Learning and Growth

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“We have had the privilege of working with some very talented and courageous people, who through their experiences of mental ill health have had their lives disrupted. It is our job to help them rebuild a future that they can succeed in.”

Technical Instructor via theguardian.com - read more here

Growing Places



As you can probably tell from the title, this theme is about learning and growth! It focuses on how therapeutic relationships can nurture healthy development and gentle movement towards a young person’s own idea of holistic success. This involves the young person learning how to independently manage their symptoms and make the most of available treatment, as well as gaining new essential life skills and developing new, particularly life-enhancing activities, which they can carry into their everyday life.
15 and 16 year olds start to develop a set of values and their own sense of right and wrong. This can result in tensions if the young person seems to discard viewpoints that their parents value highly. It’s also a time of intellectual expansion, with broader interests and greater awareness of (and inquisitiveness about) the world. Having a stay on a CAMHS ward offers a chance to question things previously taken for granted, as they safely discuss and debate issues with peers and staff.
“One of the nicest characteristics of adolescents, especially in their late teens, is their idealism, their tendency to question everything, to try to find a social or political cause they can commit themselves to, and to try to find solutions for what ails the world.”

Fenwick & Smith, 1998
Older adolescents start to have more engagement with life, work and relationships outside the family, and face the task of learning to cope with the new stresses this inevitably brings. They’re nearly ready (or at least they may feel that way, or not) to become an independent and self-sufficient adult, maybe wanting to leave the family home and find a place of their own.
Parents may have high hopes for their future but find themselves in a much more passive position. They can offer advice, suggest ways of doing things and try to assert sanctions, but more and more it’s the young person who decides whether to agree, follow or obey. Adolescents are faced with having to set themselves on a course to accomplish financial and emotional independence, and anxieties or insecurities about the future often do no favours for their confidence and self-esteem - both of which are particularly diminished by the problems that led to their admission.

fredom

Lasting self-esteem doesn’t just magically appear by making young people feel good or happy (wouldn’t that be wonderful?). It builds up when they claim their independence and attempt to show the world around them that they’re unique individuals with unique skills and personal qualities. When they begin to achieve things through their own effort, they blossom in self-confidence. Young people develop this healthy self-concept through managing responsibility. In turn, they learn and grow best when they feel good about themselves. Wards can create situations and activities that exploit the rewards of young people’s strengths; helping them become aware of their strengths and building from there.
“One of my greatest passions is helping children and parents grow into the best versions of themselves they can possibly be.”

Susan Stiffelman, psychotherapist and family therapist
By getting help with working through what’s most troubling them, young patients can get back on track and continue becoming who they want to be, and eventually become an adult who can be satisfied with themselves and their lifestyle. So this theme is about them moving through a ward stay, in order to be able to do whatever seems important, enjoyable and valuable in their life, form fruitful, nourishing, mutually-enriching relationships with others, and cope well under the pressures and difficulties they will unavoidably meet during their journey.

A coaching approach can be really useful in clarifying how the young person will know when they’ve reached their goals, and what they’re already doing to reach them. While on a young people’s ward, they can be supported in working towards solutions, and in uncovering the skills that are needed. Psychosocial nursing can be used to tackle worries, and to work on supportive changes in their relationships and behaviour - changes that are important to them. It's crucial to help every young person discover something they can feel they are good at, and to show pride in their achievements. In providing a truly holistic approach, the whole of a young person’s life is embraced and explored, in order for them to reach their full potential.

Drawing power from what they do well can help the young person rise to the challenge of coping with difficult areas more easily. Of course, this doesn’t mean you should totally ignore areas of growth, just that these shouldn’t be majorly focused on at the expense of their strengths. (Fay & Foster 2014). However, it does mean avoiding situations that emphasise the young person’s weaknesses.
“The Life Skills group… is an opportunity to think about and explore issues affecting everyday life including topical issues. Some of the subjects that might be explored include bullying, self-esteem, growing up issues, environmental issues, safety and practical day-to-day tasks.”

Source: a welcome booklet via gosh.nhs.uk - more here

By getting help with working through what’s most troubling them, young patients can get back on track and continue becoming who they want to be, and eventually become an adult who can be satisfied with themselves and their lifestyle.

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Good Relationships Develop Healthy Brains


“We must do more as a society to open up opportunities for young people – whatever their backgrounds. And that starts with listening to what they have to say, and what they see as the barriers to their future success.”

Javed Khan, chief executive Barnardo's
As we highlight throughout CAMHeleon, the human brain works at its best in good relationships; they’re vital for emotional, social, cognitive, behavioural and even biological development. Young people who experience good relationships as they grow up naturally express themselves in interests and activities most congruent to them. Most of all, young people need to be valued as they are, and for who they are. When they receive this precious gift they thrive; they can more comfortably begin to value themselves as well, even while there are more downs than ups.
It’s within young people’s emotional connections that they develop a fuller sense of themselves and a capacity for relating. For example, “Attention paid to emotional and relational difficulties as they arise… has the capacity to increase opportunities for recovery from difficulties and foster optimal development and resilience” (Walker 2011). Interpersonal relationships and self-reflection encourage the ongoing growth of the mind. Dr. Stephan Collishaw (2015), lead author of a study on parents with recurrent depressive episodes, says that multiple protective factors are needed for children to show sustained good mental health: “Enhancing mental health resilience in children...requires focusing on multiple aspects of children’s lives – their own thinking and behaviour, family functioning and support, as well as social relationships.” (source)

As you know, young people’s fluctuating journey is one of exploration, which means they can often test situations and press buttons! They challenge us to remain flexible and to maintain our emotional equilibrium (Siegel & Hartzell 2003). Young people need to collect new experiences, test boundaries and take risks (especially 15 and 16 year olds). Trying stuff out, experimentation and pushing boundaries are integral to their pursuit of independence. That’s part of their job at this stage in their life, and part of the work of CAMHS staff is to help them to understand and navigate safely through their emotions and self-discovery, learn from the past, have hope for the future and feel good about themselves as individuals. Relational security values the young person’s work of discovering and being true to themselves, so they can continue growing up feeling appreciated, self-confident and unrestrained.
Young people learn a lot by observation, so in part, this is about being mindful of what you do and say in the presence of, and to the young person. Being mindful means that what one says and does is intentional and not reactionary. And the more mindfulness is practiced, the more it becomes second nature and instinctive. Being mindful helps ward staff to be proactive rather than reactive. See Caring Relationships for more on mindfulness.
"Parents, teachers and other school staff need the tools to help these young people early in their lives. And the earlier, the better. It is proven that early action prevents problems later in life."

