The Emotionally Healthy Schools (EHS) Programme brings together colleagues from education, health and the voluntary sector to support educational establishments in Cheshire East in their efforts to improve emotional and mental health education for young people and their families. School staff are reporting increased confidence in responding to the mental and emotional health needs of their children and young people with clearer pathways to support, help and advice across the Thrive Pathway. All aspects of the EHS programme are FREE to all Cheshire East schools, nurseries and colleges. Commissioned by Cheshire East Local Authority the programme is made up of three distinct offers.
Please briefly describe your project, group, team or service, outlining what you do and why it makes a difference.
The Emotionally Healthy Schools (EHS) Programme brings together colleagues from education, health and the voluntary sector to support educational establishments in Cheshire East in their efforts to improve emotional and mental health education for young people and their families. School staff are reporting increased confidence in responding to the mental and emotional health needs of their children and young people with clearer pathways to support, help and advice across the Thrive Pathway. All aspects of the EHS programme are FREE to all Cheshire East schools, nurseries and colleges. Commissioned by Cheshire East Local Authority the programme is made up of three distinct offers.
Cheshire and Wirral Partnership NHS Foundation Trust alongside Just Drop In provide EHS Links Team which seeks to improve knowledge and confidence in schools to respond appropriately to emotional and mental health needs, to develop a shared language around mental health, improve pathways across young people’s services and improve links between education and mental health providers. The team offers Mental Health Awareness Training, Mental Health Service Consultation and facilitated Reflection to all Cheshire East schools and colleges.
Tools for Schools is helping children and young people to thrive by offering specialist training to schools staff that promotes good mental health and wellbeing. The aim of the training is to help schools become more emotionally healthy through their school ethos and culture and by embedding emotional health and wellbeing into the curriculum. The team can also train staff to deliver interventions that equip children with tools to become resilient, develop healthy social skills and manage emotions and thoughts in a positive way.
School leads offer support and guidance for schools on development of a whole school approach to emotional health and wellbeing through completion of a self-assessment framework, which can lead to formal accreditation from The AcSEED Initiative. Schools are also supported to develop policies and procedures which enable all children and young people and staff in schools to have a greater awareness of the support available to them, both in school and the wider community, to reduce stigma perceived by young people around emotional/mental health difficulties and to be able to have a voice in how services are shaped in schools.
What makes your service stand out from others? Please provide an example of this.
The EHS Programme has been developed across a range of agencies and has been successful in engaging with children and young people to ensure their voices are heard and drive strategic change for the whole system. This strategic coordinated approach has united the local authority, education, health and the voluntary sector in providing our young people access to appropriate and timely responses ranging from maintaining a healthy mind to dealing with acute crisis.
Adopting a “winning formula” approach has helped build a multi-agency partnership with a strategic vision that is incorporated into the joint agency transformation plan for children and young people’s services incorporating the voice of the child. Practical support for school ethos, processes and support mechanisms has promoted open and honest discussion around mental health. Therefore early intervention and prevention has been possible by working in partnership and training adults on the front line. The impact has been that they are now better equipped and more confident in providing suitable advice and support. This has streamlined the access to health services meaning they are more able to function with high risk young people, while early help and prevention is being taught through schools and other learning organisations. Due to the innovative approach across agencies Cheshire East Council was highly commended at the 2018 LGC Awards for Children’s Services.
The programme has a strong theory of change which is routed in primary and secondary prevention models. The initiative is shaped by evidence based and evidence informed programmes.
How do you ensure an effective, safe, compassionate and sustainable workforce?
