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Promoting Resilience and Emotional Well Being Amongst Children and Young People


SCOPE OF THIS CHAPTER

This guidance is primarily for staff working in Universal Services (such as schools, youth services & health visiting) in Hull, or for targeted services not specifically related to the provision of services for emotional wellbeing. This guidance should be read in conjunction with the Threshold of Need Framework and Guidance.

It was added to the Guidelines and Procedures in September 2019, it provides guidance for practitioners on promoting emotional well-being and resilience in children and young people, including how to support young people in distress and when and how to refer concerns to specialist support services. It aims to improve emotional well-being and resilience making it ‘everybody’s business’.

This chapter was added to the manual in September 2019.

 


Quick Links:

Introduction
Emotional Well-being is Everybody’s Business
Prevention and Promoting Appropriate Emotional Development for all CYP
Early Identification and Additional Support
Targeted or Specialist Support for Emotional Well-being and Mental Health
Supporting CYP in (or approaching) Crisis
Additional Support and Information


Introduction

Emotional well-being is fundamental to the quality of life of children and young people (CYP), including their academic attainment and overall life chances. All CYP will have a level of emotional well-being reflecting both current life challenges and their individual capacity to cope with these. This will change over time, with reduced emotional well-being often occurring as a natural and adaptive response to significant life events.

Resilience refers more specifically to a child / young person’s capacity to resist stress, cope with challenges and recover from stressful experiences. This will be based on their personal characteristics as well as the environmental support available to them (as outlined in the HeadStart Hull Resilience Model [1]). A resilient child / young person will still move up and down the spectrum of emotional well-being and may still struggle to cope at times, however they will fare better than a less resilient child /young person in the same circumstances.

Resilience arises from everyday interactions, with each new challenge either ‘steeling’ (reinforcing) their capacity to cope or ‘sensitising’ them to future challenges. When experiencing challenges, CYP will only seek support from someone they trust - this will not necessarily be an allocated emotional well-being member of staff. As such, everybody working with CYP will affect their resilience and thereby their emotional well-being. Therefore, emotional well-being is inevitably ‘everybody’s business’. However, exact roles and responsibilities will vary depending on an individual’s place in the overall framework of support provided by a service.

There are four roles, each defined by the type of interaction with CYP:

  • Responders – who work in ways that promote resilience but are not in a position to discuss specific emotional issues except in response to concerns raised by CYP;
  • Initiators – who have regular contact with CYP and provide informal support on a day-to day basis, discussing everyday challenges and encouraging behaviour change;
  • Interveners – who offer formal, structured interventions to support emotional well-being; and
  • Influencers – who provide support and guidance to colleagues to help develop practice.

[1] See the HeadStart Hull Resilience Model, included in the HeadStart Training Diary


Emotional Well-being is Everybody’s Business

Making emotional well-being everybody’s business is about streamlining every day practice to promote good emotional and social development and also providing low-level, early intervention to address emerging problems before they escalate to the point of requiring specialist intervention. It is not about delegating the responsibilities of specialist services to Universal settings. Staff in those services are not expected to take on counselling roles or deliver specialist services, unless they are specifically trained and employed to do so. Working in this way will;

  • Improve CYP’s life experiences;
  • Support the main work of the settings;
  • Increase the capacity of Specialist Services to support high level cases;
  • Normalise discussions about emotional well-being and mental health; and
  • Reduce stigma and encourage self-care and help-seeking behaviours by making these things commonplace.

Settings should develop a framework of support which outlines the support available internally, providing clear roles and responsibilities for staff and explaining procedures for escalating concerns and intensifying support, as needed. This should also explain how support within the setting fits with external support, including who can make referrals and how. Appropriate training should be provided to all staff to support them in fulfilling their specified roles [2].

Top tip for practitioners: be clear about your own roles and responsibilities and find out about the wider support available to CYP in and beyond your setting.

[2] See the HeadStart Hull & Hull Safeguarding Children's Partnership Training Diaries


Prevention and Promoting Appropriate Emotional Development for all CYP

Developing resilience and emotional wellbeing

Opportunities to develop resilience [3] and emotional well-being should be embedded into everyday practice, both through explicit discussions of related topics and through interactions which reinforce healthy habits. For instance, skills such as celebrating success could either be explored through a structured activity about the ways in which people celebrate successes or by holding regular celebrations and involving CYP in deciding what and how they celebrate. Opportunities to practice skills such as these should be provided by all staff to all CYP as a preventive, resilience-building measure.

