The Scottish Government

« Previous | Contents | Next »

Listen

4 Promoting mental health and emotional well-being through professional partnership

Introduction

The third element in the promotion of mental health and emotional well-being in schools is partnership. The 'health promoting school' concept views schools as the primary site for intervention, placed as it is at the centre of the community. As such, schools must work together with families, communities and other professionals and agencies. This section of the report examines aspects of partnership with other professional groups within a whole school approach, again using both evidence from the literature followed by reports from the empirical fieldwork from scoping surveys and case studies.

Section A: Evidence from literature

Developing 'joined-up' approaches

The importance of 'joined-up service delivery' across different agencies and professionals is emphasised in government social policy. However, it is clear that this level of collaboration poses many challenges - strategic, practical and cultural. The issue is fundamental to many initiatives set up to promote mental health and emotional well-being of children. In Scotland inter-agency/professional working is central to the development of Integrated Community Schools, the roll out of which is due to be complete by 2007.

Lloyd et al 2001 refer to a 'terminological quagmire' with respect to different professionals and agencies working together. Thus the literature makes reference variously to 'inter-agency', 'multi-agency', 'multi-professional', 'multi-disciplinary' work etc, often without distinction or clarification. Tisdall (2004) suggests that the prefix 'inter' suggests a closer relationship than 'multi'. 'In other words, multi-agency or multi-professional working involves agencies and professionals working alongside each other, with common goals. Inter-agency or inter-professional working involves developing a common agenda and/or understanding, as well as common goals.' (Tisdall 2004:34)

As Tisdall (2004) points out, language shapes understandings and impacts on how professionals 'do' working together. Thus inter-agency/professional work suggests a blurring of professional boundaries which has significant implications for joint strategic planning and implementation of policy where professional practice in different areas is characterised by different underpinning philosophies and values. Multi-professional working raises questions about co-terminosity and the dangers of children and young people falling through 'gaps' in provision. However, the 'multi-' dimension of joined up working also needs to be emphasised, since 'effective support for young people with SEBD involves utilising the full range of professional skills' in which professionals 'recognise that no one group has all the answers' (Hamill and Boyd 2001:141).

Warmington et al (2004:4) suggest that within the UK a form of working practice that they refer to as 'co-configuration' is emerging, 'oriented towards the production of intelligent, adaptive services, wherein ongoing customisation of services is achieved through dynamic, reciprocal relationships between providers and clients'. Significantly, 'co-configuration' is a participatory model that includes clients as well as professionals. They argue that this form of working is characterised by distributed expertise and the development of 'knotworking' i.e. 'rapidly changing, partially improvised collaborations of performance between otherwise loosely connected professionals.' The authors suggest that in many parts of the UK many agencies are operating 'on the cusp' between these newer practices and older established forms of working, creating tensions within services that may give rise to barriers to effective working.

General and strategic issues in working together

McCulloch et al (2004) discuss 'benefits, barriers and rivalries' in the development of effective 'inter professional collaboration'. Such collaboration, while widely recognised to be necessary in order to prevent the 'underlapping' of services ( NECF 2004) may be seen as problematic and even threatening to professional competence. Different services, due to different histories, language and aims will perceive their clients in different ways. Differential status of professionals may also constitute a barrier.

The structure and culture of schools may present particular challenges to the development of collaborative practices. NECF (2004:45) quotes a Children's Fund worker saying that,

I can talk with a child and make suggestions about his anger, but then another professional, a teacher, can actually ruin all that work with just a look.

In this case 'the priorities and historical practices of the school took precedence over the way that the Children's Fund worker wanted to engage with children.' Thus, the aims of different professionals may come into conflict and this may cause particular tensions where the school is the location for services. Different attitudes towards children's behaviour may also emerge, with therapeutic workers focusing on the need to understand a child's behaviour rather than control it. This can create conflict with schools since teachers (in particular secondary teachers) may see maintaining challenging children in class as detrimental to their professional role. However, as Hamill and Boyd (2001:142) point out, 'Out of all the professionals supporting young people only teachers have to provide support in the context of a mixed ability classroom where the needs of a large group of young people are all equally valid and have to be addressed.'

Tensions may also arise where outside agencies are seen to be straying into the 'core' areas of expertise in schools. McCulloch et al (2004) suggest that schools are most accepting of professionals whose work clearly lies beyond the remit of the school and which is not seen as impacting negatively on the work of the school, for example, health workers. In their research, in areas seen as 'core', for example the teaching of specific subjects, teachers placed greater emphasis on additional funding for extra resources. However, the authors noted a difference in attitude between primary and secondary teachers with primary teachers more positive about the benefits of working with other agencies. They suggest that greater loyalty to subject among secondary teachers means, '[t]hey are less likely to feel that they have much to gain from the expertise of others , or from being part of broader networks of other professions, nor see the value of benefiting the wider community.' ( ibid: 140).

Difficulties may also arise with respect to confidentiality. There is a clear tension between the need to share information about young people in order that their circumstances may be understood by the wide range of people with whom they come into contact, and the right of young people to confidentiality. Pettit (2003:58) suggests that confidentiality 'may not be a high priority' for schools and that schools are 'frustrated when they are not informed of outcomes'. She suggests there is a need for greater trust between workers, schools and parents and an increased understanding of the different policies and practices of professionals. According to the report ' Support in school. The views of harder to reach groups' ( SEED 2004d:5.4) confidentiality was an issue of acute concern to young people themselves, who felt that 'workers shared information without permission, and in some instances carelessly and with little respect'.

Pettit (2003) discusses a number of factors promoting effective 'joint working' between Child and Adolescent Mental Health Services ( CAMHS) and schools. Many of these factors relate to strategic level support of the 'blurring' of professional boundaries such as enabling secondments between different organisations, being based in the same location, flexible recruitment across professional boundaries etc. However, personal commitment to joint working was also key, as was the development of shared goals. Joint training may be part of the response to breaking down professional barriers, both in initial training and in continuing professional development (Riddell and Tett, 2001). However, research suggests that providing shared courses does not, on its own, necessarily promote effective inter-professional working. The evaluation of sexual health education intervention in Grampian and Lothian (Tucker et al 2005) reported that where interagency training was successfully implemented the participants described a positive effect on their commitment to joint working, but this was not translated into practice in schools due to obstacles encountered in the workplace.

Models of partnership in schools

A range of initiatives involving both statutory and voluntary bodies can be found in the literature embodying different models of partnership. Some focus on different elements or actors, e.g. working with teachers to build capacity and mentor; working directly with children to support, counsel and change behaviour. Another way, however, of framing the huge variety of school responses to mental health and behaviour problems is to look at the level of ownership and responsibility that schools retain over schemes designed to provide solutions. We can attempt to frame these within the following typology:

• Export problems off-site by referring troubled or poorly behaved children off for expert services delivered elsewhere or into containment schemes
• Import skills into schools to solve problems of mental wellbeing/indiscipline, but devolve authority to another agency or professional group
• Retain ownership of 'problem' in school, importing skills and personnel, but using these in integrated service teams to develop new approaches that are embedded in school life.

