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Current inclusive practice varies from school to school, this assignment will focus on – “Can mainstream secondary schools be fully inclusive for students with social, emotional and mental health issues (SEMH) or are specialist provisions more effective?”
ABSTRACT: This assignment reports the issues surrounding students with SEMH in both a mainstream and specialist setting. It explores the difficulties both staff and students face and identifies some of the key strategies and interventions that are being successfully used in other schools. It compares good practice in both schools and evaluates which has the best outcomes for the students.
The Warnock report 1978 gave rise to the Education Act 1981 which included the first requirement to include children with special educational needs and disabilities (SEND) in mainstream schools. The concept was that the majority of students with SEND would attend mainstream schools and very few would need a specialist provision. One of the positive outcomes of the report was transforming the terms used to describe disabilities and how disability was seen by the general populace. In 2005 Baroness Warnock did a U-turn on her recommendations from the original report. In the House of Commons Education and Skills Committee Special Educational Needs report (2005), Baroness Warnock states, “I do not think we ever wanted our recommendations about integration to be taken quite as far” …. “There were people of my committee who thought the comprehensive ideal would never be fully realised unless there was one kind of school for everyone” (Ev.1). She also agreed to describing inclusion as a “disastrous legacy” and children were “physically included but emotionally excluded” (Ev.7). Also, in the report Baroness Warnock state “Fortunately a new category of special needs, emotional and behavioural difficulties, now includes social as well” (Ev.5). This was 14 years ago so how far have schools come in being inclusive to students with social, emotional and behavioural difficulties.
Since January 2015, the SEND Code of Practice (5.32) has identified Social, Emotional and Mental Health Difficulties as one of the four main categories of SEND:
- Communication and Interaction
- Cognition and Learning
- Social, Emotional and Mental Health
- Sensory and Physical
According to the Department of Education SEN statistics 2018 SEMH is the third largest SEND group at 12.8% of all students with an EHCP. It is also the second largest group for students who require SEN support, just behind students with moderate learning difficulties. What is SEMH? It is a broad term that covers a range of mental health and behavioural issues. Becton Loveless (2019) split it into two distinct groups:
- Psychiatric disorders with the common issues being anxiety, depression, obsessive compulsive disorder, attention deficit hyperactivity disorder and eating disorders.
- Behavioural disorders to include oppositional defiant disorder and conduct disorders.
Social, emotional and mental health difficulties can affect the behaviour of a child hugely and have a great impact on their learning. Teachers and support staff need to continue to develop strategies that enable inclusion. Supporting good social, emotional and mental health should be the responsibility of all school staff. Importantly teachers should have secure knowledge of SEMH so that early signs of mental health problems can be identified (DfES 2015).
The inclusion of SEMH into the SEND code of practice has been subject to debate arising from differing perspectives associated with different models of disability. Different models of disability use different terminology to describe impairment, SEN is a term widely used in education but not used in discourses around the social model of disability. The social model assumes that the disability lies not with the individual but with society and society needs to change to fit in with the disability, not the other way around. Oliver (2015) points out that the social model does not address all the barriers faced by individuals with social or emotional disabilities. Owens (2015) argues that the social model excludes individuals with learning difficulties, “because adjusting the social environment is not always possible, leaving personal and social differences unacknowledged and undifferentiated”. The social model has limitations where individuals with SEMH are concerned. The medical model of disability makes the assumption that the individuals disability is seen as an illness and as such can be treated; Focus is on the impairment and how to minimise it, not on how the individual can become part of society and be included (The Alliance for inclusive education 2017). The Alliance for inclusive education also argues that the social model works better for individuals that identify as disabled when it comes to improving education, employment and social prospects, then the medical model which can lead to defining individuals by their impairment.
