Making a lifetime of difference to children in schools
Place2Be, 13/14 Angel Gate, 326 City Road, London EC1V 2PT
Tel: 020 7923 5500 Email: enquiries@place2be.org.uk
Children’s outcomes 2011/12
Primary schools
L. Herlitz, J. White, N. Naag and H. Barnes
July 2013
Executive summary
Place2Be provides emotional and therapeutic services in schools across the UK to give children
the chance to explore their feelings through talking, creative work and play. In the school year
2011/12, Place2Be delivered services to 155 primary schools across the UK, reaching a total
school population of 56,615 children.
Place2Be provides a range of interventions for children in schools:

Place2Talk is a lunchtime drop-in service with a counsellor open to all pupils in the school
through self-referral.

One-to-one counselling is provided on a weekly basis for children with considerable social,
emotional and/or behavioural difficulties.

Group counselling is provided on a short-term basis to address particular issues, for example,
children’s concerns about moving on to secondary school, friendship and self-esteem.
This report describes the service use and characteristics of children attending Place2Talk, one-toone and group counselling, and presents children’s outcomes for one-to-one counselling.
I)
Service use and children’s characteristics
Place2Talk
More than one in every three children (38%) in schools visited the self-referral service. 20,901
children attended the Place2Talk of whom two thirds (68%) visited more than once. Boys were
under-represented; almost two-thirds of children using this service were girls. Children most
frequently raised problems with friendships; other common issues were emotional problems, family
and school issues.
One-to-one and group counselling
Over the year, Place2Be supported 2,787 children in one-to-one counselling and 896 children
through group counselling.
Many children’s families were managing on low incomes: over half of children (54%) were
receiving free school meals (FSM) in comparison with a quarter of children in primary schools in
Children’s outcomes:All hubs 2011/12  Page 1 of 30
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the local population. Almost half of children had special educational needs (SEN). In comparison
to other children in the local population, a high number of children seen were coping with difficult
circumstances in their home lives: 2.6% of children were looked after by the local authority and
11% were the subject of a child protection plan (see figure 1). Around half of children’s families
(46%, n=1614) were involved with another statutory agency or support service in the last year.
Just under a quarter (24%) had been involved with social care, 9% had been involved with
CAMHS, and a further 9% with the police and criminal justice system.
Figure 1: The needs and circumstances of children supported by Place2Be in comparison to children
in the local population
60%
54.0%
Place2Be
49.0%
Percentage of children
50%
Local population
40%
30%
25%
21%
20%
11.0%
10%
2.5%
0.4%
0.8%
0%
Free school meals
II)
Special educational
needs
Child subject to a
child protection plan
Looked after child
Children’s social, emotional and behavioural difficulties before
coming to Place2Be
Children’s difficulties were measured by the Strength and Difficulties Questionnaire (SDQ),
completed by teachers, parents and children before and after counselling.
Over half of children had overall difficulties in the abnormal clinical range pre-intervention
according to teachers (53%) and parents (52%) and around a third of children (35%) scored their
own difficulties in abnormal range. This is much higher than the 10% that would be expected in a
community sample of children (Goodman, 1997). Looking at issues within the SDQ, there were
large proportions of children in the abnormal clinical range for hyperactivity and conduct problems
(see figure 2).
Figure 2: Percentage of children with difficulties in the abnormal range in each domain by
respondent
Children’s outcomes: All hubs 2011/12  Page 2 of 30
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60%
Teacher
Parent
49%
50%
46%
44%
45%
Percentage of children
43%
40%
40%
31%
30%
Child
48%
33%
28%
28%
29%
20%
17%
15%
11%
10%
0%
Emotional
Conduct
Hyperactivity
Peer
relationships
Prosocial

Boys were more likely to be in the abnormal range than girls – 61% of boys compared to 43%
of girls. Boys also had significantly higher scores for hyperactivity and conduct problems while
girls had greater scores for emotional problems and showed more positive (prosocial)
behaviour. There were no differences for peer problems.

Children with SEN were more likely to in the abnormal range; 63% of children with SEN
compared to 42% of children without SEN.
Children’s difficulties had a significant impact on their lives. Many children had been experiencing
difficulties for more than one year (60%) and had difficulties that upset or distressed them
considerably (‘quite a lot’ or ‘a great deal’). Parents reported that over half of children had
difficulties which significantly impacted on their home life (53%) and on the family (54%). 42% of
children said their difficulties impacted significantly on their family, friends and teachers and over a
third (36%) reported their difficulties interfered with their friendships. According to teachers, 71% of
children had difficulties which interfered with their classroom learning and 47% of had difficulties
which considerably burdened their teacher or the class.
III)
Improvement in wellbeing for all children
Teachers reported improvements for two thirds of children (66%); parents reported 73% of children
had improved wellbeing and 71% of children reported they had improved. Improvement rates are
consistent with findings from the previous four years (figure 3).
Figure 3: Percentage of children with improved difficulties following counselling
over time (2009/10 – 2011/12), by respondent
Children’s outcomes: All hubs 2011/12  Page 3 of 30
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100%
Teacher
90%
Parent
80%
Child
70%
60%
50%
40%
30%
20%
10%
0%
2007/8
2008/9
2009/10
2010/11
2011/12
The proportion of children in the abnormal clinical range decreased by over a third according to
teachers (37%) and around a half according to parents (45%) and children (55%) (see figure 4). It
should be noted that for all the findings on improvement, the absence of a control group means it
is not possible to definitively quantify the scale of improvement in outcomes from the intervention.
Figure 4: Percentage of children in each clinical category before and after counselling, child SDQs
70%
66%
Before counselling
After counselling
60%
50%
42%
40%
34%
30%
24%
19%
20%
15%
10%
0%
Normal
Borderline
Abnormal
Emotional symptoms improved the most – approximately 60% of all children had improved after
the intervention. Scores for emotional symptoms dropped by 1.4 for parent SDQs and 1.5 for child
SDQs, equivalent to a medium effect size (ES) of 0.53 and 0.60 respectively. Just over half of
children had improved conduct problems, hyperactivity and peer relationships. About a quarter of
children had improved pro-social behaviour (see figure 5).
