Supporting children's mental health and wellbeing
Supporting children's mental health and wellbeing

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Supporting children's mental health and wellbeing

1 Professionals involved in children’s mental health

There are many health and social care professionals who work to support, treat and ultimately to improve the mental health of children.

Here are examples of professionals who may work with children, and their roles and responsibilities.

Educational psychologists: have studied psychology and have taken additional training and study to specialise in working with children and families in education settings. Psychologists are not medical doctors (which include psychiatrists) and therefore do not prescribe medication. They can assess children and recommend interventions to support children experiencing social and emotional difficulties.

Activity 1 The role of an educational psychologist

Timing: Allow about 30 minutes

Watch the following interview with Liz talking about her work as an educational psychologist (about 5 minutes). Then reflect on each of the questions that follow and make a note of your responses. Watch the clip a few times if that helps you recall what was said.

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Transcript: Video 1

LIZ MIDDLETON
When I was a teacher, I was really lucky to be working with lots of other colleagues in London. And I became really interested in those children who had difficulties. They sort of drew me towards them, or they sort of caught on to me. So that I really felt that maybe I did have a way, or a rapport, or whatever of working with specific children.
And then when I explored it further, I was fortunate to be able to be supported. And then beginning to go on training, and then having the opportunity to actually then become an educational psychologist through funding. So that was what sparked it all off in the first place.
It's a big question, what an educational psychologist does. But it depends also on what expertise or interests you've got as an educational psychologist. In my case, for example, I was particularly interested in preschool. So I became the psychologist that went round lots of nurseries and preschool establishments and helped with teachers there and parents, working with various children to help with their practical skills, the things that they were finding difficult.
Some people might want to be involved more in behaviour management. So they might go into schools looking specifically at training staff to do with behaviour. Others might look much more at specific learning difficulties. I did that for a while myself. But specific learning difficulties, so the dyslexia or attention deficit. So they might have specific skills in that area.
There's the need to be very much someone who works within a team, ability to work within a team with other colleagues, but also the whole multidisciplinary approach. So you'll be going to meetings with psychotherapists, with health professionals. You'll be sometimes going to social services meetings. So a whole range of people that work in and around the child as well.
When you're assessing children, it's not just about what might be called individual formal assessment of the child, but you're actually doing a lot more to see what the child is doing within a particular context. So for example, some children may have problems at home where they don't have them at school, or have problems at school where they're not seen to have so many problems at home.
So you're looking to see where the problem is most apparent, but also seeing who it's the most problematic for. So you're looking in which context, how the child behaves with different people. So you're building up a whole larger framework and picture of the child, rather than just saying it's the individual child in isolation from everything else.
Thinking through all of the skills that psychologists would need, I think one of the most important is the ability to listen, listen really carefully to what people are saying, whether that be teachers, parents, the child in particular. But really not just listening, but actually looking attentive and being there, so that people can feel that you are genuinely interested in what they're saying. So that's a key skill.
And another one would be, you're not trying to solve problems as such, but more help people explore what the problem actually is. So really looking at it from all angles. So it's a bit like a detective in that sense. So you're finding out the different bits of evidence from everybody, and then seeing how it all pulls together to get a whole picture of what's happening with the child in that particular situation.
I think with working in many different professions, particularly when you're looking at sensitive issues to do with mental health, it's making sure that you look after your own mental health as well. Because it's so easy for people to then get into burnout situations where they're giving too much of themselves without actually looking at what they need to keep healthy, both physically, mentally, and also to keep the boundaries between yourself and also what you're working with. So I think that's crucial.
In a good day for me, as an educational psychologist, would be, for example, when a child has suddenly taken on, oh, so that's what the difficulty is, or, oh, so that's why I have the problems that I do have, or, it all makes sense now.
When I saw a child recently who had ADHD, oh, you understand what I'm talking about? So you're one of the few people that's understood when I say that my mind might be in a different space, what that actually means, because other people think I'm doing it deliberately, or that I might not actually be paying attention when I'm trying my hardest. But it's not easy for me to do that. So just getting that they actually feel themselves, that they can have an insight into their own difficulties is really pleasing.
End transcript: Video 1
Video 1
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Part 1

What kinds of work do educational psychologists do?

