Behaviour &
Bristol Education Centre, Sheridan
0117 377 3239
esther_pickup-keller@bristol-city.gov.uk
Attendance Consultant for the Secondary Road, Horfield, Bristol, BS7 0PU
Strategy
Behaviour and Attendance Programmes – Targeted nationally funded programmes to improve behaviour and attendance. Programmes include the
Behaviour Improvement Programme, Learning Mentors and Learning Support Units
Contact
Address
Tel/Fax
Email
Brigid Allen, Excellence in Cities
Bristol Education Centre, Sheridan
0117 903 1295
brigid_allen@bristol-city.gov.uk
Road, Horfield, BS7 0PU
8
SECTION 1
REFERENCE SHEET cont’d
Educational Psychologist for each school has an allocation for whole school support. With respect to young people's social, emotional, behavioural
and
mental health and well-being your link EP can advise and support you in a variety of ways ranging through:
 assessment of difficulties in order to inform appropriate interventions to promote student mental health and well-being
 work with individuals and / or groups (along with school staff) to enhance well-being and mental health as well as develop social skills and behaviour
management
 consultative / coaching work to help enable school staff to enhance students' mental health and well-being
 whole school work at a policy and / or training level to meet the mental health and well-being of students and their social, emotional and behavioural needs
 work to help staff groups and individuals maintain their own mental health and well-being
 evaluation and analysis of strategies being developed / run / piloted by school
EPs can work at all the above levels through regular visiting and through taking on a specific project. Time will need to be negotiated prior to initiating a particular
project in order to ensure that it can be completed.
Contact
Address
Tel/Fax
Email
Bristol Education Centre, Sheridan Road,
North Bristol 0117 903 1392
judy_evans@bristol-city.gov.uk
Horfield, BS7 0PU Or Orchard House, Hengrove East/Central Bristol 0117 903 1250
School Nurse Service
Contact
Address
Tel/Fax
Email
South Bristol - Sharon Schools
Knowle Clinic
0117 919 0213
sharon.schools@ubht.nhs.uk
North Bristol – Jennie Turner
0117 957 3206
jennifer.turner@nbt.nhs.uk
- Each school has a named school nurse who can accept a written referral from school (after the teacher has gained parent/carers consent to the school making
the referral and shared concerns) and will then contact the parents to consider the best way forward.
- School nurses often run young peoples drop-in sessions when pupils can contact the school nurse directly if they want to.
- School nurses can offer support to pupils around mental health and well-being and are a good point of contact if school are worried about how the young person is
feeling.
-School nurses can, with parents consent, liaise with the G.P. around concerns and make referrals to Child and Adolescent Mental Health Services if it is felt that the
problems are more serious
From 01 April 2006 there will be two School Health Nursing Teams in Bristol, Bristol North and Bristol South.
If schools are concerned about the mental health of pupils they should talk to their Named School Health Nurse after seeking consent from the person with parental
responsibility for the child or young person. This will result in completion of a School Health Nurse Request form or a Single Point of Entry Form (or MARS in South
Glos) depending on need. Alternatively, as is frequently happening, school will complete a School Health Nurse Request Form and send it to their Named School
Health Nurse.
Education Welfare Officers / Service – The EWS has a statutory role regarding school attendance and all work we do is in relation to referrals of children
not attending school
Contact
Address
Tel/Fax
Email
Gill Tippetts – Principal Education
South Bristol Team - Orchard House,
South Bristol 0117 903 1660
gill_tippetts@bristol-city.gov.uk
Welfare Officer
Hengrove School, Petherton Rd, Hengrove,
North Bristol 0117 903 1354
pat_cummings@bristol-city.gov.uk
Pat Cummings – North Bristol Team
BS14 9BU
North Bristol Team – Bristol Education
Best to phone in duty time
Centre, Sheridan Road, Horfield, BS7 0PU
3.00 – 4.30pm
9
REFERENCE SHEET cont’d
SECTION 1
VOLUNTARY AGENCIES
Directory of Bristol’s Voluntary & Community Sector Organisations working with Children & Young
People with Emotional, Behavioural and Mental Health difficulties, produced by The Care Forum for Bristol CAMHS Partnership in Spring 2005.
Reference could be made to the
Website: www.thecareforum.org.uk. Detailed information about 900 local agencies for 0 – 19 year olds is also available online at www.connexionswest.org.uk. This
information is searchable by topic and local area and is updated regularly.
Contact
Address
Tel/Fax
Email
The Care Forum
The Vassall Centre, Gill Avenue,
Tel: 0117 965 4444
admin@thecareforum.org.uk
Fishponds, BS16 2QQ
Fax: 0117 965 0200
CHIPS programme – Childline in Partnership with Schools – offers resources, workshops on issues such as bullying and peer support training for
pupils and staff. Website: www childline.org.uk
Contact
Address
Tel/Fax
Email
Judith Moore
Childline South West,
Tel: 0870 336 2905
jmoore@childline.org.uk
2 St Paul’s Road. Newton Abbott,
Fax: 0870 336 2906
Devon,TQ12 2HP
Direct Line: 0207 650 6981
Samaritans – offer a volunteer 24 hour confidential support service. Tel 08457 90 90 90 Website: www.Samaritans .org
Samaritans Emotional Health Promotion Schools Programme This programme will be launched in October 2006 when it will be available to all schools
free of charge via the Samaritans website and local Samaritans branches.
Most work is done with 14 – 18 year olds and some branches will run sessions for students, provide training for staff and participate in events such as health fairs.
Focus on resilience, challenging attitudes, communication and listening skills, and knowledge of routes to support as well as issues such as depression and self harm. .
Contact
Address
Tel/Fax
Email
For Programme information –
Tel: 020 8394 8380
t.schmidt@samaritans.org
Tonja Schmidt – Emotional Health Promotion
Fax: 020 8394 8301
Officer (Schools)
For Local information – Samaritans Bristol
37 St Nicholas Street, BS1 1TP 0117 983 1000 (Helpline & Queries)
Project Myrtle – 2006 onwards
Project Myrtle is a partnership project originally commissioned by the Health Promotion Service Avon. The project aims to provide meaningful and relevant drugs
education for Year 6 students. The project comprises of a stimulus piece of theatre, “Myrtle on the Mainline” (written by Lucy Catherine), interactive workshops to
develop a range of personal skills – decision making, risk assessment, strategies for dealing with peer pressure and communication – and a student performance to
their parents / carers.
Contact
Address
Tel/Fax
Email
Myrtle Theatre Company
14 College Road, Clifton, BS8 3HZ 0117 974 4660
info@myrtletheatrecompany.co.uk
Parentline Plus see website: www.parentlineplus.org.uk
Contact
Jo Gray
Address
The Park, Daventry Road,
Knowle West, BS4 1DQ
Tel:
0117 953 5525
Helpline: 0808 800 2222 Free, Confidential and 24 hour.
Free text phone for people with speech or hearing
impairment – 0800 783 6783
Email
jog@parentlineplus.org.uk
10
SECTION 2 – Advice & Support for those showing Continuing Concern
SERVICES TO SUPPORT THE MENTAL HEALTH OF CHILDREN & YOUNG PEOPLE CONTINUING TO SHOW
CONCERN

