Supporting the whole-school approach

1.1.6.

Support the whole-school approach by:

• having an outward-facing approach to the community and to engaging with local communities and groups
• strengthening links to external agencies that can provide additional support, such as local children’s health and care services and relevant voluntary and community sector organisations
• having shared principles for engagement between education and mental health services, for example agreeing referral pathways
• promoting the involvement of education providers in wider local strategic decision making about children and young people’s mental health
• having ways of feeding back to parents and carers.

1.1.7.

Ensure that school governance structures support the whole-school approach and that school leadership is actively involved in supporting the whole-school approach. Make the responsibility for social, emotional and mental wellbeing curriculum content part of the remit of school leadership (including governance).

Supporting staff

1.1.8.

Ensure that staff have continuing professional development to support both their own wellbeing and the implementation of the school’s approach. This could include training in emotional literacy, trauma, neurodiversity, communication needs and relational approaches.

1.1.9.

Signpost staff to quality-assured local and national resources to support their wellbeing in line with the Department for Education’s education staff wellbeing charter.

1.1.10.

Support staff in their pastoral roles by providing protected time for supervision and continuing professional development.

1.1.11.

Make peer supervision available for teachers and other school staff to enable them to have space and support to discuss issues and reflect on practice.

1.1.12.

Ensure that all teachers can recognise children and young people’s pastoral needs, and that they understand the wider context of the pupils’ lived experiences and how they interact with their environment. Provide them with additional training or support if needed.

1.1.13.

Ensure that all information held by the school related to the local early help offer is kept up to date.

Involving families and pupils

1.1.14.

Involve parents and carers in designing and implementing the whole-school approach.

1.1.15.

Involve children and young people in discussing and agreeing whole-school approaches and communicate with them regularly about decisions, so they understand how their views inform practice. Take into account the opinions of all members of the school community. This may mean making adjustments to address neurodiversity and communication needs.

Implementing the whole-school approach

1.1.16.

Designate a lead person to determine what is needed to successfully implement universal curriculum interventions. The lead should also be the go-to person for advice on the most appropriate educational resources for any intervention. The lead person should be someone in a leadership post who has strategic responsibilities and oversight of social, emotional and mental wellbeing across the school.

1.1.17.

When implementing whole-school approaches, take into account the core values that the school culture and practice are built on, and the psychological safety of pupils, staff members and leadership. For example, this could involve developing a school culture and ethos in which children, young people and staff feel safe to make and learn from mistakes.

1.1.18.

Adopt a ‘graduated response’ (or ‘step up–step down’) approach to support (moving between universal and targeted support as relevant) as an integral part of the whole-school approach alongside broader universal approaches. Ensure that staff understand this approach and have the right support to implement it (see the recommendations on targeted support).

Local support

1.1.19.

Local public health departments, and children and young people’s mental health services, should proactively gather and be responsive to the views and concerns of schools and colleges in their area about children and young people’s social, emotional and mental wellbeing.

1.1.20.

Local authorities should compile, and keep up to date, a directory of the local services that promote children and young people’s social emotional and mental wellbeing and are available to support schools in their area. This should include:

• what the services can offer
• local mental health and special educational needs and disability (SEND) services, including services that might be less well known
• details of how to access the services.

1.1.21.

Take risk factors for poor social, emotional and mental wellbeing into account when developing the Joint Strategic Needs Assessment. This should include the contribution that schools can make to improving social, emotional and mental wellbeing and take into account schools’ impact on learning and life chances (see the recommendations on identification and risk factors).

1.1.22.

The local integrated care system and schools should work together to identify opportunities for joint practice to support the social, emotional and mental wellbeing of children and young people, for example agreeing principles for when and how to share information.

Identification and risk factors

1.3.1.

When considering whether a child or young person has risk factors for poor social, emotional and mental wellbeing, take into account:

• the number, duration and complexity of risk and protective factors, their cumulative effects and interactions between them
• that the effects of risk and protective factors, or combinations of factors, might differ across life stages
• that they may have unidentified or unmet educational needs, for example special educational needs or disabilities that impact on their ability to access education.
  For a list of risk and protective factors, see table 1 in the Department for Education’s mental health and behaviour in schools guidance. Be aware that the list is not exhaustive.

