This case study outlines the Shropshire wide schools based programme Think Good, Feel Good which initially started as a pilot programme in 2009. The programme adopts a universal population based approach for children and young people at tier 1, and targeted support for those at tier 2.
It is widely recognised that the commissioning and delivery of high quality mental health and wellbeing services is an investment that will lead to population health gains and financial savings both in the medium and long term. The evidence base for mental health is strong and over the past decade there have been numerous strategies, studies and programmes that can demonstrate the impact of intervening early especially in the crucial childhood and teenage years that will help to prevent the future development of mental health illness. Some examples of potential savings are taken from the Mental Health Promotion and mental illness prevention: The economic case (Knapp et al, 2011):
Social and emotional learning programmes results in returns of £84 for each £ invested
The Shropshire Picture
It is estimated that there are over 4000 children and young people in Shropshire with diagnosable mental health problems. In a typically sized class of 30 children, it is estimated that 3 will have an emotional or mental health need. The most common presenting issues are related to drugs and alcohol misuse, self-harm, depression, domestic violence within the home and post abuse distress. Children in residential care, those with a learning difficulty and those in contact with the youth justice system have an increased risk of developing a mental health condition.
Children with a serious physical disability are twice as likely to suffer from mental ill health, and the number of children with disabilities is rising.
It is estimated that approximately a quarter to half of all adult mental health conditions could be prevented with the right interventions in childhood. These include promoting positive attachment and bonding between a baby and their main carer to promote healthy brain development and good mental health as an adult. Maternal ill health, domestic violence and substance misuse in the home can all harm the mental health of children and young people.
Children living in deprived households are three times more likely to have mental health problems than children living in more affluent household. It is estimated that over 7000 children in Shropshire live in poverty. Children who have significant caring responsibilities for other family members are more likely to develop mental health problems often linked to stress, feeling isolated and overwhelmed. Based on national statistics, it is estimated that 900 children and young people in Shropshire act as young carers.
Intervening Early in School Settings
The core aim of the Think Good Feel Good programme is to develop a whole school approach on emotional health and well-being through the delivery of an evidence based training programme across all Shropshire schools. There are 130 primary schools, 20 secondary schools, 2 special schools and Tuition Medical Behaviour and Support Service units (TMBSS). To date the programme has been aimed at school age children 5-16 years as well as their families and the whole range of school based staff. All of the training programmes that are delivered are evidence based, either nationally or internationally.
The programme adopts a whole school/ service approach with the following key objectives:-
Schools and partner agencies are invited to attend centrally based multi-agency core training on issues such as self harm, suicide prevention, domestic abuse, loss and bereavement, anxiety, anger management. The training increases the knowledge base of staff enabling them to recognise early signs and symptoms of need, provides practical examples of how to respond to the emotional needs of young people as well as tips and strategies on what to do and say following identification of need. The more in-depth intervention based training provides resources and clearly structured programmes that school based staff can deliver within the school setting to support a wide range of emotional needs.
The programme is delivered through a project manager with a small core team and the success to date is due to the joint ownership and delivery of TaMHS training and interventions in collaboration and consultation with schools and partners. The programme supports, involves and builds on existing work of all local professionals who work in and around schools, including school nurses, the local authority health development team, specialist CaMHS service and those working on a prevention agenda for children and young people including the voluntary sector.
Intervening Early in School Settings
The core aim of the Think Good Feel Good programme is to develop a whole school approach on emotional health and well-being through the delivery of an evidence based training programme across all Shropshire schools. There are 130 primary schools, 20 secondary schools, 2 special schools and Tuition Medical Behaviour and Support Service units (TMBSS). To date the programme has been aimed at school age children 5-16 years as well as their families and the whole range of school based staff. All of the training programmes that are delivered are evidence based, either nationally or internationally.
The programme adopts a whole school/ service approach with the following key objectives:-
Schools and partner agencies are invited to attend centrally based multi-agency core training on issues such as self harm, suicide prevention, domestic abuse, loss and bereavement, anxiety, anger management. The training increases the knowledge base of staff enabling them to recognise early signs and symptoms of need, provides practical examples of how to respond to the emotional needs of young people as well as tips and strategies on what to do and say following identification of need. The more in-depth intervention based training provides resources and clearly structured programmes that school based staff can deliver within the school setting to support a wide range of emotional needs.
The programme is delivered through a project manager with a small core team and the success to date is due to the joint ownership and delivery of TaMHS training and interventions in collaboration and consultation with schools and partners. The programme supports, involves and builds on existing work of all local professionals who work in and around schools, including school nurses, the local authority health development team, specialist CaMHS service and those working on a prevention agenda for children and young people including the voluntary sector.
This table of interventions shows the whole toolkit of knowledge based and targeted intervention training which constitute the TaMHS core offer (Purple and green boxes). This annual programme of training is available and delivered on a multi-agency basis. Additional training for multi-agency teams, professionals and whole staff training for schools is also delivered on a request basis, stress management, lunch time supervisor training. Many but not all schools are signed up to the programme with varying degrees of delivery and the long term goal for the next two years is for all Shropshire Schools to have access to the complete toolkit of targeted and knowledge based interventions and training
There are various measurement tools in place within the programme either programme related or school based indicators at a qualitative and quantitative level. The school and pupil related indicators include individual measures of anxiety, feelings, pupil perception and attitudes with others related to attainment, attendance and exclusion. The training programmes include measures on activity levels of schools and participant feedback with pre and post baseline to capture impact.
From April 2013 the programme has extended it’s reach to cover 0-19 year olds with a renewed vision for the future based on a sustainable model. Additional elements include a core offer for all schools and the development of a mental health PHSE curriculum resource from KS1 through to KS4 and educational resources on self harm for school staff. Further work on the analysis of data is being done with colleagues from public health and there are future plans for the evaluation of the model and rigorous collection and analysis of data.
Key Learning Points
Key Success Factors
Main Components of Think Good Feel Good
For further Information please contact:-
Kay Smallbone, Programme Lead 5-19, Shropshire Public Health,
Renee Lee, Project Officer, Shropshire Public Health,
Jo Robins, Locum Consultant in Public Health (BSc, MSc,FFPH), Shropshire Public Health, Shirehall, Abbey Foregate, Shrewsbury. 01743 253935,
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