Encourage carers or parents to visit their GP

School nurse may be able to offer additional support

Sexual Health

Behaviour Support Services

Preventing Exclusion

Educational Psychologist

Looked After Children – (refer to designated teacher)

EMAS – Ethnic Minority Achievement Service

Youth Offending

Bristol Early Intervention Service
Therapies - Schools might consider purchasing appropriate
therapies - Art, Music, Drama, Play, Dance.
Support can be provided on
And by

Connexions

The Primary Mental Health Specialist

Children and Young People’s Services
The Voluntary Sector has considerable experience of working with
individuals and small groups and a selection of some of the important
agencies are listed below.
Personal recommendations are valuable but some possible
contacts are listed below.
11
SECTION 2
REFERENCE SHEET
Behaviour Education Support Teams (BEST) – A multi agency generic service for early intervention in Henbury, Hengrove, Knowle West, St
George and Withywood. BEST aims to promote emotional well-being, positive behaviour and
school attendance, by identifying and supporting those at risk of developing emotional and
behavioural problems.
Address
Tel:
Email:
Bristol Education Centre, Sheridan Road,
0117 903 1295
lindsey_dowdell@bristol-city.gov.uk
Horfield, BS7 0PU
Fax:
alison_findlay@bristol-city.gov.uk
0117 377 3240
Contact
Lindsey Dowdell, BEST Co-ordinator,
(Henbury and St George)
Alison Findlay, BEST Co-ordinator,
(Knowle West and Withywood)
Behaviour Support Services – working with individuals and groups of children/students who have been referred by Head teachers
Contact
Judy Easterbrook (Pupil Support
Team – Primary)
Sue Jackson BSS (Secondary)
Address
Bristol Education Centre, Sheridan Road, Horfield,
BS7 0PU
Tel:
0117 903 7082
Email:
judy_easterbrook@bristol-city.gov.uk
0117 903 1375
sue_jackson@bristol-city.gov.uk
EMAS – Ethnic Minority Achievement Service brought in by schools to support under achieving ethnic minority children
Contact
Claudette Radway
Address
Tel:
Email
Bristol Education Centre, Sheridan Road, Horfield
0117 903 1269
claudette_radway@bristol-city.gov.uk
Bristol BS7 0PU
Bristol Early Intervention Service –From 2006 will offer 1:1 sessions with secondary school children & young people who have drug issues either
themselves or with others
Contact
Address
Tel:
Email
Geraldine Smyth
Bristol Public Health Directorate, King Square House
0117 900 2652
geraldine.smyth@bristolnorthSenior Health Promotion Specialist King Square, Bristol BS2 8EE
Fax: 0117 900 3409
pct.nhs.uk
Sexual Health
Contact
Anne Colquhoun
Teenage Pregnancy Co-ordinator
Address
Bristol Directorate for Public Health, King Square
House, King Square, Bristol BS2 8EE
Tel:
0117 900 2635
Email
anne.colquhoun@bristolnorthpct.nhs.uk
Bristol Education Inclusion Officers – support in exclusions / prevention of exclusions by referral
Contact
Jane Hicks
Address
Bristol City Council
Children and Young People’s Services, PO Box 57
Council House, College Green, Bristol BS99 7EB
Tel:
0117 903 7747
Mob:077479 79211
Email
jane_hicks@bristol-city.gov.uk
Education of Looked After Children – Schools must have an LAC designated teacher who has completed appropriate training. There is a dedicated
Contact
Yr 7 Mike Godfrey, Yr 8 Pam Hawkins
Yr 9 Mike Taylor, Yr 10 Maggie Saunders
Yr 11 Helen Tann
‘Education of Looked After Children Service’
Address
Tel:
ECLAS
0117 377 3056
1b Amercombe Walk,
Bristol BS14 8AN
Email
pauline_cole@bristol-city.gov.uk
12
REFERENCE SHEET cont’d
SECTION 2
Bristol Young Carers – offer a service to children who provide care for someone with long term physical ill health, disability, mental/emotional distress,
substance misuse etc
Contact
Lin Thatcher
Address
Tel:
Email:
PRT Carers Centre – Vassall Centre
0117 958 9980
lint@carers-bs.org.uk
Gill Avenue, Fishponds, Bristol BS16 2QQ
Mob: 07812 675831
Youth Offending Team – Children & young people are referred by the Criminal Justice System – only take those in trouble with the police
Contact
Address
Tel/Fax
Email
Bristol Youth Offending Team
Kenham House, Wilder Street, Bristol, BS2 8PD
T: 0117 903 6480
F: 0117 903 6481
Connexions offers information & advice for 13 – 19 year olds. Opening hours: Mon – Wed 9.30 to 4.30, Thurs 9.30 to 6.30, Fri 9.30 to 4.0pm
Website: connexionswest.org.uk Referral is through the school Connexions Personal Advisor
Address
Connexions, 4 Colston Avenue, Bristol BS1 4ST
www.connexions-direct.com offers a direct confidential on-line service to 13 – 19 year olds. There is a phone number available from 8am till 2am the
following day to answer queries on anything that concerns the caller. 080 800 13 2 19. They can also text for advice on 07766 4 13 2 19
Primary Mental Health Specialists
Contact
Maggie Pickering
Address
Tel / Fax
CAMHS, Southwell House, Southwell St.
0117 928 5466
BS2 8EJ
or Knowle Clinic 0117 919 0330
Social Work Teams – if already have family involvement or child protection issue – contact local teams:o Avonvale Road (East Bristol) 0117 955 8231
o Ridingleaze (Lawrence Weston) 0117 903 1700
o Greystoke Ave (Southmead) 0117 903 8700
o Welsman (Central) 0117 903 6500
o Broadwalk (Knowle) 0117 903 1414
o Symes House (Hartcliffe) 0117 353 2200
