It is exciting to see that there are others who know that the diagnostic grip on mental health practice in adult and child services is damaging and needs resisting and that this resistance is now coming together via a range of pyschologsits and psychotherapists across the country. There is the Cumbria Resliience Project and now we are having conferences run in the are of the British Psychological Society Power-Threat-Meaning Model. I think the The Adult-Child Well-Being 'I Matter' Framework puts the Power Threat Meaning Framework into a teachable format intending to help and influence those in making decisions about child and family practice.
According to the recently published Lancashire Children and Young People’s Resilience, Emotional and Mental Health and Well-Being Transformation Plan for 2015-2020, it is recognised that:
The newly published Transformation Plan notes that:
This is important but shocking information. In the I Matter Project however we contend that there is also a key gap in models for practice in child and family work. We argue in particular that in spite of the rhetoric of evidence-based practice there is no practice model in child and family work that adequately connects up the relationship between adult well-being, child well-being and development. There is also a gap in models of service delivery that can respond to the sheer scale of the current unmet needs.
What we think is therefore needed is some big picture innovative thinking about what is really underpinning the rise in child mental health difficulties, and some lateral thinking about how the difficulties might be more meaningfully addressed.
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Attachment Theory? What's that? In my work I regularly encounter significant lack of understanding amongst professionals and parents about the meaning or relevance of Attachments for those who work with children. However in my view Attachment Theory is one of the most important areas of psychological thinking for anyone who works with children with complex needs. It is one of the key foundations of the practical framework that I call The I Matter Framework.
Attachment Theory refers to a body of work first developed by a researcher John Bowlby and by a research group which included Mary Ainsworth (photo on the left) best known for her work on something called The Strange Situation Studies. These specific studies are some which I think it is vital for all professionals and parents to understand. The original works, listed below, deserve a read if you ever have a very long holiday as they represent an extraordinarily detailed piece of careful observational work, but, if you don't have time for this, even a basic understanding can take you forward.
Attachment Theory is now a very well-established body of work which describes the relationship that a child has with the adult figures on whom he or she depends. It makes a very clear distinction between children who have a secure relationship with their key carers and those who have an insecure relationship. This research has clearly established a powerful link between patterns of early attachment relationships and a wide range of educational and mental health outcomes.
Here are 5 reasons why I think Attachment Theory is so important:
1. Attachment Theory provides a universal framework - that helps us to understand ourselves and our own reactions, not just those of our children
An attachment refers to the relationship that a younger vulnerable person develops with a bigger more powerful older figure that he/she depends upon - it is usually used to describe the relationship between a infant and his or her first primary carers. Attachment Theory draws our attention to the fact that for young children this need to depend on someone else for care is as universal and fundamental as hunger. As children we all had a basic need to look to the adults who were responsible for our care and to whom we depended totally for our safety and survival. The challenge of growing up is to learn to transfer some of these needs for assistance to ourselves. However, loss of access to the adult we depended upon when we were small was very alarming to all of us. As adults, we know this rationally to be true, but it is interesting to me how as adults we can forget that we are now the adults on whom our children legitimately depend for their experience of safety and well-being when they are feeling wobbled. Attachment Theory invites us to think about ourselves and our own reactions as they are influenced by our own past experiences and this awareness can increase our sensitivity to why so many of our most complex children really are struggling in their relationships today.
2. Attachment Theory helps us tie many diverse observations together in educational practices and in mental health
A huge body of research has now demonstrated that early attachment histories are powerful predictors of educational and mental health outcomes. Children with a relatively secure attachment history with key carers (ie children who have parents who are responsive and helpful in attending to their physical and emotional needs) tend to be more prosocial and skilled in co-operative relationships, they tend to feel better about themselves and have better mental health and they tend to experience greater ease of learning in the classroom. Relative security of attachment clearly is an important variable.
3. Attachment Theory provides a developmental understanding for a wide variety of challenges seen in complex children that become labelled as if they are discrete issues.