All of these clearly tackle the issues and utilise professional partners in very different ways.

In some senses the elements of this typology may represent stages of transition in the development of integrated, inclusive schooling, since it is not hard to see that the first of these options probably represents the model of school management many of us would be familiar with from twenty years ago. Then, mental wellbeing would not have been seen as the professional responsibility of teachers, and other professional groups would have been seen as more expert in dealing with psychological issues of adjustment. Similarly problems identified with bad behaviour were often dealt with by isolating the individuals concerned, at least in part to maintain order elsewhere.

Growing acceptance of the notion that schools do indeed share responsibility for the wellbeing of pupils, and that discipline issues may be closely bound up with more general issues of adjustment, stress and mental health may lead schools and authorities as a first response to move closer to the second model and to import expertise from elsewhere and then give that imported expertise some considerable freedom to operate in the school but not as part of the school.

The most recent policy agendas, however, on inclusion, the development of integrated community schools and the development of the health promoting school concept all position the whole problem of children's and young people's wellbeing firmly in the lap of those who manage the very complex environment of the modern school. Solutions to problems of indiscipline, and the need to monitor and maintain the health of young people at transition stages or in traumatic circumstances are likely to be found in complex interventions which are threaded through the heart of the schools' operation. They will take in issues of school structure and ethos, of curriculum and delivery, of capacity-building in staff and partnership with other agencies.

It would be wrong, however, to see these only as stages towards the development of a gold standard 'right' way of doing things in school. It will always be the case, for instance, that for children with acute or severe problems, there is no alternative but to seek expert help outwith what any school could reasonably offer.

Similarly it is clear from both the review of published literature and from the variety of survey and empirical work undertaken as part of this study that there is massive variety within these categories, and that it was not unusual for several elements of this framework to be running concurrently in some of the settings we explored.

We use the literature to examine the first of these models, that in which services to pupils/families are offered off-site. This model raises questions about the extent to which such initiatives locate problems within the child and his/her family (rather than looking at the broader issues, including the school environment, which may have induced or exacerbated the problem). It is also arguably less likely that this model of operation will promote and support change within schools. However, where school may itself be seen as contributing to the pupil's difficulty, or where the pupils is excluded from school, being off-site can be a positive factor. For example, the Notschool.net (Literacy Trust website) initiative provides young people excluded from school and other non-attenders with a range of new technology and supports them to produce webpages, graphics, music, poetry and prose etc. The young people are referred to as 'researchers' and their tutors as 'mentors'. Evaluations suggest that these can effectively engage young people - and spark interest among their families too - but do not work for all youngsters, for example those who are completely disengaged from learning or who live in very chaotic and dysfunctional families.

Connexions (Connexions website) provides support to young people aged 13 to 19 in England in making the transition to adulthood and working life. The Connexions Service provides support to, or works collaboratively with, groups engaged in a variety of projects. The focus of these projects is on the personal and social development of individuals enabling them to take more control over their lives ( YALP 2003). Many of these individuals are disenchanted with education and many of the projects thus aim at 'reconnecting' disengaged young people.

Evaluations of the Connexions service (Britton et al 2002; Crimmens et al 2004) suggest that such initiatives can be effective but that there are substantial challenges to be overcome. For example, maintaining contact with individuals, even over the short term can be problematic; overcoming suspicion or hostility of some young people to professional help; and tension between a 'fire-fighting' role and the slow sometimes 'tortuous' process of re-engaging youngsters (Crimmens et al 2004).

The second element of our typology describes schools importing skills (in the form of individuals or agencies) to deal with problems in their midst. A scan of the literature reveals that this happens both at the level of importing skilled personnel to work with teachers to develop their capacity to deal with discipline issues which may be related to mental wellbeing, but also the importation of individuals or agencies who will deal directly with children in school time and on school premises, albeit not as part of the school's general operation

We look first at the literature on initiatives aimed specifically at building the capacity of schools to deal with issues related to mental health by developing the skills of staff/pupils. For example, the 'Chips' programme (ChildLine in Partnership with Schools) provides training for schools to set up peer support schemes to tackle bullying. The scheme trains children and an in-school co-ordinator. Recent evaluation of this initiative is largely positive (Smith and Watson 2004) and the authors conclude that, while it does not stop bullying 'in a broader sense it helps children with conflict resolution and creates a school climate in which bullying should be less likely' ( ibid:37). The involvement of an 'outside' trainer was seen as an important aspect of the scheme, making it seem 'important and special'.

Another example of this model of support is provided by Southampton LEA's development of 'Emotional Literacy Support Assistants' ( ELSA) (Nelig website). ELSAs are part of the Educational Psychology service and work peripatetically. Their aim is to encourage schools to recognise the importance of emotional learning and to develop greater acceptance and inclusion of children with emotional and behavioural difficulties. ELSAs work with Learning Support Assistants in schools who then carry out aspects of the work, thus building capacity within schools. However, another important aspect of the initiative is that the ELSA is independent and free from the ambiguity associated with the roles of behaviour support and guidance systems within schools.

Drawing on the work of CAMHS, the Department for Education and Science in England has set up BESTs (Behaviour and Education Support Teams). The aim of BESTs is to 'promote emotional well-being, positive behaviour and school attendance' ( DfES website). BESTs are drawn from a range of professional services and offer support at school level (including development of whole school strategies as well as support to individual teachers); to groups of children and parents; and intensive support to individuals.

The aim of the capacity building model is to support the school in developing practice that promotes pupil welfare. However, such models raise questions about the embedding and sustainability of services within schools. Thus, in initiatives such as the 'Chips' project outlined above, research shows that continued support and input is needed from the external agency in order for initiatives to thrive (Baginsky 2004). In the case of ELSAs it might be questioned whether the presence of a trained Learning Support Assistant is sufficient to bring about a sustained change in culture.

An alternative model is one in which the school is a site for a service operated by an 'outside' agency, e.g. the counselling services offered by the charity The Place2Be.

Trained counsellors help children deal with their emotional reactions to the difficulties they encounter during their school years - divorce, deprivation, abandonment, long-term family illness and death, domestic violence, homelessness, eating disorders, physical or sexual abuse and the trauma of war zone refugees. (The Place2Be website).

The Place2Be offers a range of services including: group/individual work with referred children and a 'drop in' service to which children can self-refer. The Place2Be has recently extended its services to 10 schools in Edinburgh following a 'successful pilot' in two schools. While little formal independent evaluation appears to have been undertaken, The Place2Be carries out its own evaluations and they point to favourable mentions in Ofsted reports as an indication of their success. However, using the school as a site for such activity creates potential tensions that need to be examined. A case study of The Place2Be forms part of this report.