Attention Deficit Hyperactivity Disorder – interactive resource developed by Lilly UK
Website: www.adhdcarepathway.co.uk for professionals involved in the care of children
Website: www.adhdmatters.co.uk for parents and/or carers
Email
maggie.pickering@ubht.nhs.uk
THERAPIES
Dance Movement Therapy – to work with emotional and behavioural problems. Therapists offer presentations or work in schools or on a one-to-one
basis. Website: www.dancevoice.org.uk
Contact
Address
Dance Voice Therapy Centre. Quaker Meeting House,
Wedmore Vale, Bedminster, Bristol BS3 5HX
Tel / Fax
0117 953 2055
Email
admin@dancevoice.org.uk
Tel/Fax
0117 903 1370
Email
musicservice@Bristol-city.gov.uk
Music
Contact
Philip Sims, Deputy Manager,
Bristol Arts & Music Service
Address
Bristol Education Centre, Sheridan Road, Horfield,
BS7 0PU
13
REFERENCE SHEET cont’d
SECTION 2
VOLUNTARY AGENCIES
CSV – helps schools to implement citizenship, voluntary & community focused projects for students. Trainers are available to work on site.
Website: www.csvcommunitypartners.org.uk (There is a charge of £100 plus)
Contact
Address
Tel:
Email
National Headquarters
237 Pentonville Road, London, N1
020 7643 1314
CSV – Education for Citizenship
9NS
Kirsty Wilson
CSV, St David’s Centre, Queens
kirsty@csvenvironment.org.uk
Road, Withywood
Bristol Pyramid Scheme - offers routine checks of emotional health for Y3 or Y6 children, selection of children to join 10 week therapeutic activity clubs, follow
up reviews. Website: www.nptrust.org.uk
Contact
Address
Tel:
Email
Sarah Ledger
Bristol Education Centre, Sheridan Road,
0117 903 1375
sarah_ledger@bristol-city.gov.uk
Horfield, BS7 0PU
Mob: 07967 565 242
Shakti Imani Inclusion Project (Barnardos) promotes the emotional, spiritual, social and educational development of Black (Asian/Afrikan) children & young
people. Referral is by schools or individuals
Contact
Address
Tel:
Email
Di Desmond
114 Whitehall Rd, Whitehall, Bristol
0117 955 1703
shakti.imani@barnardos.org.uk
BS5 9BH
Fax 0117 955 5907
Right Track works with black and minority ethnic children & young people aged 10 – 17 in Bristol who are at risk or involved in the Youth Justice system. Referral
is by individuals, schools or Youth Offending Team
Contact
Address
Tel:
Email
Ann Tolaini
Fairbridge
Contact
The Old Malthouse,
0117 935 1515
aet@childsoc.org.uk
4/6 Pennywell Road, Easton,
Fax:
Bristol, BS5 0TJ
0117 935 1525
offers tailor made programmes for individuals aged 13 – 25. Includes a one-week residential activity course. Website: www.fairbridge.org.uk
Address
Tel:
Email
Frances Harrison (Manager)
Fairbridge West,
0117 942 5362
west_outreach@fairbridge.org.uk
22 Stokes Croft, Bristol BS1 3PR
Childline offers a free, confidential 24 hour helpline for children 0800 1111
Website: www.childline.org.uk
Childtime offers a counselling and psychotherapy service for children and young people experiencing emotional difficulties and their families/carers in the Bristol
area. Charged on a sliding scale. Currently offers a free service to: children looked after, children adopted or being prepared for adoption and refugee/asylum
seekers. Website: www.childtime.org.uk
Contact
Address
Tel / Fax
Email
Sue Taylor
30a College Green, Bristol BS1 5TB
0117 929 1533
info@childtime.org.uk
14
REFERENCE SHEET cont’d
SECTION 2
The Bridge Foundation offers a free counselling and psychotherapy service to people residing in Bristol’s inner city area, including refugees and asylum
seekers. Also a fee based counselling service to children and their families.
Website: www.bridgefoundation.org.uk
Contact
Address
Tel /Fax
Email
The Bridge Foundation
12 Sydenham Road, Cotham,
0117 942 4510
bridgefoundation@tinyonline.co.uk
Bristol BS6 5SH
Help! (Bristol) Ltd provides a counselling and psychotherapy service to children & young people. Contribution to costs required.
Website: www.help-counselling.org.uk Referral is through schools, social services, self referral, GP, Off the Record etc
Contact
Address
Tel / Fax
Email
18 St Joseph’s Rd,
0117 950 2511
peter_flowerdew@hotmail.com
Brentry, Bristol BS10 6QL
Off the Record provides a free, confidential counselling service. Also advice, information and support through a telephone helpline and drop-in facility. Open
Mon – Wed for 11 – 25 year olds. Also offers peer support in schools, dealing with emotional well-being, anger management, bullying etc. Also offers immediate
crisis support and first line counselling so that children or young people can go into the centre on the day that they or a supporter phones.
Contact
Address
Tel / Fax
Email
Sean O’Brien
2 Horfield Road, St Michael’s Hill
Bristol BS2 8EA
Helpline: 0808 808 9120
Office: 0117 922 6747
sean@otrbristol.org.uk
Our Place – is a charity which offers help and advice to professionals who work with looked after and adopted children of all ages
Contact
Address
Tel:
Email:
193 Fishponds Road, Eastville, BS5
0117 951 2433
ourplace1@btconnect.com
6PR
Papyrus (Prevention of young suicide) operates a helpline available to give support, practical advice and information to anyone who is concerned about a
young person they know. Website: www.papyrus-uk.org
Contact
HOPEline 0870 170 4000
YWCA Bristol Young Women’s Centre is a registered charity working with young women, aged13-30, who face poverty, discrimination or abuse. It