Figure 5: Percentage of children who improved by SDQ domain and respondent
Children’s outcomes: All hubs 2011/12  Page 4 of 30
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70%
Teacher
64%
61%
60%
Percentage of children
55%
50%
Parent
57%
55%
57%
53%
55%
52%
Child
52%
51%
45%
40%
30%
30%
28%27%
20%
10%
0%
Emotional
Conduct
Hyperactivity
Peer
relationships
Prosocial
Of children whose difficulties had a significant (‘quite a lot’ or ‘a great deal’) impact before
counselling:
IV)

Teachers reported that 63% of children were finding that their difficulties interfered less
with their classroom learning, and that the ‘burden’ of children’s difficulties on the teacher
or class had reduced for 68% of children.

Parents reported that the impact on children’s home life and family had reduced for seven
out of ten children.

Three quarters of children reported that the impact of their difficulties on their home life,
family, friends and teachers, and friendships had reduced after counselling.
Improvement in wellbeing for children with the greatest difficulties
For children in the abnormal clinical category, rates of improvement were higher than for children
as a whole: three-quarters of these children improved and half achieved clinical ‘recovery’ (moving
from the abnormal to the normal or borderline clinical range) according to teachers. Parents’
assessments of improvement were higher – 82% of children improved and 54% achieved clinical
recovery – and children themselves noted even greater improvement, with almost 9 in 10 reporting
improvements and 7 in 10 reporting clinical recovery.
The difference in pre- and post-intervention total difficulties scores was greatest for child SDQs –
reducing by 7.0 points, a large ES of 1.50. The change in scores reported by parents and teachers
was also considerable – 6.6 for parents (ES = 1.16) and 5.5 for teachers (ES = 1.02).
According to teachers, the greatest improvements were for conduct problems and hyperactivity –
an effect size of 0.6 and a reduction in the mean score of 1.4 and 1.6 points on each scale
respectively. Children and parents reported the greatest improvements for emotional symptoms
and conduct problems. Figure 5 shows the proportion of children in the abnormal range in each
subscale before and after counselling.
Figure 5: Percentage of children in the abnormal range by subscale before and after counselling,
parent SDQs
Children’s outcomes: All hubs 2011/12  Page 5 of 30
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80%
74%
Before counselling
70%
68%
70%
After counselling
57%
Percentage of children
60%
50%
43%
41%
37%
40%
35%
30%
23%
20%
16%
10%
0%
Emotional
Conduct
Hyperactivity
Peer
relationships
Prosocial
Children’s outcomes: All hubs 2011/12  Page 6 of 30
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Contents
1. Introduction
7
2. Children’s service use and their characteristics
9
2.1
2.2
Place2Talk
One-to-one and group counselling
9
10
3. Children’s difficulties before coming to Place2Be
3.1
3.2
3.3
Children’s total difficulties
The domains in which children experienced the most difficulties
The impact of children’s difficulties
4. Improvement in wellbeing for all children
4.1
4.2
4.3
Improvement in children’s total difficulties
Improvement in the domains of children’s difficulties
Improvement in the impact of children’s difficulties
5. Improvement in wellbeing for children with the greatest
difficulties
5.1
5.2
Improvement in children’s total difficulties
Improvement in the domains of children’s difficulties
14
14
15
16
18
18
19
20
21
21
22
Conclusion
23
References
24
Appendix 1
Appendix 2
26
27
Missing data analysis
Mean change and effect sizes for each subscale
Children’s outcomes: All hubs 2011/12  Page 7 of 30
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1.
Introduction
Mental health problems are common in childhood and adolescence – around 10% of children in
the UK are thought to have a mental health disorder (DH, 2011, Meltzer et al, 2000, Green et al,
2005), equivalent to three children in every classroom. School-based counselling services can
reach large numbers of children with mental health needs, providing accessible services which are
less stigmatising than statutory mental health services (Jenkins & Polat, 2006, Fox and Butler,
2007), Research indicates that school-based counselling services are highly acceptable to young
people, pastoral care coordinators and teachers (Cooper, 2009, Pattison et al 2009, Cooper,
2006).
Place2Be provides emotional and therapeutic services in schools across the UK to give children
the chance to explore their feelings through talking, creative work and play. In each Place2Be
school, an experienced clinician – the School Project Manager (SPM) – provides counselling and
supervises trained Volunteer Counsellors (VC), working closely with school staff and practitioners
in other children’s services.
Place2Be provides a range of interventions in schools:

Place2Talk is a lunchtime drop-in service with a counsellor open to all pupils in the school
through self-referral.

One-to-one counselling is provided on a weekly basis for children with considerable social,
emotional and/or behavioural difficulties. Parent partnership sessions are offered to all
parents/carers of children who attend one-to-one counselling to help them understand and
support their child.

Group counselling is provided on a short-term basis to address particular issues, for
example, children’s concerns about moving to secondary school, friendship and selfesteem.

Place2Think is support and guidance offered to teachers and school-based staff on an
individual or group basis.

A Place for Parents is a counselling service for parents and carers.
In 2011/12, Place2Be delivered services to 155 primary schools in 20 geographical areas – known
as ‘hubs’ – reaching a total school population of 56,615 children (hub areas are presented in table
1i). The organisation provided 2.5 day or 3 day service model in most schools (82%)ii.
This report presents the service outputs for children for Place2Talk, one-to-one and group
counselling in primary schools in the school year 2011/12. In addition to data on service activity
which is recorded for all children, baseline data on children’s characteristics is collected for
children in one-to-one and group counselling, and in a shortened form for Place2Talk. Outcome
data is collected for children in one-to-one counselling only. Place2Be’s services for adults –
Place2Think and A Place for Parents – are evaluated and reported on separately.
i
There is some change in the population of the schools per year but their demographic characteristics are
broadly comparable.
ii Each VC is a trainee or qualified counsellor who volunteers for one day a week for a minimum of one
academic year. Each VC delivers one-to-one counselling only with a caseload of three children; all other
services are delivered by the SPM. 1.5 day, 2 day and 2.5 day models operate with 4 VCs, 3 and 3.5 day
models operate with 6 VCs, a 4 day model operates with 8 VCs and a 5 day operates with 10 VCs.