'Young People Speak Out' ( YPSO) is a voluntary body that works with disruptive young people in schools. ' YPSO use video work as a tool to help young people develop their confidence, self-awareness and interpersonal skills so they can deal more effectively with their lives' (McCluskey et al 2004:35). Evaluation of the initiative points up the positive nature of the intervention for disadvantaged young people, but highlights some issues for the voluntary sector working in schools. In particular, such initiatives can seen as merely 'a useful way to occupy some problematic pupils'. Projects can thus become marginalised

'which reduces their power in terms of requiring good practice from the schools and means that sometimes they collude with a model of individual difficulty that locates all difficulties within the young person, rather than acknowledging the dynamics of the interaction with the relationships and structures of school.' (ibid:39).

The third element of our typology concerns a situation where schools retain ownership of the problem, and, whilst involving other professionals or external agencies, draw them more fundamentally into the operation of the school. Such ways of working are relatively new, dating from the pilot new community schools established since 1997. The data from them and their successors, the integrated service or integrated community schools, is still coming in. Most involvement between NCS/ ICS schools and other agencies is in the form of additional services to individuals. Sammons et al (2003) suggest that, in terms of the curriculum, involvement of external agencies is most notable in the areas of health education and the provision of alternative curricula for young people in secondary schools which were 'generally viewed as successful in sustaining involvement in education' ( ibid:5). The HMI report, The Sum of its Parts? The Development of Integrated Community Schools in Scotland ( HMI 2004b) points to several initiatives aimed at improving the achievements and wellbeing of young people through the curriculum in conjunction with other agencies.

Wilson and Pirrie (2000) query the evidence of the efficacy of 'multidisciplinary teamworking in educational settings'. Recent research, however, points to the positive impact of initiatives involving joint working. Thus, Pettit (2003) reports on the impact of CAMHS/schools initiatives in a range of settings in terms of children's increased happiness, their improved behaviour, academic achievement and exclusion/attendance. In addition, in Pettit's study, health professionals spoke of being able to access children and families who needed support but who would not otherwise have been reached.

Evidently there are challenges to the development of joint working practices. Allan et al (2004) highlight the need for support for professionals to enable them to develop new conceptualisations of practice. But the authors suggest this will require radical changes in school culture and structure. Sammons et al's (2003:9) evaluation of New Community Schools suggests that at present schools are offering 'significant additionality in terms of extending what they refer to as multi-agency involvement in service provision and targeting services to identified individuals rather than offering, as yet, radical or innovative new services to modernise schools.' In this sense 'the jury is still out' on whether the third model of partnership working will deliver better results and solutions for both troubled young people and their teachers

Section B: Evidence from empirical work

In this section we mirror the findings discussed above by looking at the extent to which schools and education authorities were already engaging with other professional groups in partnerships to promote young people's mental health. How well was this working at strategic level and also at the grass roots? What models of partnership are identifiable in practice and how effective and sustainable do they appear to be?

Partnership working with other agencies at strategic level

The linking of mental and emotional wellbeing to wider themes of social inclusion, regeneration, health and welfare has underpinned the policy rhetoric and the drive for partnership and multi-agency working. Alongside this lies further recognition that children and young people do not exist in a vacuum but that their welfare is inextricably knitted into the context of family, community and school. This encompasses a holistic approach to issues of mental and emotional wellbeing and behaviour in schools.

As part of this process, health services have engaged more systematically with local authorities and the voluntary sector with the aim of enhancing preventative work through mechanisms such as Community Planning and Changing Children's Services planning. The need to ease pressure on overstretched specialist services has accelerated this process and highlighted the importance of co-operation between frontline professionals, parents and young people themselves. However it is important to note that currently some of these groups remain outside these strategic planning processes and many of the localised assessment teams, while, for others, involvement can be tokenistic or uneven.

Much strategic work at local levels has been channelled through Changing Children's Services units and funding streams. This has already had significant impact in some authorities, for example Stirling, East Renfrewshire, and Midlothian. In these areas a deliberate attempt has been made to build teams which include representatives from health, social services, and the voluntary sector, thus giving schools a much greater flexibility in seeking support for pupils with mental health difficulties. Such co-operative relationships allow a move away from the medical model of seeking a 'cure' for the child with mental health problems and encourage a more holistic view of the problem and enable support to be targeted at the child or at the family, or both. Very often through these more accessible and responsive working relationships pupils can be supported to remain in mainstream school who otherwise would be at risk of exclusion or self exclusion through truancy or other activities.

One clear example of this is Bright New Futures: a strategy for children and young people. This strategy document was developed by NHS Borders, local authority social work and education services, the police service, the Children's Reporter service and representatives from the voluntary sector under the leadership of the Changing Children's' Services Unit. Within this strategy five locality integration teams are expected to ensure a joined up approach to planning and service provision in the catchment areas of the 9 high schools in the area, and will build on the work of the integrated community schools to implement service provision for all 0-18 year olds ( www.scotborders.gov.uk/news/5700.html ).

The teams include headteachers from secondary and primary schools and the strategy was viewed as a means of underpinning work that had previously taken place within discrete areas but often in the absence of a coherent strategy or overall co-ordination. These new plans therefore represent a major change in the way services for children and young people are designed, consulted on and reviewed. It also encompasses the need for general population-wide approaches and more targeted work with so called high risk or vulnerable groups. All of this has major implications for work on mental health and wellbeing in schools and for the role of teachers.

How well do those involved in multi-agency working at strategic levels feel that the energy expended so far has delivered worthwhile results?

Some interviewees in the scoping survey of health services expressed optimism about how strategic plans in principle could foster interagency working by legitimising it, broadening ownership and linking it into overarching plans:

I think because they have been given the opportunity to be brought in at the beginning of it and to influence it from the start it has sort of got everybody's enthusiasm and commitment as well. (Health Promotion worker)

Others in the health services felt that specific programmes such as the new community schools (hereafter integrated community schools) initiative had provided a basis on which to extend multi-agency working in and around schools. A number mentioned the national adoption of the health promoting school concept as having strengthened the case for multi-agency work on mental and emotional wellbeing.

With the emergence of the new community schools we certainly found that there was a much more collaborative approach and that was built on and built on. What has been particularly useful has been the health promoting schools agenda and, say, setting standards for 2007. That's been a kind of wake-up call, and mental health is right up in there… it's certainly focused attention. (Health Manager)

However this enthusiasm was matched by more cautious observation about how information and direction would, in reality, filter through to practitioners. It was clear that where communication channels were known and understood, multi-agency working had a stronger impetus. However mechanisms for sharing information across and within health and local authorities were often unclear and did not transcend sectional boundaries. Within health services, a wide range of personnel had some remit for mental health but these were not always 'joined up'. Similarly within education authorities aspects of mental health were dispersed within different departments ( e.g. inclusion, educational psychology, guidance, behaviour support, anti-bullying), so strategic work sometimes failed to engage with internal working arrangements.