provides support, information and the opportunity to learn. It campaigns with young women from a variety of different faiths, cultural backgrounds and sexuality and
carries out research on issues they feel are holding them back.
It offers a service funded by CAMHS for Free One to One Counselling for young women aged 16-17 who are living in deprived areas of the city and not
attending school on a regular basis. This service started in June 2006 and will take place for one year.
Website: www.ywca.org.uk
Contact
Address
Tel / Fax
Email
Amy Greenslade
107 Wells Road, Totterdown,
Bristol, BS4 2BS
Tel: 0117 971 6770
Fax: 0117 971 6770
amy.greenslade@ywca.org.uk
15
SECTION 3 – SERVICES TO SUPPORT THE MENTAL HEALTH OF CHILDREN & YOUNG
PEOPLE WITH THE MOST SERIOUS ONGOING CONCERN
Specialist CAMHS
Children and young people with severe, complex and persistent mental health needs can be referred to Specialist CAMHS (sometimes also known
as core or Tier 3 CAMHS). In Bristol this level of services is currently provided by four operational teams based at sites at Southmead Hospital,
Downend Clinic / Eastville Health Centre, Southwell House and Knowle Clinic
Health professionals including GPs, school nurses, health visitors and paediatricians can refer into specialist CAMHS, usually after some discussions
or first level assessment.
The flow diagrams below illustrate two possible routes of referral.
School / Education Concern
School / Education Concern
School/education staff discuss concern with child/young
person and parents/carers and refer in writing through
appropriate forms to School Nurse
School/education staff discuss concern with child/young
person and parents/carers to encourage and advise visit
to GP. Letter or report given to parent/carer for GP may
be helpful.
School Nurse to discuss and assess level of need
School Nurse offers intervention with clinical supervision from
specialist CAMHS (via PMHS)
OR
School Nurse refers to Community Paediatrician for further
assessment (or to other appropriate service)
OR
School Nurse refers to Specialist CAMHS (with parent consent
and informs GP
GP to assess level of need and refer to specialist CAMHS if
appropriate
The role of Primary Mental Health Specialists (PMHS) within CAMHS is evolving and schools should become more familiar with these roles and the
links between schools and specialist CAMHS via PMHSs, throughout 2006.
ANNEXE ONE
EMOTIONAL WELL-BEING AND MENTAL HEALTH
Context
Schools face a wide range of challenges in their drive to raise levels of achievement and many of these are linked to mental health. The
importance of psychological well being in children and young people for their healthy emotional social, physical, cognitive and
educational development is well recognised and increasingly so now. Thanks to work in the 1990’s by Gardner, Goleman and others,
the terms “emotional intelligence”, “emotional literacy” and the like are becoming widely used while strategies to support this need are
being developed. Recent research by HMCI shows that the development of social, emotional and behaviour skills does result in a wide
range of educational gains, while the converse is clear. Mental ill health is associated with educational failure, family and relationship
breakdown, drug taking, anti-social behaviour and an increased risk of involvement in crime. Sadly the children of most concern are the
most reluctant to seek help.
Some salutary statistics:
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10% of all 5 – 15 year olds will have a diagnosable mental health disorder, while the same number will have lesser problems that
need some help.
40% of children with learning disabilities suffer diagnosable mental illness.
Looked after Children are five times as likely as their peers to suffer mental ill health.
As schools continue to report an increase in challenging behaviour and much higher levels of stress, depression, self-harm and sadly
occasionally suicide, it is no surprise that national policy has responded accordingly with a range of initiatives aimed at improving the
emotional health of children and young people.
The most recent policy instruments include:“Every Child Matters: Change for Children” This really represents the key overriding policy which became law in the 2004
Children Act. The
basic five outcomes of staying safe; being healthy; enjoying and achieving; making a contribution; and enhancing economic well
being are now a feature of all aspects of education life, while the focus on a Children and Young People plan will help ensure that
there is a common assessment framework to identify need and target referrals better, with earlier intervention and much stronger
partnerships between all the agencies.
17
New Inspection Framework – this commenced in September 2005 with much greater emphasis on school self-evaluation, but
the role of the outcomes of Every Child Matters is now central to the inspection process. At the same time Joint Area Reviews will
examine the performance of all children’s services in every area.
School Strategies – the development of teaching and learning to support the social, emotional and behavioural skills (SEBS) or
