Feeling good about yourself
Briefing for staff

Why this briefing

The purpose of this briefing paper is to tell you more about the emotional and mental health needs of young people with learning difficulties/disabilities and/or special educational needs (the term learning difficulties will be used in the rest of the document). These young people have a far greater risk of developing mental health problems compared to others yet they experience huge problems in having them recognised. Through work carried out by the Foundation for People with Learning Disabilities (the Foundation) it is has become clear that schools and colleges have a key role to play in identifying and accessing good mental health support for these young people as well as contributing to their social and emotional well being through the totality of their school and college experiences.

Some facts and figures

Over one in three children and adolescents (36%) with a learning difficulty in Britain has a diagnosable psychiatric disorder. They are more than six times more likely to have a psychiatric disorder than their non disabled peers. Young people themselves say that they have:

• difficulties in getting along with their peers
• significant behavioural, emotional or social difficulties
• difficulties in concentrating.

These young people are likely to face considerable social adversity. Disabled people and their families are generally poorer, they are likely to live in more challenging family circumstances and have fewer friends. These facts are known to be associated with an increased risk of mental health problems.

Another major contributing factor to social adversity is health. People with learning difficulties are far more likely to have secondary health problems such as epilepsy, sensory deficits or other disabilities.

To sum up, young people with learning difficulties are more likely to:

• be boys
• have poor general health
• have been exposed to a greater variety of adverse life events
• be brought up by a single parent
• live in poverty
• live in a poorly functioning family
• have a mother who is in poor health
• have a mother who has mental health needs
• live in a family with lower educational attainments and higher rates of unemployment
• have fewer friends (Emerson and Hatton, 2007).

All these are risk factors that can contribute to the occurrence of poor mental health in the general population. Read more about Emerson and Hatton’s work.

What can schools and colleges do

Schools and colleges have two major roles in supporting these young people and their families:

• They can offer advice about where to get further help and support.
• They can contribute to young people’s general social and emotional development and well being.

Getting help and support

It is important for schools and colleges to be able to identify their local services and other voluntary organisations that offer support to this group and their families. They include:

• Child and Adolescent Mental Health Services (CAMHS)
• Community Teams for people with Learning Disabilities (CLDT)
• Adult Mental Health Teams.

All are now required to provide services for young people and young people with learning disabilities

Child and Adolescent Mental Health Services (CAMHS)

CAMHS is a term used to describe the range of services and professionals working in the field of child and adolescent mental health. Each area or region is generally organised into four tiers of support:

• Tier 1 – non-specialist services, which include general practitioners, health visitors, social services, schools, youth workers and voluntary agencies.
• Tier 2 – services provided by professionals such as psychologists, psychiatrists, paediatricians, nurses and educational psychologists.
• Tier 3 – a more specialised service for those with severe and complex mental health problems.
• Tier 4 – services usually provided by in-patient units or highly intensive outpatient teams.

Community Learning Disability Teams (CLDT)

If the young person is aged 18 years and over, they can be referred to their local Community Learning Disability Teams. However, if the person has a very mild learning disability they may be referred to the local Adult Mental Health team instead (see below).

Community Learning Disability Teams support people with learning disabilities and their families. Teams consist of a range of professionals including social workers, psychiatrists, care managers, community learning disability nurses, dieticians, independent living officers, physiotherapists and speech and language therapists. Each patient or client is assigned a key worker from among the team who is usually a social worker or nurse. The key worker's job is to get to know the person well and to make sure that they are getting the help they need.

Adult Mental Health Teams

These are community based teams generally consisting of a consultant psychiatrist, community psychiatric nurse, clinical psychologist, social worker, occupational therapist and a pharmacist. The team may also include outreach workers such as mental health workers, support workers, vocational therapists, art therapists and psychotherapists. Like the Learning Disability team, each patient or client is assigned a key worker from among the team, again usually a social worker or nurse.

Fostering young people’s social and emotional development and wellbeing

Schools and colleges have enormous potential to contribute to young people’s social and emotional development. The New Secondary Curriculum makes the Every Child Matters outcomes and the Social and Emotional Aspects of Learning (SEAL) fundamental planks of the curriculum. The SEAL curriculum aims to help every young person to develop their:

• self-awareness
• motivation
• empathy
• social skills
• and to manage their feelings.

The QCA guidance on the 14-25 curriculum for young people with learning difficulties also emphasises the importance of thinking about the whole person through genuinely listening to learners in ways that respect their ideas and opinions when planning the curriculum. Find out more about this currculum guidance

What practical steps can schools and colleges take to achieve these outcomes for young people with learning difficulties? The following suggestions are all designed to contribute to young people’s feelings of self esteem and self efficacy.

Developing communication skills

Communication lies at the heart of relationships and yet we know that the majority of people with learning difficulties are also likely to have some form of speech and language problem. The frustration of being unable to communicate with others can lead young people to find alternative ways of communicating their feelings which can appear to others as challenging or difficult behaviour.

There has been a shift away from teaching standardised systems of communication towards ways of working that recognise an individuals’ communication preferences within environments that support a whole range of different approaches. This means carefully observing how individuals prefer to communicate, so that staff and carers can respond to and build on these.

Some of the teaching strategies that can help to address communication difficulties are:

• modelling appropriate speech and language
• seating with others who are good speech models
• using role play, debates and story telling to develop oral language skills
• using non-verbal clues – gestures, body language or visual aids
• defining, highlighting and reinforcing new vocabulary.

