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Keywords:

  • Mental health;
  • emotional well-being;
  • scoping survey;
  • schools

Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References
  9. Appendix

Background

Schools play an important role in promoting child mental health, but little is known about the approaches they undertake.

Methods

A scoping survey in England, involving 599 primary and 137 secondary schools.

Results

Although two thirds of school approaches focused on all pupils, these were predominantly reactive, rather than preventive interventions. They were also largely not evidence-based, were instead based on a plan while open to adaptation. Gaps were identified in teacher training and support.

Conclusions

The findings have implications on the use of preventive versus reactive approaches, staff training and consultation, use of evidence-based practice in schools and joint care pathways.

Key Practitioner Message
  • A survey of primary and secondary schools in England aimed at establishing the types of their mental health provision
  • Although two thirds of schools reported input for all pupils, interventions were mainly targeted to children and young people with developing or established mental health problems, rather than of preventive nature
  • Interventions were largely not evidence-based, and teacher training and consultation were relatively limited
  • The findings are promising in terms of attention to children's emotional well-being within schools, but there needs to be a more systematic development of preventive interventions with clearer conceptual frameworks and evidence of effectiveness; joint care pathways with external agencies; and opportunities for staff training, supervision and consultation in relation to school mental health competencies

Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References
  9. Appendix

Approximately 10% of children and young people experience clinically significant mental health difficulties that would require assessment and possible intervention (Green, McGinnity, Meltzer, Ford, & Goodman, 2005). This figure has risen in the last 30 years (Maughan, Iervolino, & Collishaw, 2005). The long-term consequences of child mental health difficulties can include an increased risk of a range of adverse psychosocial outcomes in later life (Farrington, Healey, & Knapp, 2004; Colman et al., 2009). These children and their families come into contact with a range of educational, mental health and social care agencies, although often in a noncoordinated way, and with high levels of unmet needs. The child mental health survey in England found that a third of parents worry about their child's mental health, of whom 90% have sought help (Green et al., 2005). Of those families and young people who had sought help, nearly three quarters had first approached a teacher, in contrast with a quarter who had visited their family doctor. It is in this context that schools are increasingly being seen as central sites for the promotion of emotional well-being. Indeed, there is an intuitive logic to the notion that schools can and should make a difference in this area (Weare & Markham, 2005). Greenberg (2010) suggests: “By virtue of their central role in lives of children and families and their broad reach, schools are the primary setting in which many initial concerns arise and can be effectively remediated” (p.28).

Governmental directives in England have thus increasingly emphasised the role for schools in preventing mental health problems and promoting well-being as part of the move away from the rationalist to a more holistic view of education. This has included ‘broad brush’ policies such as Every Child Matters (Department for Education & Skills, 2003); national strategies/initiatives such as the National Healthy Schools (Department of Health/Department for Education & Employment, 1999) and Social and Emotional Aspects of Learning (Department for Education and Skills, 2005, 2006; Department for Children, Schools & Families, 2007); and attempts to promote synergy between education and related services through the development of (for example) the Common Assessment Framework (Children's Workforce Development Council's, 2007). In parallel with the implementation of policy, some schools in England have imported evidence-based programmes and practices from the United States and elsewhere (Little & Hopkins, 2010). However, despite this progress, effective provision is still hindered by barriers between services, different priorities, poor understanding of individual roles and use of professional language. For example, a recent study of CAMHS and educational practitioners’ experiences of joint working indicated limitations in knowledge and competencies, and identified possible solutions such as establishing linking posts on the interface between CAMHS and schools, building local relationships and joint training (Vostanis et al., 2012).

