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Keywords:

  • Health;
  • education;
  • schools;
  • mental health;
  • collaboration

Abstract

  1. Top of page
  2. Abstract
  3. Key Practitioner Message:
  4. The rationale for collaboration between health and education
  5. The school as a logical initial place for assessment and intervention
  6. Models for schools-based mental health programmes
  7. Examples of collaborations between health and education
  8. Factors contributing to success
  9. Obstacles to multi-agency collaboration
  10. The future
  11. Acknowledgements
  12. References

It is now widely agreed that meeting the mental health needs of children and young people is a task only possible if all children's services work together. Recent epidemiological data indicate that schools are a key entry point to mental health services for children and young people, and have an important role in the assessment and management of children with neurodevelopmental disorders. This paper explores the rationale for collaborative working between health and educational professionals, examines some examples of good practice, explores factors contributing to their success or failure and considers future developments.


Key Practitioner Message:

  1. Top of page
  2. Abstract
  3. Key Practitioner Message:
  4. The rationale for collaboration between health and education
  5. The school as a logical initial place for assessment and intervention
  6. Models for schools-based mental health programmes
  7. Examples of collaborations between health and education
  8. Factors contributing to success
  9. Obstacles to multi-agency collaboration
  10. The future
  11. Acknowledgements
  12. References
  •  Many young people with mental health disorders are not known to specialist Child and Adolescent Mental Health Services.
  •  Young people with mental health problems often receive services from more than one agency.
  •  When assessing children with suspected neurodevelopmental disorders, such as ADHD, DCD and ASD, it is important to ensure that a multi-agency, multi-professional perspective is obtained.
  •  Patterns of service use suggest that schools are a key entry point to mental health services for children and young people.
  •  Current policy highlights the importance of multi-agency collaboration and recommends the development of extended schools.

The central tenet that partnership working in children's services is important is not new and has been stressed in a succession of both health and education professional guidance documents published over the last twelve years (Audit Commission, 1999; Department for Education (DfE), 1994; Department for Education and Skills and Department of Health (DfES/DoH), 2002; Department of Health (DoH), 1997; Department of Health and Department for Education and Skills (DoH/DfES), 2004; Health Advisory Service (HAS), 1995; House of Commons Health Select Committee, 1997; Welsh Assembly Government (WAG), 2002, 2004). Multi-agency collaboration is thought to be essential for delivering co-ordinated services to particular groups of children including those who have disabilities, have mental health problems or who are otherwise in special circumstances (DoH/DfES, 2004; WAG, 2004). It would be unreasonable to expect any one professional or agency to be able to manage such children alone as the range of difficulties they present with may affect any or all of their health, general development, education or behaviour (Williams & Salmon, 2002).

In this paper the rationale behind professionals from the fields of health and education working together to improve outcomes for children with mental health and neurodevelopmental disorders such as Attention Deficit Hyperactivity Disorder (ADHD), Developmental Co-ordination Disorder (DCD) and Autistic Spectrum Disorder (ASD) is explored. In addition, some examples of successful collaborations are described and factors which might contribute to the success or hinder the progress of such initiatives are considered.

The rationale for collaboration between health and education

  1. Top of page
  2. Abstract
  3. Key Practitioner Message:
  4. The rationale for collaboration between health and education
  5. The school as a logical initial place for assessment and intervention
  6. Models for schools-based mental health programmes
  7. Examples of collaborations between health and education
  8. Factors contributing to success
  9. Obstacles to multi-agency collaboration
  10. The future
  11. Acknowledgements
  12. References

Mental health disorders

Although it is thought that approximately 10% of young people under the age of 16 in the UK cross ICD-10 (World Health Organisation (WHO), 1992) diagnostic thresholds for mental health disorders at any one time, many of these young people are not known to specialist Child and Adolescent Mental Health Services (CAMHS) (Meltzer, Gatward, & Goodman, 2000). Research in the USA suggests that it is only 10–20% of young people with mental health disorders who are in fact seen by specialist mental health services (Costello et al., 1993). Farmer et al.’s (2003) study of mental health problems and service use over three years in 1420 young people aged 9, 11 and 13 at study entry, found that the education sector was the most common point of entry (60.1%) to mental health services and the provider of services across all ages studied. Specialist mental health services were the first point of entry for approximately a quarter (27.3%) whilst 12.9% of young people gained access to mental health services through general medical services. Of note, young people who entered the mental health system through the education system were the least likely to receive services from the other agencies and the least likely to meet criteria for any psychiatric diagnosis. In comparison, young people who entered the mental health system through specialist mental health services were the most likely to receive services from other agencies and were more likely to be severely disturbed. Overall, 45% of service users received services from more than one agency.