Learning how to learn

Young people can be taught strategies that provide them with more control over how they learn. They can be encouraged to question what they are doing through modelling by the teacher, asking, for example, ‘what will I do first?’ ‘next?’ And through using different types of questions such as ‘why’ and ‘how’ type questions as well as ‘what’ and ‘where’. Other useful strategies for learning how to learn include motivating learners by ensuring that they know what the purpose of the task is, setting time limits, using collaborative approaches and groupwork, teaching mnemonics or memory strategies and concept or mind mapping.

Problem solving

A number of programmes have been developed to improve young people’s problem solving strategies. The stages in solving a problem include:

• perceiving the problem
• thinking about the problem and its solution
• trying out the solution
• evaluating the success of the solution.

Pupils can be taught to adopt this approach in a whole range of situations but will need careful prompting to do so. Some may have difficulties in recognising that a problem exists at all while others will find it hard to think of possible solutions. By asking careful questions, learners can be prompted to recognise and respond to the problem by making a plan. Having written or visual prompts available to help the learner work through the steps can be helpful. Finally the learner needs to evaluate the solution. Posing questions such as ‘What happened?’ or ‘Can you think of another way to solve your problem?’ can help to reinforce the learning.

Behavioural techniques

Shaping and modelling are based on behavioural principles. The desired behaviour is broken into small steps and the young person is rewarded as they achieve each step. Modelling involves someone demonstrating each step of the desired behaviour, possibly thinking aloud as they go. This could be on such issues as how to deal with bullying, asking for help or playing a game.

Coaching, on the other hand, involves telling rather than showing a learner what to do. These techniques are often used to help an individual work co-operatively with others such as turn taking. The teacher asks the student to explain what they think the idea means (for example, ‘waiting for my turn to choose’) and then asks them to provide examples of when the desired behaviour is not happening (for example, ‘pushing in’). Then a practical task is set when the learner can try out the skill as well as being asked to think of other times and places when he or she can practice the skill. These examples are later reviewed with the pupil.

Involvement in planning and reviewing own programmes

Like most young people, those with learning difficulties have aims, aspirations and opinions about who they are and who they want to become. And yet our beliefs about an individual and what is best for them can form an implicit set of rules which guide the decisions that are made by carers and/or professionals on the young person’s behalf rather than genuinely exploring how to respond to their wishes. Through genuinely listening and respecting their views and ideas, staff and students can work together to develop a curriculum that has meaning and relevance for them. This, in turn, adds to the student’s feelings of self control and self efficacy and provides a genuine motivation for engaging in learning.

Developing friendships

Having friends is an essential part of life and their benefits and contribution to our mental and physical health is undisputed. And yet most people with learning difficulties have few friends outside the family unit – a situation often made more acute if they attend a special day or residential school away from their local community. How can schools and colleges foster friendships? It is important to create opportunities that allow friendships to develop naturally through doing something together and sharing experiences. Examples might include putting on a play, creating a garden, making a meal together. Practical steps are also required to enable young people to sustain these friendships outside school or college through involving parents or making links with local statutory or voluntary organisations. Successful inclusion projects also take account of young people’s need for friendships as well as their academic needs which, in turn, can open up new learning opportunities and experiences for young people with learning disabilities as well as their non-disabled peers. These can be fostered through peer support.

Peer support

There are many terms used to describe these programmes, for example, mentoring, buddying, peer tutoring, peer coaching and Circles of Friends. Some programmes twin peers who share particular interests and hobbies, for example, football or music. As well as helping to foster friendships, peer tutoring has been used to solve problems relating to bullying and bereavement.

Circles of Friends, which began in North America, were influenced by the desire to develop approaches that challenge the ways in which traditional services work. Instead of focussing on the demands and regulations of the service providers, Circles focus on the concerns, and needs, of the individual and their family. Led by a trained facilitator or advocate, Circles may consist of close family members, classmates, friends or perhaps key professionals who support the individual. Consisting of no more than six to eight people, they meet on a regular basis anywhere the target person feels comfortable to review progress, identify problems and decide on a plan of action. Circles can be used for a range of purposes but have been most widely developed in the UK in support of individual young people in schools or colleges, families with disabled children or in support of young people in developing their own plans for their future. The process is essentially about enabling individuals to have more control over their own lives.

Whole school and college strategies

Involvement in school and college self-assessment, school and college councils, student unions and governing bodies can all help to foster a sense of control in young people as they can see their voice making a difference to what happens around them. Information such as agendas or minutes should be provided in accessible forms that are genuinely inclusive of all participants and meetings conducted in such a way as to encourage everyone to feel that their opinions will be respected and valued.

Providing new opportunities

Opening up opportunities can trigger new experiences and interests which can contribute to young people’s sense of self as well as to their motivation. One means of providing these is through school/college links and taster programmes. These offer young people a chance to try out new opportunities at their local colleges before choosing a full-time course.

Planning for change

Any major changes or transitions that young people will be expected to make will require careful planning and preparation, especially at the school or college leaving stage. Good practice in helping young people and their families prepare for changes in their lives includes:

• recognising that making decisions can be difficult and complex
• respecting the need for everyone‘s voice to be heard equally within the decision-making process
• providing clear, timely and accurate information
• making sure that young people’s interests, aptitudes and aspirations guide the decisions that are made
• ensuring that learners are supported to express their feelings and anxieties
• providing many opportunities to learn about change and to come to terms with it
• ensuring that everyone who knows the young person can spend time together to share their knowledge of the learners’ likes and dislikes and their preferred means of communication
• creating networks and links with other young people or parents or carers who have already experienced the transition process.