There is increasing evidence of the impact of both universal (for all children, designed to prevent problems from occurring – the ‘inoculation’ metaphor) and targeted/indicated (for children at risk of or already experiencing difficulties) mental health interventions delivered in school settings (Wilson & Lipsey, 2007; Durlak, Weissberg, Dymnicki, Taylor, & Schellinger, 2011; Dix, Slee, Lawson, & Keeves, 2012). However, almost all of the studies in this area originate outside England and are tightly controlled ‘efficacy’ trials in which schools access levels of support and technical assistance not normally available to them (Shucksmith et al., 2007). This is an important issue, because bringing interventions ‘to scale’ in real world settings can be problematic (Elias, Zins, Graczyk, & Weissberg, 2003), in that even well-validated programmes can produce null results in ‘effectiveness’ trials (Kam, Greenberg, & Walls, 2003). The reason is that such interventions do not occur in a vacuum, but rather form part of a complex set of approaches to developing effective provision in schools, which might include ‘one-stop shops’, that is concurrent input from different agencies (Tisdall, Wallace, McGregor, Millen, & Bell, 2005) or consultative models (Clarke, Coombs, & Walton, 2003). Many schools also develop their own sets of approaches ‘from the ground up’, and their work in this area often involves joint initiatives with other agencies, usually child mental health and educational psychology services. However, when joint initiatives are employed locally, they are often disjointed or lack generalisable outcomes with no evidence base. This may be due to response to short-term funding and other opportunities between agencies, which are not necessarily followed by partnerships, evidence to drive the opted intervention or service model and a sustainable strategy. What has been lacking thus far is a framework that brings such work together in a coordinated way, with rationalisation of the adopted interventions and service criteria; and in parallel to this, research to explore patterns and trends that emerge in terms of the kinds of strategies and approaches to promoting mental health in which schools subsequently engage.

The targeted mental health in schools (TaMHS) initiative

The latest government initiative aimed at fostering the role of schools in England in promoting mental health was rolled out from 2008 onwards (Department for Children, Schools & Families, 2008). It was developed not to test a particular hypothesis or model of practice, but rather to provide a framework through which local authorities and schools could develop their own context-and-situation-appropriate ways of working. Such an approach would theoretically increase the sense of ownership among staff and, ultimately, lead to more sustainable practices (Weare, 2010). In this article, we report on the service typologies present in participating schools during the baseline period of the TaMHS evaluation (Wolpert et al., 2010, 2011), that is before the government programme began, and representing typical provision in schools. This is the first large-scale study of its kind to be conducted in England. In a previous US survey (Teich, Robinson, & Weist, 2007), school-based mental health services were found to be widely available and to address a range of needs. However, their static or decreasing resources and funding did not often match children's increasing needs.

Our broad aim was to identify the mental-health-focused activities that schools in England were using, adopting and developing. Specifically, we sought to ascertain the general features of schools’ overall approaches to supporting the mental health of their pupils, that is whether interventions utilised were in the main preventative or reactive; their level of prescriptiveness; and the nature and extent of specific interventions put in place for pupils presenting with externalising/behavioural and internalising/emotional difficulties.

Methods

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References
  9. Appendix

Design

A cross-sectional survey was used.

Sample

The sample consisted of 599 primary schools and 137 secondary schools that responded to the new initiative and agreed to participate in this survey before the implementation of the TaMHS programme. All Local Education Authorities (LEAs) were invited to participate, and 25 were selected through a competitive process according to the funding available. LEAs then decided internally which schools would be involved from their area, and all of these took part in the survey. All schools were mainstream public settings. The average proportion of pupils eligible for Free School Meals (FSM) was 22.4% for primary and 20.5% for secondary schools. These figures are somewhat higher than the national FSM eligibility averages of 18.5% and 15.4%, respectively (Department for Education, 2010), indicating a slight tendency for participating schools to be serving more economically deprived areas. The average proportion of pupils from non-White British backgrounds was 26.3% for primary and 26.5% for secondary schools; the corresponding national averages are 25.5% and 21.4%, respectively (DFE, 2010), indicating a slight tendency for participating secondary schools to be more ethnically diverse than is usual.

Measures

A designated member of staff (normally the Head Teacher or Deputy Head) in each school completed an online questionnaire regarding their school's strategies and approaches to supporting pupils’ mental health. Each school had several staff involved in the TaMHS programme, who contributed to determining of the interventions offered by their school, but the designated person acted as link for this survey. The questionnaire was designed to elicit the types of help and interventions used by each school for children experiencing difficulties in this area. The questionnaire was designed by the TaMHS evaluation team based upon literature on mental health promotion in schools and accompanying experience in school settings. The survey was designed to be as accessible and transparent as possible; hence, technical jargon was kept to a minimum, and ambiguous/equivocal terms avoided. To aid participants in completing the survey, vignettes described the characteristics of a child presenting with externalising/behavioural (Child A) and internalising/emotional difficulties (Child B) (see Appendix A).