A further issue was that health board and local authority boundaries were not always coterminous. Health boards were working with different numbers of local authorities which could each have different kinds of administration and which each required health service staff as representatives on strategic and other planning groups. In some areas representation from local authorities on strategic planning groups was sporadic and drawn from different sections within the authority. While many of these teething problems were being remedied, commitment to the joint planning process appeared to raise more intractable problems. For some commentators, the lead agency was inevitably the fund holder and this coloured a number of participants' views on the extent to which joint working was embedded across agencies. One education authority representative made the following blunt comment about the relationship with the health board:

It's my feeling, my personal view, that until we have some joint budgeting it will be very difficult to work together. Agencies can be very precious about resources. Until we are sharing resources, if ever, I think it will be very difficult. (Education authority representative)

Such questions about allocation of resources were continually raised in survey responses, but an additional problem also raised by many in both education and health sectors concerned the very different conceptual framing of young people by different professional groups. Issues around the extent to which agencies adopted 'child friendly' approaches, and/or acknowledged the competence or the agency of young people were frequently raised.

Similarly, different professional groups notoriously had different practices with respect to the handling of confidential information. Within one local authority, a group had been meeting for five years to establish confidentiality guidelines that could be applied across the local authority but, at time of writing, these are still being debated.

Partnership working has also emphasised the need to draw in voluntary organisations as well as joining up the work of statutory authorities. Voluntary groups potentially offer flexibility, innovative working, an issue specific focus and methods of working which often reach those parts of the populace traditional services do not reach.

For those in the voluntary sector, power differentials between partners often made joint working difficult, with some voluntary agencies sitting at the table with local authority officials who were responsible for making decisions about the continued funding of their agency, thus placing them in a very subordinate role. In addition small organisations were often loath to allocate time and resource to preparation and attendance at meetings and work on strategic plans when this detracted from their core activity. This resulted in having to make some hard decisions about whether this should be traded off against potential long term gains. Larger agencies could absorb such costs while the penalties for small organisations for dropping out of networks could lead to lost funding opportunities:

…We just don't have the capacity you know…That's another thing that we find difficult as well. We're very much, you know, out there doing the job and there's regular commitments with the school whereas people want us to come to meetings…I need to keep my hand on the pulse in terms of what's going on, and I could be out at meetings just all the time …it's really, really difficult. (Voluntary sector representative)

Despite these practical problems of participating at strategic level whilst also trying to mount delivery in the field, the voluntary sector was usually clear in our scoping survey responses about the benefits of multi-agency working as a means of building synergy between different participants. This synergy was often helped by the sheer range of initiatives at national and local levels which some viewed as creating a more favourable climate for work on mental health and emotional wellbeing.

Voluntary agency respondents were clearer than most about the impossibility of providing 'one size fits all' solutions to social problems, and clearly saw their role as one of filling niches or working with difficult to access groups. It also offered the possibility of dealing with issues that were unlikely to be solved by one agency or approach:

We need to look at not only what services we offer but how they can interact with the other organisations in the consortium, we'll be looking at how we can cover the cold spots where we don't have a branch and what sorts of communication is easiest for children, 'cos certainly for teenagers you know, we're looking at developing systems for texting and emailing and so on, to offer support. (voluntary sector representative)

Partnership working with other agencies at practice level

It is clear that there is huge variation across Scotland in the extent to which these strategic policies of joined up working on mental health issues have filtered down to practice level. What we have is a patchwork of initiatives which take a variety of forms. We look in the next section at the variety of ways in which partnerships are operating on the ground, and refer again to the three models of partnership working identifiable in the literature, namely:

• Export problems off-site by referring troubled or poorly behaved children off for expert services delivered elsewhere or into containment schemes
• Import skills into schools to solve problems of mental wellbeing/indiscipline, but devolve authority to another agency or professional group
• Retain ownership of 'problem' in school, importing skills and personnel, but using these in integrated service teams to develop new approaches that are embedded in school life.

We noted in an earlier section that this typology may represent the process of transition between traditional 'solutions' to dealing with troubled or troubling children towards more integrated and inclusive solutions which identify the 'problem' in different ways and seek the solutions also in a more broad-based way. The staged intervention approach, which has been introduced in many authorities, emphasises the importance of school staff retaining ownership of problems wherever possible, using other professionals in the first instance for advice and consultancy. If direct support beyond this is necessary for a particular child or young person, this should be delivered in the school environment by importing the professional expertise. Only where there is no alternative should schools export pupils to be supported elsewhere.

However our understanding of ownership goes beyond responding effectively to problems, it would describe a proactive whole school approach to mental wellbeing, which permeated all aspects of school life. Clearly many schools have not traditionally seen the promotion of mental wellbeing as a specific operational priority, and the process of transition, as one respondent noted, may be akin that of stopping a loaded oil tanker in mid stream and turning it through 180 degrees. One commentator from a sector outwith education comments on this difficulty sympathetically:

It's a matter of capacity - how can you focus on things like that when your main work that you are dealing with is curriculum-based and you know there are quality standards to be met? All of these issues are uppermost in the school culture you know. Having to focus on the whole person - in particular on their mental health - is something that you think, 'Well if I've got the time…' The will is there, but I don't think they've got the time and I don't think the resources to save them the time, as it were. (Health Manager)

On a cautionary note it is clear that most of the interventions we describe do not fall neatly into boxes. An intervention can be off-site and distinct, but still offer services back to the school which help build capacity. A service offered on-site in the middle of the school day might operate in so impervious a manner that there is little contact with the rest of the school staff. Even schools with a strong emphasis on integration of service delivery may find that only a fraction of the staff get drawn into such ways of working. The typology is therefore offered as a device through which to explore different forms of service provision and their implications for professional working and effective service provision, but they should not be read as simple stereotypes.

Models of partnership in practice: exporting problems

This category of the typology is capable of being construed in a variety of ways. It is true that schools in the past would possibly have exported their problems off the school site, and that this export may have resulted as much from a school's need to metaphorically 'wash its hands' of the problem. Children with mental illness or conditions which led to inappropriate behaviour would be seen as problematic in and of themselves, and the responsibility for containing or treating them seen to lie within the purview of more specialist services.

At local authority level, there was significant tension in the balance between models of export whereby children and young people were supported by removing them from school, and models of ownership, where schools were supported to work with the young people in their own environment. Whilst education authorities all maintained some facilities outside of the mainstream school system, often in partnership with voluntary sector organisations, there was a nation-wide imperative to minimise these types of intervention, driven by the inclusion agenda, but also by financial considerations and staff shortages. In many instances schools did not currently pay for these interventions in any case ( e.g. North Glasgow Youth Stress Centre / drama in schools) and voluntary sector or health services subsidised or applied for specialist funding. For some schools and authorities the expertise of outsiders was a continuing necessity in some respects ( e.g. school nurses) but what was uncertain was their remit to stray beyond traditional roles into 'educational' work in the classroom.

However, there was a marked difference reported in schools' commitment to taking ownership of these difficulties, as described here:

Sometimes the view that is coming to me across the table is that the school perceives an amputation of the problem rather than some kind of internal solution to it. (Head of service)

External services often described setting up rigorous referral procedures to act as barriers to schools exporting pupils unnecessarily, …..

Because otherwise what happens is that schools will just fire referrals into external agencies without having tried to sort it themselves. (Mental health development worker).