In addition to this, it is important to ensure that CYP can easily access informal support during times of difficulty. When CYP have a trusted adult to support them through major life events (e.g. bereavement, birth of a sibling) or significant issues (e.g. bullying), help-seeking behaviours are reinforced and CYP gain confidence that they can overcome difficulties. Similarly, if a child / young person begins developing unhelpful lifestyle behaviours (e.g. such as comfort eating), a brief intervention [4] from someone familiar can get them back on track. This support is best coming from someone with a pre-established relationship who sees the child / young person regularly but can also be provided by anyone who has the skills and time to listen non-judgementally. Initiators are often best placed to fulfil this role, but all staff must be ready to act as a ‘trusted adult’ should a child /young person approach them.

Top tip for all practitioners: get to know the skills and attributes CYP need in order to be resilient and identify small changes you can make to your practice in order to promote these.

[3]See the HeadStart Hull resilience model, included in the HeadStart Hull Training Diary
[4]See Making Every Contact Count


Early identification and Additional Support

Early identification of needs is essential to preventing issues from escalating. If a child / young person becomes distressed by things, displays extreme or minimal emotional responses and/or struggles to recover from challenges, they may need more focussed emotional well-being support. These needs might present in a number of ways such as avoidance, aggression, worrying, friendship difficulties, unexplained physical symptoms or lack of self-care. Staff work regularly with CYP and know them well (usually those with Respond or Initiate roles) are best placed to notice these subtle symptoms or behavioural changes that indicate emerging needs or changes in circumstance as long as they are attuned to the underlying need rather focusing on controlling the behaviours.

Settings should support prevention and early intervention by ensuring that all staff have clear roles and understand the boundaries of their role. Staff should be supported to identify opportunities for promoting resilience and given training, where needed, to ensure they are confident to discuss issues relating to emotional well-being [5]. All policies and procedures should complement the aim of promoting emotional-well-being, ensuring they do not create unnecessary difficulties and/or create barriers to good practice. For instance, encouraging CYP to talk about their feelings and worries will be detrimental if, when they do so, staff are unable to make time to listen due to inflexible working practices.

Settings/ services should have clear processes in place for assessing and responding to emerging need. Assessments should be evidence-based, rigorous and completed in collaboration with CYP. They should be used to plan a programme of intervention. This should include low-level interventions on common topics, such as social skills, bereavement and self-esteem, either by having appropriately trained staff, such as Emotional Literacy Support Assistants [6], or through partnership working with other Universal services [7]. Specific approaches should be chosen to meet the needs of CYP in the setting and resources (including time) should be allocated to support this work. All staff should be informed of this provision, including who it is for and how it can be accessed.

Top tip for Responders & Initiators: learn the signs and symptoms that indicate reduced emotional well-being or mental health and find out how to pass on concerns.

Top tip for Interveners: always begin intervention with an appropriate assessment, such as the Outcomes Star [8], completed collaboratively with the CYP and use this as the basis for your intervention plan. Make sure to network and share practice with others in a similar role to help you build up a toolkit of strategies and resources on a range of topics.

[5] See HeadStart Hull & Hull Safeguarding Children Partnership Training Diaries
[6] Training provided by Hull City Psychological Services
[7] Listed on page 30 of the old of Need Framework and Guidance
[8] Outcomes Star is used as the Early Help Assessment – the Early Help team provide training for this. Guidance on other emotional well-being assessment tools is available from CORC


Targeted or Specialist Support for Emotional Well-being and Mental Health

Where CYP have multiple needs or they do not respond to additional support, they should be helped to access external support from targeted or specialist services. This could be provided by a single external agency (such as one of the HeadStart Hull Delivery Partners [9], for emotional well-being, or CAMHS interventions [10], for diagnosable mental health conditions). Alternatively, where there are specific risk factors or circumstances impacting on the CYP’s emotional well-being, Early Help or Social Care teams should also be involved as part of a multi-agency approach to provide a Team Around the Family [11]. Support from targeted or specialist services should not be seen as a replacement to the informal or additional support provided within the setting. Consideration should be given as to how support within the setting can best complement external support, for instance ensuring that the child / young person receives regular 1:1 sessions from an Intervener or that there are specific Initiators available to provide informal support.

Top tips for intervenors and influencers: make sure you are aware of local services and know who within your organisation deals with referrals for these. Ensure you follow the protocols for effective collaborative working (in the Thresholds of Need Framework and Guidance).

[9] See the HeadStart Hull checklist
[10] Through Contact Point 01482 303 688
[11] See the Threshold of Need Framework and Guidance


Supporting CYP in (or approaching) Crisis

Crisis, in relation to emotional well-being, is an episode of overwhelming distress that poses an immediate threat to an individual’s physical or emotional well-being. Any child /young person can experience crisis, whether or not they have mental health problems. This may occur as a result of a traumatic event or bereavement [12]. Equally, it can arise from the accumulation of smaller difficulties. Having effective provision for resilience-building, informal support and early intervention can reduce the risk of a child / young person experiencing crisis. Still, all settings should have clear (preferably written) procedures of how to respond should an incident occur. These must include what should be done by the person identifying concerns as well as how, where and by whom the child / young person in crisis should be supported.

