Health of Children

risenessy minds Promoting frantic wellness and s public assistance in checks Contents Executive summary1 Key findings4 Recommendations6The lineament of crops in providing for pupils with psychological wellness difficulties7 Whole- initiate appeales to promoting approximate psychogenic wellness10 Recognising and providing for separate needs17 bestows in partnership with separate agencies17 Relationships with pargonnts24 In stately positionings27 Provision with master key referral31 Notes34 Further information35 Publications35 Websites36 Executive summary This idea examines the vital occasion vie by cultivates in promoting the activated well-being of their pupils.It analyses enforce base on evidence gathered from visits by Her Majestys Inspectors (HMI) to 72 schools and reports on the conflict of the counsel provided to schools four years ago by the subdivision of Education and Skills (DfES) and the guinea pig robust Schools exemplificationizeds (NHSS), hold in 1999. 1,2 Both brighten the importance of good supplying to ensure that schools meet the needs of pupils with intellectual wellness difficulties. Schools need of know guidege of the DfES guidance results from a missed hazard to improve the quality of planning for pupils with mental wellness difficulties.The boastful public figure of schools visited for this sight who were non fermentning(a) towards meeting the NHSS is of serious concern. Only safe over half(a) of them were aw be that such(prenominal) standards existed. Of these, only a precise sm totally minority of schools were running(a) towards or had met the criteria for providing for pupils activated wellness and well-being. angiotensin converting enzyme barrier was the get-go level of awareness of the importance of the issue. It is unsurprising, therefore, that training for supply on mental wellness difficulties was found to be needed in three manages of the schools.Most training te nded to focus on strategies for managing pupils conduct rather than on promoting positive approaches to relationships and resolving conflicts. Despite such a need of awareness in schools of mental health issues, there was good go for in unity threesome of the schools in the analyse, including an ethos which precious and respected individuals a serious approach to bullyrag and pupils difficulties with relationships, and swift resolution of problems good arrangements for listen carefully to pupils views the involvement of parents in revealing problems and making provide for their children.Good sum totalt meshing between health go, neighborly function and schools was at the heart of strong planning and purvey for individual pupils. Although multi-agency functionals was becoming better launch indoors topical anaesthetic education regime, it was unsatisfactory in a quarter of the schools. Schools, parents and pupils were not al slip fashion aware of how they force gain access to services. The beat extinct arrangements included regular meetings ascertained by a range of professionals, where work was coordinated, referrals do and difficulties followed up.Health services, loving services and schools utilize different terms to portray mental health difficulties. The lack of a customary language added to difficulties in recognising and meeting pupils needs. Schools set some star in twenty pupils with mental health problems, although the surgical incision of Health suggests a figure nearer mavin in ten. Arrangements for pupils to refer themselves for plump for and help were popular with them, as well as legal. This was supererogatoryly so where a pupil was struggling stimulatedly but where the school had not noticed changes in the pupils deportment.Mentoring and fend for from peers was similarly very effective at providing a auditory sense ear and opportunities for positive friendships. The report concludes that schools should define the promotion of pupils emotional health and well-being a priority and ensure all rung are aware of the guidance avail qualified. Key findings were nearly all principal(a) or special schools and pupil referral units (PRUs). Secondary schools found it nigh difficult to exploit arrangements for multi-agency working a priority and they rarely as wellk the lead in astir(p) this aspect of their work.The lack of common language between education, health and social services professionals contributed to the difficulties in establishing good partnership working. Recommendations Local political science and separate agencies should ensure that services for pupils with mental health difficulties are co-ordinated effectively at bottom their field of operations and that access to services is sink to schools, parents, children, junior passel and other service accustomrs commission, where eliminate, the services of instinctive organisations. Schools and other setting s should use the DfES national guidance on mental health difficulties to develop clear procedures, that are cognise and use by all round, for identifying and supporting pupils ensure that issues concerning mental health are tackled successfully, either finished the depicted object Healthy School Standard (NHSS) curriculum or the PSHE course of instruction establish arrangements for pr heretoforeting bullying and promoting positive relationships and superintend their effectiveness work together to ensure that the DfES guidance is disseminated to all round.The role of schools in providing for pupils with mental health difficulties 1. M any services execute an historic role in promoting pupils emotional health and well-being, including health services, social services, voluntary organisations, early years provision and schools. However, the notion of mental health difficulties carried a considerable stigma for many pupils and their parents. This, together with the need to attend a clinic, created difficulties for Child and affable Health Services (CAMHS) in working with young flock and their parents.A some pupils in the espouse said that they did not propensity to attend clinics for their appointments and did not want to be labelled as mentally ill. Schools, therefore, play an important role in supporting children and young people in this area. 2. Guidance provided by the DfES in 2001 aimed to help t apieceers and others, working on base mental health professionals, to promote childrens mental health and to interpose effectively. 