Over the last 15 years, policy initiatives have aimed at the provision of more comprehensive Child and Adolescent Mental Health care. These presented a series of new challenges in organising and delivering Tier 2 child mental health services, particularly in schools. This exploratory study aimed to examine and clarify the service model underpinning a Tier 2 child mental health service offering school-based mental health work. Using semi-structured interviews, clinician descriptions of operational experiences were gathered. These were analysed using grounded theory methods. Analysis was validated by respondents at two stages. A pathway for casework emerged that included a systemic consultative function, as part of an overall three-function service model, which required: (1) activity as a member of the multi-agency system; (2) activity to improve the system working around a particular child; and (3) activity to universally develop a Tier 1 workforce confident in supporting children at risk of or experiencing mental health problems. The study challenged the perception of such a service serving solely a Tier 2 function, the requisite workforce to deliver the service model, and could give service providers a rationale for negotiating service models that include an explicit focus on improving the children's environments.
This article provides an overview of the development and delivery of a mental health teaching and training programme offered to Family Support Workers (FSWs) working in a range of schools in an economically deprived part of Bedfordshire. The FSWs had received no prior teaching in the area of child mental health, or in ways of engaging and communicating with children and families. Both topics were considered crucial to their role. The training was delivered in two phases. Phase 1 consisted of 4 full days of teaching. Topics covered included (1) engaging children and families, (2) child development, (3) self-awareness, and (4) systemic thinking. Phase 2 was delivered through 'practice sets', which were held monthly for 4 months, and lasted 2 hours. These were used to develop the FSWs' theoretical understanding of the issues, and link this with their practice. The training was evaluated using a semistructured questionnaire. Results suggested that participants had changed the ways in which they engaged families and children. They were more able to adopt a collaborative, nonexpert, position which focused on empowering families to make decisions for themselves. This represented a significant shift in the way they worked. This process was enhanced by their more sophisticated level of understanding of child development and behaviour problems, which took into account the impact of wider systemic and relational factors and moved away from locating problems within individuals. Participants also demonstrated the ability to reflect on how their personal beliefs and experiences impacted on the work they undertook, and why this was important. Recommendations following the training included the need for regular, ongoing practice support, the need for the training to be more widely disseminated (e.g. to school staff), and the benefits of having clear descriptions of the roles and responsibilities of Family Support Workers.
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