Anxiety and Emotional Wellbeing - The Grid

Anxiety and Emotional Wellbeing - The Grid

Emotional Wellbeing and Anxiety in Schools and Settings 16/3/17 Breda ONeill CAMHS Schools Link Manager East and North Hertfordshire Clinical Commissioning Group Roz Frampton Educational Psychology Manager (S/NH) Which strategies have best helped you to support these children/YP in school?

During this session, please write down your ideas on post-it notes & place these on the boards. These will be typed up afterwards & made available to participants. Emotional Wellbeing A range of factors impact on emotional wellbeing and any feelings of loss of wellbeing Take care of yourselves you need to have spare emotional capacity how do you achieve this?

Group Activity: Emotional Wellbeing (10 minutes) How are you feeling right now? How has what has happened in the last 24 hours affected your wellbeing now and for the rest of the day? Think about children/YP you know who exhibit a loss of emotional wellbeing. How might the following factors impact on their perception of a loss of emotional wellbeing and what can educational settings do differently to promote emotional wellbeing? Systemic/organisational factors Interpersonal interactions (peer-peer, adult-peer) Individual factors (eg self-esteem, subject interest, skill level,

confidence, fatigue, self-beliefs) Moving forwards/Goal-setting Promote a whole school approach emotional wellbeing: it is important for this to be the starting-point. Involve children/young people when setting their goals Start with smallest possible step and build on this. ENVIRONMENT / MANAGEMENT

(Perceived world) BIOLOGY THOUGHTS ACTIONS FEELINGS Resource Pack 1 Introduction/Ideas during the session 2 Emotional Wellbeing

3 Emotional Wellbeing Group Activity (10 mins) 4 Moving forward/goal setting, interactive factors framework 5a Scenarios: A, B or C (look through following information on anxiety/group discussions relating to scenarios 15 mins, followed by whole group discussion) 5b Anxiety 6 Support/Approaches/Resources Group Exercise Scenario A Groups to look at either Scenarios A, B or C as identified. If time, groups can look at the other scenarios. Discussion: 15 minutes A 4 year old boy has speech and language issues and some developmental delay. His behaviour includes hitting out

and biting people on a regular basis. (Use the framework in the pack to consider any underlying factors within the environment and the child impacting on what is seen.) What observations may be important to gain an understanding of this behaviour, supporting this young child and advising staff? How might these observations suggest different interpretations underlying the behaviour adults are seeing? What might these behaviours be communicating? How could settings provide systemic approaches to respond to what is being communicated? What reasonable adjustments might need to be made in accord with the Equality Act (2010)? What training do different groups of staff need in order to become more confident in supporting this child within the setting? How many children do you see similar to this within your settings? What would you consider when exploring exceptionality?

Feedback: Possible interpretations underlying the behaviour seen and possible approaches Group Exercise Scenario B Groups to look at either Scenarios A, B or C as identified. If time, groups can look at the other scenarios. Discussion: 15 minutes An 11 year old girl, who has difficulty coping with change and transitions at school, appears very preoccupied and worried. She has disengaged from learning. (Use the framework in the pack to consider any underlying factors within the environment and the child impacting on what is seen.) What observations may be important to gain an understanding of this behaviour, supporting this young child and advising staff? How might these observations suggest different interpretations underlying the behaviour adults are seeing? What might these behaviours be communicating?

How could settings provide systemic approaches to respond to what is being communicated? What reasonable adjustments might need to be made in accord with the Equality Act (2010)? What training do different groups of staff need in order to become more confident in supporting this child within school? How many children do you see similar to this within your settings? What would you consider when exploring exceptionality? Feedback: Possible interpretations underlying the behaviour seen and possible approaches Group Exercise Scenario C Groups to look at either Scenarios A, B or C as identified. If time, groups can look at the other scenarios. Discussion: 15 minutes

A 13 year old boy has had a difficult childhood including a mother who has had difficulties with substance abuse and a father who has been very strict and aggressive. He was neglected emotionally and physically and has witnessed DV. He has had many home moves. He becomes very angry without any identified triggers and can be physically aggressive. At other times he is very warm and engaged. Normal sanctions are not effective. (Use the framework in the pack to consider any underlying factors within the environment and the child impacting on what is seen.) What observations may be important to gain an understanding of this behaviour, supporting this young child and advising staff? How might these observations suggest different interpretations underlying the behaviour adults are seeing? What might these behaviours be communicating? How could settings provide systemic approaches to respond to what is being communicated? What reasonable adjustments might need to be made in accord with the Equality Act (2010)? What training do different groups of staff need in order to become more confident in supporting this child within school?

How many children do you see similar to this within your settings? What would you consider when exploring exceptionality? Feedback: Possible interpretations underlying the behaviour seen and possible approaches Anxiety A normal response in certain circumstances - we all get anxious at times Can help performance Usually future-focused Problems with anxiety are really common. Anxiety UK state as many as 1 in 6 young people will experience an anxiety problem at some point in their lives

Brain arousal Triggered by brain responses to perceived threats alerting the body systems to respond (perceived threat can be due to being asked a question, for example). This perceived threat leads to a physiological response involving the hormone adrenaline, which results in the fight or flight responses. We either have to hit out (actions, words) or remove ourselves. (This is difficult for children/YP who are often penalized either way, even though they are caught up within a physiological response, which leads them to doing one or

the other. Eventually, when they no longer feel threatened/anxious by these situations, they will be able to respond differently.) Overwhelming feelings of fear, dread and a desire to avoid this provides a short-term solution Anxiety is maintained if avoidance continues as this reinforces the danger