HRH The Duchess of Cambridge

*We would also add ward staff to this statement :-)
"A child who receives adequate help with his emotions can later, as a parent, guide a child in the same kind of way, and this can take place quite spontaneously."

Mirabelle Maslin, 2013 - read more here
‘We wait until we have major problems and then attempt to deal with them instead of early intervention. Very often a child gets into trouble and ends up in the youth court. We have some good projects that help. I want to see CAMHS in a much better environment."

– Senator Andrew Green, Jersey's health minister (source)

It’s within young people’s emotional connections that they develop a fuller sense of themselves and a capacity for relating.

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A Wholly Holistic Relationship



Psychosocial nursing can be used to holistically explore areas of difficulty, and to work on positive changes in young people’s relationships and behaviour. Psychosocial interventions include a range of techniques, aspects of which can be applied to inpatient care. Interventions tend to emphasise strengthening and maintaining the young person’s personal, social and emotional development, before providing anything more specific.
Psychosocial nursing care is nursing that integrates:

  • Nurse-patient interaction and the therapeutic relationship.

  • Finding opportunities to optimise the nursing role, through appropriate closeness and tenderness.

  • Developing meaning in the patient's and the nurse's experience.

  • Developing self-awareness and professional growth.

Psychosocial assessment:

  • Involves a willingness to listen to the patient's account of their symptoms and illness in their own terms.

  • Addresses physical, psychological, social and spiritual concerns.

  • Values diversity.

  • Forms the basis for a partnership in planning and delivering nursing care.


Roberts, D, 2013
"Preparing for adulthood is about how professionals across education and training, health and social care support children and young people... in preparing for adult life and help them to go on to achieve the best possible outcomes in respect of employment, independent living, health and taking part in and contributing to their local communities."

Source: ‘SEND: guide for health professionals’ - view it here
What relational and professional skills are needed to work with young people? Staff views:

  • Listening skills.

  • Being able to communicate on different levels.

  • Training in adolescent developmental issues.

  • De-escalation skills.

  • Empathy, sensitivity.

  • Unconditional positive regard for the young people.

  • Flexibility, tolerance and openness.

  • Ability to set boundaries.


Adapted from YoungMinds' Where Next? Report 2

 

Psychosocial nursing can be used to holistically explore areas of difficulty, and to work on positive changes in young people’s relationships and behaviour.

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It’s a Goal!



One of the main concerns for young patients is knowing when they are likely to be discharged (and the steps involved) in order to give them something to aim for. The length of their stay is important to young people in different ways. Some young people are keen that it shouldn’t be too long, so they can reintegrate back into normal life. Others feel that it shouldn’t be too short; to make sure they’re ready to move forwards from the ward. Either way, it’s most ideal if the focus is on the long-term, so young people are able to cultivate meaning, become inner-directed, and increasingly less directed by, and reliant on, external factors.
Here’s what Wardipedia.org (CAMHeleon's big sister) has to say:

Even voluntary patients can experience an enormous sense of humiliation and distress, and this is certainly heightened for those arriving attached by handcuffs to a police officer. Paradoxically, leaving hospital can also be hugely daunting, and the more positive and healing the patient’s time on the ward, the scarier and less attractive it can feel for many patients.


You don’t need to just take our word for it! There’s a bunch of social psychology research demonstrating the lasting power of primacy and recency (i.e. first and last experiences) and, interestingly, the more all over the shop people are, the stronger these effects are. The intensity of these moments provides lots of scope for making them actively therapeutic for patients.

A checklist for collaborative goal setting:

  • Responsibility of staff doing pre-admission assessment.

  • In combination with the staff who will be working with the family during admission.

  • Completed before pre-admission case conference.

  • Drawn up and agreed with the young person and their family.

  • Professional network contributes where there are statutory proceedings.

  • Establishes priorities.

  • Part of engaging the family.

  • Main focus is on young person.

  • Parents/carers also commit themselves to grow.

  • Common types of goal:

    • Understanding a problem

    • Changing dysfunctional patterns of interaction

    • Learning new skills

    • Identifying future needs




Adapted from Jonathan & Jacob 1998

In-patient Child Psychiatry: Modern Practice, Research and the Future
Goals should be:

  • Conceivable

  • Believable

  • Achievable

  • Controllable

  • Measurable

  • Desirable

  • Growth-supporting


Source: ctb.ku.edu - read more here

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It’s most ideal if the focus is on the long-term, so young people are able to cultivate meaning, become inner-directed, and increasingly less directed by, and reliant on, external factors.

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This is a good attitude to take when thinking about setbacks:

“Every setback is educational and will help you learn how to succeed. See the journey to your goal as an adventure. Any setbacks are interesting twists in the plot rather than damning verdicts on your abilities.”

Michele Solis via scientificamerican.com - read more here

Caring Coaching Questions



As Solis says above, every temporary stumbling block carries within it a precious gift for success. Teaching this to young people on the ward (through reframing for example) is a very powerful thing. Motivating them to keep moving forward when success feels miles off is invaluable. It’s so important that they develop the courage and skills to move beyond stumbling blocks when (especially when) it would be easier to give up. Experiencing success creates internal motivation. Success creates more success. This kind of approach is far less stigmatising and pessimistic than one focusing on problems and deficits.