1.3.2.

Base the identification of children and young people at risk of poor social, emotional and mental wellbeing on information from a variety of sources, for example observation, self-report and consideration of their early life experiences. Be aware that some children and young people will internalise their distress and will therefore be more difficult to identify.

1.3.3.

Assess children and young people identified as at risk and decide whether to monitor their social, emotional and mental wellbeing or to offer them targeted support (see the recommendations on tools and techniques). Take into account any existing assessments, for example from educational psychologists or child and adolescent mental health services.

1.3.4.

When identifying risk in children and young people with disabilities or special educational needs, ensure that staff understand the graduated response to need as specified in the current Department of Health and Social Care and Department for Education’s special educational needs and disability (SEND) code of practice, and that they can respond with relevant interventions. If necessary, they should seek input from specialised external agencies.

Tools and techniques

1.3.5.

If using a tool or technique to assess a child or young person who has been identified as at risk of poor social, emotional or mental wellbeing, consider using one that is validated (see Public Health England’s guidance on measuring mental wellbeing in children and young people).

1.3.6.

When selecting a tool or technique to assess social, emotional and mental wellbeing, take into account:

• the child or young person’s needs, wishes and feelings
• the purpose of the assessment
• how the tool or technique fits with the school culture and ethos
• contextual factors, such as the child or young person’s chronological or developmental age or ethnicity and any communication needs (being aware that assessment tools are context specific and vary in quality).

All transitions and life changes

1.5.1.

Train staff to recognise the wide-ranging impacts of transitions and life changes on children and young people’s social, emotional and mental wellbeing, taking into account that they may differ between individuals, for example because of cultural background, age and gender. This includes recognising both planned (for example, moving between schools or classes) and unanticipated life changes, and the different ways that a child or young person typically expresses their mental health problems and responds to trauma.

Transitions between schools and classes or leaving education

1.5.2.

Plan and offer tailored interventions to prepare children and young people for educational transitions and for leaving education completely. This includes:

• Establishing a relationship with the child or young person and their parent or carer.
• Gathering the child or young person’s views about their transition.
• Supporting the child or young person to feel ready for the transition, for example understanding how they will get to and from the new school or job.
• Sharing with the new class or school and staff information about the child or young person that will help them. The information should be positive and not set out to victimise or stigmatise them, and it should be shared in line with the National Data Guardian’s Caldicott principles.
• Identifying and communicating with the professional and personal network around the child or young person, if there is one, as part of good transition support.
  Also follow these principles for any managed moves (in which a child or young person is placed in a new school by the local authority or by school-to-school voluntary agreement).

1.5.3.

Support the child or young person at the time of the educational transition to cope with the loss of important relationships caused by the transition.

1.5.4.

Enhance children and young people’s sense of belonging in the new school or class, for example by organising a peer mentor or buddy for them (see recommendation 1.4.6).

After transitions between schools

1.5.5.

Check on an ongoing basis to see whether the child or young person is settling in and thriving after moving to a new education setting. Offer them tailored support if necessary. Check more regularly if the child or young person is at a higher risk of poor social, emotional and mental wellbeing.

1.5.6.

Promote peer mentoring between a child or young person entering a new education setting and a peer who has training in mentoring (see recommendation 1.4.6).

Significant life changes

1.5.7.

Address needs identified by children or young people (or their parents or carers) going through significant life changes, mental health problems or mental illness. This should involve the special educational needs and disabilities coordinator (SENCo) or designated safeguarding lead and other agencies if necessary.

1. Early signs of poor social, emotional and mental wellbeing

What are the early signs of social, emotional and mental wellbeing issues, including in children and young people who are internalising it?

a)

What early factors predict poor social, emotional and mental wellbeing?

b)

How do children and young people with poor social, emotional and mental wellbeing describe their thoughts and feelings at early onset stage?

c)

What are the barriers and facilitators to identifying children and young people at risk of poor social, emotional and mental wellbeing at school?