3 It provides a useful description of the nature of pupils with mental health difficulties and a thorough overview of the issues relating to joint working between health services, social ervices and education. It suggests accommodative strategies for schools to use. Few schools, however, were aware of the guidance which should fritter a crap provided a good fortune to improve the quality of provision for pupils wi th mental health difficulties. 3. A survey referred to in the DfES guidance indicated that near 10% of pupils experience clinically specify mental health difficulties. The schools visited, however, set only between 4% and 6% of pupils overall with al nearly form of mental health difficulty, indicating some to a lower place- acknowledgment.This talent go some way to explaining why schools struggle to manage the behaviour and attendance of some pupils, if they are not correctly identifying their difficulties and providing for them. 4. The 1999 Mental Health Foundation publication Bright futures defined children who are mentally powerful as able to develop psychologically, emotionally, intellectually and spiritually initiate, develop and observe mutually satisfying in the flesh(predicate) relationships use and enjoy solitude go aware of others and empathise with them play and learn develop a good sense of right and wrong resolve (face) problems and set arses and learn from them. 4 5. Health services, social services and schools all use different terms to describe pupils and their conditions. There are many definitions of the term mental health difficulty ranging from the highly categorised, ordinarily used by many health services, to those based on much descriptive terms which are prevalent in schools and other educational settings. 6. Mental health and mental health difficulties are more commonly used terms inside health and social care.Schools and local authorities are increasingly using the term emotional health and well-being in relation to both the care they take of pupils and the curriculum they provide. 7. The lack of theatrical roled definitions and understanding of mental health problems, however, wangles it difficult for schools to identify and discuss these pupils. In a small proportion of particular schools, boys were pinpointed as more likely to exhibit mental health difficulties, but most schools inform no pattern. Some l owly schools identified more girls who were depressed, ego-harming or who had eating disorders.However, no real gender differences were apparent and boys and girls were equally likely to retain mental health problems which were evident in school. Whole-school approaches to promoting good mental health 8. The best schools promoted good emotional health and well-being by valuing and respecting either individual. In the schools visited, those which embodied a value system that embraced all children identified fewer children with mental health problems. These schools promoted many and varied opportunities for pupils to share their thoughts and feelings.They used the curriculum to develop pupils listening skills and an understanding of other peoples points of view this culture permeated school life. font deliberate A indigenous election school in a di dolefulvantaged area had a fondness and supportive ethos in which the personal development and emotional well-being of pupils was very effectively promoted. There was a strong emphasis on evolution all pupils self-esteem and ensuring that they had the language and opportunities to express their feelings and emotional needs.The school council and staff were concerned that some pupils did not throw off friends to play with at halt time. Very good initiatives, including Playground Buddies and a Friendship Area, were introduced in response to these concerns. The school worked very hard to build up and insist supportive relationships with parents and guardians, who felt that the school was a very safe and sympathize with place for the children. The whole staff, including t individuallyers, teaching assistants, administrative staff, catering staff, the site coach and cleaning staff contributed to this whole-school thos. 9. Pupils interviewed for the survey identified a lack of friendships and bullying as reasons for emotional difficulties in school. In all the schools with good arrangements for promoting healt h and well-being, bullying was not tolerated at any level. Pupils were able to discuss any incidents where they felt bullied and matters were discussed sensitively and resolved speedily. In these schools the pupils specifically commented that they were happy at school because they could talk to an adult if they had problems and know that action would be taken. 