The differences between schools that took greater ownership and those which sought to export problems was often said by interviewees in the health and education sectors to relate to the personal management style of the head teacher.

Less pejoratively, however, it is equally clear that some young people's problems are indeed so severe that they require levels of specialist help that can only be accessed in other settings.

Then too a modern construction of the problem that looked at the environment which created the problem (rather than the child as a problem child') might also conclude that since schools themselves can represent very stressful or challenging environments for some children, there will always be a minority of cases where the school setting is the least appropriate place to intervene and support a young person on the road to recovery, rehabilitation and reintegration.

Services offered outwith schools can offer 'time out' for some young people and enable them to work with adults with whom they can develop very different relationships from the relatively non reciprocal teacher/student relationship. Fairbridge offers this opportunity for young people in Glasgow and Edinburgh who are being considered for exclusion. They work with staff in schools and provide an alternative curriculum with the aim of reintegration at the end of the programme. Similarly, the Roc Project run by Aberlour Childcare Trust works with runaways both in school and via their refuge, offering support and guidance to young people who have been forced to live away from home or who have run away.

One voluntary sector representative felt strongly that removing young people from the school should be balanced with other efforts to retain them in the mainstream but with additional support or a more imaginative syllabus. She believed that the exploration of different options was hampered by a 'tramline' approach:

In my experience, pupils are either off site or they are doing no fewer than five standard grades. Now I'd like to see a degree more flexibility. I mean young people don't necessarily have to be off site…. I'd like to see them taken care of within school and particularly looking at their specific needs rather than having to go to other provision just because there's a traditional curriculum to stick to and it's the only way they[schools] can operate. (Voluntary sector)

Clearly instances where children are shipped off site for remedial interventions are able to do little to develop the capacity of schools to deal better with such difficulties in the future, unless sensitive feedback is given by the specialist agency. Problems will, at a conceptual level, remain located in the child or young person, as far as the school is concerned.

Models of partnership in practice: importing skills

In this section we look at evidence about the ways in which schools were gearing up towards their new responsibilities through the importation of skills and capacities into the school. We focus on two aspects:

• the drawing in of those with additional or different skills and their utilisation in developing the capacity of teachers and school staff to take on new roles, and secondly,
• the importation of skilled professionals to take on direct service delivery to young people on school premises.

Recent policy developments clearly mean that schools are now required to meet the needs of young people with a wider range of difficulties, than would have been the case in the recent past. Consequently it is essential that schools are supported to develop their own capacity to respond appropriately to the behavioural manifestations of these difficulties.

Yet our scoping surveys revealed that local authority representatives were not always confident of schools' abilities to meet these new responsibilities, particularly secondary schools. Primary schools were generally seen as having a stronger focus on pastoral care, which permeated the whole school. In secondary schools, by contrast, it was recognised that many staff simply were not skilled in working with vulnerable children, as suggested in these two comments, which were typical of the responses:

Probably there is still, the way I would see it, too much emphasis on, I suppose what I would call the techniques of teaching in comparison with what I would call the relationships of teaching (local authority representative).

I think a sort of theme that will run through a lot of what I have to say to you this morning is that the class teachers' awareness of mental health problems, emotional problems, I think, is the route to dealing with it [developing better responses], and that requires much more training (local authority representative).

Given this position there is a sort of inevitability to the way in which many solutions have focused around the buying in of skills from other quarters, either on an ad hoc or on a more systematic basis. In this section we look at the ways in which capacity building issues were approached through importing skills from other professional groups, as evidenced in the scoping surveys and case studies. Three principal routes are identified in this section:

• traditional in-service sessions, offered in schools, using visitors from external agencies
• newer attempts to develop, support and mentor staff within the teaching community using mentors from external agencies
• parallel working in integration teams with professional staff from other agencies.

Other ways of capacity building (through mentoring staff using existing teachers and also parallel working with staff from other professional groups within an integrated school setting) are discussed in the following section on 'ownership' patterns of partnership.

The scoping study shows that, in their attempts to address the mental health issue, local authorities commonly offered courses related to mental health issues to teaching staff, but almost always as one of many possible in-service options. The focus of the courses was usually very well defined and targeted specific aspects of the mental health landscape such as bereavement, self harm, or ADHD. Those who enrolled on the courses would be a small minority of the total teaching force, mainly those with responsibilities for pastoral care. The appeal of these courses to subject teachers was somewhat limited as demonstrated by this comment:

We just ignore that side… leave that to the pastoral people… "that's your job, you can go and do all that". Probably we're so flaming busy delivering a curriculum that it's not the kind of thing that I would seek out on the CPD catalogue, you know (Principal teacher).

Highland Council was in the process of developing a one-day course on mental health to be delivered by a range of partners. If sufficient funding was secured this course would be made available to all primary schools in the authority. However, some of the attempts at training elsewhere were less well developed.

Trainers from other agencies frequently referred to the cursory way in which training courses were planned and the frustrations of trying to work on complex issues in school settings:

In-service days are usually planned like years in advance and you'll get phone calls, 'We'd like you to come along and do an input on mental health'. 'Very good and how long would you like this session to last?' 'Oh, we're thinking about 45 minutes.' 'Right… ok'. So that is one of the challenges and one of the barriers. We do appreciate that time is precious for them but there is no way that you can do it justice [in that time] at all. (Voluntary sector representative)

Many authority representatives were of the opinion that the traditional style of in-service training was not very effective in changing attitudes, and took a more proactive role in staff development.

You can talk professional development all you like, but if it is done in an intellectual way people find it hard to take it on board in terms of their own practice. You would always hope that children and young people wouldn't suffer a significant emotional and mental health issue, but it's difficult for staff to understand these issues if they haven't experienced it. I think staff develop a better understanding if they have seen a case and experienced the interagency working. (Head of service)

In Glasgow a team of peripatetic teachers had been trained to work with schools, both directly with pupils experiencing mental health difficulties but also working with teachers to develop their understanding of the issues, a system not dissimilar to the ELSA and BEST systems developed in England and discussed in the earlier part of this chapter.

Also within Glasgow a number of health development workers had been assigned to school clusters with a remit which included capacity building. One such worker believed that teachers in her area were generally receptive but that becoming part of the fabric of the schools was a long term aim:

It's early stages and you have to have the same person in post to actually become ingrained into the education system. And for them to begin to value what you put in … it doesn't happen overnight. They still do see people like me as an add-on, not part of the bigger picture. And for schools it is a huge issue. It would be great if we were an integrated community school all under the same roof. (Health development officer)

In some cases the presence of imported staff with specialist skills delivering service direct to children could actually result in a loss of capacity amongst teaching staff, particularly in primary schools where the pastoral role is seen as a more intrinsic aspect of what it is it be a teacher. Prior to the introduction of alternative sources of support the class teacher would have been likely to be aware of difficulties in the child's life, and may have been a confidante for pupils and their families, although possibly unable to offer much constructive support. With the introduction of new models of supporting pupils, rigorous codes of confidentiality often came into play which excluded the classroom teacher from learning information about the child. Several teachers expressed some frustration at being aware of the existence of a difficulty being experienced by a child, but, in the absence of any specific information being passed on, worrying about failing to react in the most helpful manner.