Children’s outcomes: All hubs 2011/12  Page 8 of 30
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Table 1: The number of primary schools 2011/12 in each hub
Hub
Number of schools
Hub start year
Brent
Wandsworth
Ealing
Edinburgh
County Durham
Enfield
Greater Manchester
Medway
Nottingham
Croydon
Greenwich
Southwark
Leeds
Cardiff
East Lancashire
East Lothian
Shoreditch
Harlow
Northumberland
Glasgow
12
11
10
10
9
9
9
9
9
8
8
8
7
6
6
6
6
5
4
2
1999
2007
2009
2004
2002
2001
2008
2002
2001
1999
2002
1999
2009
2009
2008
2010
2010
2006
2006
2010
Section 2 describes the numbers and characteristics of children accessing Place2Be services and
presents a summary of the issues discussed in the self-referral service Place2Talk.
Section 3 describes the nature and level of children’s difficulties before starting one-to-one
counselling.
Sections 4 and 5 present the changes in children’s wellbeing following counselling; section 4 looks
at the improvement of all children who completed one-to-one counselling and presents
improvement rates over the last five years, while section 5 focuses on children with the greatest
difficulties.
Children’s outcomes: All hubs 2011/12  Page 9 of 30
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Registered office address: Place2Be, 13/14 Angel Gate, 326 City Road, London EC1V 2PT Tel: 020 7923 5500.
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2.
Children’s service use and characteristics
This section provides a summary of the numbers of children accessing Place2Talk, one-to-one
and group counselling and presents children’s demographics. It also describes the issues
discussed in Place2Talk.
2.1
Place2Talk
On average, around one in three children (38%) in each school attended the self-referral service in
2011/1, a similar level of service use to 2010/11. The service was widely used across all year
groups. Of the 20,901 children who accessed Place2Talk, one in three attended only once
(n=6,775) and two thirds of children attended more than once (n=14,126).
A higher proportion of girls accessed the service than boys – 63% girls and 37% boys, and girls
were more likely to use the service more than once (see figure 1).
Figure 1: Number of times children visited Place2Talk by gender
45%
42%
40%
Boys
35%
Percentage of visits
Girls
30%
27%
24%
25%
22%
21%
19%
20%
17%
15%
13%
10%
8%
7%
5%
0%
One
Two
Three or four
Five or six
More than six
Friendship was the topic children most frequently wanted to discuss, raised by two thirds of
children who visited Place2Talk (see figure 2). Many children also talked about emotional
problems, family and school issues. There were significant gender differences in the issues raised
– girls were more likely to have discussed friendships, bereavement, physical issues, divorce,
other family issues (including relationships with family members and parental discipline), bullying
and cyber-bullying, transition between schools, and cultural and racial issues. Significantly more
boys raised issues relating to their local community or reported visiting the service out of curiosity.
Children’s outcomes: All hubs 2011/12  Page 10 of 30
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Figure 2: Issues that were raised by children at Place2Talk
Academic Issues
4%
13%
Bullying / cyber bullying
Community tensions/issues
2%
Cultural / Racial issues
3%
13%
Curiosity about the service
Eating disorders
0.3%
Emotional Issues (i.e. Anxiety, anger, depression)
29%
Environmental
3%
Friendships / relationships
66%
Loss / Bereavement
12%
26%
Other family issues
Other Issues Discussed
26%
Parental separation / divorce
5%
Parental substance misuse
1%
Personal achievement
4%
Personal substance misuse
2%
Physical / Puberty
2%
School issues
20%
Sexuality / Sexual issues
1%
Support friend
15%
Transition issues (betw een schools)
7%
Violence in the home
2%
0%
10%
20%
30%
40%
50%
60%
70%
Percentage of children
2.2
One-to-one and group counselling
2,787 children attended one-to-one counselling and 896 children attended group counsellingiii.
Nearly half of all children were referred to Place2Be by their teacher (49%), the majority of other
referrals came from the SENCO (24%), the Head or Deputy Head teacher (20%) or parents
(13%)iv. 1,100 children were referred or signposted to other agencies following assessment: the
greatest number of referrals was to CAMHS (17%), another service within the school (16%, 7%
higher than in 2010/11) and social services (14%, see figure 3).
55% of children seen were boysv. Girls were more likely than boys to attend group counselling –
59% were girls – and a greater proportion of boys attended one-to-one counselling – 59% were
boys. Over two-thirds of children (71%) were in year groups 3 to 6, 29% of children were in
reception to year 2, and 0.3% of children seen were in nursery.
1130 children attended Place2Talk in a total of 36,099 visits.
iii
Of the latter, baseline data was available for 734 children.
iv
Children are often referred by more than one person - each child can be referred by up to three people
vThe figures given in this section do not include missing data. Missing data for children’s characteristics ordinarily ranges
from 0 – 5%. Where missing data is greater than 10% it will be reported in the body of the report.
Children’s outcomes: All hubs 2011/12  Page 11 of 30
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Figure 3: Referrals and signposting to other agencies
3%
11%
Child Psychologist
0.4%
Child Psychiatrist
8%
Educational Psychologist
2%
2%
Family Mediation
Systemic Family Therapy
6%
14%
Home School Liason
Voluntary/3rd sector agency
CAMHS
13%
GP
Behavioural and Educational Support Team
16%
Behavioural Intervention Plan
Another service within the school
17%
2%
Social Services
6%
0.5%
Other
58% of all Place2Be children were White British (54% of children in England/Wales and 97% of
children in Scotland) in comparison to 67% of children aged 0 to 15 years in the local population in
hub areas in England and Wales (Office for National Statistics, ONS, 2011)vi and 95% of people in
Scotland (General Register Office for Scotland, 2011). There was a much higher representation of
children of Black/Black British ethnicity – 17% in comparison to 9% of children in the local
population (figure 3).