We believe that one of the best ways to teach young people to handle their emotions, manage their behaviour and develop self-control is a caring coaching approach. Young people can benefit greatly from having adult role models who are able to put things in perspective, and who can focus on fulfilling more significant emotional goals. For example, helping young people to understand that they may experience a range of different feelings, which may not always be mutually exclusive. For instance, someone being angry with you doesn’t always mean they don’t care about you (Dogra et al 2002). We now live in a world where a multitude of ‘answers’ are at hand, with a click of a button or a swipe of an app. This means today’s young people rarely puzzle over challenges, and so miss out on ‘cognitive-music-building’ and consequential thinking. One of the greatest skills ward staff can help them develop is the capacity to solve problems - to think them through, to get in touch with what they feel, and to consider the best options. A CAMHS ward stay can be an opportunity to learn the value of critical thinking.

Asking change-oriented questions can also be enormously powerful and revealing for young people. Questions encourage a young person’s thoughts and exploration. When they’re asked with curiosity and genuine interest, most young people will open up. Questions are a lot more effective than lectures!
The use of a solution-focused coaching or ‘interviewing’ approach can help young people to uncover their skills, work out exactly what it is they want, and find their own solutions in the shortest possible time. Staff can walk alongside them on their unique pathways to change, and respond with questions that convey confidence and trust, showing young people they think it’s possible for them to reach their goals.

Combining this approach with reflective listening, or empathic listening as it’s sometimes called is an invaluable strategy. It helps young people move through their difficult feelings more quickly and easily, towards acceptance or problem solving (Janis-Norton 2012). And those who grow to accept themselves are more likely to develop a stronger sense of self-confidence.

Ultimately, young people need to know they’re inherently worthy of love and happiness, so they’ll be able to soak up all the good that comes their way (Susan Stiffelman). Building on direct experience is really effective here. Remembering goals they’ve already achieved gets them in touch with their potential, and helps them feel more confident about the future.

coaching

Here are some solution-focused coaching questions you might like to try out:

  • What are your best hopes from coming here?

  • How will you know coming here has been useful?

  • Suppose you achieved your best hopes overnight, what would you be doing tomorrow?

  • What would be the signs that you had moved up one point on the scale? What would you be doing differently then?

  • Where on this scale would you be happy to get to? Where would be 'good enough'?

  • What would it take for you to do that?

  • What does that say about you as a person?

  • What does it tell others about your skills and qualities?

  • What's been better since we last met?

  • What are you pleased to have noticed yourself doing?

  • What have been the effects of that progress on others?

  • Given how difficult things have been, how have you managed to cope? What have you done that's impressed others?

  • How will you know you're back on track?


 

Adapted from Ratner & Yusuf 2015

Brief Coaching with Children and Young People: A Solution Focused Approach
These sorts of questions help young people to look for wellbeing-inducing resources, rather than deficits; to consider possible and preferred happy futures; to consider what’s already contributing to those futures; and to treat themselves as the experts in all aspects of their lives.

One of the greatest skills ward staff can help them develop is the capacity to solve problems - to think them through, to get in touch with what they feel, and to consider the best options.

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Skills and Qualities



Dr Martin Seligman (2011), a leading psychologist who has written extensively on happiness and wellbeing, asked parents what they most desired for their children’s future lives. Their responses were:

  • Happiness and confidence

  • Contentment and fulfilment

  • Kindness and the ability to be civilised

  • Good health

  • Good life balance, satisfaction

  • Love

skills poster


And here are some corresponding skills and qualities that parents usually want their children to develop:

  • Cooperation

  • Respectful, friendly tone of voice

  • Generosity, patience, consideration

  • Self-reliance and independence

  • Flexibility

  • Honesty, courage, self-control

  • Paying attention to details, doing their best

  • Creativity

  • Perseverance


(Janis-Norton, 2012)


Here are a few more we’ve added:

  • The consideration of others.

  • The appropriate articulation of needs.

  • Finding acceptable outlets for frustration.

  • The ability to forgive and be forgiven.

First, these have to be modelled by both the staff and the ‘system,’ within a culture of transparency, self-reflection and fairness. Angela Sergeant makes this significant point in the very excellent handbook ‘Working within child and adolescent mental health inpatient services’: “Staff members function as role models. Adolescents are in a much better position to learn appropriate social skills and behaviours when observing or being part of professionally managed communication and interactions. They need to observe others modelling positive behaviours.”  And, “Modelling of coping strategies and positive behaviour are likely to have a profound effect on a dysfunctional individual.” (View in full here)

Life skills are developed by young people having the right to make mistakes and to process these and learn from them. The path of recovery isn’t linear. Two steps back and three forward is, in sum, a step forward. Making it a habit to express appreciation helps staff - and therefore young people - shift away from focusing on what’s wrong, towards celebrating what’s great (or at least get a balanced picture). Appreciation is at the heart of almost every quality we think of as moral, which is why we mention this vital capacity throughout the COLOURFUL themes. It’s the ability to value ourselves and others and to be mind-aware.

Interestingly, recent research at Rutgers University reveals that people who felt a setback was within their control were more likely to persevere afterwards. Bounce-back-ability is what we need. Read more here.
Some of the skills and abilities that create a sense of inner-calm include being able to:

  • Have a clear sense of the world.

  • Recognise and express inner emotions.

  • Cooperate and listen to the opinions of others.

  • Weigh up different choices and make balanced decisions.

  • Communicate in a clear, straightforward way.

  • Delay gratification by waiting, observing and reflecting before reacting.


(Downshire & Grew 2014)

Teenagers Translated: How to Raise Happy Teens

Life skills are developed by young people having the right to make mistakes and to process these and learn from them.

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Emotional and Social Competences



“The process of learning should be exciting, enlivening and, more often than not, anarchic. It should ignite passions that will carry on into adult life. It should make children aware that each and every one of them is in possession of her own unique combination of gifts, talents and competencies.”

Phil Beadle, Secondary Teacher of the Year 2004
What follows is an attempt to make the concept of emotional and social competence more concrete; through suggesting some essential competences that may be useful to some people (young people and adults alike) some of the time. This impressive list is adapted from What Works in Developing Children’s Emotional and Social Competence and Wellbeing? by Katherine Weare and Gay Gray (2003). Available in full here.