2. Intersecting social, cultural and personal factors

What is the role of intersecting social, cultural and personal factors in developing poor social, emotional and mental wellbeing?

3. Targeted support

What is the effectiveness (including long-term effectiveness) and cost effectiveness of targeted group or individual interventions for children and young people who have been identified as needing additional mental health support, and does it vary by ethnicity, socioeconomic status or other cultural and personal factors?

4. Effectiveness of interventions

What components of interventions or approaches to promote social, emotional and mental wellbeing are effective and cost effective?

5. System leadership and service delivery

How can practitioners, institutions and organisations work together to improve systems leadership that impacts collectively on positive outcomes for children and young people’s social, emotional and mental wellbeing?

Children and young people with special educational needs

Are children and young people with special educational needs at higher risk of poor social, emotional and mental wellbeing?

Harms and unintended consequences

What are the possible harms and unintended consequences of targeted group or individual interventions for children and young people who have been identified as needing additional mental health support?

Targeted support

What are parents’ and carers’ views on targeted group or individual interventions for children and young people who have been identified as needing additional mental health support?

Views on transitions to secondary school

What are the views and experiences of children about moving to secondary school?

Support for transitions

What do children and young people, including those from underserved populations, find useful to support life changes in the context of their education?

Impact of COVID-19

What is the medium-to long-term impact of the COVID-19 pandemic on children and young people’s social, emotional and mental wellbeing?

Why the committee made the recommendations

The committee agreed that the inclusion health agenda (for example, see the Office for Health Improvement and Disparities [previously Public Health England] inclusion health: applying all our health) and tackling inequalities were central to this guideline. When implementing the guideline, schools and wider system partners would need to pay particular attention to marginalised or excluded groups, both in terms of their involvement and in terms of tailoring the recommendations to meet the needs of those groups. The committee made special consideration of the needs of children and young people with learning difficulties and special educational needs and disabilities (SEND). They agreed to place neurodiversity at the heart of their considerations and received expert testimony on the topic to inform their discussions. Professionals from special schools were represented on the committee, and the focus group work with children and young people that NICE commissioned included people from schools with high rates of SEND and from special schools and pupil referral units.

The committee discussed the benefits of implementing a whole-school approach for children and young people’s social, emotional and mental wellbeing, including preventing the onset of poor outcomes and supporting those with identified needs. They agreed that this could have implications far beyond school environments, for example on employability and anti-social behaviours. The quantitative studies included various whole-school approaches with different combinations of components and various aims, although the strongest evidence was about bullying. They showed some benefit and no harms or adverse consequences. The qualitative evidence showed that pupils and teachers valued whole-school approaches and believed that they had a positive effect on school culture. Overall, the committee agreed that there was some evidence to support the effectiveness of whole-school approaches. There was evidence about the acceptability of whole-school approaches and what made them more or less likely to work, and the committee had more confidence in the findings from these studies than the quantitative ones. This evidence was supported by their expertise and experience and by the testimony of invited expert witnesses.

The committee heard expert testimony about relational approaches being more effective than using purely punitive behaviour management systems for managing social, emotional and mental wellbeing in children and young people. Together with this and their own experience and expertise, they agreed that embedding a relational approach in the overall culture and ethos of the school was the basis of a successful whole-school approach, and this would need to be reflected consistently in school policies and procedures. Reviewing policies regularly would help to ensure that this happens. Although the committee were not able to set a specific timeframe for review because there was no evidence, they agreed that annually would be reasonable. They also agreed that leadership was key to embedding this approach and that the leadership needed to come from a senior person. They discussed that this might fit well with the role of the designated school mental health lead. However, because this is a developing role, they agreed it would be premature to specify this. Additionally, having heard expert testimony about trauma-informed approaches in schools, the committee encouraged a shift towards these approaches to understand and therefore manage behaviour.

The committee regarded the whole-school approach as a framework that other interventions can slot into. They noted that interventions such as targeted support have a better chance of success if schools actively engage with local agencies. They also agreed that, to be effective, a whole-school approach needed monitoring and evaluating to make sure the approach was working.