For each vignette, there were 13 accompanying items addressing how the child would be helped, by whom within the school, the nature of the intervention(s) provided, whether support would be extended to the child's parents/family, the extent to which external, multiagency referrals would be undertaken and how progress would be assessed. In addition, staff completed seven items that sought to ascertain aspects of the school's overall approach to supporting the mental health of its pupils, such as whether interventions utilised were in the main preventative or reactive, and the level of prescriptiveness inherent in them.

Results

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References
  9. Appendix

Schools’ general approaches and strategies to promote pupils’ mental health

Responses to the items exploring the general approaches used by schools to promote the mental health of their pupils can be seen in Tables 1 and 2. Several interesting trends are evident. In both primary (61.2%) and secondary (64.4%) schools, the majority reported focusing their efforts on all pupils, rather than small group or individual work. The individuals reported to be working to help pupils were much more likely to be members of school staff with no specialist mental health training in primary (67.1%) than in secondary schools (49.3%). Only a third of both primary and secondary schools reported undertaking evidence-based practices, for example those with a national or international evidence base, with the largest proportions (57.6% and 49.3% respectively) reporting that interventions were developed locally.

Table 1. Frequency of support for pupils with emotional and behavioural difficulties available in primary (n = 304) and secondary (n = 73) schools
 Primary schools %Secondary schools %
Schools aim to help students by mainly focusing on:
Specific individual pupils27.627.4
Small groups of pupils10.96.8
All groups of pupils in the school61.264.4
Not available0.31.4
The person or people in the schools who help pupils are in the main:
Members of school staff with no specialist mental health training67.149.3
Members of school staff with some specialist mental health training28.645.2
Mental health specialists2.61.4
Not available1.64.1
The ways of helping pupils are in the main:
New and have not been tried before4.69.6
Tried before locally and seem to help57.649.3
Tried before nationally or internationally and found to help34.534.2
Not available3.36.8
The ways of helping pupils in our school(s) were chosen in the main:
By the school56.961.6
By the local authority2.61.4
By the school and local authority jointly39.534.2
Not available1.02.7
The ways of helping pupils are in the main:
Based on a set plan of working that has to be strictly adhered to3.91.4
Based on a plan but open to adaptation81.382.2
Not based on any set plan: up to the person leading13.215.1
Not available1.61.4
The ways of helping pupils with emotional and behavioural difficulties are in the main focused on:
Preventing problems arising36.523.3
Helping children who are starting to develop problems45.750.7
Helping children who already have problems14.820.5
Not available3.05.5
Table 2. Frequency of responses to the types of interventions and support available (n = 365)
Types of interventions and support available in schoolsNot at all %A little %Somewhat %Quite a lot %Very much %
Social and emotional skills development0.57.419.238.634.2
Creative and physical activity3.312.924.139.220.5
Information for pupils10.733.229.019.27.9
Peer support for pupils5.221.626.029.018.1
Behaviour for learning and structural support0.33.814.538.143.3
Individual therapy12.120.828.222.516.4
Group therapy26.820.525.517.39.9
Information for parents5.223.835.626.48.8
Training for parents28.926.324.715.64.7
Counselling and support for parents23.637.821.911.25.5
Training for staff25.527.426.317.83.0
Supervision and consultation for staff41.631.217.37.72.2
Counselling and support for staff23.636.423.013.73.3

Schools experienced a significant degree of autonomy in developing their mental health provision, with approximately two thirds of both primary and secondary schools reporting that they chose which interventions to implement. The overwhelming majority (>81%) of such interventions were positioned in the middle ground between prescriptiveness and flexibility, being based upon a plan whilst open to adaptation. Finally, there was a clear trend towards reactive, rather than preventive approaches, particularly in secondary schools, where 71.2% reported focusing in the main on helping children who were starting to develop or already experiencing problems as opposed to preventing problems arising.