Having self esteem

This competence includes:

  • Valuing and respecting yourself as a unique individual.
  • Seeing yourself as separate from others, with the right to be treated with respect and kindness by others.

Having an accurate and positive self-concept

This competence includes:

  • Being able to identify and feel positive about your own strengths.
  • Being able to identify your own weaknesses, and accepting them without self blame or guilt.
  • Having a clear view of aspects of yourself, such as your personality, preferences and needs.
  • Having a coherent and continuous life story.

Autonomy

This competence includes:

  • Being able to have an appropriate level of independence from others, to think critically, and to resist pressure from others.
  • Being able to make sense of yourself and what has happened to you and integrate your life story into a coherent whole.

Experiencing a full range of emotions

This competence includes:

  • Experiencing, recognising and accepting the full range of emotions as they happen.
  • Being aware of the effects of different emotions, for example on your body, mood and behaviour, and on how others around you start to act.
  • Talking about our feelings, including naming the full range of emotions.

Expressing feelings

This competence includes:

  • Expressing feelings through facial expression, gesture, body language, verbal language and tone.
  • Developing a complex language of the emotions, with a wide and precise vocabulary and range of expression.
  • Expressing feelings clearly through writing and other forms, for example dance, music and art.

Taking the social context into account in expressing feelings

This competence primarily involves being able to express our feelings appropriately, with due regard for the social context, taking into account, for example, the feelings of others, and our own long term best interests.

Controlling the emotions

This competence primarily involves being able to manage our emotions and not respond immediately or directly to a feeling, or to put it behind us if we judge this is the best thing to do.  Some specific competences involved in this include being able to:

  • Observe our own emotions.
  • Be aware of what events, circumstances, thoughts and past experiences may have triggered a feeling.
  • Soothe ourselves when anxious.
  • Calm ourselves when angry.
  • Contain our excitement when it’s unhelpful.
  • Think straight when in the throws of powerful emotions.
  • Avoid sulking or withdrawal when angry or frustrated.
  • Talk positively to ourselves when things go wrong.
  • Relax physically.
  • Distract ourselves by thinking of, or doing, something else that is incompatible with the emotion.

Increasing emotional intensity and frequency

This competence primarily involves knowing how to increase the frequency and intensity of emotions and inner states that we and others find pleasurable. Some emotions and inner states that most people find pleasurable include:

  • Happiness
  • Optimism
  • Amusement, fun and laughter
  • Joy
  • Love
  • Engagement with a task, ‘flow’
  • Rapture
  • Calmness and inner peace
  • Relaxation
  • Losing the self in the moment
  • Living in the here and now

Being resilient

This competence involves being able to process and learn from a difficult experience, use it to aid our own development, and then move on, rather than be dragged down or immobilised by it.

Using information about the emotions to plan and solve problems

This competence involves being able to use information about one’s own emotions, and those of others, to plan ahead and organise the emotions in pursuit of a goal, or to solve problems.  Some of the constituent competences include:

  • Looking to long-term not short-term benefits and gains/delaying gratification.
  • Anticipating consequences of present action.
  • Generating effective solutions to interpersonal problems.
  • Being creative and seeing several ways forward and round a problem.
  • Having a realistic appraisal of the likelihood of various outcomes.

Social competences

Attachment to others This competence involves the ability to love and care about others, and to trust that they love and care about you.

Empathy

This competence involves being able to see the world from the point of view of another person.  It includes:

  • Recognising emotions in others.
  • Having compassion for others.
  • Refraining from harming others.
  • Sensitivity - being able to intuit how people are feeling from their tone and body language.
  • Giving people the same concern and respect as we give ourselves.
  • Accepting others and tolerating difference.

Communicating effectively

This competence involves being able to communicate our own feelings and opinions clearly and openly with due regard for the feelings, level of understanding and interests of the people we’re communicating with.  It includes:

  • Choosing our own response.
  • Listening to others.
  • Responding effectively.
  • Being clear.
  • Giving others the respect we expect them to give us.
  • Motivating others.

Experiencing a full range of emotions

This competence includes:

  • Experiencing, recognising and accepting the full range of emotions as they happen.
  • Being aware of the effects of different emotions, for example on your body, mood and behaviour, and on how others around you start to act.
  • Talking about our feelings, including naming the full range of emotions.

Managing relationships

This competence involves the ability to make relationships with others that promote our own wellbeing, without damaging theirs.  It includes:

  • Establishing rapport.
  • Making connections with people.
  • Establishing appropriate levels of trust.
  • Taking appropriate responsibility for others.
  • Negotiating ‘win win solutions’.
  • Managing difficulties in relationships.
  • Breaking and ending relationships where necessary in an appropriate and positive way.
  • Managing conflict.

Source: webarchive.nationalarchives.gov.uk
read more here
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What Is Social and Emotional Learning?


From: Collaborative for Academic, Social, and Emotional Learning (CASEL)

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Social and emotional learning (SEL) is the process through which children and adults acquire and effectively apply the knowledge, attitudes, and skills necessary to understand and manage emotions, set and achieve positive goals, feel and show empathy for others, establish and maintain positive relationships, and make responsible decisions.

SEL programming is based on the understanding that the best learning emerges in the context of supportive relationships that make learning challenging, engaging, and meaningful.

The short-term goals of SEL programs are to (1) promote students' self-awareness, social awareness, relationship, and responsible-decision-making skills and (2) improve student attitudes and beliefs about self, others, and school. These, in turn, provide a foundation for better adjustment and academic performance.

The Five Social and Emotional Learning Core Competencies

CASEL has identified five interrelated sets of cognitive, affective, and behavioral competencies. Educators, parents, and policymakers who recognize that the core SEL competencies are necessary for effective life functioning also know these skills can be taught.

Setting the Scene - CAMHeleonCAMHeleon

 

 

Read more here
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Education in CAMHS: Distinct and Hugely Therapeutic



"Children and young people who are in hospital...should have access to education that is on a par with that of mainstream provision..."

