Fiona Wilson, Lead Occupational Therapist at Mindworks Surrey, describes how her work within The Educational Pathway of the Reaching Out service demonstrates the application of the THRIVE Framework for system change (Wolpert et al., 2019) in an educational context. The service aligns with the THRIVE Framework’s Getting Help needs based grouping. Furthermore it aligns with key principles of the THRIVE Framework; shared decision making, partnership working, outcomes informed.
The Reaching Out service at Mindworks Surrey, supports the most vulnerable and isolated children and young people in the community, through a multi-agency network. The Education Pathway provides Occupational Therapy group interventions into Surrey’s Short Stay Schools (previously Pupil Referral Units), to children at risk of exclusion or who have been permanently excluded from mainstream education.
The aim of this service is to enable children and young people to build self-esteem and resilience through activity, and assist them to develop strategies to cope with their everyday stresses, negative feelings, and issues they may be facing. It’s about making a direct link between the activities they regularly engage in (occupations), and their impact on well-being. In the Short Stay Secondary Schools, key components of the group programme are: doing together, giving choices about the activities, using the local community, validating feelings, and giving positive feedback.
SHARED DECISION MAKING
In our first session, we explain the programme and try and get to know the child or young person’s strengths, challenges, preferences and aspirations. We write an occupational formulation to share with the student in a 1:1 follow-up – this is an important opportunity to validate the young person’s perspective and agree their focus for the intervention. The input we receive from students continues throughout their intervention. Secondary school students are involved in deciding on the content of sessions – e.g. what sort of activity or outing we’ll do.
In secondary schools, groupwork is complimented by 1:1 sessions with attendees. On completing the programme, young people receive a letter summarising their engagement and progress, which outlines appropriate services or resources that might be beneficial, including mental health services, sports clubs and hobby groups. We also support young people to seamlessly transition to our Alliance partners who have a myriad of support available. Where there are concerns about engagement or vulnerability, young people may need to be referred and supported to engage with more specialist services who can better meet their needs. By the end of the session, the hope is that they develop trust in the Occupational Therapist and are more willing to engage with services they are signposted to, to help with their ongoing needs.
PARTNERSHIP WORKING – BUILDING CAPACITY THROUGH CONSULTATION AND INFORMATION SHARING
Mutual respect and shared responsibility
Working in partnership across different schools, social care, charitable sectors and CAMHS has been paramount to providing a safe and effective service. Working with educational colleagues has been vital to understand students’ backgrounds, what the student is currently facing and also the dynamics between students which can be complex and influence sessions. We work with school colleagues to offer new insights on sensory and mental health needs. It’s very much about working together in partnership to best support young people and learn from each other, building capacity.
For example, teaching staff support sessions, encouraging engagement and help students make links to their broader school life. In primary schools we share our co-produced regulating strategies with the school so they can begin to support the child to use them before returning to their mainstream school.
Supporting Children and Young People’s emotional mental health needs to be understood and met.
We work closely with our Mindworks partners and members of the young person’s network to meet their needs. Where a young person has an undiagnosed neurodevelopmental condition, is attending a Short Stay School and there is growing risk or deteriorating mental health, we have escalated this with colleagues in CAMHS or the ND service, as appropriate.
In the primary schools the Occupational Therapist and child co-create an individualised “my safety plan” which is shared with the child’s Short Stay and mainstream school SENCOs. It incorporates information about triggers for distress, what it looks and feels like to the child and what the child and others can do to pre-empt or respond to distress. It includes many simple sensory activities that the child can trial in groups.
“ The fact that this has been jointly created with the child and yourself as someone with a specialism in this area, combined with the opportunity to practice these strategies is incredible. We will very much be using this resource” (Feedback from SENCO).
Capacity building through development of a shared understanding of YP’s MH across services
Young people in Short Stay Schools have most often had to endure so much in their lives, they need time and care to understand them and meet their needs. Our work with schools supports a shared understanding of what could be underlying chaotic, withdrawn or disruptive behavior. We are able to learn from one another, adopt a trauma informed approach and view challenging behaviours through the lens of the young person which can promote meaningful engagement and transformation.
Feedback from schools, children and young people
Young people have reported improved motivation, engagement and positive first contact with emotional wellbeing and mental health services. We have observed major improvements in young people’s ability to regulate emotions and manage distress.
The secondary school programme has been well-received by young people.
- 83% of secondary school attendees agreed they felt listened to in the group
- 78% of the students agreed that they liked most of the activities in the group
- 83% of the students agreed they felt included in the group
- 100% of the students agreed that Occupational Therapy staff were friendly to them.
“The activities were helpful because I can feel when things are not right, because all these things and drawing stuff makes me feel better and calms me down.” Primary student
“We love the Reaching Out project, the pupils look forward to the sessions and are happy and willing to participate. The different strands to the project certainly meet the needs of our pupils and help in the process of successfully reintegrating pupils back in to mainstream education.” Assistant head teacher (secondary)
NEXT STEPS AND GOALS TOWARDS BEING MORE THRIVE-LIKE
- Outcome informed – continually refining our offer by utilizing pre-post assessment outcomes and feedback. We also intend to evaluate the impact of the service on resilience, confidence and engagement in occupations that support student’s mental health through goal-based measures.
- Accessibility – Some students are undergoing assessments for EHCPs whilst we are seeing them and we have begun sharing our pre-group assessments with the aim of supporting the child or young person to access the right support in the most appropriate setting. We would like to be in a position to offer sensory assessments within school across all the Short Stay Schools. Addressing children and young people’s unmet sensory needs could increase engagement at school.