In terms of the nature of general approaches and strategies to supporting pupil mental health (Table 2) there were also several key trends evident. The most frequently used (proportions ‘quite a lot’ or ‘very much’) were those often provided by and linked with education services, that is social and emotional skills development (72.8%), creative and physical activity (59.7%) and behaviour for learning and structural support (81.4%). Those least likely to be available were support and counselling (16.7%) and training (20.3%) for parents, which are usually provided by family support, nonstatutory or child mental health services; and, somewhat worryingly, training (20.8%), supervision/consultation (9.9%) and counselling and support for school staff (17%).

School provision to help pupils experiencing mental health difficulties

Tables 3 and 4 present schools’ responses to items focusing on the specific help they would provide for Child A (externalising/behavioural difficulties) and Child B (internalising/emotional difficulties). These responses indicated similar patterns of intervention, regardless of the nature of the difficulties experienced by the child, or the phase of education (e.g. primary or secondary). Common trends included:

  1. Almost all respondents (>99%) reported that the child in question would be able to see someone in school for help.
  2. The form of help most likely to be applied by a member of school staff in all cases was listening to the child's problems and offering understanding and general support (>94%); the form of help least likely to be applied in all cases was discussing providing medicine (<20%).
  3. In most schools (>70%), the pupil would be encouraged to join a support group, and in all cases these support groups were least likely to be used to explore the roots of children's difficulties in their family/past (<46%), and most likely to discuss problems and share ideas and support (>64%) and/or gain skills to get on better with children (>68%).
  4. The vast majority of schools (>94%) would offer support to the child's family, and this was most likely to take the form of meetings as a family to help them find solutions (>61%), and/or techniques to help them deal with their own anxieties in all cases (>58%).
Table 3. Frequency of responses for a ‘disruptive child’ in primary (n = 304) and secondary (n = 73) schools
Frequency of ‘yes’ responses to how a pupil described as ‘disruptive’ would be helpedPrimary school %Secondary school %
Would this child be able to see someone in your school for help:
Yes99.0100
They would help by:
Listening to their problems and offering understanding and general support97.094.5
Teaching them how to behave and think differently in situations they find difficult95.795.9
Exploring with them the root of their difficulties in their family/past71.178.1
Teaching them new skills to solve problems and get on with other children96.195.9
Discussing providing medicine to help them control their feelings or behaviour9.519.2
Other19.423.3
Would they be encouraged to join a support group:
Yes78.470.3
This group might help the child to:
Discuss any problems and share ideas and support71.464.4
Behave and think differently72.465.8
Gain skills to get on better with children74.068.5
Explore the root of their difficulties in their family/past35.941.1
Develop appropriately through involvement in a nurture group48.447.9
Learn emotional skills through involvement in a small group61.556.2
Other7.66.8
Would the family be offered any help or support by the school
Yes99.094.5
What would the family/carers be offered
Techniques to help them deal with their own anxieties63.263.0
Meetings with other families to share thoughts and support30.638.4
Training to manage their child's behaviour51.637.0
Meetings as a family to help them to find solutions that work for them61.863.0
Other33.927.4
Table 4. Frequency of responses for an ‘unhappy child’ in primary (n = 304) and secondary (n = 73) schools
Frequency of ‘yes’ responses to how a pupil described as ‘unhappy’ would be helpedPrimary School %Secondary School %
Would this child be able to see someone in your school for help:
Yes99.3100.0
They would help by:
Listening to their problems and offering understanding and general support98.7100
Teaching them how to behave and think differently in situations they find difficult82.684.9
Exploring with them the root of their difficulties in their family/past65.571.2
Teaching them new skills to solve problems and get on with other children88.289.0
Discussing providing medicine to help them control their feelings or behaviour5.315.1
Other14.119.2
Would they be encouraged to join a support group:
Yes78.082.2
This group might help the child to:
Discuss any problems and share ideas and support74.380.8
Behave and think differently65.574.0
Gain skills to get on better with children68.479.5
Explore the root of their difficulties in their family/past37.545.2
Develop appropriately through involvement in a nurture group51.354.8
Learn emotional skills through involvement in a small group64.864.4
Other6.32.7
Would the family be offered any help or support by the school
Yes96.195.9
What would the family/carers be offered
Techniques to help them deal with their own anxieties59.258.9
Meetings with other families to share thoughts and support31.931.5
Training to manage their child's behaviour37.528.8
Meetings as a family to help them to find solutions61.563.0
Other26.623.3

However, there were also some instances where the nature of provision varied as a function of the difficulties experienced and/or phase of education. Specifically, secondary schools were more likely than primary schools to discuss medication as an option. Furthermore, there was a slight tendency for staff to explore the root of the child's difficulties in their family/past in the case of a child presenting with externalising/behavioural difficulties. Teaching behaviour management techniques as part of the package of support offered to the child's family was also more likely in this case than in that of the child presenting with internalising/emotional difficulties.

