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Effective Strategies to Support Families with
Mental Health Issues
Dr Trisha Waters
Training consultant, YoungMinds in Schools
Mental health in Britain
• 1 in 4 people will experience some kind of mental health problem in
the course of a year
• Mixed anxiety and depression is the most common mental health
disorder in Britain
• One in ten children between the ages of one and 15 has a mental
health disorder.
(The Office for National Statistics Mental health in children and young
people in Great Britain, 2005)
'Mother love in infancy and childhood is as important for mental
health as are vitamins and proteins for physical health.’
John Bowlby 1953
Attachment theory
• Innate psychobiological system (the attachment behavioral system)
that motivates us to seek proximity to significant in times of stress,
• Sensitive and responsive attachment figures promote positive
mental representations of self and others through:
– Physical warmth and proximity
– Mutually enjoyable activities
– Co-attunement of affect
– Co-construction of meaning
Characteristics of child who has experienced
secure attachment
Able to make positive attachments with teachers and peers
Expect interaction with adults to be affirming of their own worth
More able to take risks when exploring new situations- have
expectation that help will be there for them
More able to tolerate frustration in the learning process
Able to share adults attention with other children
5
Behaviours of children with attachment difficulties
related to their internal emotional world
• Poor concentration in class -‘I can’t trust anyone, so I must constantly be
watchful’
• Constant talking - ‘Silence is scary and talking keeps bad thoughts away’
• Ignoring instructions- ‘I’m in control, don’t tell me what to do’.
• In trouble during breaks- ‘I can’t handle unstructured situations, I feel out of
control, the chaos is frightening’
• Refusal to be helped with work- ‘I was left helpless- I’ll never be helpless again.’
• Explosive reactions when making mistakes- ‘If I get it wrong I will be rejected
AGAIN’
• Sudden deterioration in behaviour- ‘Something has triggered difficult memories
from my past’
Attachment anxiety indicators in school
• Good positive behavioural programmes have not worked
• No biological reason for poor behaviour
• ‘Kicking off’ for no apparent reason
• History of separation- either physical or emotional- from
parents/primary carer
7
Secure child Child neglected in infancy
University of Michigan
Attachment and Cognitive Development
front
Cells that fire together are wired
together…
Triune Brain • Survival Brain
– Reptilian
• Emotional Brain
– Limbic
• Thinking Brain
– Neo-cortex
Effect of parent on pupil
achievement
Effect of school on pupil achievement
Age 7 0.29 0.05
Age 11 0.27 0.21
Age 16 0.14 0.51
(Sacker et al., 2002, cited in Desforges and
Abouchaar, 2003)
Effect of Parent on Pupil Achievement
Intergenerational Attachment
Patterns
• Research (Ainsworth et al) indicates around 30 %
of children have some sort of attachment anxiety
• Adult attachment interview research (Maine et al)
shows 70% - 80% correspondence between
parents early experience and their own parenting
style
Just as children are absolutely dependent on their parents for
sustenance, so in all but the most primitive communities, are
parents, especially their mothers, dependent on a greater society
for economic provision. If a community values its children it must
cherish their parents.
(Bowlby Maternal Care and Mental Health. 1951:84)
Approaching parents/carers about mental
health concerns
• Listen to the parent – they know their child better than anyone
• Think about the language used – emotional wellbeing/ helping the child to feel
happy/settled may be better than ‘mental health’ particularly with younger children
• If possible, provide a graduated response using in-school resources such as:
– Nurture groups
– Attachment figures
– School counsellor
– Parent support groups
• Provide information about the mental health issue and if appropriate, clear guidance
about referral to CAMHS and external parent support networks
Engaging Parents with mental health difficulties
• Be aware that engagement may be difficult for these parents as they are likely to be
under stress and may have difficulty coping with day to day matters
• Ensure there is a whole school approach to parent partnership i.e. ‘normalise’ parental
involvement
• Check the communication system and send reminders about times etc
• Provide an emotionally containing environment for the parent
• Listen and facilitate rather than being didactic
• Keep solution-focused and build on parent’s strengths – what do they do well as a
parent
• Build on their desire to support their child’s education
• Provide clear information about support and resources available
Case Study: Owen
•Solution-focused parent-partnership intervention
• Uses therapeutic storywriting to develop parents’ capacity to ‘hold’ their
child’s internal emotional world in mind.