Figure 4: Place2Be children’s ethnicity in comparison to children’s ethnicity in the local population
80%
68%
70%
Place2Be
Local population
Percentage of children
60%
58%
50%
40%
30%
17%
20%
8% 9%
10%
9%
9%
6%
5% 4%
3% 2%
0%
White British
White Irish/Other
Asian/Asian
British
Black/Black
British
Mixed ethnicity
Chinese or any
other ethnic
group
Many children who came to one-to-one or group counselling were from lone parent families – 43%
compared to 30% of households with dependent children in the local population (ONS, 2010). 38%
lived with both biological parents and 10% lived in a step-family. Over half of children seen were
child population figures – the ‘local population’ – are based on average percentages from the local
authorities in which Place2Be hubs operate.
viComparison
Children’s outcomes: All hubs 2011/12  Page 12 of 30
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from households with low income: 54% of children were receiving free school meals (FSM) in
comparison with 25% of children aged 5 to 10 in maintained nursery and state-funded primary
schools in the local population (Department for Education, DfE, 2012a). This figure was an
increase on 2010/11 when 47% of children received FSM.
Almost half of children had special educational needs (SEN): 46% were on school action or school
action plus and 3.3% had a full statement. This compares with 18% of children on school action or
school action plus and 1% with full statements in the local population (DfE, 2012b) (figure 5). Many
children were facing very difficult circumstances in their home lives; 2.6% were looked after by the
local authority compared to 0.8% in the local population (DfE, 2011a) and 11% were the subject of
a Child Protection Plan in comparison to 0.4% of children in the local population (DfE, 2011b,
figure 5).
Figure 5: Place2Be children’s needs in comparison to other children in England
60%
54.0%
Place2Be
49.0%
Percentage of children
50%
Local population
40%
30%
25%
21%
20%
11.0%
10%
2.5%
0.4%
0.8%
0%
Free school meals
Special educational
needs
Child subject to a
child protection plan
Looked after child
Around half of children’s families (46%, n=1614) were involved with another statutory agency or
support service in the last year. Just under a quarter (24%) had been involved with social care, 9%
had been involved with CAMHS, and a further 9% with the police and criminal justice system (see
figure 6). A small proportion of families (4.4%, n=156) had seen multiple agencies (four or five): of
those families, 83% had contact with social care, over half (52%) had contact with the police and
criminal justice system and around 44% had seen an educational psychologist or CAMHS (see
figure 6).
Children’s outcomes: All hubs 2011/12  Page 13 of 30
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Figure 6: Statutory agencies and support services involved with the child's family in the last
12 months
Bereavement services
1%
5%
9%
CAMHS
Child psychiatrist
1%
6%
2%
Child psychologist
22%
3%
Domestic violence project
31%
3%
Drug and alcohol support services
23%
7%
Educational psychologist
2%
Family mediation
43%
12%
3%
Home school liaison
28%
1%
Mentoring schemes
12%
13%
Other agencies
44%
9%
Police and criminal justice
Refugee support services
44%
0%
52%
3%
24%
Social care
4%
Speech and language therapist
Systemic family therapy
1%
Youth Offending Team
1%
0%
83%
21%
5%
6%
10%
20%
30%
40%
50%
60%
70%
80%
Percentage of children's families
Families seen by multiple agencies
All children's families
Children’s outcomes: All hubs 2011/12  Page 14 of 30
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90%
3.
Children’s difficulties before coming to Place2Be
This section describes the nature and level of difficulties children were experiencing before coming
to one-to-one counselling.
3.1
Children’s total difficulties
Place2Be uses the Strengths and Difficulties Questionnaire (SDQ) to measure children’s social,
emotional and behavioural difficulties, (Goodman, 2001), which is completed by teachers, parents
and children before and after counselling (see box 1). The child version of the SDQ is completed
with children aged 7 and above only, at the discretion of the SPMvii.
A total of 2,787 children attended one-to-one counselling in primary schools across the UK, 2,089
of who were aged 7 or older. The return rates for pre-intervention SDQs were excellent: 95% for
teachers (n=2,634), 86% for parents (n=2,402) and 83% for children (n=1,731).
For every ten children seen, around five had overall stress – ‘total difficulties’ - in the abnormal
clinical range according to teachers (53%) and parents (52%); this compares to one in ten children
that would be expected to have severe difficulties in a normal child population (Goodman 1997).
The mean teacher score was 16.0 (SD 7.2) and the mean parent score was 17.0 (SD 6.9). Around
a third of children (35%) scored their own difficulties in abnormal range (see figure 7); the mean
score was 16.8 (SD 6.2)viii.
Figure 7: Percentage of children with total difficulties in each clinical category by SDQ respondent
60%
Teacher
53%
Parent
52%
Child
50%
Percentage of children
42%
40%
35%
31%
30%
27%
23%
20%
20%
17%
10%
0%
Normal
Borderline
Abnormal
The proportion of children with severe difficulties differed by hub – ranging from 44% to 75% of
children in the abnormal range according to teachers (2 (19) = 65.9, p <.001). These differences
would benefit from further exploration, in particular to see to what extent they reflect varying
patterns of need across hubs, or differences in referral practices.
vii
The self-report version of the SDQ has been validated for children aged 11 to 15 (Goodman, 2001). Norwood (2007)
reviewed the internal validity of the self-report SDQ with children aged 4 to 11 and found children aged 7 or older were
able to distinguish well between internalising and externalising symptoms, though there was some question of whether
they could distinguish hyperactivity from other types of psychopathology.
viii The abnormal clinical range for teacher SDQs is 16 – 40, for parent SDQs is 17 – 40, and child SDQs 20 – 40.
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Boys were more likely to be in the abnormal range than girls – 61% of boys compared to 43% of
girls according to both teachers (2 (1) = 78.4, p <.001) and parents (2 (1) = 18.8, p <.001).
Children with SEN were much more likely to be in the abnormal range according to teacher and
parent reports – 63% of SEN children in comparison to 42% without SEN (teacher report, 2 (1) =
106.5, p < .001). According to parents only, a higher proportion of children receiving FSM were in
the abnormal range – 55% of FSM children in comparison to 49% without FSM (2 (1) = 6.8, p
<.01).