Several other studies from the USA (Burns et al., 1995; Leaf et al., 1996) have also found that young people with mental health disorders are more likely to contact school-based services in relation to their mental health than other agencies and it has been shown that mental health services based in schools are perceived as more accessible and used more by pupils than services located off site (Catron & Weiss, 1994; Kaplan et al., 1998).

Epidemiological research in the UK has revealed similar findings. For example, in a follow-up of the Office of National Statistics (ONS) survey, Ford, Goodman, and Meltzer (2003) found that 53.4% of the children who had a psychiatric disorder diagnosed in the original study had seen a professional by the time they were re-contacted 20 months later. In line with the USA findings, education services were more likely (43.3%) than specialist CAMHS (22.1%) to be contacted by the young person or their family regarding the young person's mental health. Indeed, in a UK-based survey on mental health needs, 80% of adolescents questioned said that they would approach a teacher for help (Clarke, Coombs, & Watson, 2003).

The likelihood of help being sought also depends on the child's presenting disorder. For example, nearly all children with diagnosed hyperkinetic disorder in the initial ONS study had seen a professional by the time they were re-contacted 20 months later, whereas the proportion of children with conduct and emotional problems not in contact with services at 20-month follow-up was considerably higher (Ford et al., 2003). Similarly, Angold et al. (1998) found that children who had depression or anxiety disorders were experienced as less burdensome by their parents than those with other disorders, and were thus less likely to be referred to specialist CAMHS.

Neurodevelopmental disorders

Neurodevelopmental disorders, such as ADHD, DCD and ASD, all have associated functional impairments which impact many areas of the child's life including home and school. The importance of ensuring that a multi-agency, multi-professional perspective is obtained when assessing and managing these children is highlighted when the literature relating to co-morbidity is examined.

For example, there is clear evidence of association or comorbidity of ADHD with a number of other psychiatric conditions including oppositional defiant disorder, conduct disorder as well as depression and anxiety disorders (Barkley et al., 1990; Gittelman et al., 1985; Loeber et al., 1982; Mannuzza et al., 1993; Taylor et al., 1991). ADHD has also been associated with learning difficulties. These include specific reading difficulties (Cantwell & Scatterfield, 1978; Gilger, Pennington, & DeFries, 1992; Lambert & Sandoval, 1980, Pliszka, Carlson, & Swanson, 1999) and dyslexia (Dykman & Ackerman, 1991; Semrud-Clikeman et al., 1992). For example, in one study it was found that approximately 50% of children with ADHD were also found to have DCD (Gillberg, 1998), the symptoms of which impact on writing and ball skills, and have a long-term impact on future psychological development (Hellgren et al., 1993; Rasmussen, Almvik, & Levander, 2001).

National Guidance on the use of Methylphenidate (Ritalin, Equasym) for Attention Deficit/Hyperactivity Disorder (ADHD) in Childhood (National Institute for Clinical Excellence (NICE), 2000) recommends that diagnosis of ADHD should:

involve children, parents and carers and the child's school …… multidisciplinary assessment which may include educational or clinical psychologist and social workers is advisable for children who present with significant comorbidity … (p.1).

It further recommends that:

a comprehensive treatment programme should involve advice and support to parents and teachers … (p.1).

In areas where there are no multi-agency agreements in place for the assessment and management of children with ADHD, schools can often only access support through education channels. Many children with undiagnosed ADHD are difficult to manage in the classroom so are likely to be referred to a pupil referral unit (PRU) and in some cases, it may only be when these specialist placements are on the verge of failure that a medical referral is made (Keen, Olurin-Lynch, & Venables, 1997). Place et al. (2000) looked at prevalence rates of psychiatric disorder within a primary school for emotionally and behaviourally disturbed children who were all in receipt of a statement of Special Educational Need (SEN) from the Local Education Authority (LEA). Using DSM-IIIR criteria (American Psychiatric Association (APA), 1987), the authors found that 70% of the children fulfilled diagnostic criteria for ADHD.

Further evidence of the need for greater collaboration between health and education comes from an Australian study which suggests that a significant number of pupils who are excluded, either for a fixed term or permanently, may in fact have a condition that is amenable to medical treatment, such as ADHD (Bain & Macpherson, 1990).