the social and emotional aspects of learning (SEAL) is now central to raising achievement levels in both primary and secondary
schools using national strategies at both Key Stage 2 and Key Stage 3. Further support may be given by Behaviour and Support
Teams (BEST) or by Behaviour Improvement Plans (BIP).
Removing banners to achievement – “The Government’s Strategy for SEN” Dfes 2004
“The Mental Health and Psychological Well being of Children and Young
People” Dfes/DH National Service Framework Standard 9. This has the
vision of tackling issues from birth to 18 years through improving access
to mental health care by providing early and timely interventions, with
a higher level of service and through multi-agency partnerships.
“Healthy Schools” A series of standards sponsored and supported by the Dfes/DH with a strong emphasis on the theme of
emotional well being so as to contribute to raising pupil achievement, as well as promoting social
Inclusion and reducing inequality.
Education Act 2002 which creates a statutory duty on all parties in the
Education service to promote the welfare of children.
Extended Schools – the policy which aims to enhance the work of schools making them more the centre of their communities by
developing their role as a wider provider of services in partnership with other agencies.
The recent Ofsted report (July 2005) on the role of schools in supporting the mental health of children makes for salutary reading
with many secondary schools being criticised for not making this a high enough priority despite doing valuable work in PHSE.
Youth Matters The 2005 consultative document on the teenage years with a greater focus on expanding opportunities, services
and advice as well as giving young people a much greater say in their future.
18
ANNEXE TWO
CHILD AND ADOLESCENT MENTAL HEALTH SERVICE
(C.A.M.H.S)
This is the generic term for a wide range of services that support the mental health of children and young people. It is a term that
is frequently misunderstood and is ideally best separated into CAMHS and specialist CAMHS. CAMHS is the term used to refer
to all services that support children, but mental health is not their primary function. This would include schools, colleges, social
services and these agencies need to be aware of their important role as a part of CAMHS. Specialist CAMHS support children at
a variety of levels with the primary function being mental health.
CAMHS across Bristol is structured broadly on a four tiered model of service that is recognised and implemented in most areas
nationally. Tiers range from front line children and young people services and primary care (Tier 1) to specialist inpatient and
regional resources (Tier 4). This structure reflects the increasing complexity severity and persistence of mental health need for the
child, young person and their family or carers. While these tiers are not always neat boxes and provision they can be summarised
as:
Tier 1
CAMHS at this level are provided by frontline and primary services such as teachers, learning mentors, social workers, GPs,
school nurses, health visitors, project workers and the voluntary agencies. This is where the majority of children’s mental health
needs are addressed.
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The key functions of tier 1 are
To identify problems early in their development, offer general advice and implement strategies and treatment for less severe
mental health problems.
To refer to specialist CAMHS when and as appropriate.
To pursue opportunities for mental health promotion and prevention.
19
Tier 2
Tier 2 consists of uni-professional groups, rather than a specialist team. These may be paediatricians, educational psychologists,
counsellors and some of the professionals working in tier 3 specialist CAMHS such as primary mental health specialists and
community psychiatric nurses who offer assessment and/or treatment working on their own or with tier 1 staff. Some voluntary
agencies also offer a service at this level.
In terms of mental health need, this Tier is harder to define and reflects some of the blurring of definition around the interfaces of
these tiers. In Bristol, it is evolving. ( Some CAMHS view this tier as aiming to address mental health problems, rather than mental
health disorders which shifts the level of need to Tier 3.
The key functions of Tier 2 are:
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Training and consultation for Tier 1.
Assessment which may trigger treatment at a different tier.
To offer intervention and treatment where it is indicated that short episodes may ameliorate difficulties.
Outreach to identify severe or complex needs which require more specialist interventions but where children or families are not
accessing specialist services.
Tier 3
Tier 3 is often referred to as specialist CAMHS and consists of specialist teams, usually multi disciplinary, that are most often
based in a community clinic. The professional mix in teams varies, but usually includes clinical psychologists, child and
adolescent psychiatrists, community psychiatric nurses, primary mental health specialists, art/occupational/drama/music
therapists and child psychotherapists.
The key functions of Tier 3 or core CAMHS are:

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
Assessment and treatment child and adolescent mental health disorders.
Consultation to Tiers 1 and 2.
Assessment for and referral on to Tier 4 services.
Participation in research and development.
20
Tier 4
This consists of infrequently used but essential specialist services such as day units, highly specialised out-patient teams and
inpatient units for young people. These will again be multi disciplinary. These are service for young people with the most severe,
complex and persistent mental health needs, who require a particularly specialised service that may be provided by more than
one NHS Trust or across a region. These young people will be assessed to be significantly at risk, particularly to themselves or
others.
The NSF for the Mental Health and Psychological well being of the Child and Young People proposes an increase in CAMHS
provision so that better services and greater access is provide and that the needs of the young people between the ages of 16
and 18 are especially met. Such an expansion of the service will have clear resource implications and require an effective
recruitment and training strategy. It can only be successful if CAMHS is seen as a universal service based on multi-agency
professional working together. Partnership working is very challenging and requires cultural shifts. It is not a quick fix as
protocols needs to be established so that mutual understanding of roles and responsibilities; organisations; systems and
procedures can take place and communication and trust be achieved.
The NSF is keen to promote and facilitate joint working between CAMHS and schools and notes several factors that assist joint
working including:
- being based in the same location
- Having a clear rationale for working together
- Strong commitment to joint working from all levels of the service
- secondments between organisations
- Flexibility in recruiting between organisations to allow internal movement
- Improved communication and understanding of roles, responsibilities, expertise
- Informal meetings, team building, good networking.
21
ANNEXE THREE
Schools at Tier 1
Schools need to recognise the importance of emotional well-being and develop strategies to enhance it in every young person.
Many have and as a result are emotionally healthy institutions with rising levels of achievement. Others have much to do. The
starting point needs to be in the words that “there is no separation of mind and emotions; emotions, thinking and learning are all
linked”. Clearly where staff and pupils feel good about themselves they perform better. As Goleman notes “80% of all adults’
‘success’ comes from their emotional abilities rather than their cognitive ability”
Schools needs to use the opportunities that the Healthy Schools
Programme and the National Strategies afford and to be aware of the work of Wells and Stewart-Brown which indicates that
effective emotional well being comes from on-going whole school programmes that promote positive mental health rather than
reactive strategies which focus on reducing poor behaviour. Emotionally healthy schools develop a climate where all in them are
valued, motivated and inspired to achieve. They develop in everyone the social, emotional and behavioural skills that enhance
learning. It requires a recognition that approaches to teaching and learning need to change remembering that in communication
only 7% of what is said is absorbed and much more is absorbed through action and body language.
To be effective schools need to be aware of three key strands:


The role of emotion in processing information. Recent neuro-science has taught us much, but put simply the brain
shuts down from fear or boredom and is stimulated by active engaging tasks.
That teachers are powerful role models especially in modelling emotional behaviour. Their own well being is important
and it affects how children react.
Social, emotional and behavioural skills can and should be taught. While PHSE and Citizenship can play their part,
such skills are most effectively gained when their delivery is across the curriculum and feature naturally in all subjects
and all teaching.
Interventions in the early years are especially important because inappropriate child rearing practices and language delay may
lead to emotional or behavioural disorders.
22
What can schools do at Tier 1?
 Have a strong commitment to the emotional health of their students and staff marked by an overt stance taken by the
leadership team
 Realise how emotional well being improves the achievement of school goals and targets
 Ensure that the creation of emotional well being is a whole school strategy
 Create a climate that uses praise widely
 Give pupils and staff every opportunity to be listened to either individually or in a group situation depending on
circumstances
 Establish teaching strategies that have an emotional health component which makes learning more appropriate and
effective
 Model emotional healthy behaviour. Modelling is the most effective way that most learn
 Support all staff so that teaching even in challenging circumstances is a positive and enjoyable experience.
 Provide all staff with access to explicit training about the mental health of children.
 Ensure that referral routes are clearly established and understood.
Some small steps to consider