Box 1: The Strengths and Difficulties Questionnaire (SDQ)
The SDQ has 25 questions covering 5 domains of children’s wellbeing: emotional distress,
behavioural difficulties, hyperactivity and attention difficulties, peer problems, and kind and helpful
(‘prosocial’) behaviour. The sum of the first four domains (also called subscales) is the child’s ‘total
difficulties’ score. The measure has additional questions – the ‘impact supplement’ – to assess
whether children’s level of social impairment and distress may be indicative of a psychiatric
disorder. Scores from the impact questions are summed together to make a total impact score.
The information provided by teachers, parents/carers and children is used to predict how likely a
child is to have an emotional, behavioural or concentration problem severe enough to warrant a
diagnosis according to ICD-10 or DSM-IV classifications. The scores from each SDQ domain, the
total difficulties and the total impact can be classified into three diagnostic groupings/clinical
categories – ‘low risk - normal’, ‘medium risk - borderline’ and ‘high risk - abnormal’
(www.youthinmind.info). The thresholds for each grouping are based on relative level of wellbeing
in the child population – about 80% of children are in the normal clinical range, 10% are in the
borderline range and 10% are in the abnormal range (Goodman, 1997).
Overall, there is reasonable agreement between the risk category and what an expert would say
after a detailed assessment of a child. Between 25-60% of children who are rated as high risk and
10-15% of medium risk children turn out to have a relevant diagnosis according to experts. Only
about 1 – 4% of low risk children would be given a diagnosis (www.youthinmind.info).
3.2
The domains in which children experienced the most difficulties
There were large numbers of children in the severe range for hyperactivity and conduct problems,
according to teachers and parents (see figure 8). SDQs from all respondents indicated children
with a high level of conduct problems were likely to present with high hyperactivity and low prosocial behaviour scores. The association was strongest for teacher ratings (conduct and
hyperactivity: r = .58, p <.001; conduct and pro-social: r = -.49, p <.001).
Parents’ responses differed greatly from teachers on emotional symptoms, as is consistent with
other studies in this area (Stone et al, 2010). Parents’ and teachers’ knowledge about a child
differs – teachers see children’s behaviour in the classroom and amongst their peers on an almost
daily basis, while parents have deeper knowledge of their child’s thoughts, moods and how they
have developed. According to teachers’ ratings, 48% of children had pro-social behaviour in the
abnormal range though parents’ and children’s responses on pro-social behaviour problems were
much lower at baseline (17% and 11% respectively).
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Figure 8: Percentage of children with difficulties in the abnormal range in each domain by
respondent
60%
Teacher
Parent
49%
50%
46%
44%
45%
Percentage of children
43%
40%
40%
31%
30%
Child
48%
33%
28%
28%
29%
20%
17%
15%
11%
10%
0%
Emotional
Conduct
Hyperactivity
Peer
relationships
Prosocial
The profiles of boys and girls differed (see figure 9). Boys had significantly higher scores for
hyperactivity (t(2634) = 17.9, p < .001) and conduct problems (t(2633) = 12.0, p < .001) while girls
had greater scores for emotional problems (t(2634) = -5.1,p < .001) and showed more positive
prosocial behaviour (t(2631) = -12.2, p < .001). There were no differences for peer problems.
Figure 9: Children’s difficulties by gender
8
7
Mean SDQ score
6
5
Boys
4
Girls
3
2
1
0
Emotional
Conduct
Hyperactivity
Peer
relationships
Prosocial
To explore whether children were presenting with difficulties in one main area or across several
domains, the four subscales for total difficulties were recoded and grouped by the number of
subscales for which scores were in the abnormal clinical range, based on teacher SDQs. About a
quarter of children seen were either in the normal or borderline range on all domains (26%), one
domain only (4% peer problems, 8% hyperactivity, 7% conduct problems and 8% emotional
symptoms), or two domains. Just under a fifth of children (19%) were in the abnormal range on
three or all subscales.
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The reasons for referrals for children in the normal clinical range are currently being explored via
case studies. Early anecdotal feedback from practitioners suggests children can be referred to
prevent problems escalating during or following difficult life events such as bereavement, domestic
violence or witnessing a traumatic event. Further information will be provided by monitoring
information on presenting problems in the next academic year. There may also be a measurement
issue as the SDQ is known to be less sensitive at identifying disorders that do not present with
overt behavioural problems – for example, specific phobias, eating disorders, separation anxiety
and panic disorders (Goodman et al, 2000).
3.3
The impact of children’s difficulties
The SDQ impact supplement was completed with high return rates pre-intervention: 94% for
teachers (n=2,633), 86% for parents (n=2,382) and 81% for children (1,689).
Three quarters of children had considerable (‘definite’ or ‘severe’) difficulties according to teachers,
64% had according to parents and just over half of children (51%) said they had considerable
difficultiesix.
Around six in every ten children had experienced difficulties for more than one year and reported
significant distress (‘quite a lot’ or ‘a great deal’), based on average figures across respondents
(see figure 10).
ix
Teachers, parents and children who do not think a child has difficulties are not asked to complete the
remainder of the impact supplement. Hence, the results that follow relate to a sample size of 2,469 for
teacher, 2,200 for parent and 1,424 for child SDQs.
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Figure 10: Length of time children had experienced problems before coming to Place2Be by
respondent
Teacher
80%
Parent
Percentage of children
70%
Child
60%
50%
40%
30%
20%
10%
0%
Less than 1
month
1-5 months
6-12 months
More than 1 year
Mean teacher, parent and child total impact scores were in the severe range – the mean teacher
score was 2.8 (SD 1.8), parent score was 3.2 (SD 2.4) and child score was 2.8 (SD 2.4)x (see
table 3).
Teachers reported 71% of children had difficulties which interfered significantly (‘quite a lot’ or ‘a
great deal’) with their classroom learning and 47% had difficulties which significantly burdened
their teacher or the class. According to parents, over half of children had difficulties that impacted
significantly on their home life (53%) or the family (54%). Around two fifths of children reported that
their difficulties significantly impacted on their home life (39%), their family, friends and teachers
(42%) and their friendships (36%).