The importance of multi-agency collaboration in the assessment of children with neurodevelopmental disorders is not restricted to those with suspected ADHD. For example, Moore et al. (1998) emphasise the necessity of integrating both the health and the educational components of the assessment of children suspected of having an ASD. They propose that health-based ASD assessment services liaise closely with educational services to reduce the risk of any conflict occurring between the assessment of a child's educational needs and the diagnostic assessment. They recommend the incorporation of classroom assessments by educational staff into the health-based diagnostic process. In line with this, the Department for Education and Skills and Department of Health (2002) have produced a document entitled Autistic Spectrum Disorders Good Practice Guidance which recommends the development of multi-agency models for identification of ASD. The latter are also proposed in The National Autism Plan for Children (National Initiative for Autism: Screening and Assessment (NIASA), 2003) and the Autism Exemplar published as part of The National Service Framework for Children, Young People and Maternity Services (DoH/DfES, 2004), both of which set out a vision for what a good service for the child with suspected or diagnosed ASD should look like.

The school as a logical initial place for assessment and intervention

  1. Top of page
  2. Abstract
  3. Key Practitioner Message:
  4. The rationale for collaboration between health and education
  5. The school as a logical initial place for assessment and intervention
  6. Models for schools-based mental health programmes
  7. Examples of collaborations between health and education
  8. Factors contributing to success
  9. Obstacles to multi-agency collaboration
  10. The future
  11. Acknowledgements
  12. References

Given that children spend a lot of time in school, it follows that, as well as being informants, teachers could be involved in mental health promotion and reinforcing treatment strategies. This is in line with the World Health Organisation proposals that mental health promotion should be integrated into the school curriculum, secondary prevention should target pupils at high risk while children with psychiatric disorders should be referred to specialist CAMHS (Hendren, Birrell-Weison, & Orley 1994). Fonagy and Target (1996) propose that the delivery of mental health interventions within schools would be one way of developing Tier One services so that they reach children who might not otherwise obtain help. In recognition of this, guidance for teachers entitled ‘Promoting Children's Mental Health within Early Years and School Settings’ has been produced (DfES, 2001a).

Models for schools-based mental health programmes

  1. Top of page
  2. Abstract
  3. Key Practitioner Message:
  4. The rationale for collaboration between health and education
  5. The school as a logical initial place for assessment and intervention
  6. Models for schools-based mental health programmes
  7. Examples of collaborations between health and education
  8. Factors contributing to success
  9. Obstacles to multi-agency collaboration
  10. The future
  11. Acknowledgements
  12. References

In the USA, there are 2 main models for schools-based mental health programmes: one has off-site services delivered in a school by a children's outpatient psychiatric clinic; the other is the mental health component of a school-based health clinic (SBHC). A SBHC is a free-standing health clinic in a school that provides a variety of primary health-care services. Expanded School Mental Health (ESMH) programmes involve the provision of comprehensive mental health services for young people in schools to include assessment, multi-modal treatment, consultation and strategies for preventing poor mental health that are available to all pupils in both special and mainstream education (Baruch, 2001).

Despite some moves to locate mental health services for young people in schools (Department of Health, 1999; HAS, 1995), this practice is not yet widespread in the UK. This may however be set to change as a result of recent government policy. The green paper, Every Child Matters (DfES, 2003), proposes that in the long-term, key services for children and young people (education, social services and some health services) are integrated as part of Children's Trusts. It further recommends reconfiguring, co-locating and facilitating easier access to services around the places (schools and children's centres) where children and young people spend much of their time, in the belief that this may improve outcomes. This has led to the concept of extended schools in England (DfES, 2005) and community-focused schools in Wales (WAG, 2003). The idea is that these will provide a range of services and activities, with extended opening hours, to help meet the needs of the children, their families and the wider community. The DfES (2005) document on extended schools sets out the following core offer:

Swift and easy referral to a wide range of specialist support services such as speech and language therapy, child and adolescent mental health services, family support services, intensive behaviour support, and (for young people) sexual health services. Some may be delivered on school sites ...(p.8).