Source: ‘SEND: guide for health professionals’ - view it here
“I am... the Re-integration Officer in our Education Base alongside…. the class teacher. Together we can help you continue your studies if you are in education and for those of you who are not we can arrange time with our Futures Advisor to look at what options are available to you. Some of you may need support to get back into school/college which we are very experienced in doing and can help you with this.”

A Re-integration Officer at Thorneywood Adolescent inpatient unit in Nottingham. Read more here


“Learning is an emotional experience, and your ability to learn is affected by your emotional state. Stress is learning’s nemesis.”

Phil Beadle, Secondary Teacher of the Year 2004
For many young people, school stimulates a strong sense of anxiety and stress associated with learning, even without the added anxiety of their mental health condition. But education in a CAMHS setting can be an opportunity to uncover the many positive aspects of education. It can create a sense of normality and a positive focus, and provide individual educational programmes and group work as part of a varied therapeutic programme. It’s best if educational activities are complementary to the treatment philosophy being used to support the young person, while clearly being seen as a distinct part of it. Educational activity plays an extra role on a CAMHS ward, as well as its usual one, because it acts as a therapy in its own right and plays a massive part in recovery. Of course, doing schoolwork depends on how therapeutic this would be for each young person, and it shouldn’t be looked upon as simply a handy way of occupying or distracting them.
Young people should never be made to feel ashamed if they don’t perform as well as their peers, or excessive pride at the expense of or in comparison with others, if they perform better. Actually, it shouldn’t be about performance at all. Achievements and expectations in a CAMHS setting may not be measurable in terms of the conventional standards. Both education and nursing staff can find a good balance between the young person’s right to education, and what they can take on board while feeling unwell.
“We believe that education is crucial to protecting the life chances of the especially vulnerable young people who need inpatient treatment for mental health problems, particularly as in some cases these admissions may last many months. It is essential that clear standards are set for the quality of education provision in inpatient units, and that there is clear accountability and ownership for ensuring that these standards are upheld. As a first step towards this, we recommend that OFSTED, DFE and NHS England conduct a full audit of educational provision within inpatient units as a matter of urgency.”

 The Health Committee 2014. View in full here

school

The role of inpatient education is to:

  • Act as one part of a whole in terms of the treatment package offered to a young person in a unit.

  • Offer young people the opportunity to access learning in a highly supportive environment, when their difficulties may have prevented their access to mainstream education.

  • Give young people another opportunity to develop and experience a secure attachment (with education staff).

  • Provide a crucial link back into life outside the unit, in terms of liaison with mainstream education, or further training possibilities.

  • Be highly therapeutic, motivating and cathartic.

  • Offer a stable, focused and containing learning environment.

  • Provide a good range of learning activities including music, core curriculum subjects and creative work.

  • Be part of a wide-ranging, multidisciplinary assessment.

  • Help make clear the connection between the young person’s performance at school and their illness/symptoms.

  • Be wide-ranging and balanced - it should be both complementary yet similar to education in a conventional school setting.

  • Provide a well-considered curriculum for both the individual and the pupil group.

  • Provide creativity in the classroom to help offset the destructive experience of mental illness.

Ward schools can offer an extensive range of classes and courses such as:

  • GCSEs

  • Accredited vocational training courses

  • English

  • Maths

  • Science

  • Information and Communications

  • Technology (ICT)

  • Art and Textiles

  • Food Technology
  • Physical Education (indoor and outdoor)

  • Design and Technology

  • Horticulture

  • Media Studies

  • Health and Social Care

  • Personal Social Health Education (PSHE) including Sexual Health

  • Music

  • Drama

  • Registered Exam Centre

  • Essential principles of teaching and learning

    The Creative Teaching & Learning Toolkit’ by Brin Best and Will Thomas (2007) shows how creativity is at the heart of effective teaching and is vital to teaching in every subject area. Knowing the foundations upon which you operate ensures you and your students experience consistency of expectation. Here are the essential principles for effective learning which appear in the book:

    • Create a learning agreement based on the behaviours required tram everyone to allow learning to flourish.

    • Engage learners through a variety of experiences.

    • Balance support with challenge.

    • Create space for learners to find and secure connections.

    • Encourage students to reflect on how they learn and how they can improve.

    • Model the behaviours that you want to see in your students.

    • Make learning memorable by engaging learners through all of the senses and their emotions.

    • Build-in choice at all stages of the learning process.

    • Develop your learners as teachers.

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    Education in a CAMHS setting can be an opportunity to uncover the many positive aspects of education. It can create a sense of normality and a positive focus, and provide individual educational programmes and group work as part of a varied therapeutic programme.

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    "We know that healthy, happy children perform well at school, and we know how significant an impact a child’s health has on their life chances."

    Source: Department for Education, 2014

    Mainstream Schools



    Missing school for just a few days a year can damage pupils’ chances of gaining good GCSEs, according to a report published by the Department for Education. A 2016 survey found that many school leaders reported increases in the number of students suffering from mental health and wellbeing issues over the past five years. More than half (55 per cent) said there had been a large increase in anxiety or stress, and over 40 per cent reported a big increase in the problem of cyberbullying. Nearly eight out of ten (79 per cent) reported an increase in self harm or suicidal thoughts amongst students. Read more here.

    Mainstream schools should have strong links with CAMHS, for those pupils identified as at risk. Reassuringly, Government guidance created by the Department for Education in consultation with the Department for Health has given assurances that mainstream schools will get help in identifying and best resolving mental health problems in pupils. Guidance will increasingly be made available to all schools, with the aim that those who are unwell will receive appropriate help at an appropriate time (read more here).
    "...many schools want to do more to help children who are, or may be, experiencing mental health problems. Many now have their own programmes and mental health support – such as a school-based counsellor, whilst others have whole school approaches to mental and emotional health."

    Source: Closing the gap: priorities for essential change in mental health - view it here 
    “Emotional wellbeing must be a larger part of any learning, and by association, the educational agenda…. Schools may be the optimum sites for buffering the impact of stress, building resilience and enhancing individual capacities for learning.”