The abnormal clinical ranges for the total impact score are: 2 – 6 for teacher SDQs, 2 – 10 for parent SDQs
and 2 – 10 for child SDQs.
x
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4.
Improvement in wellbeing for all children
This section presents the improvement in difficulties for all children who completed one-to-one
counselling in 2011/12.
For the findings reported in this section and section five, the absence of a control group which did
not receive counselling means that it is not possible to definitively quantify the scale of
improvement in outcomes. At least some of this improvement could have been expected to occur
even in the absence of any intervention (often referred to as ‘regression to the mean’) – although
this is well-documented in adults, there have so far been relatively few such studies among
children (but see Cooper et al., 2010 and Daniunaite et al., 2012 for indicative findings).
4.1
Improvement in children’s total difficulties
Of the 2,787 children who attended one-to-one counselling in 2011/12, 2,006 children completed
counselling in the same year (72%). The return rate was 88% for teacher data (n=1,764), 63% for
parent data (n=1,257), and 73% for child data (children aged 7 and above, n=1,122). For the
analysis of missing data see appendix 1.
The mean number of counselling sessions attended was 21 (SD 11). A fifth of children attended
short-term counselling over 3 months (mean 8 sessions, SD 4), a fifth attended counselling for 4 to
6 months (mean 16 sessions, SD 5), nearly half (45%) were supported in counselling for 7 to 12
months (mean 24 sessions, SD 5), and 15% of children were supported for over a year (mean 37
sessions, SD 12).
Following counselling, 66% of children had improved overall stress (total difficulties) according to
teachers, 73% improved according to parents and 71% of children reported improvement. Parents
reported the greatest overall change – a mean change of 4.2 points and a medium effect size
(ESxi) of 0.62. The mean change score reported by children was 3.7 (ES = 0.6) and for teachers
was 3.2 (ES = 0.45).
From pre- to post-intervention, the proportion of children in the severe range decreased by around
a third according to teachers (37%), and around a half according to parents (45%) and children
(55%) (see figure 11).
Figure 11: Percentage of children in each clinical category before and after counselling, child SDQs
xi
Effect sizes were calculated using Cohen’s d (Cohen, 1988) – difference between the means (M1 – M2) divided by the
pooled standard deviation – sq. root of ((SD1)2 + (SD2)2/2).
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70%
66%
Before counselling
After counselling
60%
50%
42%
40%
34%
30%
24%
19%
20%
15%
10%
0%
Normal
Borderline
Abnormal
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Improvement rates pre- and post-counselling have been consistent over the last five yearsxii: an
average rate of 64% according to teachers, 72% according to parents, and 68% according to
children (see figure 12).
Figure 12: Percentage of children with improved total difficulties following counselling over time
(2007/8 to 2011/12), by respondent
100%
Teacher
90%
Parent
80%
Child
70%
60%
50%
40%
30%
20%
10%
0%
2007/8
4.3
2008/9
2009/10
2010/11
2011/12
Improvement in the domains of children’s difficulties
Approximately 60% of all children had improved emotional symptoms after the intervention, and
just over half of children had improved conduct problems, hyperactivity and peer relationships.
About a quarter of children had improved pro-social behaviour (see figure 13).
Figure 13: Percentage of children who improved, by SDQ domain and respondent
70%
Teacher
64%
61%
60%
Percentage of children
55%
50%
Parent
57%
55%
57%
53%
Child
55%
52%
52%
51%
45%
40%
30%
30%
28%27%
20%
10%
0%
Emotional
Conduct
Hyperactivity
Peer
relationships
Prosocial
xii
Sample sizes for teacher (T), parent (P) and child (C) reports: 2007/08 T = 1,655, P = 946, C = 1,242; 2008/09 T =
1,839, P = 1,095, C = 1,280; 2009/10 T = 1,558, P = 1,221, C = 1,219; 2010/11 T = 1,662, P = 1,232, C = 1,205;
2011/12 T = 1,747, P = 1,257, C = 1,122. The schools in each sample vary from year to year.
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Children’s improvement was similar across all of the domains according to teachers, with average
points on each domain reducing by 0.7 – 0.9 (see appendix 2). Parents and children reported the
largest improvements in emotional symptoms, a reduction of 1.4 for parent SDQs and 1.5 for child
SDQs, a medium effect size of 0.53 and 0.60 respectively. The smallest change was for pro-social
behaviour.
4.4
Improvement in the impact of children’s difficulties
The return rates for the pre- and post-intervention SDQ impact supplement were 85% for teachers
(n=1,700), 62% for parents (n=1,239) and 73% for children aged 7 or above (n=1,122).
70% of teachers, 85% of parents and 86% of children reported that children’s difficulties were
better (‘a bit’ or ‘much’ better) since coming to Place2Be. 26% of teachers, 12% of parents and
11% of children thought their difficulties were about the same. 5% of teachers, 4% of parents and
3% of children reported that their difficulties had worsened since coming to Place2Be.
The percentage of children with total impact scores in the severe range reduced by approximately
25% according to teachers and parents and by 16% according to children’s reports. On average,
children’s total impact score reduced by 1.1, 1.7 and 1.2 points according to teacher, parent and
child SDQs respectively.
According to parents, three quarters of children (76%) who had difficulties that distressed them
significantly (‘quite a lot’ or ‘a great deal’) before counselling had reduced distress after the
intervention. 68% and 71% had reduced distress according to teachers and children respectively.
Of children whose difficulties had a significant impact before counselling, according to teachers,
63% had difficulties which interfered less with their classroom learning after counselling, and the
burden of children’s difficulties on the teacher or class had reduced for 68% of children. According
to parents, for seven out of ten children, the impact on children’s home life and family had
reduced. Children’s reports indicated that around three quarters of children felt the impact of their
difficulties on their home life (75%), family, friends and teachers (74%), and interference on their
friendships (77%) had reduced after counselling.