Examples of collaborations between health and education

  1. Top of page
  2. Abstract
  3. Key Practitioner Message:
  4. The rationale for collaboration between health and education
  5. The school as a logical initial place for assessment and intervention
  6. Models for schools-based mental health programmes
  7. Examples of collaborations between health and education
  8. Factors contributing to success
  9. Obstacles to multi-agency collaboration
  10. The future
  11. Acknowledgements
  12. References

Mental health disorders or behaviour problems

A working example of collaboration between health, education and other agencies in the UK which provides a valuable source of information and expertise regarding multi-agency practice are the Behaviour and Education Support Teams (BESTs). These are multi-agency teams typically including a mix of the following professionals: behaviour support staff, clinical psychologists, education welfare officers, educational psychologists, health visitors, primary mental health workers, school nurses, social workers/family workers, and speech and language therapists. BESTs target children and young people aged five-18 years of age who are considered to have or to be at risk of developing emotional and behaviour problems. They provide support in three differing ways: support to schools at a whole school level; group support to children and their families and intensive support to individual children and families where appropriate. In their evaluation of BESTs, Halsey et al. (2005) report a hierarchy of factors impacting on effectiveness which include:

Structural factors

  •  The importance of having a distinct accessible base, either within a school or within the local community, to operate from which facilitates a sense of team cohesion and identity;
  •  Staff themselves reporting the benefits of working in a multi-agency team within which they can exchange views, expertise and knowledge with others from different professional and agency backgrounds.

Factors associated with relationships

  •  Clear and open communication with schools with a specified key contact in school providing a link to the BEST for referrals and ongoing liaison;
  •  Communication within the team and a willingness of staff to think in a ‘multi-agency’ way.

Factors concerning interventions

  •  The ability of the team to offer holistic support packages to children and families by virtue of the pool of skills which are available within the multi-disciplinary team.

In the UK, twenty-four multi-agency initiatives were developed as a result of the Department of Health CAMHS Innovation Grants. The multi-agency nature of these projects allowed for a holistic approach to the child and/or family's needs to be taken which often spanned the traditional boundaries of health, education and social services (Kurtz & James, 2002). One of these projects, based in Bury and Rochdale, north England was staffed by a multi-disciplinary team comprising of a play worker, educational psychologist, social worker and nurse therapist. The main aim of the project was to reduce school exclusion by providing early intervention for children aged between 4–12 years who were considered to be at risk on account of their behaviour. The project also aimed to improve the relationship between school and the child's home and increase teacher awareness of emotional and behavioural problems. The evaluation of this project showed that the number of excluded days (both fixed-term and permanent) was reduced as a result of the intervention although the finding was not statistically significant. However, more positive results were seen once those children and parents who did not engage with the project were removed from the analysis (Panayiotopoulos & Kerfoot, 2004). An additional qualitative evaluation revealed that referrers to the project both from mainstream and special school settings found the service provided to be of value (Panayiotopoulos, 2004).

Another of the CAMHS innovation projects involving multi-agency collaboration between education and health as well as social services and the voluntary sector was the Multi-Agency Prevention (MAP) project based in Tower Hamlets. This project aimed to improve emotional wellbeing, improve chances of success at school and reduce anti-social behaviour in Bangladeshi boys in three secondary schools. The staff employed included youth workers, clinical psychologists, social workers and community resource officers who offered a variety of interventions including therapeutic support groups based in schools, solution-focussed counselling, recreational activities and awareness raising initiatives for parents/carers (DfES, 2003; James, 2001).

A different model of working which has been developed in Flintshire, Wales, has a named primary CAMH liaison specialist attached to all Tier One services for children within a defined geographical area (all schools in the appropriate age range and all general practices). Consultation, liaison, development of screening programmes, joint work and referral is then possible. In addition, in schools, both universal and targeted classroom-based interventions (e.g., for problem-solving and affective development, classroom behaviour management interventions, or prevention of bullying) have been incorporated into the service framework (Appleton & Hammond-Rowley, 2000).

Neurodevelopmental disorders

Salmon, Cleave and Samuel (2006) describe the development of multi-agency referral pathways for ADHD, DCD and ASD in South Wales. They note a number of features that the three pathways have in common. These include:

  •  Bringing together a number of different professionals from a variety of different agencies who are already working with the child separately;
  •  Reflecting the key features of the Special Educational Needs Code of Practice (DfES, 2001b) by offering:
  • -
    A graduated response;
  • -
    An inclusive response for children, professionals and parents;
  • -
    An evidence base about how children have responded to school-based interventions;
  •  Assessments are carried out over time and in various contexts;
  •  Interventions offered move from the general to the more specific;
  •  Specialist assessments and interventions are only offered when a child has not responded to initial approaches;
  •  There is a single clear point of entry;
  •  A consensus has been reached between professionals regarding terminology.

Other examples include the development of a multi-agency forum for assessing and treating ADHD (Keen et al., 1997) and the development of an integrated care pathway for ADHD involving professionals from education, community paediatrics, child and adolescent mental health services and general practice (Burgess, 2002).