The committee also noted that it would be more useful if future research focused on the effective components of interventions or approaches (see the recommendation for research on effectiveness of interventions).

How the recommendations might affect practice

The recommendations reinforce current best practice. They are based on existing processes that most, if not all, schools should be following. However, the committee recognised that adopting and maintaining a whole-school approach needs significant additional time, ongoing leadership and dedicated resourcing. For example, school staff may need more protected time to engage with pupils and local agencies and to undertake relevant training. This could partly be delivered as part of a school’s ongoing continuing professional development, for example in inset days.

Return to recommendations

Why the committee made the recommendations

The committee looked at a substantial amount of evidence about the effectiveness of universal curriculum-content interventions to improve social, emotional and mental wellbeing in primary and secondary education. Although they noted that much of the evidence was limited in terms of the confidence they could have in its findings, it supported their experience that universal curriculum-content interventions help promote the skills needed for good social, emotional and mental wellbeing. It also supported statutory guidance about what should be covered in the universal curriculum. They also considered a smaller amount of qualitative data of mixed quality. Because the qualitative evidence was from only a few studies and its findings were not useful for making recommendations, it was used only to contextualise the recommendations rather than to provide a basis for them.

The committee agreed that lessons from universal curriculum content should be cumulative and should be integrated into other school subjects and activities to consolidate children and young people’s understanding.

The committee also agreed that using a ‘strengths-based’ approach to support children and young people’s social, emotional and mental wellbeing would help to remove the fear of failure and would bring a focus on providing skills that children and young people would be able to use in the future.

Some evidence also showed that mindfulness interventions had benefits in developing social, emotional and mental skills in both primary and secondary school children and young people, and for academic outcomes in secondary school pupils. Cognitive behavioural approaches increased social and emotional skills and reduced anxiety in primary school children. However, the committee noted that trauma-focused cognitive behavioural approaches may be more appropriate for children and young people who have previously experienced trauma.

Evidence from expert testimony highlighted the value of regular rhythmic physical activity, such as running, bouncing or cross-training, in helping children and young people manage their social, emotional and mental wellbeing. They agreed that these interventions would be most useful in schools where there was a good fit with the whole-school approach.

Social connectedness was highlighted by the committee as a key factor for good social, emotional and mental wellbeing in children and young people in the context of the COVID-19 pandemic. The committee agreed that this encouraged the use of support by both peers and trusted adults.

How the recommendations might affect practice

The recommendations reinforce current best practice because they are based on existing processes that schools should generally be following, such as using a spiral curriculum and promoting the spiritual, moral, cultural, mental and physical development of pupils. There may be an impact on financial resources and day-to-day staffing for the training and peer support needed to deliver these interventions, but this may be partly covered as part of the staff’s continuing professional development programme.

Additional time may be needed to establish good communication channels between staff and pupils, to help pupils and the trusted adult develop their relationship and to train teachers on the benefits of interventions.

Return to recommendations

Why the committee made the recommendations

How the recommendations might affect practice

School-based practitioners routinely undertake many of these tasks and monitor children and young people’s risk factors as part of their pastoral role. However, there may be an increase in the number of children and young people being observed, assessed and offered interventions. This may have cost implications if the extra workload falls on school staff. The committee agreed that many of the tasks will be part of the already planned rollout of the mental health support team and educational mental health practitioners. However, it should be noted that currently there are only plans for mental health support teams to reach 25% of the country and no commitment or resourcing to extend this beyond 2023/2024.

Although school-based professionals are likely to have some awareness of poor social, emotional and mental wellbeing, there may be costs to train staff on identifying it, and on using trauma-informed approaches.

Return to recommendations

Why the committee made the recommendations

The committee discussed evidence on delivering targeted support for children and young people in secondary and further education who have been identified as needing mental health support (for example, because of symptoms of depression or anxiety). The committee had low confidence in the findings of the quantitative evidence, even though there were quite a lot of studies.

