Introduction
The British Association for Counselling and Psychotherapy (BACP) is pleased to respond to this important inquiry into the emotional and mental health of children and young people in Wales, focussing on the Together for Children and Young People programme (T4CYP). BACP is the UK’s leading body for counselling and psychotherapy, we have over 44,000 members in the UK, of which 1,900 are based in Wales.
Our evidence focuses on a key facet of the T4CYP programme – Resilience and Early Intervention. BACP has worked with a range of partners, including the Welsh Government (WG), to further this critical agenda in Wales over a number of years. In 2008-09, we worked with WG to develop a toolkit to support the development of school counselling services in Wales. In 2011, BACP was again commissioned by Government to undertake an evaluation into the strategy and the programme’s impact. Our written evidence focusses on the effectiveness of this important intervention to improve the emotional and Mental Health of Children and Young people in Wales.
Effectiveness of school-based counselling for children and adolescents with mental health problems in Wales
Since 2009, the Wales School Counselling Service has supported children and young people aged between 11 and 18 and pupils in Year 6 of primary school, providing opportunities to:
§ Discuss difficulties in a confidential and non-judgemental atmosphere
§ Explore the nature of their difficulties
§ Increase their self-awareness
§ Develop a better understanding of their difficulties
§ Develop the personal resources needed to manage their problems
§ Develop strategies to cope with change.
Evaluation evidence clearly demonstrates that this programme plays a fundamental role in supporting the health, emotional and social needs of pupils, and a key foundation the whole school approach to mental health being led in Wales. The Welsh Government undertook an extensive evaluation of their School-based Counselling programme in 2011[1]. This highlighted compelling evidence of positive impact:
· Counselling was associated with significant reductions in psychological distress across the board.
· Approximately 85% of respondents felt more positive about going to school after experiencing counselling
· Similarly, 85% of respondents said that they felt more able to cope since going to counselling
· Senior teachers reported counselling services had made a positive impact on the attainment, attendance and behaviour of young people
· Counselling was seen as highly accessible, allowing children to easily attend counselling sessions and leaving teachers to concentrate on teaching.
The Welsh Government’s latest statistics on the performance of service continues to positively affirm the important impact that this intervention is having on vulnerable school children in Wales. The latest statistics show that the level of psychological distress reported by service users before and after counselling was significantly reduced. This analysis used the YP Core score[2], on average this fell from 19.2 to 11.6 following the intervention[3]. In addition to this decrease in distress, the vast majority of children and young people who received counselling (88%) did not require any form of onward referral once counselling sessions had been completed.
Building on the success of school based interventions
School-based services can improve accessibility to interventions; better address school related stress and ease pressures on specialist Child and Adolescent Mental Health Services (CAMHS) by reducing inappropriate referrals. Although it is too early to meaningfully evaluate, BACP welcomes two recent announcements by Welsh Government which should build on the success of School-Based provision to facilitate a wider of positive mental health and well-being.
· The announcement in February 2017, that every child in Wales will now have access to a dedicated school nurse throughout their time at school, formulised through the revised School Nursing Framework for Wales in May 2017.
· £1.4m Welsh Government funding, announced in August 2017, for three new pilot projects where Specialist CAMHS practitioners will be recruited as link workers within the pilot schools. They will provide on-site help and advice for pupils experiencing difficulties such as anxiety, low mood and compulsive self-harm. We believe this will complement support provided by the school-based counsellors.
Conclusion and recommendations
The evidence shows clearly that investing a fraction of the mental health budget on school based counselling services helps to keep children in school and avoid unnecessary and often stigmatising mental health diagnoses, as well as reducing the burden on the already stretched and costly CAMHS provision - the cost of five sessions of counselling is equivalent to just one contact with CAMHS. We have identified a couple of areas where this success could be further built on.
1) Securing a more realistic funding offer - The School Standards and Organisation (Wales) Act extended school-based counselling for year 6 pupils in transition to secondary school and for those children and young people not in schools back in 2012. Despite this, there has been no increase in funding to local authorities to help them deliver these additional requirements.
Recommendation: Anecdotally, we believe demand is growing and waiting lists for school-based counselling are increasing and we urge the Welsh Government to review funding to ensure that the provision is at least as good as it was prior to becoming a statutory requirement.
2) Improving links between CAMHS and School-based Counselling - BACP practioner members have also reported that the relationship between school-based counselling services and CAMHS is mixed and often dependent on individual relationships at ground level rather than through a strategic approach at local level or through a national directive. This was also supported by a scoping report commissioned by BACP and led by the University of South Wales[4], which reaffirmed that these relationships were highly variable in both structure and effect, ultimately impacting on quality of outcomes.
Recommendation:Local authorities should be encouraged to forge and maintain strong relationships between schools and specialist CAMHS where this does not already occur to develop a sound mutual knowledge of the other’s experience, qualifications, policies, procedures and client groups, and encourage confidence in the capacity of the other.
Sources
Scoping Report: The relationship between specialist child and adolescent mental health services (CAMHS) and school- and community based counselling for children and young people. Spong, Waters, Dowd and Jackson, June 2013: http://counsellingminded.com/wp-content/uploads/2013/12/spong_MindEd_report.pdf
Evaluation of the Welsh school based counselling strategy – Executive Summary: http://wales.gov.uk/docs/caecd/research/111118EvalWelshSchoolCounsellingStrategyExecSummaryen.pdf
Evaluation of the Welsh school based counselling strategy – Final Report: http://wales.gov.uk/docs/caecd/research/111118EvalWelshSchoolCounsellingStrategyFinalReporten.pdf
[1] Welsh Government, Evaluation of the Welsh School-based Counselling Strategy, November 2011
[2] The Young Persons Clinical Outcomes in Routine Evaluation (YP CORE) is a standardised 10 item measure commonly used by counselling services for evaluation and outcome measurement of 11 to 16-year-olds. The YP CORE is short, therefore not too onerous, and focuses on feelings that young people are experiencing. The measure has eight negative and two positive items. It includes a single (negatively framed) risk-to-self item. Each item is scored from 0 to 4 on a Likert scale, with lower scores indicating lower levels of psychological distress – the maximum score is 40.
[3] the average YP Core score for children and young people who received counselling in Wales in 2015/16 prior to counselling was 19.2, compared to 11.6 following the sessions, an improvement of 7.6 in the average score
[4] Spong, Waters, Dowd and Jackson , ‘Scoping Report: The relationship between specialist child and adolescent mental health services (CAMHS) and school- and community based counselling for children and young people’, June 2013