Factors contributing to success

  1. Top of page
  2. Abstract
  3. Key Practitioner Message:
  4. The rationale for collaboration between health and education
  5. The school as a logical initial place for assessment and intervention
  6. Models for schools-based mental health programmes
  7. Examples of collaborations between health and education
  8. Factors contributing to success
  9. Obstacles to multi-agency collaboration
  10. The future
  11. Acknowledgements
  12. References

Salmon (2004) reviews the literature relating to factors contributing to successful multi-agency collaborations for children, particularly in relation to CAMHS. She concludes:

Research on successful collaborations has highlighted the importance of effective communication plus mutual understanding between professionals from different agencies (Akhavain et al., 1999; Kopser, Horn, & Carpenter, 1994; Marino & Kahnoski, 1998). Having a task or patient focus where there is a common interest linking agencies as well as an overlapping agenda also seems to facilitate collaboration (Alter & Hage, 1993)… (p.160).

There are a few papers in the literature which specifically relate to collaborations between CAMHS and education. Hilton et al. (2006) in their description of an interagency project between CAMHS and a PRU, suggest that the following factors have an important role in the success of multi-agency collaborations:

  •  Careful project management with senior representatives from each agency being engaged in both strategic planning and overseeing implementation of operational issues;
  •  Developing a shared vision and values at an early stage of interagency collaboration;
  •  Establishing a common definition and language for the work that takes account of the perspectives of the different professionals involved;
  •  Revisiting discussions about shared values and vision and language used every time new staff join;
  •  Giving as much attention to ‘how’ professionals work together as to case- related activity.

Waxman, Weist and Benson (1999), when discussing the establishment of new collaborations between mental health and educational professionals, emphasise the importance of communication and initial planning meetings. A necessary first step is for teachers and mental health professionals to recognise that although they have the same ultimate goal they may have different ways to go about achieving it. Waxman et al. (1999) recommend that in planning meetings, educational staff should discuss their views on the issues that they are concerned about including the problems that the pupils present with, how these are being addressed by the systems currently in place and any perceived gaps in provision. They suggest that mental health staff can then share their ideas about how they might provide services to address the gap. Following the agreement of a common set of goals, appropriate interventions and services can be planned and thought given as to how these can be evaluated. Further discussion is recommended to issues such as the actual range of services to be provided, the scheduling of appointments, how children and young people can be referred, how to avoid duplication across services and the mechanism for information sharing.

Obstacles to multi-agency collaboration

  1. Top of page
  2. Abstract
  3. Key Practitioner Message:
  4. The rationale for collaboration between health and education
  5. The school as a logical initial place for assessment and intervention
  6. Models for schools-based mental health programmes
  7. Examples of collaborations between health and education
  8. Factors contributing to success
  9. Obstacles to multi-agency collaboration
  10. The future
  11. Acknowledgements
  12. References

There have been a number of papers written which discuss obstacles to multi-agency collaboration in relation to children's services (Easen, Atkins, & Dyson, 2000; Miller & Ahmad, 2000; Salmon, 2004; Williams & Salmon, 2002). One barrier to collaboration between education and health is the different way the agencies function and their differing ways of working (Axelrod, 1990). For example, within education there is an idea that each child in school is provided with a similar amount of educational resource and school provision and accesses a similar curriculum. Health however only offers interventions to any one particular child when there is a specific need. In addition, the needs of any one child will be compared with the needs of another and resource allocation may be prioritised accordingly. Where there are rising referral rates, further prioritisation may occur and the threshold a child has to reach to receive a service may rise (McCartney, 1999; Williams & Salmon, 2002).

Keen et al. (1997) describe the following organisational and professional barriers to multi-agency working in relation to ADHD: the differing roles and relationships that health and education have in relation to children and young people and their differing statutory processes; professionals fearing that they will lose their identity if they share skills; a general lack of understanding that professionals from different backgrounds and agencies have about other professionals’ ways of working; concerns about information sharing and ‘medical confidentiality’; lack of agreement about the implications of a diagnosis; differing views about labelling, and the tendency for individual agencies to become inward looking when referral numbers and workload pressures increase. Organisational factors can also get in the way of multi-agency collaboration. One example of this is the differing impact of a centrally-held SEN budget compared with one devolved to individual schools on the likelihood of any one individual child receiving the appropriate educational support.