The mental health awareness training, skills training, and opportunities to benchmark practice has been introduced effectively across the county with opportunities for supervision, consultation and reflection with a focus on staff wellbeing and personal development. There is very much a focus on taking the supervision structures, reflective practices and staff support that exists in Children’s and Young People’s mental health services and transferring these into schools and colleges to ensure that staff there can be supported to develop healthy workplace cultures and reflective spaces so they are better equipped to cope with the day to day stresses school staff face. The whole school approach training for example provided by Tools for Schools help education staff consider their structures, processes and policies and how they can improve their responses as a whole school team to those children and young people they are supporting. The facilitated reflection sessions provided by CWP’s EHS links team has been reported to have had positive effects on staff’s wellbeing and resilience, a key factor in developing emotionally healthy schools (Promoting children and young people’s emotional health and wellbeing: A whole school and college approach, Public Health England 2015). Essentially by upskilling staff and building their confidence, the workforce in schools and college are better equipped to respond sooner to emotional and mental health need, they are the best placed people to address children’s and young people’s needs at the earliest possible time.
Staff Wellbeing training being delivered to schools is enabling staff to identify how they could better address their own wellbeing and provides ‘staff voice’ feedback to individual schools which are being used as a starting point for senior managers to address this issue as part of their whole school development.
Through quality improvement measures schools can benchmark their development, including staff development and training. The agreed measure is the AcSEED Framework which recommends best practice in schools in their response to mental health needs of their students. The EHS Programme helps support schools complete their AcSEED documentation to work towards the accreditation. Already there are five Cheshire East schools achieving AcSEED accreditation (and there are more in the review pipeline) suggesting that the EHS programme is having a very positive impact on the provision of comprehensive mental health and wellbeing support in local schools and is ensuring a consistent approach to wellbeing support across schools which is a key objective of the EHS programme.
Who is in your team?
Each of the service providers have clear staff structures which is shared across the EHS programme.
EHS Links team: 1 whole time equivalent band 7 team coordinator.; 0.5 wte band 3 team administrator.; 2 wte band 6 Primary Mental Health Workers; 1 wte Project worker (Sub-contracted from Just Drop In)
Strategic Leadership 20 days/year- Headteacher – SLE*; Programme coordinator- 0.6 fte – Assistant Head-SLE; Secondary school lead- 20 days/ year- Assistant Headteacher- SLE; 4 Primary school leads- all Headteachers- 3 SLE, 1 NLE**; 1 College lead- 20 days/year
*This component of the EHS Programme is coordinated by Middlewich High School and senior leaders from other CE schools who are SLE- Specialist Leaders in Education for Emotional and Mental Health Education and 1 lead who is a National Leader in Education.
How do you work with the wider system?
From the inception of the programme a clear governance structure exists to include all agencies who are part of the commissioned programme, including other children and young people’s services, such as CAMHS, School Health, Safeguarding Leads, Children and Young People’s voice groups. There are strong links with charitable sector organisations who work with children and young people, and with the existing sub-contract arrangements with Just Drop In and partnership with Visyon, their contacts and relationships are brought together to work closely with the programme and help map out provision in the locality.
There exists a governance meeting structure which ensures that clear lines of communication are open between all involved parties. Each provider attend monthly Triangulation Meetings which in turn report into the EHS Leadership Meeting which is a quarterly meeting of school leads from Early Years, Primary, Secondary, Alternative Provision and Colleges, Local Authority and Clinical Commissioning group Commissioners, CAMHS leads, School Health, and Safeguarding Leads. This group reports in to the Children and Young People’s Mental Health Strategy Group which is concerned in the implementation of Local Transformation Plans and commissioning arrangements across the county.
The EHS Programme supports the Local Authority Transformation Plan so that in 2020 we will have built on the following objectives:
Every young person in CE has access to a graduated and timely response to emotional health issues, ranging from maintaining a healthy mind to acute crisis.
That CE has a joined up system that operates across the THRIVE Model and harnesses the capacity of the third sector.
All CE educational settings are better equipped to support the emotional health of their populations, working within the getting help and getting advice quadrants of the THRIVE Model.
Coordinated and robust risk support is available for the most vulnerable between partners, including youth justice.
Everyone in contact with children and young people feels equipped to actively support their mental health and wellbeing.