In work with complex children there is a very powerful drive to try to label behaviour that challenges adults as discrete psychiatric disorders: ASD, ADHD, ODD, OCD, Anxiety Disorder, Depressive disorder, Reactive Attachment Disorder. This labelling tends to suggest separateness. Implicit is the belief that if we can give a cluster of symptoms a name, we may be able to find a useful discrete drug or 'treatment' that helps. Apart from the obvious concern about more and more children being prescribed medication because a certain label appears on file, this labelling of the child too often prevents adults from thinking about the relationship issues in which they are personally involved, and the way in which these difficulties are so often connected.
4. Attachment Theory encourages us to focus on relationships between children and their key carers not just on the child.
As a psychologist and an educationalist, I am interested in understanding how different patterns of behaviour develop in the context of relationships. We know there can be genetic vulnerabilities to specific challenges, but more often than not, challenging behaviour, poor learning, or mental health issues develop when there has been a sensory processing issue, a disruption to the relationship or more critically a poor fit between the fundamental needs of a child, and the adult care and life opportuntiies that is and have been provided. We have very little control over a child's DNA or sensory processing (at least not yet!) and even as adults there are a lot of things we cannot controrl, but adults do have control over their own choices. So learning to fit our care provision to the needs of the child rather than expecting them to adapt to us, beyond their capabilities, is a process that can make a powerful difference to a wide variety of outcomes.
5. Attachment Theory provides a very clear and practical direction of travel for therapeutic and educational work
it is important to remember that the distinction between secure and insecure is NOT a value judgement - a securely attached child or adult is not BETTER than an insecurely attached person. On the contrary, insecurity in attachment relationships can become a powerful driver for achievement in business for example. However, given that there is such a powerful body of evidence of the benefits of greater security in our key attachments, for both mental health and for educational outcomes, attachment theory can provide a very strong framework to guide the priorities of our policy making and practices. Thus any step that can be taken to encourage key adults to respect and respond appropriately to a child's attachment needs and thus increase their attachment security will be fundamentally important ones.
Attachment Theory is an extremely powerful organising framework. In The I Matter Framework therefore, attachment relationships form one of the most important organising ideas in the frame, but attachment is not the only organising idea. I have found that by adding in ideas that are well-described or more elaborated in other psychological approaches, an even more powerful and practical framework can emerge. More on this in future blogs!
How much have you read about Attachment Ideas? Let me know how they have influenced you, or what you would like to know more about!
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First Annual Conference: How Can We Really Work Together to Improve Mental Health and Educational Outcomes? Prioritising Parent Understanding and Competence
The seeds of this conference started a long time ago from a sense of confusion and overwhelm experienced in response to the ever rising tide of need I have seen in day to day practice in health and education settings over my career of the last 20 years. How do you turn frustration into something constructive, how do you turn this sense of overwhelm and hopelessness into something that feels worth doing?
The final trigger for this particular conference taking shape was a sense of exasperation about the NHS Future in Mind and 'transformation' process. Then the exasperation became an idea. So why not run a conference sharing what my colleagues and I really think? And we did it! The I Matter Project in partnership with the Centre for Adoption Support (CFAS) ran a half day conference in Lancaster on the 8th October 2015. It took us 2 1/2 weeks from idea to reality with lots of really good conversations, and a final diverse turn out of colleagues from education and health from both North Lancs and South Lakes for the event itself.
I felt we were on track when just prior to the conference when I was sent a list by a local teacher describing the Y5/Y6 pupils in her local lancashire apparently privileged school. Of 34 pupils only 6 had uncomplicated home circumstances. The rest were facing a catalogue of challenges in their home lives involving child protection investigations, parent alcohol, and drug abuse, complex divorce cases.
I guess this confirmed in black and white my concern about the scale of the challenges that I have been observing in day to day practice. The professional and personal challenge is how to respond. It is easy to grumble about what is not happening, and much more challenging to work out how to do something positive. This conference therefore set out to offer a critique of the current rhetoric on outcomes and evidence based practice in services to children and families with a view to offering a small glimpse of what a future 'really evidence based vision' might be. My belief is that we are failing to see the wood for the trees. The scale of the unmet need for children and families is in my view enormous but the biggest contributing factor in poor mental health and educational outcomes is not poor services per se but a collective failure to recognise the critical importance of child development, brain development and the adult role.
