Hertfordshire TaMHS Project

Evaluation

March 2011

Contents:

1. Background (page 1)

2. Key outcomes and achievements (page 2)

3. Provision – Overview (page 8)

- Primary Mental Health Workers (page 9)

- Training in school led interventions (page 11)

- Partner Providers (page 14)

4. What could have been better? (page 18)

5. Were the outcomes met? (page 20)

6. Considerations (page 22)

7. Recommendations (page 25)

1. Background

The Targeted Mental Health in Schools (TaMHS) project in Hertfordshire was a two year project funded by the DCSF / DfE from 2009 to 2011. The project focused on the community of Watford. 33 schools were involved from the West and North Watford Extended Schools Consortiums.

Aim/Vision

The vision for the project was to develop whole school approaches to supporting pupil mental health and emotional well being. To build capacity in early intervention and prevention and support children and young people to access targeted services through a multi-agency and systemic approach.

Proposed Outcomes

·  Staff across the school community will understand and value their role in supporting children and young people in relation to their emotional and mental health

·  Staff across the school community will feel empowered to lead some targeted interventions and be aware of other interventions that they can signpost to

·  Staff across the school community will work in an integrated way using common processes to assess, plan and meet the emotional and mental health issues of children and young people

·  Child and Adolescent Mental Health Service (CAMHS) specialist service will be used appropriately and effectively

·  Children and young people will achieve well, not miss school and be happy in school

·  A model of provision and the capacity to disseminate and embed new practice across the county will be developed.

Scope:

The project focussed primarily on three areas:

1.  Develop a culture that supports emotional wellbeing and mental health by building capacity within universal school settings to promote and prevent, and identify and intervene early

2.  Evidence based, targeted individual and group support for children and young people at risk of and experiencing emotional and mental health problems, including parent support, facilitated by CAF

3.  Strengthening multi agency partnerships by bolstering the interface between universal, targeted and specialist services

2. Key outcomes and achievements of the project:

Needs Assessment 2009

The research and bench marking for the project resulted in a report which initially served to shape the delivery of the project. The depth and breadth of the information gleaned from the needs assessment has meant this report was relevant to a wider group of colleagues. The report was therefore disseminated and used by a number of professionals and organisations in a meaningful way.

‘Tools for Schools’ has been developed in response to the need for consistent processes when responding to children and young people with potential mental health needs. The document consists of the following:

·  When to worry tool - a universal assessment tool for all staff to identify children and young people with potential difficulties. These questions should be at the forefront of professionals’ minds and can help to build a picture of an individual's needs. If there is an initial concern, there may be other things the professional can ask themselves, the individual or their parents in order to assess the situation.

·  Risk assessment tool - a series of further questions to ask the individual or parents directly which supports the member of staff or a more appropriate colleague to make decisions about escalation of concerns. The tool also includes a flow chart to illustrate the course of action required in response to the needs identified and the level of risk. A series of supplementary questions around self harm and suicide can be found in this section.

·  Care Pathways tool - a brief guide to services aligned with the level of need.

·  Services that Support - a directory of services broken down by theme to help professionals find appropriate intervention, support and advice.

·  Tools for Schools compliments the self harm and suicide guidance (2009) which is part of the HCTP Safeguarding guidance.

The feedback from schools has been extremely positive about Tools for Schools. It is cited as one of the key legacy components of the project. In light of future GP commissioning arrangements, this tool is being modified to meet their needs too.

‘How to Speak to Your Parents’ Leaflet

In 2008, Secondary pupils responding to the Health Related Behaviour Questionnaire (HRBQ) reported they would go to their parents only a third of the time with their concerns and keep their problems to themselves 25% of the time. Key Stage 4 girls (aged 14 to 16) were the least likely to talk to their parents. There are a number of resources available for parents with advice on how to go about communicating with their teenage children. However, young people find it just as difficult to discuss sensitive issues with their parents, despite needing their guidance and support.

Relate Watford provided content for a leaflet which Hertfordshire have designed and printed and sent to all secondary schools in Hertfordshire. The leaflet has also been distributed to Education Support Centres (ESCs) Youth Connexions and other organisations interfacing with young people.

‘Step 2’ Tier 2 Mental Health Service

The TaMHS project served as a good practice model in the development of the service agreement for the much anticipated early intervention service. The PMHWs were the most highly valued element of the TaMHS project. Commissioners sought to align the new service with the TaMHS model as far as possible, within the financial constraints of a countywide service.

Learning Difficulty & Disability Early Intervention Resource

Children and young people with LDD have a higher prevalence for mental health problems than their peers. Professionals working with children with Learning Disabilities and Learning Difficulties as well as Developmental Disorders will have access to a new resource with information about the differing needs of this group and how best to meet those needs.

Complimentary and Supplementary School Training

There is an under representation in Black and Minority Ethnic (BME) children and young people accessing CAMHS locally. This is in line with the picture nationally and with adult services. After exploring a number of ways to improve awareness and access to services, Community Development Workers (CDWs) from the Mental Health Services provider in Hertfordshire, Hertfordshire Partnership Foundation Trust (HPFT) were identified as appropriate colleagues to disseminate key messages.

The CDWs were supported to develop and deliver training for Complimentary and Supplementary school staff in the project area. The training was so well received that the workers are being supported by Standards and School Effectiveness (SSE) to deliver the training more broadly around the county. Complimentary and supplementary school staff are well placed to identify pupils and families who may need support and can offer credible and effective signposting to services.

Education Support Centre Engagement

Chessbrook ESC fully embraced the vision of TaMHS. It is closely aligned with theirs and they made best use of the provision available. Chessbrook was rated Outstanding by Ofsted in 2010 and their Healthy Schools submission clearly evidences effective use and embedding of TaMHS resources and the increased capacity this has brought. As the centre has a number of outreach staff, all schools in the area served by it will benefit from additional skills and approaches.