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Discussion

Liz described a range of different tasks and how these might also depend on the expertise and interests of the individual psychologist. Visiting schools and talking with staff, children and parents were mentioned, as was training.

Liz talked about managing assessments of pre-school children herself, as well as having responsibility for children with specific learning difficulties (such as dyslexia) and those with social and emotional issues.

Part 2

What other people and professionals might educational psychologists work with?

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Discussion

Liz talked about working in a team with other colleagues and also how important it was to liaise with mental health teams, social workers and systems that surround the individual child. You may recall that these systems have been mentioned throughout the course.

Part 3

What is important to consider when assessing individual children?

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Discussion

Liz explained how the ‘whole child’ needs to be seen as part of systems that includes the family and the school that the child is interacting with daily. The child is the central focus, but should never be perceived as an isolated individual.

Part 4

What does Liz suggest is one of the most important skills to have?

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Discussion

Throughout the course, but particularly in Session 5, you’ve considered the importance of listening to the child. Here, Liz emphasises the need for the same skill but with a wider application, stressing the need to listen attentively to all those involved with the child – including the child themselves of course – in order to find out how each person perceives the situation. Such listening can be very intense and tiring, especially when this involves hearing about adverse childhood experiences first-hand on a day-to-day basis, which is also why Liz highlights the need for professionals to take care of their own health and wellbeing to avoid ‘burnout’.

Part 5

Why does Liz suggest that the role is not being a ‘problem solver’?

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Discussion

Liz brought in an interesting metaphor of the work being similar to a detective gathering evidence from everyone so that a bigger picture of the child and the problem or situation can be ‘drawn up’. In this way, ideas can be thought through with others, including the child themselves, and the problem might even be reframed or perceived in a different light.

Health visitor: a registered general nurse who has done additional training to become a registered health visitor. Their role is primarily public health orientated and specifically focuses on working with children aged 0–5 years and their families.

Psychiatrists: medical doctors who have taken further training to study the speciality of psychiatry. Child and adolescent psychiatrists have specialised further and work with children with mental health conditions in both the community and inpatient mental health units. Psychiatrists can diagnose mental health conditions, prescribe medication, provide psychotherapy (i.e. talk-based therapies) and make recommendations for other interventions. They usually work in NHS-funded multidisciplinary teams with other professionals, including mental health nurses.

School nurse: a registered nurse who has done additional postgraduate training to become a specialist in children’s physical and mental health.

This is a photograph of a child with a school nurse.
Figure 1 A school nurse

Social workers: support children and their families, helping to protect children’s rights and safeguarding children. They build relationships between agencies and help advocate for the child and ensure they receive the formal supports and resources that they are entitled to.

Special educational needs coordinators: often referred to as SENCOs. This role is statutory as part of the Special Education Needs and Disability (Department for Education and Department for Health and Social Care, 2014) legislation, which requires education settings to have a designated teacher who coordinates the special educational needs of children.

Activity 2 The role of the SENCO

Timing: Allow about 30 minutes

Watch the following clips from an interview with Christine about her role as a special educational needs coordinator. You can either watch the clips all together or one at a time at your own pace.

Part 1

As you watch the first clip, make some notes in response to the following:

  • how Christine explains what is meant by the role being ‘mandatory’
  • what the routes for referral and identification of special needs tended to be
  • how social and emotional difficulties tended to be seen by staff.
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Transcript: Video 2