I believe that the only way to really shift this is to give these issues much more value in the fabric of how we make policy and practice decisions. And for this a clear educational approach is needed and a clear strategy.
Somehow if we are serious about helping children, we have to get to grips with the important role of the adult. We need to start to develop strong shared understandings and we need to think strategically
This first annual conference was a satisfying start. Click here for one of the Conference Handouts. If you are interested in working with others to tackle these issues, please get in touch!
Copyright CBetoin2015 All Rights Reserved.
Everywhere I go in the course of my work with complex children and families, I find schools and children and families and staff under huge pressure, delivering curriculum that are becoming more and more preset.
What I hear over and over again is that the curriculum has become so super-charged that the times that used to be available in the day and week for just easing off pressure and taking a step back to explore a wider field have become more and more rare. So, what has an understanding of psychology got to tell us about this situation and about it's likely impact on child mental health and educational outcomes?
One really important well-known graph that is incredibly important in understanding child and adult mental health and well-being, and educational outcomes is the Yerkes-Dodson (1908) arousal performance curve. According to many studies, and this well recognised graph, human beings perform best if there is a certain amount of heightened arousal around in the context that evokes and is associated with curiosity and focus. In the face of stimuli that evoke moderate curiosity and excitement and a sense of opportunity, human beings - children and adults - pay attention and focus much better than in the face of stimuli which evoke little or any curiosity or need to pay attention. With alertness, engagement and motivation to perform, we see children and adults producing better results than when they are bored and uninterested.
However, the Yerkes Dodson graph also shows us that too MUCH arousal or anxiety leads to very significant deteriorations in performance. This is important. Both ends of this Yerkes-Dodson curve are important to making sense of what is happening in our schools.
My observation is that the relentless pressure on adults in our schools is being transferred to our children and it is complex children where the crushing or explosive impact of these pressures are observed most. Most concerning is the situation when teachers find that the complex child is a barrier to them being able to deliver the results that are being expected of them.
Unless the teacher, and usually also their head teacher, is confident and able to resist and stand up to the Ofsted-driven pressures upon them, the child and adult in the classroom are placed in an impossible pressure cooker situation. What we find too often rather than collaboration and curiosity is a battle ground between adult and child where the adults feel they must MAKE the child learn, and the child's role becomes too often one of deeply reluctant co-operation or active resistance.
Not long ago I was asked to observe a young 9 year old with diagnosed learning difficulties - probably due to foetal alcohol syndrome - the aim was to help think about his future educational options. He was in Year 5 but was managing work appropriate to a Y2 child. I observed this child working with a TA who was trying to teach him fractions, counting beads and using worksheets. The child had questions of football on his mind, and what was going to happen at playtime because a friend had been sent home. 40 mins later, the exasperated TA lamented - "his concentration is really no good today". For my part, I wondered just how many times people had tried to teach him about fractions - and how many more times they were going to continue to try to do so on his journey through our school system .
The point was, fractions were not interesting to him in that moment - certainly not in the format being presented - yet adults were feeling obliged to keep working at it, because their job was to hit targets. I wondered how many more adults would have to spend a frustrating time trying to teach him something that was not connected to what he wanted to learn.
As I heard another headteacher talking about the numbers of staff who were disengaging and excessively stressed, I also wondered about the impact on the sense of Self of both child and adult of this very unsatisfactory set up. I heard that in a matter of a few months, the child I had been observing, had gone from being a child who was desperate to please to a child who had become disengaged and cocky and 'strutting his stuff'.
Frankly though, where do you go, and how do you behave when you start to realise that what is being offered to you in school involves endless hours doing things you are heartily fed up of doing? In such a situation, thinking about football and playing up the teacher sounds quite an entertaining option, doesn't it? So, does this child with challenging behaviour have a mental health problem? I think he is on his way there.
I wonder when it will become accepted that so many top down instructions do not bring out the best in our teachers nor in our young people?