Bowden House School is a smaller than average specialist school providing weekly residential boarding for boys age 9-18yrs with severe social, emotional and mental health issues (SEMH), previously behavioural, emotional and social difficulties (BESD). Every school is required to identify and address the SEND of the pupils they support and must use their best endeavours to make sure a child with SEND gets the support they need – in this instance, this means doing everything they can to meet children and young people’s SEMH needs. As a supplementary memorandum in the Education and Skills Committee report (2005), Baroness Warnock exclaims that some students with less profound disabilities may “be unable to learn in a large comprehensive school even if they have Teaching Assistants for a certain number of hours a week”, “Those with emotional and behavioural problems.. difficulties will increase as long as they stay in school” (Ev.9). At Bowden House School all students have an EHCP and the use of teaching assistants is integral to the teaching and learning of our students. Budget constraints in secondary schools is impacting on school SEND provision. The SEND code of practice (6.2) specifies ‘Every school is required to identify and address the SEN of the pupils and use their best endeavours to ensure the students get the support they need’. On a recent visit to an inclusive secondary school, it was interesting to note from the SEN policy in place that “All teachers are teachers of students with special educational needs”. However, not all students with SEND worked with the learning support department or had an EHCP. Looking specifically at SEMH students, the teaching assistants mainly worked with the SEMH students within the department and not in the classroom setting. This was because they did not have many teaching assistants, so it was not possible to provide support for all the students in the classroom. Where students needed support from the teaching assistants in lessons, the students shared a TA. This led to the students being grouped into 4-5 with a high level of need in one class. There is then the need to ensure that ‘sink groups’ were not created. The main aim is to make the students more independent so they can cope in lessons on their own with differentiation and quality first teaching. Are TAs necessary in supporting SEMH in mainstream secondary lessons? Or were they hindering the student and holding back progress?
A surprising find of the deployment and impact of support staff report DISS is they found that the pupils receiving the most TA support made less progress than those with little or no support. The report also made it clear that it was not the TAs themselves at fault but the training they received and how they were deployed. This seems to be a recurrent theme in inclusive education provision. Florian and Rouse (2010) believed “that the elusiveness of inclusive education can be partly explained by the insufficient attention that has been paid to ways in which teachers are prepared and supported to work in inclusive settings”. Coaching all teachers and TAs to deal with SEND students by developing inclusive practice at the training stage, will underpin inclusion from the beginning. However, in the latest Ofsted report (2017) Amanda Spielman raised concerns that in the last eight years the number of children with an EHCP designating their needs but receiving no provision, has increased, so the need for trained support staff is paramount especially as there are many parents fighting to get the support their child needs, being completely at odds to the SEND reforms. Looking at the positive correlation between the effective use of support staff and positive outcomes for students, a guidance from the Education Endowment Foundation (2016), states there is good emerging evidence that TAs can provide noticeable improvements to pupil attainment. The role of the SENCO should be to ensure correct training and staff deployment throughout the school for all the SEN students. Effective TA interventions ensure student’s develop independent learning skills, high quality one to one support using structured interventions and implement the EEF TA-pupil interaction scaffolding framework through CPD and training.
Improvements could be made in the mainstream secondary school as one major intervention missing from their SEMH provision was the use of nurture groups. The Nurture Group census (2017) states that there are 4168 mainstream secondary school in the UK and only 238 provide a nurture group provision for their SEMH students, this is only 5.7% of secondary schools. Marjorie Boxhall first introduced nurture groups in the 1970’s (Bennathan and Boxhall, 1996). Small discrete classes staffed by a teacher and a specially trained TA were set up in response to an increase in emotional and behavioural difficulties – now known as SEMH. The Warnock report endorsed the use of nurture groups in 1978. The nurture group philosophy is underpinned by the theory of attachment developed by John Bowlby (1969). Cooper and Lovey (1999) determined that without the experience of nurturing some individuals were unable to manage the demands of school resulting in behavioural problems throughout their education. Cooke et al, (2008) explained how “Neurological factors related to adolescent development”, made it important to move nurture groups from key stage 1 and 2 into key stage 3 secondary provisions. This was most significant “For the more vulnerable adolescents, particularly those who have been affected by trauma and loss in their early years”, as brain plasticity is evident during adolescent. They concluded that it had a positive impact on the students. Boxhall (2002) outlines a set of practices which support the success of the nurture group, at Bowden House these include:
- A highly structured day
- Shared dining experience: Staff and students sit down and share meals three times a day. Tables of 4-8 students and staff sit down for dining, so staff can talk to the students about their day.
- Educational focus: during the school day the focus is on academic work.
- Social activities: both at beak and lunch time social activities are encouraged.
- Free play; during the evening activities and therapeutic activities free play is encouraged.