Various respondents in the scoping survey and in the case studies pointed to the learning that can take place through contact with workers in different professional groups. Learning can range from different ways of looking at and responding to children, through substantive learning on mental health topics, to knowledge of agencies available to offer additional support and services.

The case studies give an opportunity to explore in depth the sort of capacity building that took place through effective interagency working on the ground. Where there was an imported skill mix into integration teams in new community schools for instance, some key education personnel, usually pastoral care staff and senior management were drawn into parallel working. These staff had most contact with the other agencies, they shared responsibility for the welfare of children beyond their formal education, and sometimes took the opportunity to work with young people alongside the other professionals. Consequently the capacity of these key teachers could be developed through their work with professionals who brought other ways of working with children to the discussion table. Amongst these staff there was a clear understanding of the difficulties faced by many pupils and the consequent effects that these might have on behaviour.

Classroom teachers, however, (as opposed to staff with pastoral responsibilities), often appeared to work in a different community, having little direct contact with the interagency staff and viewing their own role as quite separate. Whilst teachers would be aware of and appreciative of the work done with vulnerable children, they did not usually recognise the implications of the new ways of working for their own practice, nor did they see other professionals as a useful resource for their own development. Teachers developed their own practice through personal experience combined with observations of and discussions with other teachers. Interviewees cited their teaching colleagues as being the most likely people from whom they would seek advice about challenging behaviour of pupils (although some staff reported reluctance to discuss their difficulties with anybody). It was apparent that the teaching staff were driven by very different agendas from the other workers, and that the philosophy of the classroom was not always in tune with the work of the interagency team. Consequently there was an inconsistency of approaches amongst teaching staff to issues relating to well being of pupils, with some highly attuned to such issues, and others who felt it lay outside their remit. It appeared to be a matter of personal choice, particularly in secondary schools, as to how far any teacher subscribed to the pastoral care aspects of their role.

There was some evidence that teaching staff could be highly resistant to efforts by other professionals to raise awareness of mental health issues, even where integrated community school teams were working effectively. Demands on teachers are quite different from other professional groups, in that they are required to work with large numbers simultaneously, and to meet the demands of an overcrowded curriculum, and for this reason teachers appeared to be somewhat resentful of advice offered by people with no experience of these pressures:

Teachers don't like it when experts come in and tell them what to do but don't get their hands dirty with the pupils (Education authority representative)

An example of these difficulties was cited by one worker who had offered some whole staff training. She had opened her discussion group by describing some confrontational incidents observed around the school and went on to say:

All I asked was that we ask ourselves why are we doing all this, and - rather than see a student - to see a human being. And if we meet a human being we might be met as a human being and it caused uproar, it really did, because of some of the examples I used.

Other workers sometimes found themselves subject to trials or rites of passage, before they were taken seriously, particularly in demonstrating their capability with respect to teaching and classroom management capabilities.

Commonly, non teaching staff in school communities were aware of these issues and would draw back from offering any advice to teachers, because they did not want to be seen to be challenging teachers' professionalism. This was particularly acute in cases where the workers were not graduates, for example home-school link workers. Hence there was a wealth of expertise on children and young people's mental health and well being in school that was not readily transferable to those who spend most time with the pupils. So whilst the presence of other workers in the school would contribute to an enhanced capacity of the school to support pupils, it did not necessarily translate into an enhanced capacity of classroom teachers to work effectively with these pupils.

We have then, elaborated three different ways in which authorities and schools are trying to build the capacity of education staff to respond to the sorts of mental health issues experienced by young people by importing skills. They are, of course, not alternatives but perhaps can often be used in tandem to support and develop teachers and their managers.

Throughout the interview sample, in all sectors, repeated reference was made to the variability of schools and teachers in respect of their recognition of their responsibilities to support young people with mental health difficulties, and also to the difficulties in challenging those individuals whose interests in children and young people were too sharply focussed on curriculum and attainment.

The process of change through staff development and capacity building was largely expected to be slow, allowing more reluctant and unconvinced colleagues to come on board gradually. There were a small number of more radical suggestions, however, one being that teachers should be given more direct responsibility for the pastoral care of pupils, in the belief that this might give greater insight into some of the difficulties those in their classes were facing. Coupled with responsibility, it was suggested, should be accountability. Currently teachers are highly accountable for some aspects of their performance including attainment and discipline. But they are less accountable for the means by which those goals are achieved. An explicit expectation that all professionals working with children and young people prioritise the proactive support of mental well being and respond sensitively to those behaviours which indicate underlying mental health problems, coupled with appropriate methods of development, would raise the profile of the issue, and, it was felt, place an obligation on all staff to reconsider their pedagogy.

We turn now to look at the case where skills are imported and used to provide services directly to young people.

You know education staff don't need to deal with this themselves, there are other people out there who are experienced and well versed in such problems. I guess for me the main issue is getting collaborative working more embedded in schools, instead of this arms length approach…'Well we'll have you, but only under these criteria or with these caveats…' (Health Promotion manager)

Schools are clearly key sites for early intervention in respect of young people's mental wellbeing and most external agencies and voluntary organisations were keen to penetrate schools in order to enhance the effectiveness of their own working. What came through very strongly in the scoping survey undertaken at strategic level in health and education authorities as well as with voluntary agencies, however, as the quotation above illustrates, was a very strong sense that schools were often holding the rest of the world at arm's length or were preparing to participate in multi-agency work on school sites only on their own terms.

This is a broad category and probably the most popular mode of working (and interpreting the policy imperative for integrated multi-professional working) at the moment within schools. As well as a range of examples discovered during our scoping surveys, this category would encompass, for instance, at least three of our case study interventions, albeit that they represent very different ways of working. What characterises all of them, however, despite surface dissimilarities, is that in all cases we are looking at a model where other professionals are invited into the school to be part of the framework for diagnosing and remediating problems or offering support to young people, but where the ownership of the issues is still not necessarily rested with the school. The school is a vehicle or a site for offering service, but, for instance, at a pragmatic level, management of the initiative may lie outwith the usual governance of the school. The sorts of services provided may offer additionality but not be integral to the culture of the school or its operation.

How did such schemes using imported mixes of skills work on the ground? Where projects or schemes were underway, the experience was often mixed. On the negative side external agencies often complained about a lack of flexibility within school environments and lack of understanding of their own approaches. Again this was often played out through the allocation of inadequate space for groupwork activities or lack of communication over changes in previously agreed plans. For both sides lack of understanding and respect for the different approaches to work on these issues undermined some attempts at interagency working.

However, we were also able through several of our case studies to explore more sustained experiences of interagency working on school sites. In all of these instances it was clear that the possibility of supporting and remediating mental health difficulties was enhanced, as these workers had the time and the skills to devote intensive support to the children and young people in question, and in some cases their families as well.