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Is the school an inviting environment? Décor, warmth, equipment?
Are health needs met in terms of access to water, healthy food, and a range of sporting activities?
Is the site safe? Are their clear simple rules which minimise bullying?
Are pupils given real opportunities to talk and to be listened to?
Are there peer support mechanisms?
Is celebration, praise and rewards a major feature?
Are celebrations for all and is diversity and difference celebrated?
Is the development of positive relationships between pupils and staff a central feature of school life? Is this shown by
the tone with an absence of excessive shouting and the like?
Are values and rights clear and are pupils engaged in establishing these?
Does the curriculum create opportunities for experiences that involve feelings, emotions, reflection and empathy?
Are lessons stimulating and challenging?
How do you engage all teachers in the move to an emotionally healthy school?
23
Emotionally healthy schools are characterised by:
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
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Distributive leadership
Supportive relationships
Good communication
Openness, honesty and trust
Regular celebrations of success
Whole community participation in policies and practices
Inclusive approaches
A recognition of all achievements
Independent and group approaches to learning
Creativity and innovation
No fear of failure
Explicit morale raising activities
Clarity of expectation
Appropriate boundaries
A willingness to examine feelings and values
High levels of CPD
How many of these feature prominently in your school?
24
ANNEXE 4 - FEEDBACK
Participant partnerships and school clusters can help us to improve this document by completing the following
feedback form. Primary mental health workers, CAMHS and Healthy Schools Partnerships responses would also be
welcome.
Feedback from:
0=not useful
1= limited use/effort completing
exceeded usefulness
2=useful
3=extremely useful
1. Can you rate the general usefulness of the toolkit on a scale of 0-3
2. Improved access to services - increased appropriateness of referrals
3. Improved access to services - improved timeliness of referrals
4. Improved school staff and support worker confidence
5. Improved communication between staff, young people and services
6. Improved or led to further service development
7. Improved partnership working overall
8. Ease of use (not/limited/easy/very easy)
Total score /24
Please provide relevant comments details in text re the above, in particular making
comments or suggestions for improvements
Once completed please return this form to Sarah Young, Bristol Healthy Schools Programme Manager
Email: sarah.young@bristolnorth-pct.nhs.uk or CAMHS partnership. The NCSS would be grateful if the feedback is
copied to davidgoodban@camhs.org.uk .
25
Acknowledgements
This document has been put together by:
Sarah Young, Healthy Schools Programme Manager
John Shears, CAMHS/Schools Partnership Worker CSIP (SW)
Maggie Pickering, CAMHS
Sue Topalian, CAMHS
Jane Clutterbuck, Primary Mental Health Specialist
Jane Hicks, Bristol Education Inclusion Service
Alison Sheen, PA/Administrator, Bristol Directorate for Public Health
26