    Nagel 2009
    Teachers need to feel equipped and supported in establishing attachment-like relationships with their students, particularly with challenging and vulnerable children and young people, in order to improve their chances of learning and achieving (read more: attachmentawareschools.com). The following video outlines why it’s important for teachers to know about attachment issues.
    attsc
    “…a core personal and social education programme [would] deliberately set out to develop emotional self-awareness, to help the managing of emotions with more positive feelings about self, school and family, to harness emotions productively, to practise empathy and to improve the handling of relationships, including sharing, co-operation, communicating and helpfulness. Such a course of action could not be undertaken lightly and would have a profound effect on the educational community. It would affect relationships, policies and organisational procedures and would test to the limit the integrity of the school's aims, objectives and values.”

    Brighouse & Woods, 1999

    How to Improve Your School
    In 2015, the Education Secretary, Nicky Morgan, announced a package of measures to dramatically improve support for children’s mental health in and out of the classroom. This included new support for schools to broach mental health issues - from eating disorders and self-harm to anxiety and depression, a new vision for counselling in schools, and funding for the voluntary sector to do more. All good stuff...

    The think-tank 2020 Health recently argued that every secondary school, or chain of schools, should have a head of wellbeing. There’s a strong case for it. “Education professionals see a clear need to raise wellbeing support for both pupils and staff.” Paul Burstow, former Lib Dem MP for Sutton and Cheam (from here). A head of wellbeing – what a brilliant idea!

    The Royal College of Nursing has emphasised the critical importance of school nurses in improving the health of the nation’s children. They said that by working closely with children, as well as their parents and teachers, nurses could have an important role in helping pupils with their mental and emotional health (theguardian.com).
    “School nurses and their teams are crucial in terms of providing early help - their skills and expertise in this area often means we avoid young people getting into crisis. School nurses working with parents, schools and wider stakeholders can really make a difference to young people.”

    Viv Bennett, Public Health England's Chief Nurse from here
    Code of Practice for Children and young people with special educational needs and disabilities (SEND)

    School nurses and appropriate college support staff play a role in identifying additional health needs, in liaison with other professionals.

    To support schools in identifying special educational needs there are four broad areas of need:

    1. communication and interaction

    2. cognition and learning

    3. social, emotional and mental health, and

    4. sensory and/or physical needs


    CAMHS, therapists, and schools and colleges need to have a close working relationship so there is a clear understanding of the criteria that will be used to determine if a child or young person needs specialist support from universal or specialist services, making the referral process as quick and efficient as possible. More information on the four areas of need can be found in the 0-25 SEND Code of Practice.
     

    The above is taken from ‘SEND: guide for health professionals’ – view it in full here
    "Schools can play a key role in supporting young people but teachers are not mental health professionals and should be able to draw on support from specialist services"

    Source: National Association of Schoolmasters and Union of Women Teachers quoted by BBC News
    “Healthcare leaders have recognized that by working together and leveraging their shared knowledge and opportunities they can improve policy, service design and treatment options. For example, our School Plus program is a leading practice in [Canada] and school boards, schools and families are speaking about its strength and value.”

    Leo Glavine, provincial health minister in Canada

    SchoolsPlus is a collaborative interagency approach supporting the whole child and their family with the school as the center of service delivery.

    Learn more: https://schoolsplus.ednet.ns.ca/

    Mainstream schools should have strong links with CAMHS. Teachers need to feel equipped and supported in establishing attachment-like relationships with their students.

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    Skills and Strength for Life



    “Our approach is holistic and solution-focused, and our multidisciplinary ethos aims to make each admission as short as possible. This approach enables each child and family to return to their community with greater strengths and the ability to sustain positive changes.”

    Source: cnwl.nhs.uk - read more here

     

    “The emphasis is on supporting the young people to gain the skills to improve their life, and part of this process involves the young people defining what ‘getting worse’ would involve - in a sense, defining what it is they wish to prevent.”

    Source: from 'Listen up!' via mentalhealth.org.uk - read it here
    A ministerial taskforce is currently looking at how to improve the way CAMHS are organised, commissioned and provided, and how to make it easier for young people to access help and support, including in schools, through voluntary organisations and online. You can read the taskforce’s proposals and the main findings from their consultation here. One of the reports is titled ‘Future in mind: Promoting, protecting and improving our children and young people’s mental health and wellbeing’ which we encourage you to read. Laurence Baldwin, a consultant nurse at Derbyshire Healthcare NHS Foundation Trust, describes the report below and offers some important suggestions and concerns, which we wholeheartedly echo. Baldwin says the report generally refers to getting in early, to stop young people developing emotional difficulties and, ultimately, getting mentally ill. He also points out that ward staff are in an ideal position to help impart skills and prevent further problems:
    “To achieve this there needs to be an emphasis on developing resilience and coping skills, helped by teachers and others in schools knowing more about emotional literacy and spotting problems before they get out of hand. [Mental Health nurses are] in a good position to be working with younger people on developing good emotional coping skills, and preventing later problems in life… I believe mental health training and post-registration training ought to give us the confidence to deal with younger people, and begin the early intervention that should give better outcomes... As nurses we should be better able to do our part in building stronger children and young people.”

    Source: journals.rcni.com

    There needs to be an emphasis on developing resilience and coping skills, helped by teachers and others in schools knowing more about emotional literacy and spotting problems before they get out of hand.

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    EQ is the New IQ



    Nowadays, emotional intelligence is becoming more important than intellectual intelligence. While they’re on the ward, you can help teach young patients to be good decision makers, manage their own feelings as well as accept and empathise with the feelings of others, and to see difference as a quality rather than a threat. These skills give young people a greater insight, as well as the self-confidence they need to pro-socially solve problems (Severe 2004).

    eq

    The phrase ‘emotional literacy’ is used to describe improving emotional intelligence. Sharp (2001) defines emotional literacy “as the ability to recognise, understand, handle and appropriately express emotions.” ‘Self-efficacy’ also has a part to play in this. Self-efficacy is the belief a person has about reaching their goals, or an expectation that one can take hold of a situation to create an ideal outcome (Boniwell 2015).