That access to getting more help and risk support is available through local settings, including primary, acute and specialist care, is timely and based on clear pathways of care linked to different types of need.
Well informed commissioners with comprehensive intelligence about needs and provision who strive to co-produce with children, young people and their families; leading to innovative, creative and responsive support across a range of services from primary care to inpatient and secure settings.
Working with School Health and Clinical Commissioning Groups, engagement with Primary Care services has taken place and this will be an area of focus in any third phase of the programme in 2019.
One of the three commissions of the EHS programme is provided by a charitable sector organisation, ‘Visyon Ltd’ specialise in supporting the emotional wellbeing of children and young people, providing secondary prevention work with targeted children in schools. Children are identified using the SDQ, with referrals into this provision being from the Link Team (via consultation) or by staff trained in the use of SDQ’s.
Do you use co-production approaches?
The EHS Programme has demonstrated commitment to ensure that the voice of the child has been heard in development, planning, implementation and review. A number of initiatives which demonstrate this.
Peer Education Project – YouThink: Developed and delivered by young people for young people, this peer-mentoring programme has set itself the challenge of raising awareness about the importance of mental health and emotional well-being across Cheshire East schools. With a strong emphasis on tackling misunderstanding and stigma, the project hopes to make it easy for young people to talk openly about the way they think and feel; helping them feel more confident in getting help should they need it.
Mental Health Ambassadors – have been trained in 13 secondary schools alongside staff from those schools. These ambassadors are now working directly with staff to implement programmes/ plans in their home schools, following surveys done by the ambassadors with their peers around raising awareness and reducing stigma.
Youth Voice Video’s –’student voice’ group sessions with Special Educational Needs (SEND) young people provided opportunity to voice their views and opinions on school support. A short film capturing their views has been produced. The aim was to gather information and ideas from CYP on their views of emotional support/behaviour policies in schools.
Self-Harm Pathway –Feedback from schools indicated a consistent approach to self-harm was required. As a result of this, a pathway of best practice was developed which included pulling together national best practice, listening to how young people would want support, and hearing what teachers wanted from the pathway. The Cheshire East Self-Harm pathway is now being used to inform appropriate responses to self-harm in school and can be found here: http://cwpcamhscentre.mymind.org.uk/wp-content/uploads/2017/06/Self-Harm-Pathway-CWP-EHS-2017.pdf
In addition to these specific projects there has been much attention paid to the STITCH report (2016), “Engagement with Young People to understand Mental Health service requirements” which formed part of the 2015–2020 Transformation Agenda in Cheshire East. This report has very much influenced the direction of the EHS programme.
Lead EHS Schools also demonstrate good practice by engaging with parents and carers through surveys and parents evenings about how schools should be addressing mental health needs. They also ask their students in assemblies and form time what their views on what support should look like.
User experience and impact is constantly captured via the secondary prevention work done in schools with targeted children. Reflection with group facilitators happens after every session and helps to inform ongoing support for children and young people in school, between each of the sessions.
Work is currently being developed to help schools capture the voice of children as part of their whole system model, ensuring that all children have an opportunity to feed into this process.
Online surveys, using validated measurement tools are available to schools to help track trends in wellbeing across whole school populations.
Capturing the voice of parents is currently informing service development as their role in promoting emotional wellbeing is a critical protective factor for children and young people.
Do you share your work with others?
The EHS Programme shares its good practice through various means. The lead School Middlewich High has developed a page on their school website which describes the offer of each service provider, including links to each respective service, links to booking systems for various training, consultation and events described in the offer. The school leads take overall responsibility for sharing the offer with all Cheshire East Schools and colleges to ensure that full engagement in the offer takes place. Information and updates are shared via the CE Schools Bulletin, at Designated Safeguarding Leads meetings and Designated Care for Children Leads meetings (half termly). We also have a standing agenda slot at the termly Welfare and Behaviour meetings- The CEASH meeting (Secondary Heads meeting), ECAPH (Primary Heads meeting) and report to the LSCB and ESB (Education Skills Board) and POG (Primary Operations Group)- all half termly meetings.The page can be viewed here: https://www.middlewichhigh.cheshire.sch.uk/page/?title=Emotionally+Healthy+Schools&pid=230
We have been invited to join the local GP meetings (Middlewich). Also articles in national press and PIXL- (an education provider) newsletter.