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5. Improvement in wellbeing for children with the greatest
difficulties
This section presents the improvement of children with the most severe difficulties before they
started counselling, those with total difficulties in the abnormal clinical range, who completed
counselling in 2011/12.
About three quarters of children who attended counselling in 2011/12 completed the intervention in
the same year and the remainder of children will continue to attend counselling in 2012/13.
Teacher and child return rates in particular were very good for children in the abnormal range:
91% for teachers (n=934), 69% for parents (n=901) and 85% for children (n=380).
5.1
Improvement in children’s total difficulties
For children with severe difficulties, the mean number of sessions attended was 23 (SD 11.3).
Around half of interventions (45%) lasted between 7 and 12 months (mean 24 sessions, SD 5).
Approximately 17% of children had short-term counselling for up to 3 months (mean 8 sessions,
SD 4), 19% attended counselling for 4 to 6 months (mean 16 sessions, SD 5) and 18% of children
were supported for over a year (mean 37 sessions, SD 12)xiii.
According to teachers, over three-quarters (77%) of children with severe difficulties improved and
about half of children (49%) achieved clinical recovery, moving out of the abnormal range into the
normal or borderline clinical range, following counsellingxiv. According to parents, 82% of children
improved and 54% of children achieved clinical recovery, and children themselves reported even
larger improvements – 87% had improved total difficulties scores and 71% achieved clinical
recovery (see figure 14).
Figure 14: Comparing improvement rates for all children with those who began counselling with
difficulties in the abnormal range
100%
87%
90%
82%
77%
80%
73%
70%
71%
66%
60%
All children
50%
Children with the greatest
difficulties
40%
30%
20%
10%
0%
Teacher
Parent
Child
xiii
Percentages are based on an average from the samples based on teacher, parent and child ratings of
children in the abnormal range. Percentages differed by 1 to 4 percent only.
xiv See footnote xiii.
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The difference in pre- and post-intervention total difficulties scores was greatest for child SDQs –
reducing by 7.0 points, a large effect size (ES) of 1.50. The change in scores reported by parents
and teachers was also considerable – 6.6 for parents (ES = 1.16) and 5.5 for teachers (ES = 1.02).
Change scores ranged from -14 to 28 for teachers, -14 to 29 for parents and -9 to 22 for children.
5.2
Improvement in the domains of children’s difficulties
Improvements in individual domains varied considerably by respondent. According to teachers, the
greatest improvements were for conduct problems and hyperactivity – an effect size of 0.6 and a
reduction in the mean score of 1.4 and 1.6 points on each scale respectively (see appendix 2).
Just over three fifths of children improved on each of the difficulties subscales and a quarter of
children (25%) had improved pro-social behaviours.
For child and parent SDQs, the greatest improvements were for emotional symptoms and conduct
problems. 78% of children reported improvements in emotional symptoms and 71% reported
improvements in conduct problems. Parents reported around two thirds of children improved in
both domains. The change in mean scores for emotional symptoms was 2.5 for children (ES =
1.13) and 2 for parents (ES = 0.80). For conduct problems, on average scores reduced by 1.7
points according to both children and parents.
Figures 15 show the proportion of children in the abnormal range in each subscale before and
after counselling based on child SDQs.
Figure 15: Percentage of children in the abnormal range by subscale before and after counselling,
child SDQs
70%
64%
63%
60%
Before counselling
Percentage of children
54%
After counselling
50%
40%
33%
31%
30%
25%
20%
20%
15%
14%
11%
10%
0%
Emotional
Conduct
Hyperactivity
Peer
relationships
Prosocial
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Conclusion
The need for emotional and therapeutic services in schools can be seen in the numbers of children
referring themselves to Place2Be’s services – more than one in three children in schools visited
Place2Talk and of the children who attended. Almost two thirds of those attending Place2Talk
were girls and girls were also more likely to use the service more than once. Boys’ use and
appraisal of the service and factors that would encourage uptake could be a useful area for further
research.
Over 3,600 children attended one-to-one or group counselling in 2011/12 and most were referred
by their teacher or the SENCO. Many of the children who attended were coping with difficult
circumstances at home – around a quarter had been involved with social care and 11% were the
subject of a Child Protection Plan. Over half of children were from families managing financial
hardship and many children seen had SEN.
Within the overall child population, 80 per cent of children are assessed as being in the normal
clinical range on the SDQ, 10 per cent as borderline and 10 per cent as abnormal. As in previous
years, over half of the children seen by Place2Be were in the abnormal range, as assessed by
teachers and parents. Boys and children with SEN were most likely to be assessed in the
abnormal range.There was also considerable variation by hub. The latter is not obviously
correlated with urban/rural location or other socio-economic characteristics and it would be
interesting to explore this finding further.
Hyperactivity and conduct problems were the domains in which children were experiencing the
most difficulties and often these problems co-occurred. Parents and children themselves
highlighted greater difficulties with emotional symptoms than teachers, indicating teachers overall
may be less adept at picking up on emotional problems (a finding highlighted in other studies, for
example, Goodman et al 2000). The profile of boys and girls differed: boys had significantly higher
scores for hyperactivity and conduct problems while girls had greater scores for emotional
problems and showed more positive prosocial behaviour. There were no gender differences in
reports of peer problems. Most children had difficulties in more than one area; only about a quarter
of children were in the abnormal range in a single domain and the domain in which they had the
greatest difficulty differed – 4% for peer problems, 8% for hyperactivity, 7% for conduct problems
and 8% for emotional symptoms only. Around a quarter of the children seen were in the normal or
borderline clinical range for all domains of the SDQ. Again, exploring this finding and identifying
the reasons for referral in such cases is likely to be of value.
After counselling, teachers noted improvements in total difficulties scores for two-thirds of children.
Parents and children rated improvements slightly higher than teachers. For children in the
abnormal clinical category, rates of improvement were higher; three-quarters of children improved,
and half achieved clinical recovery. Again, parents’ assessments of improvement were higher,
and children themselves noted even greater improvement, with almost 9 in 10 reporting
improvements and 7 in 10 reporting clinical recovery.