The mainstream school doesn’t currently offer all this so could be more inclusive if a nurture group space was provided for students. A SENCO should be using research lead practice to inform of interventions throughout the school, especially ones that have been shown to have a positive effect on students with SEMH. According to the nurture group network there is compelling evidence for the impact of nurture groups. SEMH students have been shown to perform better academically, it minimises the chance of the students becoming non-attenders and is very affective at:
- Building positive relationships
- Role modelling appropriate behaviour
- Increasing educational engagement
- Improve emotional wellbeing
- Removing barriers for learning
So, nurture groups can be very successful at re-engaging and supporting SEMH students in both mainstream and specialist setting.
Other interventions that have proved successful with SEMH students includes the use of self-regulation strategies. Popham et al. (2018) completed a review of self-regulation strategies to improve academic outcomes for SEMH students and concluded that the evidence for the strategy to improve academic outcomes was compelling and serious consideration should be given to implementation of these types of strategies in schools. Neither of the schools settings discussed used this intervention and it is a way forward to improve practice around SEMH students. McKeering and Hwang (2018), undertook a “Systematic Review of Mindfulness-Based School Interventions with Early Adolescents”. They found that mindfulness-based interventions in schools were used to promote health and wellbeing of students. Benefits of the interventions include a decrease in negative mental traits and a small increase in positive mental traits. Concluding it would be a useful well-being prevention program for use with secondary ages students. The majority of students benefited from a decrease in anger, stress and anxiety, as well as improvements in concentration, behavioural management and sleep quality. A small number of students struggled to engage in the intervention but overall it is an effective strategy.
Bowden house School has an important advantage over the mainstream setting as students can get targeted and provided with specialist interventions. They can have immediate access to advice from CAMHS and other psychological services if required. Bowden House School has a specific emotional wellbeing intervention team; this includes an onsite qualified therapeutic councillor, CAHMS councillor, mental health first aiders and nurture staff. The mainstream school does not have the resources to offer all these services, especially when a student is in crisis. Maslow’s (1979) hierarchy of needs second level, after physiological needs, are safety needs. The student will not be in a position to learn unless they feel safe. Students with SEMH usually have a heightened state of arousal which leads to them being constantly hypervigilant. Once they feel safe, they are more able to learn. Bowden House School, works towards ‘consistent principles, flexible practice’. Subsequently students are all treated fairly but not necessarily equally, dependent on their level of need. The mainstream secondary school is more rigid and inflexible, therefore cannot always meet the immediate needs of a student in crisis. Staff at both schools build meaningful relationships with the students but the specialist provision has more flexibility and staff expertise to meet their needs. A child in crisis at the mainstream school assaults another student; the school policy is inflexible, and the student is excluded. In a specialist setting flexible practice will allow other options, dependent on the student’s needs. Bowden House School uses restrictive physical intervention with students when required as the students have very complex needs. The mainstream secondary would not have the trained staff to use this behaviour intervention with SEMH students so again once the students behaviour spirals with more damage, injury or destruction as the staff have no way of safely restraining the student to deescalate the situation.
Section 1.3 in the SEND code of practice stipulates “LA’s must ensure that children, their parents and young people are involved in discussions and decisions about their individual support and local provision.” Pupil voice is important when deciding what interventions to implement. Briesch and Chafouleas (2009) state “it is essential that the direct targets of our behavioural interventions be given appropriate opportunity to evaluate their treatment” ….”If children are not involved in the design and implementation of interventions, then it is generally believed that the student will be less likely to commit to, or be compliant with, the treatment.” Comparing the specialist school and the mainstream secondary I visited, in both schools the SENCO uses the annual EHCP review to plan interventions going forward and ensure that the student is involved. This is excellent practice, but the secondary school only has 30 students with an EHCP so that still leaves 224 students receiving SEN support, where no formal procedure is in place to inform their preferences in interventions. Briesch concluded that it possible to remove barriers surrounding intervention usage by facilitating more communication with the child and understanding their perceptions of interventions and personal preferences: though time constraints and lack of resources may make this unfeasible at some schools.
In order to promote inclusion and reduce exclusion of SEMH students, the use of quality first teaching, targeted and specialist interventions and an effective monitoring system need to be in place. The mainstream school has a lot of demands on the SENCO and learning support team, so will not currently be as effective as Bowden House School to ensure the best outcomes for SEMH students. Improvements to the current provision of both schools could be made to ensure outstanding practice for inclusion, especially with the use of self-regulation strategies and mindfulness interventions. More training for TAs an on effective interventions and SEND CPD training for teachers especially concentrating on positive behavioural interventions and support for SEMH students.
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