Interagency workers in these teams developed synergistic relationships whereby their relations with the school and with each other enabled them each to be more effective than they could be in isolation, as described here:

We are in no doubt of the value of working in teams. We value teams for the synergy they create. We rely on other team members for mutual support, help with planning and refining ideas, sharing resources, developing our professional understanding and offering practical backing to our work. (Discussion paper arising from seminar: Team working and the future of ICS, East Renfrewshire council)

The external agencies that were offering support in schools also experienced tensions in their role. On one hand they were trying to operate as fully embedded facets of the school structure, and on the other hand they needed a degree of separation in order to fulfil their remits. This was particularly the case in services where confidentiality was seen as paramount, such as counselling or therapeutic services. These services benefited greatly from their position in the school through their accessibility to pupils, their reduction of stigma, and from the information that was passed to them from the school staff. Outgoing information was much more guarded, as they protected the rights of the child to complete confidentiality (except in cases of child protection). Although the agencies were keen to offer support to schools in working with pupils this did not extend to passing on personal information disclosed by the children. This required careful negotiation at the boundary if the relationship was to be seen as successful.

This led to tensions in terms of how such services were viewed by other staff. If information about pupils was treated as completely confidential, the judgements made of the services were based on observations of behavioural change seen in the pupils. Yet, none of the services would have seen themselves as primarily concerned with behaviour modification, and disruptive behaviour was not always improved as a result of the interventions. This conflict of interests was highlighted by a school counsellor:

That was almost the test, you know, fix these kids, because there is in some ways, at some time an expectation that we will fix them. And that is an interesting thing that we are looking at, in terms of evaluation, is people's perception of significant change. What the person may deem as being significant to them may not in fact affect their classroom behaviour, so therefore the teacher sees a different change, or no change at all. So therefore, has the counselling in fact failed?

Within integrated community school settings a range of resources were on offer, as in some of our case studies. Thus at Newbattle this led to young people having a choice of means of support with a drop-in service where young people could simply eat lunch, read the information, chat to friends or seek more specialised support from a range of workers. In addition the school nurse could provide one-to-one support, health development workers could act as a referral, and 'friendship groups' could provide support for withdrawn children. Short life groups run by the guidance team provided a safe haven at lunch times and breaks. One-to-one counseling support was also available with self referral or through referral by staff. One young person interviewed felt that he had benefited from this and as a result was more confident and was actively promoting the need for buddying on the school council. Others interviewed were aware of the services and would use them if they felt they required help.

Such deliberately rich and complex service environments answer the calls that have been made in other places for the variety in the environment that ensures that there is something for everyone, rather than a 'one size fits all' type of service. However, the very complex nature of the interventions makes it very difficult to ascertain, in a systematic way, which elements are apparently effective in either making young people feel supported or in improving behaviour.

Clearly the confidence and enthusiasm of staff in the different sectors was central to the success of multi-agency work. Where good links already existed, more potential existed to extend joint working to bring in new partners or to expand joint activity. There was some variation in this with some schools and health services working to an overall plan with a clear contract while in others relationships were more ad hoc. In both kinds of settings however, the partnerships appeared to be based on the school inviting the agency to work in the setting.

The importance of 'champions' at strategic and local levels was stressed by a number of interviewees. Within schools, senior guidance staff were often cast into this role and seen as a key point of access for those based in schools and for external agencies seeking to gain access. Some key individuals from external agencies were also identified as important contacts who had credibility and standing within the school. Integrated school managers based with school clusters were often a key link in this process and where these were well established, good lines of communication and operational work flourished with these individuals acting as a bridge between health and local authorities and even parents.

A major difficulty identified by teachers was that of finding appropriate services which could respond quickly to needs that they identified. Thus where specialist services were based in schools they were identified as an important asset:

In secondary schools guidance … often get frustrated by the fact that they don't have the support services for instance, like counselling services. That's one of the strengths in (the school) where the counsellor is working, that you are able to get some help fairly easily for kids you know. (Education authority representative)

Some agencies identified distinctive roles for teachers and health workers or youth specialists which they felt should be recognised and incorporated into multi-agency working relationships.

…the programs can bring up some emotional stuff for young people, so you know you've got to have people that are able to notice that, pick it up and deal with it and again, in a school, teachers in the main wouldn't want to be involved in that. And young people (again, from our discussions with them) wouldn't feel able to talk to teachers, just because of the different roles, you know … (Voluntary sector representative)

Much of the innovative work that did take place within school settings was within clusters of schools. Cluster-based work has a number of benefits, not least in fostering links between primary and secondary schools. A number of initiatives around transition work were supported by integrated school teams and offered the opportunity to help ease the move for vulnerable young people. In addition these often provided an opportunity for joint working between different groups of staff.

In all these examples the incorporation of new skill mixes had allowed a whole range of innovative services to be offered to young people on or near school sites. Whilst this must be seen as beneficial in many ways, most interventions are not properly evaluated, and so we can have little certainty in pointing to which aspects of multi-professional working were most successful or how this synergy played out in terms of delivering more effective services for young people. What is also clear is that all these methods of importing skills onto school sites had only limited capacity to change the overall culture within which schools delivered the educational experience to pupils. Many teachers remained remote from the integrated service teams which bore the brunt of delivering these new initiatives. In the next section we return to examine a different model where - rather than look at importing skills to address new (or newly defined) problems - schools have chosen to retain control and claim ownership of the problem and the solutions.

Models of partnership in practice: ownership through integrated working

In this section we are choosing to characterise an approach in which schools accept responsibility for addressing the mental wellbeing of students and the discipline issues that may flow from it, feel that the solution should be generated within school, and encourage teachers themselves to tackle this through staff training, mentoring and professional support, and advocate the adoption of interventions led and managed within school by existing school staff working collaboratively. This is not a common model, but is one demonstrated in one of our case study examples (Clydebank) and picked up in small part elsewhere in the scoping surveys. We again look first at capacity building issues before moving on to look at service delivery issues.

We have noted in the previous section the impermeability (if not downright hostility) of much of the teaching profession to learning from other professional groups. Would teachers then be prepared to learn new skills, to develop a new language for naming and describing problems and new skills for handling them from their own kind?

A small number of authorities had interventions in place designed to offer advice from within education circles to staff experiencing difficulties with pupils. East Lothian's mental health worker operated a confidential drop-in for staff to discuss pupils about whom they had concerns, and to discuss their own handling of classroom situations. Clackmannanshire support service not only worked with pupils experiencing difficulties but tried to build the capacity of the school to support the pupils themselves. They operated their support at a range of levels as their head of learning support described:

The main aim of our service is to support the schools to support the children in whatever form that might take. We offer consultancy basis support to the schools. We would offer direct support to the schools, direct support to individuals, support to families acting as a bridge between school and family.

In the ASSIST scheme ( see case study), staff were able to seek confidential counselling style support from a designated colleague who had been trained in the principles of solution-focussed responses. This provided opportunities for individual self-selecting teachers to develop their capacity to respond to low level disruption. For some this was a very powerful tool for their professional development, and it provided a model for filtering new ideas into the teaching profession. However, given the self-selecting nature of this intervention, it did not have a universal impact upon the staff of the school, and, like other interventions, was viewed with scepticism by some of the staff.