10.All schools taught a programme of personal, social and health education (PSHE). nigh all primary and special schools discussed some elements of anger management, conflict resolution, bullying and friendship difficulties through such programmes. The provision was al ways at least satisfactory, and was good in over half of all schools visited. 11. Very few of the schools, however, tackled mental health difficulties specifically. These were missed opportunities to promote pupils general emotional well-being, particularly so in second-string schools where there were generally fewer opportunities to explore such issues.Only a third of the unessential coil schools visited taught PSHE programmes which included topics such as bereavement, stress and bullying. 12. The uncomplicated National Strategy has provided training and curriculum materials for schools which focus on the social and emotional aspects of learning. At the heart of the materials is the belief that positive behaviour requires an active, whole-school approach to underdeveloped childrens social, emotional and behavioural skills within a community that promotes the emotional well-being of all its members.A few of the schools visited were tough in the pilot comprise of this work to very good effect. These schools were teaching pupils how to understand their own feelings and those of others, remain when things became difficult, resolve conflict and manage worries. supply found the training utile and were in a good position to ensure their pupils learned how to take responsibility for their relationships and their learning. Following succ essful piloting, the Social and Emotional Aspects of Learning (SEAL) curriculum resource was made available to all primary schools in June 2005. 5 carapace knowledge A course of instruction 5 sieve explored what it felt like to join a new convention. Pupils talked freely around their own experiences of joining clubs, locomote to a new school and trying to make new friends. They used a good range of vocabulary to describe the feelings associated with newness and change, ranging from scared and harebrained to apprehensive and excluded. Groups then planned what they would put in a experience pack for a newcomer to their school. They gave careful thought to the kinds of information that would be helpful and to the ways in which they, as individuals, could be supportive. 3. No sympathetic national programme was observed in petty(a) schools although peerless is before long being developed. Overall, secondary schools were less successful than primary and special schools at tack ling issues of emotional health and well-being through whole-school initiatives. 14. In over half of the secondary schools visited, behaviour policies created stress or tensions for pupils. For example, in one school, exclusion was a common response to difficult behaviour as a result, the pupils felt under- value.Schools made only very limited efforts to provide a suitable curriculum to meet these pupils emotional and learning needs. In one learning support centre within a school, pupils were taught by bungling staff in poor surroundings which contributed to their low self-esteem. In a PRU, Year 11 pupils involved in a transition programme jointly run with the youth offending team reported that they were displace home on study leave two months before their ordained leaving date, even though they were not taking any formal examinations. They felt unwanted and this has had a negative effect on their self esteem, behaviour and attendance. 5. A signifi atomic number 50t minority of the secondary schools found ways to promote emotional well-being through their behaviour policies. For example, one large secondary school was developing ways to ensure that older pupils remained diligent with their school, even though they were soon to leave. A group of Year 11 pupils certain two days training to develop skills of listening and service of process pupils to find their own solutions to problems. The pupils subsequently provided a non-threatening opportunity for pupils who were experiencing difficulties to confide in someone and share their problems.The trained listeners received an external accreditation award for finish their training. 16. adept barrier to improving provision for pupils emotional well-being was the low level of awareness amongst staff of its importance. Hardly any schools were aware of the comprehensive guidance issued by the DfES in 2001. 6 Even fewer schools had provided any staff training to elevator awareness of the issues and the strateg ies described in the guidance. 17. Training for staff on mental health difficulties was unsatisfactory in just over a third of the schools visited and good in only just under a quarter.Most training tended to focus on managing pupils behaviour rather than on promoting a positive approach to relationships and resolving conflicts. However, a few secondary mainstream and special schools were developing an approach to conflict resolution based on restorative justice. This ensured that, where there were conflicts, all points of view were aired and discussed. The pupils valued this they felt they could have their say and that their views were respected. The training programme for staff was effective teachers and support staff felt able to implement the programme successfully. 8. The National Healthy Schools Standard (NHSS) is at the core of the governments level-headed schools programme. 