“I am delighted with the project and consider us very lucky to be able to access so many great opportunities… the TaMHS project has already made a positive difference to many lives.” (Deputy Head)

Increased confidence, awareness and provision in schools

Schools, education professionals and strategic colleagues confirm that confidence and awareness has increased amongst school staff. Positive feedback also highlights:

·  Excellent level of staff training / advice for staff / high quality, appropriate

·  Excellent level of support for pupils / vulnerable pupils

·  Valuable information about agencies in the area / how to access

·  Involvement in CAF / TAC

·  Quick and easy access to Mental Health professionals to support schools

·  Detailed needs assessment including feedback from pupils, parents and staff

·  Engagement of voluntary organisations

·  Supporting documentation for schools

·  TaMHS workers liaising directly with schools ensuring consistency of approach

·  Direct support to children and young people in schools and at home

·  Provided substantial additionality in project area now supporting the development of Tier 2 services across the county

·  Increased front line resources directly in schools

·  Bridged the gap between schools and Specialist CAMHS clinic, approachable

·  Partnership working and flexible approaches to delivering services

·  79% of stakeholders surveyed feel the project has reduced stigma, more parents happy to see TaMHS workers than CAMHS

Confidence of school staff before and after the TaMHS project:

(Of those responding to a TaMHS survey)

Responses
Confidence Level

“Now we know the value of this level of support, we will fight much harder to ensure that all future students in need have this quality of support available to them. It’s also clear that a well managed project such as this one is much more effective and makes better use of resources.” (Deputy Head)

“Many more people will get the help they are entitled to due to the TaMHS project and the information it has provided to many people in their various roles in the workplace.” (Stakeholder)

“This has been one of the most supportive projects I have been involved in.” (School Colleague)

“Hopefully our children will grow up with different attitudes to mental health problems.” (School Colleague)

The picture in Data

In 2008, the Health Related Behaviour Questionnaire (HRBQ) was used to take a baseline of pupil perceptions about themselves and their schools. At that time, primary pupils worried more about family (40%), transition to secondary school (32%) and war and terrorism (30%). In 2006, the biggest worries were tests (43%), crime (32%) and family (30%). In 2011, the same cohort of schools completed the same questionnaire. Tests had become the biggest worry again (52%) followed by family (50%) and transition to secondary school (49%). In 2008, staying safe at home was a worry for 17% of pupils. This has increased to 27%. The levels of worry among this age group are increasing despite the evidence of recurrent themes.

Secondary school pupils worried mostly about exams and tests (48%) particularly at KS4, their health (40%) and family problems (37%) in 2008. In the recent survey, tests were again the biggest worry (52%) followed by family (37%) and appearance (34%). In 2006, the biggest worries were family problems (53%), exams and tests (49%) and friends (38%). Generally, girls worried more than boys.

Self esteem scores are generally static with 6% of primary pupils scoring low, 24% low to medium, 42% medium to high and 28% high. A similar picture exists in secondary schools with 6% of pupils scoring low, 21% low to medium, 35% medium to high and 38% high. In 2008, only 4% of primary and secondary pupils scored low indicating a slight increase in the number of pupils with the lowest level of self esteem. Self esteem has risen slightly among secondary school pupils but high levels of self esteem have decreased among primary school pupils from 35% to 28%.

Secondary pupils were also asked how happy they felt with their lives. 4% said not at all, 10% not much, 23% weren’t sure, 40% quite a lot and 23% very much. There has been a decrease from those regarding themselves as very happy with their lives from 30% to 23%. Boys remain more positive than girls. In 2008, KS4 girls showed low levels of life satisfaction in relation to their male counterparts. This has evened out and it is KS3 girls who now show a marked lack of high levels of life satisfaction in relation to KS3 boys (boys 38%, girls 16%).

Primary pupils say the school teaches them how to manage feelings and cares if they are happy or not (approx 60%, this is in line with the 2008 response). More girls than boys think the school cares about how they feel but the feeling declines in year 5 and 6. Less secondary pupils feel this way; 20% say their school cares whether they are happy or not and this has decreased from 30% in 2008. There was an increase in secondary pupils agreeing that their school helps them to manage their feelings from 18% in 2006 to 31% in 2009 but this has reduced to 19% in 2011, the lowest group agreeing with this statement was KS3 girls.

More primary pupils (40% in 2011, 35% in 2008) feel shy or uneasy talking to teachers. 26% often find they need to make new friends and 30% experience falling out with peers. 29% said they had nasty things said about them. 45% wanted to change something about themselves and 1 in 5 felt lonely at school. These are similar results to 2008 however 5% more pupils feel lonely at school.

15% of secondary pupils feel foolish when they have to talk to their parents, this is higher among KS3 boys. 20% still feel shy or uneasy talking to teachers and 1 in 5 pupils feel other pupils say nasty things about them. 35% wanted to change lots of things about themselves (54% of KS4 girls) and while 52% are happy with their weight, 41% wanted to lose weight. 1 in 10 pupils feel lonely at school.

Secondary pupils indicate that they are least likely to share concerns about the environment, gambling, and their appearance with anyone. KS4 pupils still tend to favour their friends in initial conversations as opposed to their parents or another adult. Teachers remain an unpopular choice for discussion about anything other than school work issues, only 11% of pupils would tell a teacher if they are being bullied.

The 2011 HRBQ was completed by 460 primary pupils and 324 secondary pupils in January.

3. Provision:

The project sought to develop new targeted approaches from a range of providers and partnerships. It also ensured awareness of existing underused resources, as well as continuing to improve universal provision as a sound foundation for skill development and care pathways to be established.