    However, emotional intelligence can’t be bought or rushed. Young people's innate capacity for emotional intelligence matures over time with the slow emergence of identity, and the gradual building-up of life experiences (Payne & Ross 2009). For this skill to develop, it's important that they gradually arrive at some insight into and acceptance of their own feelings and behaviours, and what they might be needing at any given moment.

    Emotional intelligence also partially comes from a young person’s inner world, including their emotions, being acknowledged by someone who is willing and able to listen and provide reflection. Acknowledging informs a young person’s emotional intelligence and encourages language development. It also demonstrates understanding and acceptance.

    Read more on acknowledging in the Opportunity and expression theme.
    The psychologist Daniel Goleman (1996) defines emotional intelligence as:

    • Knowing one’s feelings and using them to make good decisions in life (and while on the ward).

    • Being able to manage moods and control impulses (including in relation to the ward community).

    • Being motivated and effectively overcoming setbacks in working towards goals. (click here to read the Learning and Growth section).

    Emotional Intelligence Core Competencies

    In his book, Emotional Intelligence, Daniel Goleman, 1996 argues that schools should attempt to teach the core competencies or domains of emotional intelligence, which he terms emotional literacy. These core competencies are referred to as:

    • Knowing one's emotions.

    • Managing emotions.

    • Motivating oneself.

    • Recognising emotions in others.

    • Handling relationships.


    Source: Daniel Goleman 1996
    While an inpatient, there’s a possibility that young people can learn the skill of understanding and recognising their own feelings, while gaining the ability to give them a name. This is where emotional ‘literacy’ comes in: possessing a broad range of emotional words and language. Being a patient is an ideal opportunity for them to enrich their emotional intelligence (EQ) and build their emotional vocabulary, as we said in the Opportunity and Expression theme. Through developing emotional intelligence, young people have a greater ability to regulate and utilise their emotions, to enhance their success in all areas of their lives.
    The following questions can help ward staff understand the different characteristics of emotional intelligence and work out the areas that a young person may benefit from:

    • Can the young person talk about the way they feel?

    • Does the young person have a number of words they can use to describe feelings?

    • Can the young person recognise when other people are happy/sad/angry/scared?

    • Can the young person recall past memories and the way they felt then?

    • Does the young person enjoy and feel confident in their play?

    • Can the young person show friendliness and care towards others?

    • Can the young person control their anger and frustration?

    • Can the young person use words and negotiation to solve disputes?

    • Can the young person play co-operatively with others?

    • If s/he is feeling anxious, is s/he reassured by a familiar adult or friend?

    • Can the young person wait just a little before his/her needs are met?

    • Can the young person initiate his/her own ideas and contribute in a familiar group?

    • Can the young person occupy him/herself when playing as well as playing with others?

    • Can the young person demonstrate confidence when trying something new?

    • Is the young person beginning to be aware of right and wrong?

    • Does the young person feel able to make mistakes and learn from them?


    Source: adapted from Mortimer 2003

    Emotional Literacy and Mental Health in the Early Years (Education in the Early Years)

    Emotional intelligence partially comes from a young person’s inner world, including their emotions, being acknowledged by someone who is willing and able to listen and provide reflection.

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    Featured Tools and Ideas



    Click on the headings to read more and add a selection of ideas and tools to you own "Palette"

    SchoolsPlus

    “Healthcare leaders have recognized that by working together and leveraging their shared knowledge and opportunities they can improve policy, service design and treatment options. For example, our School Plus program is a leading practice in [Canada] and school boards, schools and families are speaking about its strength and value.”

    Leo Glavine, provincial health minister in Canada

    SchoolsPlus is a collaborative interagency approach supporting the whole child and their family with the school as the center of service delivery.

    Learn more: https://schoolsplus.ednet.ns.ca

     

     


    Signature strengths

    Identifying signature strengths reduces challenging behaviour

    Dr Martin E.P. Seligman and his team asked young students to discover what their ‘signature strengths’ were, in other words the character traits unique to them, through which they could continue to achieve positive outcomes in all aspects of their lives. For example, ‘I am patient, friendly, positive and kind’. The results demonstrated evidence for a reduction in challenging behaviour, better empathy for others and a higher degree of curiosity in lessons.

    Source: Gardner 2015 - read more here


    Identify strengths and areas for development

    Occupational Therapists - identify strengths and areas for development

    Occupational Therapists work with young people to identify their strengths and areas for development, in order to help them set goals and manage their day-to-day activities. This work is done with groups, as well as on a one-to-one basis, and includes helping young people to increase their independence through the development of their shopping and budgeting skills, improving their personal care, exploring their interests around further education and work and developing their social skills through sports or interest groups.

    Source: withuinmind.nhs.uk - read more here


    Life Skills Group

    “The Life Skills group is run by two staff members. It is an opportunity to think about and explore issues affecting everyday life including topical issues. Some of the subjects that might be explored include bullying, self-esteem, growing up issues, environmental issues, safety and practical day-to-day tasks. The group can also concentrate on topics that the children, parents and team think would be helpful at the time. The children set the expectations of the group, for example: not sharing the information outside the group, respecting each other and listening to what each other has to say. Staff try to make the group fun and interesting, although it can be a tough group when thinking about difficult feelings and experiences.”

    Source: gosh.nhs.uk - read more here


    Activity Coordinators

    Activity Coordinators are in effect therapy assistants. They work within Occupational Therapy and support the Occupational Therapist by contributing to assessments and providing feedback on the young people’s progress. They deliver a programme of therapeutic activities on a one-to-one basis or in groups, including living and social skills, independence and wellbeing, achieving goals, creative therapies, education, recreation and leisure, health and fitness, and cognitive skills like problem solving, to encourage and motivate young people during their stay on the unit.

    From withuinmind.nhs.uk




    The PATHS® curriculum

    The PATHS® curriculum is a comprehensive program that promotes emotional and social competencies, reducing aggression and behavior problems. The curriculum supports educators and counselors in creating an environment that helps children develop self-control, positive self-esteem, emotional awareness, basic problem-solving skills, social skills and friendships.

