The Primary Behaviour Service (PBS) is a specialist multi-disciplinary team of education and mental health staff working in Ealing primary schools with children aged 4 to 11 who are experiencing social, emotional and behavioural difficulties. They aim to prevent and reduce exclusion, and to provide a seamless service between their two core elements: outreach into mainstream schools and small group teaching delivered by specialised staff in Ealing Primary Centre (Pupil Referral Unit) for complex and severe cases.
Primary Behaviour Service – Ealing
The Primary Behaviour Service (PBS) is a specialist multi-disciplinary team of education and mental health staff working in Ealing primary schools with children aged 4 to 11 who are experiencing social, emotional and behavioural difficulties. They aim to prevent and reduce exclusion, and to provide a seamless service between their two core elements: outreach into mainstream schools and small group teaching delivered by specialised staff in Ealing Primary Centre (Pupil Referral Unit) for complex and severe cases. Evidence-based interventions address need across the contexts of home and school and include CBT, social skills, systemic working, attachment-based and parenting work. The efficacy of interventions is routinely monitored using outcome measures and child, parent and school feedback.
Referrals are received directly from schools and reviewed at half-termly panels. Working within schools has helped increase accessibility of the service to parents and carers, allowing them to meet with CAMHS clinicians within an environment which is already familiar and local to them. Delivering the service from schools also reduces the reliance on parents or carers to bring children to appointments, limiting the time away from school, which has resulted in a low non-attendance rate and increased engagement with families.
Children undergo an extended assessment consisting of school observations, discussions with teachers and other professionals, parent meetings and individual sessions with the child. The PBS team works alongside the neurodevelopmental team, conducting initial screening and feeding into any specialist assessments.
The evidence-based interventions offered by the service aim to address need across the contexts of home and school, and include CBT, social skills, systemic working, attachment-based and parenting work. Joined up interventions for a child may include individual CBT-based therapy and behaviour management, with work to develop strategies for parents and teachers. Most children will receive three or more interventions over the academic year.
The service aims to build capacity within schools and partner agencies through work to develop skills and confidence in professionals working with children with behavioural and emotional difficulties. A large proportion of work involves liaison with other agencies and contributing to multi-agency interventions. In 2015/16, 75% of children received support from at least one additional service alongside the PBS, and 25% from three or four services. A high proportion have social care involvement and the team regularly attend Child in Need and Child Protection meetings to contribute understanding of the family’s difficulties and provide support to the network. They also feed into applications for Education and Health Care plans.
Support for families
The PBS has recently established an evidence-based Multi-Family Group for children who attend the Ealing Primary Centre and their parents. This has demonstrated positive change for children at school and has proved an excellent way of engaging parents and other family members, often in cases where families have been unable or unwilling to make use of usual CAMHS-style interventions. Work with children and families is not strictly time limited, allowing space for relationships to be built with families who may have been ambivalent or anxious about seeking support, but whom schools are very concerned about.
The efficacy of interventions is routinely monitored using outcome measures and child, parent and school feedback. The PBS collects both quantitative and qualitative data using standardised questionnaires, where possible. Measures are collected at the beginning of working with a child or young person, or their family or carer; annually; and at case closure.
What makes this service an example of positive practice?
The PBS is an innovative service, being fully integrated within education and working alongside specialist teachers to provide accessible and flexible support for teachers in school. The capacity of the service enables them to make multiple contacts a week for each child, including consultation meetings, individual work and parent sessions. This enables formulations to be widely shared within the system, and a multi-agency, joined-up approach to providing care. The service functions as a Tier 2 CAMHS team, however with links to local Tier 3 specialist CAMHS, they are able to facilitate a smoother transition for families who require further intervention.
The PBS is able to work with children without being tightly time-limited, allowing for relationships to be built with families who may have been ambivalent or anxious about seeking support, but whom schools are very concerned about. From the 32 cases that were closed this academic year, the service was involved with 75% of children for over one year. This is a work pattern supported by their commissioning service.
|Commissioning||Local Authority – Education|
|Providers||West London Mental Health Trust|
|Workforce (WTE)||3.5 clinical psychology (band 7 and 8), 6 teachers, 0.2 occupational therapist, 0.2 speech and language therapist, 1 manager/administration|
|Population size||about 340,000|
|Caseload||In 2015/16 school year they saw 65 children. The mean time on an active caseload was 21 months (range = 81 months).|
|Prevention and resilience – universal and early intervention for at risk||Specific specialist assessments e.g. ADHD|
|Access and advice – consultation lines, triage and signposting||Scheduled care|
|Early support and brief interventions|
|Biopsychosocial assessment||Intensive interventions|