A second model which used teachers to train other teachers was in evidence in Newbattle High School ( see case study), in which departmental representatives were trained by the head of pupil support on such topics as learning difficulties, the framework for intervention, challenging behaviour and dealing with tricky situations. The departmental representatives were then charged with cascading these approaches to their colleagues. This approach was seen by the head of learning support to lead to more proactive identification of young people in difficulty, and to teachers seeking arrangement for targeted support. This school cluster also used team teaching as a method of enhancing skills and awareness, as a health worker worked alongside primary school teachers to deliver a course on bereavement and loss.

To some extent the conflict between embeddedness and separation noted in the previous section, where people with other professional skills were imported onto the school site, was less of an issue of an issue in the Clydebank High School model where the existing pastoral care and other support staff had been amalgamated into a single team together with the pupil and family support workers. The team was managed by the school, and more emphasis in this team lay with sharing information in order to enable teachers to respond appropriately to individual pupils by sharing relevant information.

Similarly, the nurture groups in Glasgow primary schools were able to embed very quickly into the school because the nurture teachers were selected from the existing staff team. Both the nurture teacher and the head teacher in a participating school underwent specialist training, so the principles of the intervention were understood at management and practice level in the school. Interventions for pupils were planned and discussed jointly by the class teacher and the nurture teacher, thereby allowing the class teacher to develop her own capacity to understand and respond to issues relating to mental well being, and to be fully involved with and informed of the progress of the children.

The Prince's Trust Excel scheme was a national initiative which targeted disaffected young people for a two year course aiming to help build personal and social skills which would help in future employment and training. A mix of students was seen as vital for the success of the course rather than simply taking the most disruptive but this needed to be clearly worked through with school staff. The course was based within the school with participants taking part for one module which replaced one standard grade. The course was nationally planned and a quality assurance framework was in place to ensure conformity to the agreed programme. Local co-ordinators supported teachers and youth workers to work jointly to deliver a curriculum within the school setting with an emphasis on building confidence and skills. Training was provided to the teachers and youth workers by the Prince's Trust on 'creating a positive environment' and developing emotional intelligence.

Summary

This chapter has looked at the models of partnership that schools have adopted as part of the response to new policy pressures to deliver more inclusive education and stronger integration with other welfare services.

The review of the literature alerts us to the terminological quagmire surrounding the descriptions of the ways that have developed of different agencies working together. Some inexactitude is probably permissible and even advisable, however, in light of the fact that in most cases agencies are feeling their way towards workable relationships at strategic and practice levels, rather than being required to work to a template.

Literature also alerts us to the tensions of inter-professional working with children - different conceptualisations of the child and his/her competence, different patterns of relationships between child and adult, different protocols for sharing information and maintaining confidentiality. In addition there will always be a tension between what is appropriate pride in having learned to do a skilled and professional job, and an inappropriate and stubborn defence of single ways of working and specific styles of expertise against competing frames of reference from other professional groups.

In this chapter we have used a very simple typology to describe forms of partnership working at practice level as a way of structuring our thinking and the presentation of results:

• Export problems off-site by referring troubled or poorly behaved children off for expert services delivered elsewhere or into containment schemes
• Import skills into schools to solve problems of mental wellbeing/indiscipline, but devolve authority to another agency or professional group
• Retain ownership of 'problem' in school, importing skills and personnel, but using these in integrated service teams to develop new approaches that are embedded in school life.

In practice there is considerable overlap between these categories. In addition, the tendency to see the categories as transitional (with a gradual move towards greater ownership of mental health/discipline issues by schools) may be misleading. Essentially, however, the typology is useful in forcing consideration of the extent to which schools are prepared to locate mental wellbeing/discipline issues in the school environment as well as in the child and his/her family background and to put in place structures which support young people, remediate problems and which operate preventatively.

In reviewing the empirical findings from this study we have therefore continued to use this rough typology.

It was interestingly rare to find 'export' models of dealing with mental wellbeing/discipline issues in our data. This may be because authorities no longer see these as innovative, and may not have thought to include them in their telephone responses, or respondents may well have perceived these types of responses by schools in a pejorative light. At strategic level both education and health authority spokespeople noted the need to patrol the actions of schools in referring problems onwards and outwards, and this may still be the first recourse for a school not prepared to review and revise its ways of operating and still resistant to inclusion agendas. At practice level in the case study settings, schools were much more inventive and determined to see what they could do to solve the problems they encountered themselves, whilst acknowledging that for some young people there would always be a need for expert services provided off-site.

Some forms of provision we looked at fell somewhere between a simple export model and that of importing skills, in that teams of skilled professionals from health, social care, youth work and so on had been established to work in tandem with the school population but off-site, on the basis that the school environment itself imposed too many agendas about the use of space, the types of relationships, the assumptions of outcomes etc that would be appropriate within the intervention. Both the Stress Centre case study and that of the drop-in elements of the Newbattle intervention display some of these characteristics.

The modal form of working in partnership within our empirical study was clearly that of importing a mix of skills to address some newly defined and recognised problems. This might involve 'buying in' a complete service, as in The Place2Be example, or establishing a multi-agency team working in parallel with school guidance staff as in the East Renfrewshire example. Such models potentially offered the opportunity to build capacity amongst school staff as well as directly providing new services for young people. In practice, however, some such interventions could be relatively impermeable. They were on-site, but still represented an 'export' model, with little potential for exchange of learning between teachers and other professionals. Even where multi-agency teams operated more openly within schools, their main point of contact was with guidance, discipline or learning support staff, and many class teachers remained at a distance from the interventions. However, this may simply represent the stage to which integrated multi-agency teams have developed thus far, and clearly does not preclude a more gradual drawing in of a wider group of staff nor the intervention having a more profound effect on the life of the school than it might have hitherto. In the interim - if that is indeed where we are - such imported skill mixes are bringing additional resources to bear and allowing schools to offer a varied and innovative range of interventions that they clearly would not be able to provide otherwise.

Our final category looked at the case where schools eschew imported help and look to find solutions to wellbeing/discipline problems within the school community itself. Only one of our case studies exemplified a form of this, with Clydebank using an integrated team within the school to address many of the problematic issues it faced, though the ASSIST intervention which was also one of our case studies represents a strategic level intervention to support and mentor teachers with respect to classroom discipline issues. The virtues of such an approach are clearly that it represents a statement of ownership of the issue and a commitment to resolving it by reviewing the school and the way it operates in its entirety, rather than looking for quick fixes to solve problems or provide services. The noted resistance of teachers to learn from others outside their own profession might best be countered by learning which takes place within the community of practice.

However, in both the cases cited above, there was no compulsion to participate or be part of the intervention, and the divide between those who wished to buy into the scheme and those who didn't was as marked as in the schools where other professional groups had been brought on site.

« Previous | Contents | Next »