CHRISTINE
So SENCO, or Special Needs Coordinator, is one of two mandatory roles in any school. There's the head teacher, and there is a SENCO. Those two positions must be filled. It can be one and the same person, but those two roles are mandatory. So therefore, the SENCO has a very special and unique place in the school because it is the responsibility of the SENCO to ensure that any special needs that a child has that's identified is supported and any child that has been identified as having special needs or needing support is happening.
There were at least two main routes, two main ways of identifying children who have special needs. The first one, in the secondary school setting, is that children who come from the primary schools come with some information about their learning abilities or general difficulties if they have. In the first instance, though, children in Year 7 were tested so that we would have a reading and a spelling age. So we were looking for cognitive abilities. And that initially identified those who were below average in their reading and spelling.
Very quickly then, we would look at those scores and identify those children who would need additional support just so that the children could access the curriculum, the written material. If a child comes to secondary school aged 11, has a reading age of five or six, is not going to be able to access the text in history or read the map in geography. So it was really important we did that identification very quickly.
The problem with that, though, was that we focused very much on the learning abilities. We didn't have, as such, any test or any way of identification or measuring any other areas of the code of practise as such. Yes, we would know if a child had medical needs or whether there was physical impairment. We would address that, of course. But the child who had perhaps social and emotional difficulties or communication difficulties, unless they were already flagged up from the primary schools, we wouldn't know.
So some way of then identifying that was by teachers, subject teachers coming to see me and saying, oh, well, this child is not behaving very well. And it was interesting that very quickly it was bad or poor behaviour that was noticed. And you know, do something. This child can't be in my lesson would very quickly be the conclusion a class teacher came to.
So for me, as a SENCO, it was then really important to look behind that. What was that behaviour? What was the cause of that?
Of course, parents could also flag up a need for a child. Maybe there was some situation in the family, parents themselves had concerns about something. So we would look at that as well. So there were-- those routes were available to us to identify special needs.
End transcript: Video 2
Video 2
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Part 2

As you watch the second clip, reflect on the following question:

  • How did Christine attempt to look behind the presenting behaviour of the child?
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Transcript: Video 3

CHRISTINE
So for me as a SENCO, it was really important to look behind that sentence that the teacher brought or the child-- that was brought to my attention for bad behaviour or not able to be kind to other children or so. So I needed to and wanted to look into that and not just use the sanctioned route of the school system that was available, but to really look at what does the child need in terms of supports? So I always saw that as the main role as a SENCO, to support.
One of the things that was very obvious and, for me, really important was the way different needs were viewed by colleagues and staff generally. Much easier to support someone or to accept that a child needed support if it was a recognised learning difference. And I'll call it difference rather than difficulty.
So the child with low reading or spelling was-- we can help that child. It wasn't so easy and so widely accepted when it became more about emotional wellbeing, mental wellbeing. That was just not easy to accept by some colleagues and staff. So I needed to support them, to recognise that as equally important, if not more.
End transcript: Video 3
Video 3
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Discussion

You may have noticed how Christine attempts to think about the behaviour from the child’s perspective and what they might be attempting to express. As you have seen in previous sessions, all behaviour is a form of communication, which is understandable as very young children do not always have the ability to express themselves clearly using words alone. It is the responsibility of adults to find out as sensitively as possible how children are understanding the world around them and the relationships they experience.

Part 3

In the third clip Christine discusses how the school attempted to access wider support services. Reflect on the following:

  • What kinds of support were available?
  • What were the challenges at the time of accessing external mental health support?
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Transcript: Video 4

CHRISTINE
So in terms of accessing support other than the school-based support, we had our first port of call the local authority. Because the local authority provided a package for us of support-- for example, behaviour support, dyslexia support, literacy support.
And then we also invited voluntary agencies. So for example, domestic violence charities, bullying or anti-bullying agencies. They were very happy to come in and work with our children, but also with our staff to help training. The access to mental health services was much, much more tricky, partly because waiting lists were so, so long.
But also because we from a school point of view didn't have a direct route of referral to those mental health services. So I needed to signpost parents to either go through the GP, or to go to the paediatrician, or I could use the school nurse.
We had access to a school nurse, and a school nurse could also refer to mental health services. But again, waiting lists very, very long and very, very high thresholds, so not easy.
End transcript: Video 4
Video 4
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Discussion

At the time that Christine was SENCO, the school was unable to make direct links to mental health services and had to make referrals through over-stretched GP practices. As you may recall from Session 5, there is an increasing demand for effective and joined-up thinking due to recent government initiatives for more coordinated mental health support teams.