     

    Read more here


    Self-Esteem programme

    Self-Esteem programme in schools

    The Self-Esteem Team have developed an award winning education programme for Body Gossip, which they deliver in secondary schools all over the UK.

    It is delivered by the Self-Esteem Team.  The classes give students a unique insight into the worlds of internet, media, fashion and beauty so that they can negotiate them on their own terms with confidence.

    Source: bodygossip.org - read more here


    Children with special educational needs and disabilities

    The new arrangements for children with special educational needs and disabilities (SEND)

    The SEND reforms introduced by the Children and Families Act 2014 aim to change this, with a focus on two key themes: greater cooperation between education, health and social care and a greater focus on the outcomes which will make a real difference to how a child or young person lives their life.

    For too long, health has been the missing partner in the SEND system. These reforms change that – they implement a holistic approach to supporting children and young people with SEND in all aspects of their life.

    The guide below explains the duties and responsibilities of health professionals who deal with children and young people with special educational needs and disability (SEND) and their families.

    Download link: 0 to 25 SEND code of practice: guide for health professionals


    Measuring social and emotional skills

    At a Welsh provision that supports young people excluded from mainstream schools or at risk of exclusion, the curriculum includes explicit sessions using the SEAL (Social and Emotional Aspects of Learning) programme – http://www.sealcommunity.org.

    On entry, pupils rate their own social and emotional skill levels, using a booklet which offers six pupil friendly illustrated ‘quizzes’ focusing on the five aspects of learning in the SEAL programme. The quiz titles are:

    • ‘My feel-good factor’ (focus on self-awareness)
    • ‘In control?’ (focus on managing feelings)
    • ‘Making it happen!’ (focus on motivation)
    • ‘Mind-reading’ (focus on empathy)
    • ‘My friendliness factor’ (focus on social skills)

    From their ratings and adults’ ratings using a separate scale, targets for individual students are negotiated, support put in place, and progress tracked. This form of assessment is truly formative, as it promotes a deeper understanding of the skills themselves – what they mean, what they look like for that student, how they can be developed (as well as providing evidence of progress over time for parents, the local authority, and external inspection).

    Source: From a blog by Jean Gross CBE, Early Intervention Foundation Trustee - http://bit.ly/1XDR93P 


    Free e-learning

    Free e-learning for all healthcare professionals: Healthy Child Mental Health Framework from MindEd

    MindEd is a free educational resource on children and young people’s mental health for all adults. The MindEd Core Curriculum is aimed at all adults working as professionals or volunteers with children and young people. It offers e-learning to inform about the mental health and wellbeing of children and young people, what goes wrong and what can be done to help.

    The Health Child Mental Health Framework brings together e-learning from two existing programmes (Healthy Child Programme and Adolescent Health Programme) and one new programme (Healthy School Child Programme) relating to children and young people’s mental health.

    The full programmes are freely available for all healthcare professionals working with children and young people aged 0-18, but as part of the MindEd Programme, the mental health elements are being made freely available to anyone who works or volunteers with children or young people.

    View it here: minded.org.uk


    Imaginal experiences

    If evidence of achievement is yet to be experienced, staff can use ‘imaginal experiences’ to create a desired future image of oneself - one's Best Possible Self. Encourage the young person to write, or visually create, a future auto-portrait following these instructions:

    'Imagine that you've achieved what you aimed for, that your best potentials have come to be realised. Write about and vividly imagine yourself in that future.’

    This exercise enhances confidence and optimism, helps achieve a better integration between priorities and goals, and increases happiness. The idea is to make the Best Possible Self tangible enough to encourage actions, to make sure this future self comes true.

    Adapted from Boniwell 2015 - read more here


    Growing a ward


    Of course, the ward team learn and grow too, always working towards better care and quality. Equally, there can sometimes be excessive focus on short-lived (and often well intentioned) gimmicks and on implementing “innovation” for the sake of doing something new, rather than building on the things that are proved to work.

    Here are some examples of service improvement schemes and standards:




    Example: Star Wards

    “[Star Wards] enthusiastically uses patient insights to improve the practice and quality of inpatient mental healthcare and create a more empathetic and therapeutic space on hospital wards. Its work is serious, yet never loses sight of the importance of fun, food and animals, amongst other things, in the delivery of good acute care.”  The Guardian 

    www.starwards.org.uk




     

    Example: The Quality Network for Inpatient CAMHS 

    QNIC aims to demonstrate and improve the quality of child and adolescent psychiatric inpatient care through a review system against the QNIC standards.

    Read more here or download a guide: Quality Network for Inpatient CAMHS Standards




     

    Example: Youth Wellbeing Directory / ACE-V Quality Standards

    This website is a free online space for all those who aim to improve the emotional wellbeing and/or mental health of children and young people up to the age of 25 directly; or by supporting their families and caregivers.

    ACE-V Quality Standards© have 4 main components:

    1. Accountability

    2. Compliance

    3. Empowerment

    4. Value


    Read more: youthwellbeingdirectory.co.uk




     

    Example: Standards for delivering young person-friendly health services

    The 'You’re Welcome' quality criteria provide a set of non-mandatory standards for delivering young person-friendly health services for 14-19 year-olds in England. They’re designed to be used by health services themselves, to assess how well their provision meets the needs and preferences of young people.

    Read more here




     

    Examples: CAPA – The Choice and Partnership Approach

    CAPA is a systemic approach to service organisation and to the relationship with the service user/young person/family. It aims to put the user at the CENTRE. To aid their choices and GOALS we should use our EXPERTISE in a COLLABORATIVE manner. To be the most effective we need to SMOOTH our processes and make every step ADD VALUE. We must deliver our resources by planning as a WHOLE system and LAYERING skills whenever possible.

    Read more here

     

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    COLOURFUL Themes Menu

    Caring Relationships
    Opportunity and Expression
    Leisure and Therapeutic Activity
    On and Off the Ward
    Understanding
    Relational and Physical Safety
    Family and Friends
    Unique Recovery Journeys
    Leisure and Growth