7 It was introduced in October 1999 to support the teaching of PSHE and citizenship in schools and to provide schools with practical ways to create a safe and productive learning environment and minimise potential health risks. genius of its eight key areas of activity is emotional health and well-being (including bullying). Of serious concern, however, was the large number of schools in the survey who were not working towards meeting the standard. Only just over a half were ware that the NHSS existed and, of these, only a very small minority were working towards or had met the criteria for emotional health and well-being in their school. 19. low-toned schools often had informal but effective arrangements for recording and discussing concerns about pupils well-being. Staff quickly perceived changes in pupils behaviour, demeanour or progress. An important trait of these effective schools was the quality of the communication between staff, for example between class teachers, teaching assistants and the special educational needs co-ordinator.Recognising and providing for individua l needs works in partnership with other agencies 20. All schools and LEAs recognised the importance of working well with professionals from the health and social services. Joint working with these other agencies was life-or-death in planning and providing for pupils individual needs. The challenge, however, for professionals from a range of disciplines was to achieve a common understanding of the problems of pupils with mental health difficulties. The following case study shows the benefits of effective joint working. campaign studyA counsellor in a secondary school was working with a pupil who had referred herself for support. The pupils convey did not know this. A mental health worker from CAMHS, who worked in a local clinic, was also working with the pupil and approached the counsellor to instruct if they could work together with the pupil and parent. The counsellor discussed this with the pupil who gave permission for her start out to be contacted. Both professionals becam e engaged in supporting the parent and child. The consonant approach agreed between the adults ensured more straightforward backchats and properly agreed resolutions to problems. 1. Many of the local authorities visited were in a period of reorganization as they set up Childrens Services to meet the requirements of the Children scrap 2004. Practice is beginning to develop to establish the joint planning and working at the heart of this legislation. For example, one LEA was developing multi-agency patch teams and common referral procedures were being considered. Despite this, the survey showed that there was a long way to go to ensure that the legislative intentions result in better practice in schools. 22.Partnerships with external services were unsatisfactory in nearly a quarter of the schools visited and significant improvements were required in two thirds of them. Only a few of the secondary schools had good arrangements for multi-agency working. Relationships between schools and social services were particularly variable. 23. Unsatisfactory relationships between schools and other agencies were typified by the unavailability of social workers, even for urgent cases schools inflexibilities in approaching the planning of programmes to meet the needs of some of their pupils frequent staff changes long waiting lists for referrals reliance on personal informal contacts rather than agreed systems issues relating to geographical boundaries which remain unresolved. In the third of schools where multi-agency work was good, all the agencies had found ways of resolving such difficulties. 24. The most effective strategies which promoted good joint working included regular, frequent meetings attended by all agencies. Pupils needs were discussed and plans agreed and recorded. Case study A Vulnerable Students Panel effectively identified students xperiencing emotional health difficulties and provided appropriate multi-agency support for them. The panel met monthl y and included representatives from a range of agencies. It was chaired by a deputy headteacher and a psychiatric nurse who was the manager of the school support centre. All school staff were informed confidentially about the students who had been discussed and this dissemination aided further identification. Decisions made by the panel ensured that agencies were deployed to work most effectively in their areas of greatest competence and avoided unnecessary duplication of effort.Importantly, the school and agency representatives were charged with taking action and reporting back on its success at the next meeting. In this way each organisation was accountable to the panel. 25. Identifying one person to be responsible for co-ordinating and liaising with health and social services helped communication and ensured important information about pupils was disseminated effectively. 26. In a few LEAs, networks of professionals working in the same area met on a regular basis to share effecti ve strategies.They learnt about each others working practices and this promoted a shared understanding of issues. There was good practice in schools where a large-minded range of professionals including counsellors, healers, social workers and psychologists were employed by the school. Case study A primary school had formal procedures for logging concerns about a childs academic, personal, social or emotional development. A nurture group also provided a way of identifying pupils who might have mental health difficulties. The school used short-term charitable bread and butter to employ a family officer.She maintained close golf links with families identified as being in crisis and was therefore easily able to identify pupils at risk of developing difficulties in their emotional health and well-being. This approach support partnership working so that parents referred their child to the family officer, headteacher or special educational needs coordinator if they had concerns. 