The EHS Programme has also received positive attention through a press release on behalf of David Rutley MP who is keen to promote the work the programme does. He discussed the impact the EHS Programme was having at the Young Minds Wise Up Parliamentary launch in April 2017 where he was joined by over 40 MPs and Lords who showed their support for the Wise Up Campaign which called on the Government to “to rebalance the education system to make the wellbeing of students as important as academic achievement”. Members of the EHS Links team along with a young person who had used mental health services and supported the campaign were invited to the event. The team were able to share their experience and good practice with key members of Parliament and leaders in children and young people’s mental health. More information about the campaign can be found here https://youngminds.org.uk/get-involved/campaign-with-us/wise-up/#the-wise-up-campaign-so-far For David Rutley’s press release, please visit his website here: https://www.davidrutley.org.uk/news/top-marks-emotionally-healthy-schools-programme
Public Health England are keen to learn more about the prevention work being done as part of this programme and will be linking us into a working group on the governments Green Paper, ‘Transforming children and young people’s mental health provision’ and also regionally to a practice network.
In addition to these examples, the EHS Programme strives to share the good practice amongst the local services and groups who have direct contact with the children and young people most at risk of experiencing emotional and mental health difficulties. Some examples are:
Safeguarding leads; School Health; Primary Care; Special Educational Needs Coordinators; Educational Psychologists; Local Participation Network meetings
What outcome measures are collected, how do you use them and how do they demonstrate improvement?
Schools are using Strengths and Difficulties Questionnaire (SDQ) increasingly to measure pre-post intervention/ support. Schools use the SDQ to identify need prior to utilising the EHS Links Consultation session which helps focus the information, advice and guidance, and signposting. Other outcome measures can be used, and schools are signposted to the Child Outcome Research Consortium for other popular outcome measures. The EHS Links Mental Health Awareness Training teaches attendees how to use and score the SDQ. EHS Links then records how many SDQ’s are used and scored prior to consultation. The use of this outcome measure has increased since the start of the project significantly. The EHS programme also use measures such as attendance/ attainment/ progress/ behaviour points as indicators of impact.
The use of the AcSEED framework also provides benchmarking for schools to measure impact and change against.
Data from attendance, behaviour, attainment etc. in schools is tracked and those not on track or who have poor outcomes are mentored and root causes identified.
Capturing the impact of preventive interventions is notoriously difficult but attempts have been made to track changes in general wellbeing in schools, via the WEMWBS survey which is available on the Cheshire East Local Authority website expressly for schools to utilise. In addition to this, the Child Resilience Measure is being used as a pre and post intervention measure for the projects secondary prevention work.
The Public health England whole school model is being used to gather qualitative data on the overall impact of the programme in individual schools.
Has your service been evaluated (by peer or academic review)?
In summary, key findings were a reduction of inappropriate referrals and increase in appropriate referrals to CAMHS. The report noted that evaluation outcomes demonstrated that access to a Tier 3 CAMHs “clinician for consultation; delivery of targeted interventions for pupils at risk within the school setting; and whole school approaches, combined to positively impact upon rates of CAMHS referrals made by the schools” (Foster et al, 2017). There was a reduction in stigma around emotional health and wellbeing. The report notes that it is complex to measure stigma though “personally held stigmatising attitudes were low in staff and pupils and reduced further over the project period.” There was an increase in awareness and knowledge of emotional mental health and wellbeing with a “moderate improvement in demonstrated knowledge in both groups and self-reported improvement in knowledge in staff respondents at the end of the project.” (Foster et al, 2017). Additional findings were:
Increased confidence of staff and pupils relating to emotional health and wellbeing
Young people having and keeping mentally healthy with the knowledge of what is required to maintain this and knowing where to go for help if they need it
Better understanding by of what provision is available additional to CAMHS
Increased confidence, school-focused measures self-esteem and resilience levels in young people who have participated in targeted group or participatory activities
A School environment that promotes and sustains pupil resilience, sense of worth and esteem
Ref: Foster, C., Rayner, G., Allen, S. (2017) Evaluating the impact of the Cheshire East Emotionally Health Schools Pilot Project, University of Salford.