Discussion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References
  9. Appendix

The research reported in this article was the first large-scale survey of mental health provision in schools in England, and (to the best of our knowledge) only the second internationally (following Teich et al., 2007, in the US). A study of this kind was timely, given the increasing emphasis on emotional well-being in educational policy. The survey yielded several interesting findings which have implications for policy and practice, and raised some questions that future research might be able to address.

One key finding relates to the balance between preventative, universal provision; and reactive, targeted/indicated mental health provision. The literature in this area has increasingly moved towards an emphasis on prevention, following the idiom ‘an ounce of prevention is worth a pound of cure’. By putting in place mental health provision for all children and young people, it is argued that we can effectively ‘immunise’ them from later difficulties (Merrell & Gueldner, 2010). In theory, such a system is also more cost-effective to implement, as it avoids the costly screening procedures needed to identify those at risk (which, of course, may miss some children in need of targeted support) and the use of highly trained professionals that are often required to deliver targeted interventions (McLaughlin, 2011). As a result, universal preventive approaches are considered to be more sustainable.

Also, because universal approaches by definition include all children, their potential for stigmatising participants is reduced (Greenberg, 2010), they therefore align better with the principles of inclusive education (Booth & Ainscow, 2011). However, despite the fact that two thirds of schools reported focusing their efforts on all pupils, there was a clear trend towards reactive, rather than preventive approaches, particularly in secondary schools, where most reported focusing in the main on helping children who were starting to develop or already experiencing problems as opposed to preventing problems arising. Clearly, a balance has to be struck, as it cannot be an either/or choice for schools (Wells, Barlow, & Stewart-Brown, 2003); particularly given that there are always going to be some children who need to be exposed to universal, targeted and indicated interventions for their difficulties to be effectively remediated (Greenberg, 2010). The SEAL programme, which has been implemented in most English primary and secondary schools, provides a framework that incorporates intervention at each level, but evaluations of its constituent components have been inconclusive so far (Humphrey, Lendrum, & Wigelsworth, 2010).

The survey also found that, overall, schools did not report making use of evidence-based interventions, instead tending to focus on locally developed practices. This finding is, in a sense, not altogether surprising; there has not been much of an emphasis on the use of evidence-based approaches in English schools until relatively recently (part of the TaMHS guidance for schools included a practical guide to the evidence base for different types of difficulties; DCSF, 2008)., instead they have tended to rely on initiatives from central government (which usually have little or no evidence when they are launched – SEAL being one example); or their own ways of responding, which they have perceived to be effective (akin to ‘practice-based evidence’). This is a different picture to work in this field (and education more broadly) in the United States, where there has been a tendency to focus more closely on the evidence base for a given intervention – particularly in light of the No Child Left Behind Act – hence, the proliferation of databases that help schools to ‘separate the wheat from the chaff’ (e.g. What Works Clearinghouse, National Registry of Evidence Based Programs and Practices, Blueprints for Violence Prevention). As with universal and targeted/indicated approaches, the two should converge more. On the one hand, Merrell and Gueldner (2010) state, “It is usually a waste of time and resources, and is potentially risky, to implement a programme that has no or shaky evidence that it will produce the desired results” (p.29). However, focusing solely on ‘proven’ approaches risks stifling creativity and innovation at the local level, from which some effective, contextually appropriate work may emerge. It is also important to note that simply acquiring evidence-based interventions alone is not enough: these have to be implemented well to reproduce the effects demonstrated in published studies at the local level (Durlak & DuPre, 2008).

