The School Wellbeing Service is a school-based early intervention mental health support service. It is jointly funded by health, local authority and schools in York. The School Wellbeing Workers (SWWs) are managed by the local authority, clinically supervised by the Child Adolescent Mental Health Service (CAMHS) and based across a cluster of schools. Their focus is to work with children and young people and school staff around emerging and developing mental health need. In particular, this work is with children and young people who are presenting mental health issues and concerns that are below an intervention from specialist CAMHS and above what school pastoral structures can support. The SWWs provide schools with consultation and advice, training, direct work in partnership with school staff and increased communication with specialist CAMHS services.
Part of our Early intervention into action series of case studies on innovation and evaluation
The ambition in York is to secure good mental health and emotional wellbeing for all children and young people in the city in order to ensure they achieve their optimal potential. The CAMHS Executive, which is a Partnership Board in York set up to drive forward this vision, has become increasingly aware of the need for early intervention support in schools for children and young people around their social, emotional, mental health and wellbeing. Direct feedback from children and young people, teachers and specialist services has brought into clear focus that it is ‘everyone’s responsibility’ to find an effective response to this developing need. Building on and linking in with national guidance and developments around ‘Future in Mind’ York has been able to work with partners to develop, explore and pilot an early intervention service model for schools. The School Wellbeing Service pilot (originally called the CAMHS Cluster Pilot) provided York with an opportunity to develop a partnership between the local authority, CAMHS and schools to explore an effective service model. The aim of the pilot was to increase the capacity and expertise around mental health and emotional wellbeing within schools, in order to strengthen the support arrangements for children and young people. The pilot helped York to learn together and gather evidence needed to inform discussions and decisions about the future commissioning of effective services, support and interventions for children and young people.
The CAMHS cluster pilot was created to devise, pilot and evaluate a multi-agency initiative overseen by the CAMHS Executive and delivered in partnership by Child and Adolescent Mental Health Services (CAMHS), City of York Council (CYC) and school clusters, to strengthen the emotional and mental health support arrangements for children and young people in universal school settings. Through the project, two new CAMHS band-5 roles were created. Children and young people expressly rejected ‘mental health’ as part of the job title, consequently the new role was named “Wellbeing Worker”. The Wellbeing Workers were attached to two school clusters of 10 schools each, where they negotiated the exact nature of their work in schools with pastoral leaders in each school. Clinical supervision was provided by the CAMHS service.
What worked well?
The project was led by a mature and powerful multi-agency steering group that includes CAMHS, the clinical commissioning group (CCG), schools and the local authority. Having everyone in the room challenging and steering the work is a real strength. For the pilot, there was a board and a working group. Originally, the board included senior people and the working group was the people doing the delivery, but over the course of the pilot these two merged into one, as there were many of the same people at the meetings. Now there is one consolidated steering group. This includes pastoral leads and heads in schools, principal EPs and the senior manager in CAMHS, the local authority associate director and the CCG lead commissioner. The partnership is critical, particularly where it engages in collective problem-solving, assuring accountability, ensuring good communications and overseeing delivery.
The presence of School Welfare Workers on the ground is crucial. They are a visible, accessible additional resource in schools, with capacity to put the additional resource into effect immediately and to avoid knee-jerk panic referrals to other services. Schools are managing their demand more effectively.
What is hard or challenging?
- It is hard to implement a new service where there are constraints and pressures around resources generally. The service needs to clearly identify what they are and aren’t. They can be pulled in a number of directions because there are multiple resource gaps that schools want you to fill.
- There is a need to really focus on interventions that are evidence-based and use these to up-skill schools. There is a real need to make the best use of time and resources.
- Being called a School Wellbeing Service hasn’t helped with defining the scope, because ‘wellbeing’ is so comprehensive.
How are these challenges being overcome or addressed?
- 1 and 2: The service has to be really clear what the service is and isn’t, particularly as a new service when the workers want to please and the system wants you to please it and fit in.
- 3: The service may change its name to Early Intervention Mental Health Service in Schools, although there is some reluctance to do this as ‘mental health’ carries with it some stigma.
About the evaluation
A detailed evaluation framework was developed to test and generate evidence against the intended project outcomes. Baseline data was collected through staff surveys and semi-structured interviews with head teachers. In all direct work with children and young people, a locally developed questionnaire, the Social, Emotional and Behavioural Competencies (SEB) questionnaire, was completed. Questionnaires were completed in group work and training workshops, and case studies have been developed to demonstrate ‘what has worked’.
Two measuring tools were used to record any changes in children and young people’s emotional wellbeing and mental health following involvement in group or individual work. In the majority of cases children and young people showed an improved score following intervention. A cost-benefit analysis is also provided in the interim evaluation.
What changes or outcomes were observed?
- The capacity and confidence of frontline services to respond to the emotional and mental health needs of children and young people in universal school settings is maximised and increased.
- The number of children and young people receiving effective, evidence-based and timely emotional and mental health support is increased.
- Children and young people feel more able to cope with emotional and mental health issues and concerns in a school setting.
What are the key lessons about conducting evaluation?
Evaluations need to be kept simple and focused on the ‘so what’ of the questions. Originally the evaluation plan had pages and pages and pages (eg A&E admissions for mental health, attendance, achievement, etc) with no limit to the data. However ultimately the focus is on ‘so what’ and has to help the project lead to give a clear argument and justification to a set of senior decision-makers and funders. The project lead needs to be able to show ‘this is the difference this has made’ in a succinct way that makes sense and is validated.
What effect did the evaluation or its results have?
The April 2016 interim evaluation report showed that the model was beginning to deliver positive outcomes against the project aims. The interim evaluation enabled funding to be secured for the future roll-out of wellbeing workers across all schools in York.
What are the key lessons?
- Evaluation is critical to sustaining input and buy-in, particularly when an intervention is new and could fill many roles.