Crises can be short-lived, but require immediate intervention in order to ensure a child / young person’s safety and return them to a state of relative calm. Settings should have a number of identified, trained staff who can be easily made available should an incident occur. It is recommended that settings have a fully trained Youth Mental Health First Aider (YMHFA) for every hundred CYP within a setting, with a minimum of two (for example, 15 CYP = 2 YMHFAs, 170 CYP = 2 YMHFAs, 405 CYP = 5 YMHFAs)[13].

Top tips for dealing with a crisis episode:

  • Be clear about the boundaries of confidentiality and of your role;
  • Be direct – ask if they are having suicidal thoughts and/or self-harming;
  • Stay calm and listen non-judgementally;
  • Deal with the immediate situation – reassure, don’t problem solve;
  • Support the CYP to access appropriate support; and
  • Follow-up to address underlying issues and put on-going support in place.

Before reaching crisis or between episodes of crisis, some CYP will experience prolonged periods of intense distress which they struggle to cope with. At these times, CYP might engage in self-harm or other unhelpful behaviours in an attempt to cope with their thoughts and feelings. Equally, they may experience suicidal thoughts. Whilst safety is not immediately threatened in these cases, any child / young person who self-harms or expresses thoughts about this or suicide must be taken seriously and appropriate intervention must be provided at the earliest possible opportunity in order to ensure their on-going safety. If left untreated such distress will result in the child / young person experiencing repeated, increasingly intense crisis episodes. Settings should ensure that there is always an appropriately trained member of staff available to work with a child / young person experiencing extreme distress. These staff should be confident to raise concerns with child / young person, be competent at co-creating safety plans and able to support the child / young person in accessing a range of wider support.

Safety plans

When concerns have been raised, (trained) staff should:

  • Meet with the child / young person to discuss the concerns;
  • Ascertain the child/ young persons view of those concerns; and
  • Agree a safety plan to support the child / young person in managing their distress.

The safety plan should draw on additional and informal support available within the setting as well as wider sources of support available within the local community. Also, during this meeting a referral should be made to the Hull Child and Adolescent mental Health Service (CAMHS) Contact Point where the referral will be triaged to determine the appropriate course of action, this may include a referral to Universal services, targeted or targeted plus. It may be that the child or young person is accepted for further assessment and treatment to Core CAMHS. CAMHS also provide a 24/7 Crisis Team, supporting families where CYP are in crisis. Medical treatment should also be provided, including that from emergency services, if needed.

Guidance should be sought from the clinician as to whether any measures, in addition to the safety plan, should be put in place until this assessment can be carried out.

Staff should ensure concerns are recorded and referred to the Designated Safeguarding Officer/ Lead in the same way as other disclosures. This will enable the Designated Safeguarding Officer / Lead to assess whether the circumstances constitute a safeguarding issue, by discussing where it sits in the Thresholds of Need Framework and Guidance and making a professional judgement on the level of support needed. Accurate records will allow effective monitoring of the situation and support escalation is significant risk [14]. It will also help to identify an appropriate approach to consent and confidentiality.

Following assessment, a follow-up meeting should be held with the child / young person to review the safety plan. If clinical intervention has been put in place, it is important to ensure that the agreed safety plan within the setting complements this. If not, the safety plan should provide the basis of support (i.e. for low-level cases where clinical intervention is not deemed necessary) or act as an interim measure for those awaiting treatment. Where a multi-agency approach is taken (regardless of whether this includes clinical intervention), settings should adopt the protocols described in the Thresholds of Need Framework and Guidance.

Top tips for dealing with extreme distress, including self-harm and suicidal thoughts:

  • Be clear about the boundaries of confidentiality and of your role;
  • Be direct – ask if they are having suicidal thoughts and/or self-harming;
  • Listen non-judgementally;
  • Be solution-focussed and empowering – providing alternative coping strategies
  • Refer to CAMHS for assessment and provide the contact details of other crisis support services [15];
  • Provide on-going support as part of a support team (avoid becoming the sole source of support); and
  • Report it as you would a safeguarding concern.

[12 ]Support and guidance is available from Hull City Psychological Services, CAMHS and Child Bereavement UK
[13] Youth Mental Health First Aiders must complete the full 2-day course. This is available through the HeadStart Hull Training Diary
[14] See Threshold of Needs Framework and Guidance document
[15] Crisis support for young people is available from CAMHS, Papyrus, Samaritans and ChildLine which are all included in the HeadStart Hull Z Cards for young people.


Further Information

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