How will you ensure that your service continues to deliver good mental health care?
There are ongoing discussions with all stakeholders of the EHS Programme about identifying positive outcomes, best practice and areas for development. This continues to be discussed through the Children and Young People Mental Health strategy group where CCG and Local Authority Commissioners, Education and Health Leads, and charitable sector partners all work together to ensure that the focus continues to be on early intervention and prevention and improving the pathways across the Thrive Model. While there are no guarantees of continued funding to current service providers due to tender processes and temporary funding, the work the providers are reporting on through regular contract monitoring and key performance indicators is laying best practice foundations for future commissioning arrangements. Where possible sustainability is built into the programme through co-delivery and staff training, building improved links between education and health providers, and by developing such pathways and policies like the Self-Harm Pathway, and more recently an Emotionally Healthy Schools policy approved by Local Safeguarding Children Board. The secondary prevention work uses a co-delivery model in schools so that staff can be trained ‘on the job’. Ongoing liaison continues with schools to support them when they move on to deliver independently and a quality assurance framework is used to assist with this.
EHS programme key leads continue to have two way discussions with commissioners to establish what a third phase of the EHS programme will look like and are optimistic that a longer term funding stream can be identified so that the programme can continue after March 2019.
What aspects of your service would you share with people who want to learn from you?
Agencies in Cheshire East have a successful and healthy history of relationships where all key stakeholders have really been focused on ensuring emotionally healthy schools for all. Prior to the pilot project health, education, Local Authority and CCG leads spent two years planning for the pilot phase until sufficient funding could be identified. There was commitment to the vision that early intervention and prevention in schools will have a significant positive impact on children and young people’s mental health and by preparing ahead of any identified funding, in a collaborative approach, all the key players had already established healthy working relationships.
The engagement of schools in the programme is vital and the best way this was facilitated was by commissioning leads in education to take the role in communicating the importance of the project, having that best knowledge of culture and required change from the perspective of education providers, rather than a top down approach from commissioners of from other agencies such as health. Getting everyone around the table ensured this was a collaborative approach. One key learning point is that it was and is vital that schools see the importance of a whole system change approach rather than choosing a pick and mix approach. Individual schools will have views on what they want to do to address emotional and mental health, but when the whole system changes to support schools to address these needs, there is a more effective culture change, driven by policy, processes and changes in attitudes and awareness around mental health.
What is your service doing to identify mental health inequalities that exist in your local area?
The EHS programme played a key role in updating the SEND toolkit in Cheshire East to ensure there are appropriate responses to those children identifies as having special educational needs. Language was updated in the toolkit to promote more of a focus on the Thrive framework, and updated ways of identifying need through the systematic use of SDQ’s and pathways into getting more help through consultation and mental health awareness training for staff. Getting help and advice links with the offer from Tools for Schools and this is reflected in the SEND toolkit.
An audit of CAMHS referrals from school has helped target schools where there are higher levels of inappropriate referrals over the course of the project, and these are then targeted to ensure they have engaged in the offer so their response is equal to those schools with lower levels of inappropriate referrals. This is a continuing piece of work and acknowledges that there are several factors that influence referrals including CAMHS Capacity and threshold levels. Ongoing discussion is taking place between Local Authority, CCG and health to understand this further and how this may link in with social deprivation and access to early intervention and prevention in schools.
What is your service doing to address and advance equality?