There may also be different goals and criteria in use when a child is assessed both medically and educationally (Sloan, Jensen, & Kettle, 1999). For example, when doctors assess children with suspected medical conditions, they tend to use internationally agreed criteria to confirm or rule out specific diagnoses and base their treatment plan accordingly. In comparison, educationalists concentrate more on providing the child with an educational plan. If both of these perspectives could be integrated this would be likely to result in a more comprehensive provision of care.

Issues of confidentiality can be problematic in collaborations between health and education. Waxman et al. (1999) stress the importance of mental health staff preparing teachers for the imbalance in their capacity to share information which may result in teachers feeling that they are always providing more information to other professionals than they receive back from them.

Another difficulty is that educational and health professionals do not speak the same language and use a different vocabulary (Costello-Wells et al., 2003). An example of this is outlined in The National Assembly for Wales’Child and Adolescent Mental Health Services Strategy Document (2001, p.14) in relation to the abbreviation EBD. In this document, EBD refers to educational and behavioural difficulties or problems which are severe, persistent and associated with other problems. Others however understand the term EBD to refer to emotional and behavioural difficulties. There has been little consensus among professionals as to how to define emotional and behavioural disabilities in children (Duchnowski & Kutash, 1996; Forness & Knitzer, 1992). Martin et al. (1995) conducted a comprehensive review and found 86 labels or descriptors used to refer to emotional and behavioural disabilities. The absence of agreed upon definitions of difficulties impedes the ability of agencies to integrate services (Kutash & Duchnowski, 1997), produces disparate identification criteria and processes across agencies and can lead to assumptions that the children who receive services from different agencies are also different. Bruner, Kunesh, & Knuth (1992) recommend that when agencies come together to collaborate, then an initial important task is for professionals to explore the use of terms and definitions.

The future

  1. Top of page
  2. Abstract
  3. Key Practitioner Message:
  4. The rationale for collaboration between health and education
  5. The school as a logical initial place for assessment and intervention
  6. Models for schools-based mental health programmes
  7. Examples of collaborations between health and education
  8. Factors contributing to success
  9. Obstacles to multi-agency collaboration
  10. The future
  11. Acknowledgements
  12. References

In summary, data from epidemiological research and recommendations taken from the literature suggest that schools play a central role both as an entry point to mental health services for children and young people with less severe mental health problems as well as in the assessment and management of children with neurodevelopmental disorders. This finding is in line with current policy which highlights the importance of multi-agency collaboration and recommends the development of extended schools.

One way to further develop collaborative working between health and education for children and young people with mental health disorders and/or neurodevelopmental disorders could be through the development of a generic referral pathway for specialist CAMHS and community paediatric and allied health professional services (Occupational Therapy, Speech and Language Therapy) which emphasises the key role of schools. Such a referral pathway would enable schools to take a lead in managing CAMHS at Tier One in situations when children and young people present with behaviours that are pervasive (occur at home and at school), thereby reducing waiting lists to specialist CAMHS.

A second and important factor to encourage collaboration is to consider the type of professional training that is delivered in education. Training has been largely focussed on diagnostic labels such as teachers receiving training on ADHD or ASD separately rather than seeing the management of children with neurodevelopmental disorders and mental health disorders as an overall starting point for understanding how to best support the child in the classroom. This may result in teachers becoming confused about management especially when children have either a dual diagnosis or are awaiting assessment from specialist services. There may also be misunderstandings over terminology and the language being used.

As the evidence extensively shows that overlap or co-occurrence is the rule rather than the exception for children with neurodevelopmental disorders, it may be prudent to consider delivering training that encourages the gathering of information across areas of difficulties and how to undertake this baseline ‘mapping’ exercise and then providing guidance on approaches to support the child before referral. This model aligns itself to the Special Educational Needs Code of Practice (DfES, 2001b) which discusses a graduated response.

…there is a continuum of special educational needs and, where necessary, brings increasing specialist expertise to bear on the difficulties that a child may be experiencing. However the school should, other than in exceptional cases, make full use of all available classroom and school resources before expecting to call upon outside resources (p.48).

For effective joint working to occur there needs to be a continuing reminder of the overlapping nature of both neurodevelopmental and mental health difficulties. This needs to begin in initial teacher training and in undergraduate training of health professionals to ensure a shared understanding.

References

  1. Top of page
  2. Abstract
  3. Key Practitioner Message:
  4. The rationale for collaboration between health and education
  5. The school as a logical initial place for assessment and intervention
  6. Models for schools-based mental health programmes
  7. Examples of collaborations between health and education
  8. Factors contributing to success
  9. Obstacles to multi-agency collaboration
  10. The future
  11. Acknowledgements
  12. References
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