Improvements, where they occurred, tended to be manifest across all subscales. Approximately
60% of children had improved emotional symptoms after the intervention and over half had
improved conduct problems, hyperactivity and peer relationships. Less improvement was seen in
pro-social behaviour. Again, there were differences by respondents across subscales. Notably,
parents and children reported greater improvements than teachers in emotional symptoms and
conduct problems – an effect size of 0.53 and 0.46 respectively according to parent SDQs. The
effect sizes were greater for children in the abnormal clinical range pre-intervention – 0.80 for
emotional symptoms and 0.76 for conduct problems.
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Registered office address: Place2Be, 13/14 Angel Gate, 326 City Road, London EC1V 2PT Tel: 020 7923 5500.
Registered charity number 1040756 (England and Wales) SC038649 (Scotland). Registered Company number 02876150.
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Children’s outcomes: All hubs 2011/12  Page 28 of 30
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Appendix 1: Missing data analysis
All children who completed one-to-one counselling
There was a significant difference in missing data by hub, particularly for parent data (for teacher
SDQs, 2 (19) = 83.6, p < .001; for parent SDQs, 2 (19) = 171.4, p < .001; for child SDQs, 2 (19)
= 90.1, p < .001).
There was no relationship between missing data and children’s gender. Completion rates were
also similar irrespective of year group and SEN for teacher and parent SDQs, and FSM for teacher
and child SDQs. There was significantly more missing parent data for children who received FSM
– 40% of children who received FSM had missing parent SDQs in comparison to 32% of children
without FSM (2 (1) = 14.2, p < .001).
A greater proportion of children in the abnormal clinical range at baseline, as rated by teachers,
had missing parent and child SDQ data (for parent SDQs, 2 (2) = 9.0, p < .01; for child SDQs, 2
(2) = 6.7, p < .05). This relationship was not found for children rated in the abnormal range by
parents. As expected, missing child data was greater for children with SEN.
Children with the greatest difficulties only
There was no relationship between missing data and year group, gender, FSM and SEN for
teacher, parent or child SDQs. There was a significant difference in the amount of missing data by
hub (for teacher SDQs, 2 (19) = 46.8, p < .001; for parent SDQs, 2 (19) = 93.0, p < .001).
Children’s outcomes: All hubs 2011/12  Page 29 of 30
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Registered office address: Place2Be, 13/14 Angel Gate, 326 City Road, London EC1V 2PT Tel: 020 7923 5500.
Registered charity number 1040756 (England and Wales) SC038649 (Scotland). Registered Company number 02876150.
Appendix 2: Mean change and effect sizes for each subscale
All children who completed one-to-one counselling
SDQ subscale
Before
counselling
Mean (SD)
After
counselling
Mean (SD)
Difference in
means
Effect size
3.9 (2.7)
3.1 (2.6)
5.7 (3.2)
3.2 (2.4)
5.8 (2.7)
3.0 (2.5)
2.3 (2.4)
4.8 (3.1)
2.5 (2.3)
6.6 (2.6)
0.9
0.7
0.9
0.7
0.9
0.34
0.29
0.29
0.29
0.32
4.4 (2.7)
3.6 (2.5)
5.7 (2.9)
3.1 (2.2)
7.8 (2.2)
3.1 (2.5)
2.5 (2.2)
4.6 (2.8)
2.3 (2.0)
8.2 (2.0)
1.4
1.1
1.1
0.8
0.4
0.53
0.46
0.37
0.36
0.21
5.1 (2.6)
3.5 (2.2)
4.9 (2.5)
3.3 (2.1)
8.1 (1.9)
3.6 (2.4)
2.6 (2.0)
4.3 (2.5)
2.5 (1.9)
8.2 (2.0)
1.5
0.8
0.6
0.8
0.2
0.60
0.41
0.25
0.39
0.09
Teacher
Emotional symptoms
Conduct problems
Hyperactivity
Peer problems
Pro-social behaviour
Parent
Emotional symptoms
Conduct problems
Hyperactivity
Peer problems
Pro-social behaviour
Child
Emotional symptoms
Conduct problems
Hyperactivity
Peer problems
Pro-social behaviour
Children with the greatest difficulties only
Table 6: Average subscale scores pre- and post-intervention, mean change and effect sizes
Before
After
Difference in
counselling
counselling
Effect size
SDQ subscale
means
Mean (S.D)
Mean (S.D)
Teacher
Emotional symptoms
Conduct problems
Hyperactivity
Peer problems
Pro-social behaviour
4.8 (2.7)
4.6 (2.4)
7.7 (2.3)
4.3 (2.3)
4.8 (2.5)
3.4 (2.5)
3.2 (2.4)
6.1 (2.8)
3.1 (2.3)
6.0 (2.5)
1.4
1.4
1.6
1.2
-1.2
0.53
0.57
0.62
0.50
0.48
5.7 (2.4)
5.1 (2.3)
7.5 (2.1)
4.1 (2.2)
7.1 (2.3)
3.7 (2.6)
3.3 (2.3)
5.8 (2.7)
2.8 (2.2)
7.8 (2.1)
2.0
1.7
1.7
1.2
-0.7
0.80
0.76
0.70
0.55
0.31
7.0 (2.0)
5.1 (1.9)
6.6 (1.9)
4.7 (2.0)
7.8 (1.9)
4.6 (2.4)
3.4 (2.4)
5.2 (2.3)
3.2 (2.0)
8.0 (1.9)
2.5
1.7
1.4
1.5
-0.2
1.13
0.87
0.65
0.74
0.08
Parent
Emotional symptoms
Conduct problems
Hyperactivity
Peer problems
Pro-social behaviour
Child
Emotional symptoms
Conduct problems
Hyperactivity
Peer problems
Pro-social behaviour
Children’s outcomes: All hubs 2011/12  Page 30 of 30
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Registered office address: Place2Be, 13/14 Angel Gate, 326 City Road, London EC1V 2PT Tel: 020 7923 5500.
Registered charity number 1040756 (England and Wales) SC038649 (Scotland). Registered Company number 02876150.