A gradual approach with small steps is evidence based as being the most effective. Depending on the individuals situation, the time involved to achieve this varies. When is Anxiety a problem If adults do not have enough spare emotional capacity because they are tired, stressed, etc & they are not able to be receptive or other demands take priority Severity of impact on day to day life including sleeping, eating, attending school, friendships Includes different types: social, generalised, panic, posttraumatic, phobias, obsessive-compulsive, separation How can adults help ? Gain an understanding of what thoughts and feeling may

underlie any anxieties - observation, discussion with parents/carers and child/YP. (Holistic picture including home, with their peers.) What is the child/YP communicating? Anger is often easier to express than vulnerability the child/YP may be unaware of the feelings underneath. How can we help? Use of parent-mail and workshops to promote knowledge and skills in relation to anxiety and emotional wellbeing for children/YP and adults. Common symptoms of separation anxiety: Fear that something terrible will happen to a loved one. Worry that an unpredicted event will lead to

permanent separation. Nightmares about separation. Refuse to go to school. Display reluctance to go to sleep. Complain of physical sickness e.g. headache or stomach ache. Cling to the caregiver. Common causes of separation anxiety in children Change in environment. In children prone to separation anxiety, it is possible that changes in surroundingslike a new house, school, or day care situationcould trigger

separation anxiety disorder. Stress. Stressful situations like switching schools, or the loss of a loved one, including a pet, can trigger separation anxiety disorder. Over-protective parent. In some cases, separation anxiety disorder may be the manifestation of the parents own anxietyparents and children can feed one anothers anxieties. Social anxiety Extremely common in adolescents (12-17yrs) but can be experienced much younger and one of the commonest forms of anxiety seen in school refusers

Normal social anxiety is transient and short lived, but it can be severe and disabling Fear of being scrutinised, evaluated or being at the centre of attention. Underlying fear is that they will be evaluated negatively (they wont like me, theyll think Im stupid Social situations feared include: Reading aloud in front of the class Starting/ joining in with conversations

Answering a question in class Answering or talking on the telephone Strategies to promote emotional wellbeing & reduce anxiety Encourage child/YP to talk about their feelings and reassure them that it is ok to feel anxious, upset, angry etc at times Psycho education, normalise, help identify & understand thoughts, feelings and underlying beliefs and the impact of brain and body Give the message that asking for help is a sign of strength and help child or young person label their emotions

Provide tools eg relaxation techniques, self monitoring measures helps child/YP to cope and manage anxiety Strategies (contd) Model emotional regulation Provide consistency and safety physical and emotional boundaries, structure and predictability are very important Prioritise strengths of the child and resilience factors - focus on building up small successes It is important for the child/YP to have one key relationship? Who is this? (Two key members of staff might be helpful in case one is away &/ or preventing over-attachment.) Provide a Safe Space. This could be a tent within the classroom or

identified room, for example. (NB Remember fight-flight response and the need to have somewhere to go.) Use verbs when referring to a state (eg worrying) as this suggests change is possible, rather than nouns which refer to a more fixed state. Support/Approaches Standardising recording in order to combine across the county and know more about what works for whom, etc Whole school level: using data to assess whole school effectiveness, trends, screen for emerging difficulties Triangulating mental health data with attendance and attainment data, complexities Exploring add on to SIMS / CPOMS

Engaging partners with an interest in the data potential Individual level: using tools to assess need, track progress, shape and evaluate interventions Use of therapeutic approaches, including CBT Support/Approaches (continued) Current working to produce cross-agency guidance for settings and looking at what is already in place to support early intervention within educational settings. Multi Agency Anxiety Working group including Health/ISL/School Representatives. Working with CAMHS, ISL, DSPLs

Producing materials, workshops, training www.minded.org.uk www.rcpsych.ac.uk www.rcpsych.ac.uk www.rcpsych.ac.uk Useful resources Understanding School Refusal. A Handbook for Professionals in Education , Health and Social Care.

Thambirajah, Grandison and De-Hayes (2008) SEND Code of Practice (Jan 2015) Separation Anxiety in Children Addressing School Refusal Behavior: Suggestions for Frontline Professionals (October 2005) Children & Schools. 17.4. C.A. Kearney has written useful articles on school refusal and anxiety Useful resources (continued) A Straight-talking introduction to Childrens Mental Health Problems. Sami Timimi (2009) PCCS Books Helping children who are anxious or obsessional. Margot Sunderland (2001)

Speechmark Publishing Ltd. Helping Children who bottle up their feelings. Margot Sunderland (2001) Speechmark Publishing Ltd. Helping Children with loss. Margot Sunderland (2003) Speechmark Publishing Ltd. Helping Children with fear. Margot Sunderland (2003) Speechmark Publishing Ltd. Useful resources (continued) Mental Health and the Resilient Therapy Toolkit Experience in Mind/Mind Brighton and Hove/Sussex Central YMCA/Angie Hart/Sam Taylor (2011) ISBN 978 0 9557955 1 0* A Whole School Framework for Emotional Well Being and Mental

Health, a self-assessment and improvement tool for school leaders (2016) National Childrens Bureau* Academic Resilience Framework (Children & Young People) Oct 2012 adapted from Hart, Blincow and Thomas 2007. Young Minds* Young Minds & Neuroscience* 101 Tips to reduce stress. Mental Health Foundation* How to overcome fear & anxiety. Mental Health Foundation* Useful resources (continued) Some Pointers When Considering School Refusal* CAR (Choice Theory, Reality Therapy)* School attendance & engagement in learning

questionnaire* Adolescence* Tools for Schools. thegrid.org.uk * These will be sent to you by e-mail link.

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