Fostering Resilience: An Opportunity for Improving Outcomes Mark Conway Specialist CAMHS Team Manager

Opening Activity What is resilience?

Academic resilience - definitions Good educational outcomes despite adversity We can spot the impact of academic resilience through individuals doing better than we might have expected Promoting academic resilience will lead to better behaviour and results for disadvantaged pupils.

Why is it relevant for schools? Resilience research has identified actions that can be taken to enable students to achieve good outcomes against the odds. For schools, promoting it involves strategic planning and detailed practice involving the whole school community, to help vulnerable young people do better than their circumstances might have predicted. Hart

Why Promote Resilience 33% will experience a separation parents (Faulkner, 2011) 25% experience bullying (Faulkner, 2011) 10% will have a diagnosable mental health illness (Faulkner, 2011) 25% of all children have emotional or mental health difficulties (DfE, 2014b) Those with SEN 6X more likely to develop mental health difficulties (Emmerson and Hatton, 2007) Nationally, around 18% have SEND (DfE, 2014b)

Why Collaborative Working is essential

Disease Burden Across Age McGorry, 2007

Barriers CYP report Stigma Schools report similar frustrations How do we talk to universal services? Double stigma? Safe environment to talk? Schools report similar frustrations Lack of resource Lack of knowledge Priorities? Mind the Gap!

CAMHS and Schools Link Project Pilot

CAMHS and Schools Link Project Pilot Commenced in January 2016 Joint funded by NHS England and DfE Part of a National Pilot involving 22 areas One of 10 Case Study Areas Involves 10 Schools in the West of Somerset 3 Secondary Schools 4 Primary Schools 1 First School 1 Middle School 1 Upper School Building upon current capacity

CAMHS and Schools Link Project Pilot Emphasis on: Clarifying roles, responsibilities and pathways Offering bespoke training and development Providing consultation Promoting good mental health and early intervention Speeding up access to advice and guidance Promoting joined up practice and pooled resources Challenging the “tiered approach”

Resilience in the Context of Risk

The Bio-Psycho-Social Model Positive Biological Make-up Positive Psychological Wellbeing Positive Social Experiences Resilient Child

Risk Factors Protective Factors Biological Exposure to toxins (e.g., tobacco, alcohol in pregnancy) Genetic tendency to psychiatric disorder Head trauma Hypoxia at birth and other complications HIV Infection Malnutrition Substance abuse Other illness Age-appropriate physical development Good physical health Good intellectual functioning Psychological Learning disorders Maladaptive personality traits Sexual, physical, emotional abuse and neglect Difficult temperament Ability to learn from experiences Good self-esteem High level of problem-solving ability Social skills

Risk Factors Protective Factors Social- Family Social- School Social- Community Inconsistent Care giving Family conflict Poor family discipline Poor family management Death of a family member Academic failure Failure of schools to provide appropriate environment to support attendance and learning inadequate or inappropriate provision of education Bullying Lack of “community efficacy” Community disorganisation Discrimination and marginalisation Exposure to violence Lack of sense of “place” Transitions Family attachment Opportunities for positive involvement in family Rewards for involvement in family Opportunities for involvement in school life Positive reinforcement from academic achievement Identity with school or need for educational attainment Connections to community Opportunities for leisure Positive cultural experiences Positive role models Rewards for community involvement Connection with community organisations

Likelihood of negative outcome Risk and Outcomes # Risk Factors Likelihood of negative outcome So what differentiates those who do well in adversity from those who struggle? And Can those who struggle in the context of risk be supported to achieve better outcomes?

What would we see in the emotionally resilient child?

The Emotionally Resilient Child Knows they have someone close who loves them unconditionally Will confide their thoughts and feelings in someone when needed Is able to play or work independently Has a positive outlook on life Is willing to try new things Likes to achieve things and receive praise Likes themselves Has confidence in their own abilities Has a sense of humour Has plans and ideas Has people they know they can count on to help them (Grotberg, 1997)

What Can Therapist’s in School do to foster/grow Resilience? Schools as a universal context for young people. Primary context outside of the home Frontline- Facilitate early identification of need Provide opportunities for training and development School based interventions Need for common measures

What Can CAMHS Do to Support Resilience? Primary Mental Health Link Support Be present Provide consultation Early Intervention Provide resources Training and Development- Evidence-based Partnership working

Which Way…

Not all interventions are equal Moving and creating a new ethos can be challenging (Spoth et al. 2001; Sugai & Stephan 2013) Continual Audit and Evaluation- not all interventions produce good results (Stallard et al. 2012) Does not need to be expensive- In fact, it can be very economical: Needs Championing Strong leadership CYP Involvement Family Involvement (Whole School Community Approach)

Key Themes for the CYP All approaches should have five key themes at their heart: Promoting self-awareness Developing confidence and self-esteem Becoming self-reliant and independent Recognising their own boundaries, strengths and limitations Managing feelings Learning to self-regulate Becoming emotionally resilient Being sensitive to the feelings of others Developing a positive attitude Building an effective learning style Encouraging a questioning mind Overcoming disappointments and setbacks with effective problem-solving Facilitating empathy Living and learning alongside others Respecting difference and diversity Showing appropriate care and concern for themselves and others Building social skills Developing positive peer relationships Understanding social roles and rules Knowing when and how to look for help

Key Strategic Themes Whole school focus to build an agreed shared culture and identify that support emotional wellbeing. Specific teaching of social and emotional skills Booster intervention workshops for parents of children and young people Working with parents to enhance parenting knowledge and capacity to support their child’s emotional wellbeing Working with children in small groups to help build positive pro-social behaviours and strategies to enhance emotional regulation To help generalise school and home learning, promoting positive problem-solving and strengthening emotional resilience Holding regular ‘nurture’ groups for vulnerable people Using play-based activities to build communication and relationship skills Individual teaching to identified ‘at risk’ children Building teacher skills in positive classroom management and organisation

What’s Next… The Schools Link Pilot will continue Greater emphasis on role clarification Increase awareness of the importance of resilience and early intervention Workshops on ROMs Provide training and consultation on resilience programmes for at least 2 of the schools CYP Participation Group going into schools to challenge stigma Schools to consider using CYP Champions Potential expansion of pilot being considered Establish group interventions in school Additional Consultation with professionals offering 1:2:1 support. County-wide Conference to be held