27. R egular visits by other professionals helped schools to identify pupils who might be experiencing mental health difficulties. Case study The headteacher attended the schools breakfast club every day and a mental health worker attended once a week.The club provided an effective system of identification through direct observation of children and regular communication with parents. 28. sometimes other agencies initiated the joint working and the schools grasped the opportunity to participate. Case study A consultant paediatrician at a local hospital initiated collaboration amongst different schools to promote emotional literacy amongst pupils. The initiative was inspired by an fire to deal with bullying, cited as a problem by many children who attended the hospital.The project, now in its fourth year, involved pupils from a primary school, special school, high school and the local tuition service. The projects activities were based on posters which depicted problems faced by pupils. T hey were encouraged to develop listening skills, understand the perspective of others and to negotiate and compromise. Hospital staff encouraged the use of a common language by colleagues and the project fostered strong links between the health and education services. The result was fewer individual referrals to the hospital. Pupils who go through bullying were usually referred directly to the project for support. 9. The pupils who were least mentally well were those who were withdrawn or depressed and who were underachieving as a result. Schools commonly identified pupils whose attendance was unsatisfactory and who did not participate fully in school life. Typically, these pupils had few or no friends and were isolated in the play ground. However, they presented few challenges to teachers and, too often, their problems were not followed up. Few schools saw non-attendance, lateness or falling toilet in course work and homework as indicative of deeper problems. 30.Schools relied to o much on informal methods to identify vulnerable pupils. Primary schools, particularly, insisted that they were able to identify such pupils easily because they knew their pupils very well. 31. Only a minority of the secondary schools used information from pupils previous schools to help recognise those who might experience mental health difficulties. Relationships with parents 32. A key to effective identification and provision lay in schools relationships with parents. Links with parents and other agencies were closest in the early years.Home visits, where parents could talk openly about their concerns and their childrens behaviour, and initiatives such as parenting classes, supported the identification of any problems or difficulties. As pupils grew older, schools found it harder to set out such relationships, although there were examples of very good practice in primary, secondary and special schools. The main characteristics of good practice were home visits by teachers and other support staff training for parents in developing sizable minds enate support groups regular meetings and telephone contact co-ordination with other agencies so that parents had to attend only one meeting. 33. Parental support groups were particularly common in the schools visited. In the following case study, the support groups were run by a local CAMHS team based in the school. The workers were able to talk to teachers darn they were in the school and to ensure that information about individual pupils was discussed with them when appropriate. Case study A group of six parents met for ten two-hour sessions. The aim of the group was to help parents enjoy rather than simply manage their children.Parents learned how to play games and stimulate their children, thus strengthening their relationship. They particularly appreciated the opportunity to share their concerns with other parents who understand the problems. One parent reported, You realise youre not on your own you do nt feel so distressing. The project was in its infancy, but there were signs that it was helping parents to develop trustfulness and to help each other do better. 34. Difficulties in working with parents stem from late diagnosis of a pupils problems uncoordinated support from a range of agencies poor information provided for parents about whom to contact unsatisfactory account taken of parents childcare arrangements, so that they sometimes had difficulties in be meetings negative feedback to parents about their children parents perceptions that the school had given up on their child. One parent observed, Nobody ever said what was available you had to find out for yourself or hear it from someone else. 35. Most, but not all, of the pupils identified with mental health difficulties also had emotional, social and behavioural difficulties (EBSD).Some had more than one such difficulty. Ofsted has reported recently on the provision for these pupils and its effectiveness. 