There was some better evidence from qualitative studies about the acceptability of targeted support, and the committee had more confidence in these findings. These studies included individual or group interventions that were delivered by school specialists (such as school counsellors) or external specialists (such as psychologists). Interventions lasted an average of 8 to 12 weeks. This evidence showed that targeted individual or group interventions were effective at reducing emotional distress and could also prevent a first diagnosis of depression. The committee therefore agreed that these were appropriate for pupils identified as needing social, emotional and mental health support. They agreed that although the evidence was from secondary schools, it was also likely to be relevant to primary settings. They were unable to assess from the evidence the comparative effectiveness of group and individual interventions on mental health. Nor were they able to assess the long-term impacts of these interventions or how they varied by population characteristics (see the recommendation for research on targeted support) or their potential harms and unintended consequences (see the other recommendation for research section on harms and unintended consequences).

The studies used varying criteria to determine whether a pupil would need targeted support, for example if they had symptoms of depression or anxiety based on clinical assessment or assessment tools. In practice, pupils are often identified by their externalising behaviours, and those with internalising behaviours can often be missed. The committee agreed that it is important to base referrals for targeted support on individual needs and to have clear guidance about this.

The evidence supported the committee’s view that communication between schools and parents, carers and families is important for the success of targeted interventions. Families and parents or carers can influence their child’s social, emotional and mental health behaviours, so the committee considered it was important that the school engages with parents and carers when considering targeted support. They agreed that further research could clarify what was important to parents in this regard (see other recommendations for research section on targeted support).

Specialists who provide targeted social, emotional or mental health support may be employed by the school or be external. The committee agreed that it is the school’s responsibility to ensure that specialists have the relevant training and experience. They were also aware of existing advice on using counsellors in schools (see the Department for Education’s guidance on counselling in schools: a blueprint for the future).

The committee were clear that for targeted support to be successful the pupil needs to be engaged and involved. They discussed the importance of getting their agreement (or that of their families and carers), not only because this is good practice, but also to help the pupil feel involved in the process.

The evidence suggested that when planning targeted support, it is important to consider any potential unintended consequences of the support. This supported the committee’s view that care needs to be taken to avoid negative labelling or stigmatising pupils when selecting them for targeted support. For example, if a pupil is known to leave lessons for a counselling session, classmates or teachers might treat them differently and they could be at increased risk of bullying. They may become withdrawn or defiant as a result and increase the behaviour that the intervention is intended to address.

The evidence also highlighted that a group intervention may normalise undesirable behaviours. For example, groups that include pupils who are part of an existing friendship group known for behaviours that challenge may be difficult to work with. This is because of the potential for friendship status and ‘membership rights’ in the group to be a priority for the pupils rather than working to improve their social, emotional and mental health. The committee agreed that other factors such as developmental age and cultural background were also important to take into account when planning the membership of group interventions.

Focus group research commissioned by NICE to explore children and young people’s perspectives on the draft recommendations identified the importance of peer-to-peer support. However, the committee recognised the need to offer a range of support (including peer-to-peer support). This was because evidence in the wider literature on peer-to-peer support indicates that there is a danger that it can perpetuate bullying. Furthermore, the committee highlighted the importance of environment when delivering targeted interventions, because children and young people need to feel safe and comfortable to talk through difficult feelings.

How the recommendations might affect practice

The recommendations reinforce current best practice. They are based on existing processes that all schools should be following, so they are unlikely to have a considerable resource impact.

Time and money may be needed to set up suitable environments for delivering interventions. Training and time may also be needed to ensure that school staff are able to monitor children and young people’s wellbeing for signs of adverse reactions to receiving targeted support.

Return to recommendations

Why the committee made the recommendations

How the recommendations might affect practice or services

The committee agreed that supporting children and young people through transitions to new classes, schools or out of education was part of the general responsibilities of the school. As part of their pastoral role, teachers and other school staff would be trained to engage with pupils and identify those who were not thriving. They noted that agencies outside the school could also provide important services that the school was unable to provide. The recommendations highlight the value of peer mentoring for pupils transitioning to a new school. Additional time may be needed to train older pupils on how to effectively mentor new students.

Return to recommendations