I wonder when enough teachers will have the energy at the end of the day to speak up about situations that too many know cannot be right. Is there enough space to engage curiosity and enhance motivation in your school day? How do you think these issues are related to child mental health? If you are interested in reading more about these issues, why not Click here to sign up for the I Matter Monthly Digest Newsletter
Is challenging behaviour a mental health issue? Of course it often is!
As a psychologist one of the issues that has concerns me most is that people too often make a bold distinction between young people who present with oppositional and challenging behaviour and young people who present with issues such as eating disorders, depression, anxiety and self-harm.
Challenging behaviour and anxiety and depression as examples can look very different. At first regard they demand different skill sets from adults. And if help is not forthcoming one group may end up as adults in psychiatric services whilst the other may end up in youth offending and criminal justice services.
But what are the connections? And what are the implications? What if these two growing social issues were much more closely connected and needed to be thought about as two sides of the same coin?
Challenging behaviour and mental health issues are profoundly interconnected and the reason lies in a much greater appreciation of child development and of what young people need from their relationships with adults, and why, in order to thrive.
Children with challenging behaviour often have difficulty being able to put their feelings and thoughts in words. They can be helped but without such help, we can be sure that they will struggle in relationships and this will become a mental health issue. Sometimes the most challenging behaviour is shown by children who have stopped being able to feel sensitive and vulnerable feelings. These are the children who seem to show little empathy or remorse and are the children who concern us most in terms of the dangers that they can present to others. They are children who have often been deeply wounded by their life experiences.
What is the solution? The solution to young people's challenging behaviour and mental health problems commonly lies in what adults need to be doing differently, and therefore I believe the solution also lies in more adults being willing to make time to stop and think and learn about what is happening at a deeper level.
The challenges can seem enormous and overwhelming. Where to start? There is not a quick fix solution. My observation however is that positive change can and does happen but when it does, it always starts with individuals who are willing to take responsibility for educating themselves.
If you are an adult who is willing to learn more about what is needed from you and other adults to help your child or a group of children in your setting - then why not talk with others and start a study group in your area? For more information about the I Matter Online Course click here. If you want to register with a group discount we run a course each term. Alternatively you can sign up for an Anytime Option.
So I want to tell you about why I decided to put together I Matter Training and why I think it may be helpful to you. The first and most important reason was that 20 years ago I was trying to understand a very confusing picture myself. I trained at a very interesting time as a clinical psychologist. Ideas were changing and there were fierce disagreements between psychologists about what was the proper task of a psychologist and what was not. How to resolve the confusion was a very personal question.
If you have found yourself not sure about to do to help yourself or a complex child, I want to reassure you that this is not surprising, because there really has not been clarity. Professionals have disagreed fiercely, so no wonder parents have had a challenge to work things out. Today however, something has changed, and with the advent of research on the brain, psychologists of different traditions now are beginning to find some shared points of agreement.
I Matter Training represents my attempt to pull a lot of these ideas together into a very practical back to basics approach. I am a parent myself and I was a primary teacher and I know that parents and front-line professionals find psychology fascinating but they need it to be practical. Professionals can still disagree quite vigorously and one of the things that they disagree about in children's services is whether something called CBT (cognitive behaviour therapy) is sufficient to help professionals and parents help children, especially complex children. I don't think it is. I think what is missing is a clear map that ties a wider set of ideas together.
I remember the sense of finally lifting my own head out of the fog when the ideas started to come together. Now I call the I Matter Foundation Course, from Confusion to Clarity as I have seen such a lot of confusion in work with children with complex needs, and I feel that until we can agree as a community about what we are really trying to do when helping a complex child, we probably will not be very effective in helping address the number of children who are struggling.
The second reason I decided to develop I Matter Training was the sheer numbers of children who were struggling. More on that in my Next Blog Why I Matter? Reason #2.
If we haven't spoken already, but you would like to speak to me further, email me on contact@imatterproject and let's set up a call so that I can understand more about your current interests and concerns!
Dr Cathy Betoin
Dr Cathy Betoin
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How do we improve the educational and mental health outcomes of our children?
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