8 This report focuses on the provision required for pupils who do not necessarily have special educational needs but who require additional emotional support to survive at school. Informal arrangements 36. Half the schools in the survey operated self-referral or drop-in schemes run by peer counsellors, youth and community workers, school nurses, in-school counsellors and those from voluntary organisations.These arrangements enabled the pupils to identify themselves and seek the help they wanted and needed. Case study A secondary school appointed a health practitioner who dealt with a wide range of issues developing self-esteem, anger management, relaxation and stress management. Pupils were able to make their own appointments and the work was completely confidential. She also did some teaching. This made her more accessible and reduced the stigma for pupils of knocking at the door. 37. A very small minority of primary schools offered pupils opportunities for self-referral to staff.In thes e schools, pupils could draw or keep about themselves in a reflections contain or a feelings book, make use of a bullying box, and write or talk directly to the headteacher or the PSHE co-ordinator. Pupils who had such opportunities reported that this was supportive and gave them confidence. A Year 6 pupil said of her reflections book It helps me to have a confidential conversation with my teacher about things that are worrying me. 38. A programme of education about values also helped pupils to talk freely and openly about their feelings.Each pupil was given a book in which they could write or draw a picture about the things that had made them happy or sad. Teachers monitored the books regularly to ensure that a pupils personal difficulties were identified early they were powerful additions in a school where the ethos was already strongly supportive of pupils emotional well-being. 39. Clubs and after-school activities also enabled schools to support vulnerable pupils in a way whi ch reduced the stigma of referrals. 40. In one primary school, 50 pupils regularly attended the happy/sad club, where they talked about positive or negative experiences that concerned them.Clear ground rules had been established, which were understood by pupils, such as respecting what had been discussed and not gossiping. Pupils could put a scud in a scrapbook of people that were special to them. The teacher usually led a short, directed session based on an appropriate text and provided an opportunity for meditation and reflection. The high number attending reduced the misadventure of negative labelling and pupils had good opportunities to share their thoughts and feelings openly with their peers. 1. Pupils often commented that they particularly valued opportunities to talk and be listened to. The extent to which pupils with mental health difficulties have problems in making and sustaining friendships may explain, to some extent, the success of peer support schemes. 42. Nearly ha lf the primary schools visited had effective initiatives which were based on pupils helping each other to resolve difficulties. One school focused on socially isolated pupils by appointing playground angels.The angels had weekly meetings with a teacher and were also represented on the school council. Pupils involved in these activities felt that they helped them to show responsibility towards younger children and to develop into mature and sensible people. 43. Others schools focused on the difficult point of transition between primary and secondary school. Pupils who struggled to make friends were considered by a few primary schools to be particularly at risk of experiencing problems. These schools developed a range of peer support programmes, as in the following example Case studyA group of Year 4 pupils were considered to be at risk of difficulties on transition and the school intractable to make provision in collaboration with the local secondary school. Year 8 pupils were invit ed to apply for posts of pupil mentors. They were interviewed and successful applicants were trained. Over two years, the primary pupils visited the secondary school at least once each half term for lessons, lunchtimes and social activities. On each occasion they were met by their individual mentor and had time to discuss issues with them. Primary pupils really enjoyed the programme.They were very clear how the transitional programme had helped them to prepare for secondary education. 44. Two thirds of the secondary schools visited had good peer counselling, support and mediation systems. Peer mentors who had themselves experienced difficulties in the former(prenominal) commented on how much they valued helping younger pupils who were also experiencing problems. The most successful schemes provided thorough training for the pupils offering the support, as well as careful monitoring from the teachers responsible for it. Provision through professional referral 45. Referral systems di ffered widely.In one area, the consultant psychiatrists responded to requests for information about pupils the service accepted referrals from any involved professional. More commonly, however, panels of professionals considered referrals. The latter arrangement had some advantages in that there was discussion and agreement on the type of intervention which was most likely to succeed. However, this arrangement also tended to create delays in responding to pupils needs. 46. Not all professionals were clear about how referrals should be made, and who ought to make them, for particular types of provision.This lack of clarity meant that pupils who might have benefited from services were not given access to them since the school was unaware that it could make such a referral. 47. Schools and pupil referral units (PRUs) did not always receive an true service from other agencies, especially where education, social services and health services had not agreed how resources should be allocat ed and work prioritised. It was common to find that a CAMHS worker was based in a school in one part of a local authority, while, in the same authority, another school had to make referrals to a panel.The schools were unaware of why these differences existed. 