Part 4

The fourth clip highlights the important relationships Christine built up with parents in a very sensitive way. Note how she describes parents as ‘our allies’ in school.

Reflect on the story Christine narrates of one child, and the role of curiosity and listening to parents and the child that helped the communication process evolve in such a positive way.

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Transcript: Video 5

CHRISTINE
One of the privileges of being the SENCO was also talking and working with parents. Parents were our allies, really, because they were interested in-- are continuing to be interested in the welfare of their children.
There was one little story where I had a sense that a child was probably sort of displaying some tendencies towards social and communication difficulties. And I invited the parents, and I had to be quite brave to approach that in a very gentle and tentative way.
But what actually then happened was the parent eventually turned round and said, wow, you are the one person, the first person who is not writing us off as bad parents or poor parents, because we've struggled with our child. You're listening to us. And eventually, that child was diagnosed through the correct routes as having Asperger's and being on the autistic spectrum.
And it explained his behaviours, and his way, and his reactions, and his responses. So that was a really good way, a necessary way of being curious and listening beyond what you could see, and not just make a judgement based on behaviours.
End transcript: Video 5
Video 5
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Part 5

As Christine reflects on her role in the last clip, notice how she stresses the conflicts that inevitably arise within the role, but also how keeping the child’s welfare as central and helping the child to have a ‘voice’ that can be heard by others can ultimately make a difference.

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Transcript: Video 6

CHRISTINE
When I reflect on my role as SENCO, I really have a sense of I needed to be all sorts of different parts of me. There were times when I had to be really firm because I wanted to be the advocate for the child.
So going to the department leader, or the head of department, or the subject teacher and supporting them in differentiating and supporting the child is what I have to do one minute. The next minute being really calm, and understanding, and as if nothing else in the world mattered other than the child, because the child was having a meltdown, and needed a safe space to be.
Being accountable to the local authority as well as the parents, sometimes that caused conflict, because parents want one thing. The local authorities say another.
But I found that if I kept the child's need and the child's welfare at the centre of my work, it allowed me to be the little terrier, sometimes, but also the very calm, reflective, supportive person always, always wanting and needing to be there because the child didn't have a big enough voice yet. They're the child. I was their voice.
And I really found that as I appreciated that as a huge privilege. Anyone who has that idea that they want to be there for their child and be that voice for the child, if they take that seriously, they can be a SENCO. And I think it's one of the most privileged roles any teacher can have, because it gives you insight into so many lives.
But also, it gives you that opportunity to make a difference, no matter how small. But for that one child, that you have now made it possible that they can live their life a little bit better and have it a bit better time in school, because it's school-based, then it's worth it for one child only, if that's all you can do. But it is a most amazing role. Really, it is.
End transcript: Video 6
Video 6
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Teaching assistants: perform many important roles within schools, either working alongside the class teacher with targeted children who have special needs, or with small groups of children to help boost maths and literacy skills in particular. In more recent years their role has expanded, and some teaching assistants with higher-level formal qualifications have received further training to help them to nurture the wellbeing of children throughout the school.

This is a photograph of a Teaching assistant working with a child.
Figure 2 A Teaching assistant supporting a child

Mental health nurses: Some mental health nurses have received further training and work in Child and Adolescent Mental Health Services (CAMHS) either in the community or in inpatient units, making them experts in supporting children with mental health conditions. Other health and social care professionals also specialise in child and adolescent health and work in CAMHS too, including social workers, practitioner psychologists (including clinical psychologists), child psychotherapists (specialists in talk-based therapies) and occupational therapists.

Therapist: A range of specialists who are skilled in a particular therapy or field, which can include the disciplines of speech and language therapy, psychotherapy, family therapy (where a therapist works together with the family unit in systemic therapy) and occupational therapists. All can make a valuable contribution to children and their mental health.

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