The role of school staff in supporting their pupils’ mental health also emerged as an important factor. There was an overwhelming trend towards work being conducted by members of staff, with less than 3% reporting using external, mental health specialists. In one sense, this is encouraging given what the literature base tells us – several reviews and meta-analyses have suggested that school staff are as effective as (and in some cases, more effective than) external specialists, at least when it comes to delivering universal interventions (Durlak et al., 2011; Wilson & Lipsey, 2007). Nevertheless, this survey also revealed that few schools considered training, consultation, supervision, counselling or support for their staff as a key part of their overall approach to supporting pupils’ mental health. Moreover, the largest proportion of staff involved in helping pupils were reported to have had no specialist mental health training. This is somewhat surprising, given that recent years have seen an expansion of training initiatives to improve mental health awareness and recognition of mental health problems in schools and other community frontline agencies (Madge, Foreman, & Baksh, 2008; Loades & Mastroyannopoulou, 2010). This research group has previously identified a similar gap of education-related training among child mental health practitioners, hence the importance of joint training arrangements (Vostanis et al., 2011).

In relation to the specific strategies and approaches used to help pupils experiencing difficulties, broadly similar patterns emerged between primary and secondary schools, and for both internalising/emotional and externalising/behavioural difficulties. A range of listening, communication and problem-solving skills appeared to be the first ‘in-house’ response for the vast majority of children. Some differences began to emerge when moving beyond the acquisition of social and emotional learning skills (Elias et al., 2003), for example in responses that overlapped with the role of external agencies such as exploring problems in more depth, and in relation to family issues and joint working with parents. It was not possible to establish from this data whether the schools that offered these interventions did so of their own accord or through input from agencies such as family support or CAMHS. As the vignettes were fairly broad and not diagnostic of specific types of problems, it was also difficult to establish whether responses that would consider the use of medication reflected attitudes towards specific conditions such as ADHD, or perceiving medication as an alternative to mental health problems that do not respond to other approaches. However, the rate of considering a pharmacological intervention for behavioural problems across secondary schools was, at nearly 20%, strikingly high, and it would be interesting for future research to explore the underpinning reasons.

A number of interventions implemented related to direct therapeutic work. This could be in the form of individual or group therapy, and including frameworks such as cognitive-behavioural therapy (CBT), solution focused, art and other creative therapies. This component requires clear definition of objectives, agency roles, allocation of resources and supervisory arrangements. It is important to determine what each modality aims to achieve; whether and why it should be provided within a school rather than an external specialist context; when external agencies provide direct input into the school; and whether therapists are adequately qualified and supervised. As counselling, including within school provision, is a broad and rapidly evolving field, these are important questions for future research, in addition to evidence on clinical and cost-effectiveness.

A number of limitations need to be acknowledged in this study. Although there was no shortage of reported school-based interventions for pupils, documenting these interventions can be a challenge due to the complex system in which they are embedded. Respondents may have differed in their perceptions and definitions of interventions, which were based on subjective ratings, without corroborative evidence of whether or how these were actually being provided. Despite the large number of schools involved and the socio-demographic data collected on their salient characteristics, it is plausible that more motivated schools took part, thus overestimating the rates and types of interventions provided.

Acknowledgements

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References
  9. Appendix

We would like to acknowledge input in this project of the wider research group (Wolpert et al., 2010, 2011), and to thank all schools and Local Authorities for their generous participation. This study was part of a project funded by the Department for Education in England. The funding source had no involvement in the design, delivery or dissemination of the study. This research was granted ethical approval by the UCL research ethics committee, reference: 1530/001. The authors have declared that they have no competing or potential conflicts of interest arising from this work.

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  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References
  9. Appendix
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Appendix

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References
  9. Appendix

Case Vignettes

Child A – a ‘disruptive’ child

Imagine a disruptive pupil who is abusive to teachers and other adults, who often fights with other children or bullies them, lies and is generally aggressive and difficult to manage. This has been going on for over half a term. Teachers have tried to talk to this pupil, but it doesn't seem to have helped. Parents have also been contacted but are unsure what to do.

Child B – an ‘unhappy’ child

Imagine a pupil who is unhappy, appears to be quite isolated from other children and often seems quite low in confidence and mood. They are very clingy and fearful in new situations, and can become tearful and appear worried. This has been going on for over half a term. Teachers have tried to talk to this pupil, but this does not seem to have helped. The parents have also been contacted but are unsure what to do.