48. The most common types of provision were counselling family work mentoring and support workers who visited the pupils regularly and provided advocacy and support through discussion and activities a modified curriculum and timetable nurture groups and sanctuary space. 49. This provision was largely effective when it was matched well to the assessment of the pupils needs. However not all schools were able to attract the additional resources required to provide these types of opportunities.Larger schools had more bread and butter to be able to establish support centres specifically for pupils with mental health problems. 50. Local and national voluntary organisations played an important role in working with schools and lo cal authorities to provide services for children and young people with mental health difficulties, and they were often represented on local CAMHS strategy groups. In some local authorities, partnerships with voluntary organisations provided helpful services for schools and parents, such as counselling and family therapy.Voluntary groups were often better at monitoring and evaluating the impact of their work since they depended on such evidence to attract further funding. Case study In one local authority a generosity had been working in some schools for five years. For an annual fee, the school received a large amount of support from the charity which provided an art therapist and a dance instructor who worked with pupils identified by the school and provided counsellors, oversee by team leaders, from the charity. NotesThis survey is based on the findings of a survey of 72 settings in eight local authorities. The settings and almost all the authorities were selected randomly to re present a mixture of shire and unitary authorities. One authority was chosen because of known good work in the area of mental health. Her Majestys Inspectors (HMI) visited early years settings, primary and secondary schools, pupil referral units, hospital schools and settings, maintained and independent schools for pupils with EBSD and learning difficulties, and specialist provision for pupils who had been bullied.HMI observed lessons and other activities, scrutinised policies and records and held discussions with 269 pupils and 115 parents. Discussions were also held with a range of local authority staff, headteachers and senior managers, teachers, teaching assistants, learning mentors, and representatives of voluntary organisations. They also met CAMHS regional development workers. Further information Publications Promoting childrens mental health within early years and school settings, (DfEE 0121/2001), DfEE, 2001. SEN and disability towards inclusive schools (HMI 2276), Ofsted, 2004.Managing challenging behaviour (HMI 2363), Ofsted, 2005. Mental Health and Social Exclusion, Social Exclusion Unit Report, business of the Deputy Prime Minister, 2004. http//www. socialexclusionunit. gov. uk/downloaddoc. asp? id=134 Promoting social, emotional and behavioural skills in primary schools, Primary National Strategy, DfES, 2004. Developing emotional health and well-being a whole-school approach to improving behaviour and attendance, Key Stage 3 National Strategy, DfES, 2004. Behaviour and attendance toolkits, Key Stage 3 National Strategy, DfES, 2005. http//www. standards. fes. gov. uk/keystage3/respub/ba_toolu Promoting emotional health and well-being through the national healthy school standard (NHSS), NHS Health Development Agency, 2004. http//www. hda-online. org. uk/Documents/promoting_health_wellbeing. pdf Guidance on new ways of working for psychiatrists in a multi-disciplinary and multi-agency context national steering group temporary report, NIMHE, CWP, R oyal College of Psychiatrists and Department of Health, 2004. http//www. dh. gov. uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4087352=01RXVr Effective joint working between child and adolescent mental health services (CAMHS) and schools, Research report no. 412, Bridget Pettitt, Mental Health Foundation, DfES, 2003. Websites www. dfes. gov. uk/mentalhealth DfES Mental Health www. rcpsych. ac. uk Royal College of Psychiatrists www. socialexclusionunit. gov. uk Mental health and social exclusion www. standards. dfes. gov. uk/primary DfES guidance on developing childrens social, emotional and behavioural skills www. teachernet. gov. uk/management/atoz/n/nhss/ National Healthy Schools Standard 1 Promoting childrens mental health within early years and school settings (DfES 0121/2001), DfES, 2001. 2Promoting emotional health and well-being through the national healthy school standard (NHSS), NHS Health Dev elopment Agency, 2004. 3 Promoting childrens health within early years and school settings, DfES, 2001. 4 Bright futures promoting children and young peoples mental health, Mental Health Foundation, 1999. 5 The SEAL resource box can be ordered from Prolog, Tel. 0845 602 2260, emailprotected uk. com (ref DFES 0110 2005 KIT), or viewed and ordered from the Teachernet website www. eachernet. gov. uk/seal. 6 Promoting childrens mental health within the early years and school settings, DfES, 2001. 7 The NHSS is funded jointly by the DfES and the Department of Health, hosted by the Health Development Agency (HDA). It forms part of the governments drive to reduce health inequalities, promote social inclusion and raise educational standards through school improvement. 8 Managing challenging behaviour (HMI 2363), Ofsted, 2005. Primary and SecondaryJuly 2005 HMI 2457