• Targets vulnerable pupils with behaviours related to attachment anxiety
Teachers TV
Research and Development in SEN: Working with Families
http://www.tes.co.uk/teaching-resource/Development-in-SEN-Working-with-Families-6046915
(Story Links 8.10-13.40 min)
Video Clip
Development of positive attachment
Supported by:
• Proximity
• Engagement in a mutually enjoyable activity
• Co-attunement of affect
• Co-construction of meaning
Supporting parenting skills
• Use of metaphor to address emotionally charged issues – puts parent in
the ‘adult’ position
• Developing attachment bond by sharing within the imaginary world
• Engagement in story is a right-brain activity
• Touching, holding, soothing modelled in the stories
• Opportunity for expression of empathy
• Reflecting on responses to difficult behaviour
• Supporting child’s reading skills
The research evaluated the impact of the Story Links
programme on:
a) parental engagement
b) pupils’ behaviour
c) pupils’ emotional and social well-being
d) pupils’ reading
e) pupils’ reading skills
Evaluation
Case study methodology
Quantitative methods Qualitative methods
Record of frequency of parental attendance
Goodman’s Strengths and Difficulties Questionnaire (SDQ)(Youth in Mind website, 2009) completed pre and post intervention by classteachers .
Neale Analysis of Reading Ability(NARA) (1997) pre and post intervention assessment of accuracy and comprehension.
Over 80 semi-structured interviews pre and post intervention with pupils , parents, TAs, SENCOs, classteachers and SL teachers .
Analysis of over 100 stories.
Parental attendance (names changed in all data)
• John’s got behaviour problems so my interaction with the school
was horrible all the time - the only interaction was ‘John’s been
bad, this has happened, that’s happened’... now, it’s nice to look
forward to coming in ...John glows and picks up his reading and is
eager to tell us his story. (Mother)
Reduction in pupils’ emotional stress (Goodman’s SDQ)
Key: ≤11= Close to average; 12-15=Slightly raised; 16-18=High; ≥19=Very High
Exclusion over 12 months pre-Story Links programme
Exclusion during Story Links programme
School Classroom Playground School Classroom Playground
Twice or more a week
0 5 5 0 0 3
About once a week 0 3 0 0 3 1
Less than once a week
2 + 1 self-
excluder 2 2 0 1 2
Reduction in exclusion
Increase in frequency of child reading to
parent
The school thought she would be very hard to engage.... Mum is very eager, surprisingly eager, the school is quite shocked that she’s actually turning up religiously and is very committed (SL teacher)
Change in home-school relationships
Bo the Elephant was stroppy and used to cry because he had to find food on his own He walked for miles and miles, digging at the ground and sniffing at the tree... (then) his keeper came in his lorry with a big box. The box was full of sticky buns which they ate together. So, Bo knew now that... he didn’t have to get stroppy and cry, trying to find food on his own. His keeper would look after him well.
Relation of stories and pictures to
pupils’ anxieties
SLT: Alex the guinea pig was very angry and fed up.
Pupil: He couldn’t go for a swim in the bath but his brother and sister could.
(Girl competing with 6 siblings for attention at home)
SLT: Dino the dinosaur was very angry. He sat outside his cave and growled.
Pupil: He wanted to be the King but he wasn’t so he killed the King.
(Boy often fighting to be in control)
SLT: Ranio the Rhino was very angry.
Pupil: Because Ben had run off without him after pushing Ranio into the water hole .
(Boy who had frequent fights and few friends)
Analysis of stories
Impact on reading skills
Minimal increase measured on NARA (two-thirds initially below baseline
6.01)
Increased confidence and improved attitude to reading:
What’s changed is that he now happily picks up a book and starts reading. Mark’s Mum
It was more of a chore before.... you had to make her read... But ever since she’s done this... she loves it, she wants to do it. Rosie’s Dad
He gets stuck on words but then he asks for help. But it’s the fact that he now wants to and it’s like he’s clicked with being able to retain a story... and putting it together in his head. Ed’s Mum
• ‘ … the first gift from another person is the maternal gift of taking in his/her feelings, absorbing them, thinking about them and giving them back to him/her in a way he/she can accept’
Kate Barrows
Full and summary evaluation reports of the Story Links project:
http://storylinkstraining.co.uk/?page_id=133
Contact: Dr Trisha Waters
Further information