Adherence to legislation
All schools, Charity Sector organisations and CAMHS services have equal opportunities and inclusion policies which adhere to guidance in the Equality Act 2010 and Human Rights Act 1998 and from Department of Education and Department of Health.
The EHS Programme bullying prevention work ensures that anti-discriminatory practice is promoted and that schools understand their legal duty in respect of this area of school policy.
Under the UN Convention on the Rights of the Child, we promote in particular, Article 3, 12 and 29 by considering how decision we make will impact on the child; by consulting with children and young people on both our work and their experiences in school and; by helping children develop their abilities.
Understanding needs of the population
We support schools in assessing the emotional wellbeing needs of their students through the use of online surveys and collect individual feedback from children. We have promoted the use of WEBWMS to help schools track the emotional wellbeing of students over time, so that they can identify changing trends. Schools are also encouraged to use data they collect on bullying, via a validated measurement tool, to help inform the changes in behaviour of pupils in relation to bullying a victimisation as this is a significant risk factor in the development of anxiety and depression.
The student voice work that EHS Links have done has provided insight which builds on the STITCH report about how children and young people access help in schools and their communities. The programme continues to build on this and bring this voice of the child into training sessions so that school staff are more aware of their views and wishes.
Students who are involved in our primary prevention work complete validated surveys to help assess changes particularly around resilience. These measurement tools can be used with children as young as 5 years and young people receiving interventions at age 16.
All interventions offered to children and young people are in school hours and at home school. Feedback is sought about all interventions carried out and acted on accordingly.
Reducing stigma and raising awareness
All of the training provided to schools has the aim of raising awareness and reducing stigma. Giving children and young people the language they need to express their thoughts and feelings is central to this work.
Through Mental Health Awareness sessions for staff, students and parents the EHS programme encourages all to speak openly about mental health in the same way as physical; health and not just focus on ill health. The Peer Education Project, YouThink has a specific focus on reducing stigma around mental health and utilises materials from the Time To Change campaign. Through training and consultation schools are actively encouraged to pledge to end mental health stigma through the Time to Change campaign.
How do you identify the needs of a person using the service (such as their physical, psychological and social needs)?
The use of tools such as the SDQ and Revised Child and Anxiety and Depression Scale (RCADS) helps identify those children most at risk of experiencing mental health difficulties and schools, as part of the programme, are taught the importance of using outcome measures and identifying need in their children and young people. Increased use of outcome measures demonstrates the effectiveness of the Mental Health Awareness training. Close links with the School Nurses ensure that children and young people’s health and social needs are identified across the system, with service level agreements about information sharing, for example if a child or young person self-harms and attends A&E, notification is sent both to CAMHS and School Health to ensure joined up working.
The development of a pastoral referral pathway which has been rolled out across schools engaged in the EHS Programme helps identify need earlier and provide clear pathways of support within school before any referral to external agencies can take place. This was developed alongside education, Local Authority and Health professionals and can be adapted to each schools’ different structures and processes.
What support do you offer families and carers? (where family/carers are not the service users)
Parent evening sessions – phone consultation available to parents is developing in some engaged schools. Families may also be supported through CAF and other agencies to address any family/ parental needs.
Schools are encouraged to engage with parents when their child is identified as someone who could benefit from more targeted support. Some schools are offering ‘parent wellbeing’ workshops where we discuss self-care for parents and can signpost them for more support if necessary. We also promote the use of wellbeing apps such as ‘Woebot’.
All providers in the EHS Programme actively encourage parents to visit the MindEd online resource for information on various conditions, including online learning and resources.
Brief description of population (e.g. urban, age, socioeconomic status):
Cheshire East has an area of 116,638 hectares, making it the third largest unitary council in the North West. Approximately 40% of the population live in rural areas and the remainder in the two major towns of Crewe and Macclesfield and smaller towns of Wilmslow, Congleton, Sandbach, Poynton, Nantwich, Middlewich, Knutsford and Alsager.
