The Cosla Excellence Awards 2017

THE COSLA EXCELLENCE AWARDS 2017 APPLICATON FORM

Please refer to the ‘2017 Guidance for Applicants’ before completing this form.

The application is split over three sections. It is up to you to decide the content and length of each section, but the executive summary and three sections must not exceed three pages in total (excluding the front and back cover pages). Any questions relating to your application or the submission process should be directed to [email protected] or 0131 474 9275. The deadline for submission of entries is 5pm on FRIDAY 16 JUNE 2017.

Submitting Your Application Form Please use our online application process to submit this application form. APPLICATONCOSLA EXCELLENCE FORM AWARDS 2017 02

PLEASE PROVIDE SOME DETAILS ABOUT YOUR APPLICATION:

CATEGORY APPLIED Tackling Inequalities and Improving Health FOR

PROJECT NAME (as you wish to see it Pathways to Success – The use of CBT in ‘closing the gap’ published)

LEAD Midlothian Council ORGANISATION(S)

DEPARTMENT/TEAM Education, Communities and Economy - ‘Pathways to Success’

Keith Millar Lynne-Marie Muir

PARTICIPANT NAMES OR PARTNER ORGANISATIONS

CONTACT NAME Keith Millar

CONTACT DETAILS 01312705743 [email protected]

CAN WE PUBLISH THIS APPLICATION FORM ON OUR WEBSITE? YES / NO APPLICATONCOSLA EXCELLENCE FORM AWARDS 2017 03

In one short paragraph please describe this project is about, what it has EXECUTIVE achieved, and why it is delivering excellence. SUMMARY Please note that we may use this summary for promotional purposes on our website and elsewhere. The Pathways to Success delivery of school-based Cognitive Behavioural Therapy is to provide responsive support to young people with ‘mild’ to ‘moderate’ Mental Health issues, trying to catch them early. Increasing non-attendance and disengagement from school (through high-level discussions at school meetings and an increased number of referrals for non-school engagement) was, at times, down to low-mood, stress, anxiety and self-harming – which often resulted in a waiting list for Child and Adolescent Mental Health Services, sometimes surpassing 12 months. Our service supports Social, Emotional and Behavioural needs but found this issue to be the biggest gap to close. Through the delivery model, the CBT intervention, in session 2016-17 supported 30 young people through direct 1:1, and around 80 YP receiving group work support. In 2015-16 CBT supported 44 Young people for 1:1 and 60 YP for group work, most of whom indicated an increase or improvement in their behaviours. If the CBT intervention was refined, as highlighted in our School Improvement Plan (‘MOVING FORWARD’ at the bottom of the application), it could potentially support 150 young people across Midlothian Council (each year) with either direct Therapeutic Intervention, or awareness raising and ‘sign-posting’ through the delivery of workshops to school pupils/ staff. The reason we have been delivering excellence is due to the successes we have had and the credibility of our intervention (NICE- National Institute for Health and care Excellence – recommends CBT for treatment of anxiety and depression/low mood and many other conditions) In light of the success, staff have indicated an increased interest in training for CBT and we have 2 members of staff signed up for this years’ training course, allowing us to deliver more training and increased amount of support/applied approaches to the whole authority. What is your project about, and why is it important? What are you PLANNING and aiming to achieve, and how does this fit with the bigger picture? How DELIVERING have you carried out your project effectively? Are you improving efficiency and effectiveness? In 2015/16 our service noticed there was a huge gap in supporting mental health due to the increasing demand for MYPAS (Midlothian Young Peoples Advice Service) support and CAMHS (Child and Adolescent Mental Health Service). Waiting lists for both were surpassing the 6-8 month mark (now in excess of 12 months) and the support that Pathways to Success SEBN could offer was having little impact on the young people with low mood, anxiety, self-harming and stress. We funded a masters module for one of our support teachers, also a fully qualified Cognitive Behavioural Therapist, to develop a ‘critical and integrated understanding of the developmental and psychological theories that underlie effective CBT interventions in childhood’ (Edinburgh University) This would give us scope to offer support at 2 levels or stages. 1. Low level stress with friendships & family issues, anxious about exams and group work on Emotional Literacy/thoughts, feelings and emotions. (Youth Workers) 2. Early Intervention CBT at ‘Mild’ to ‘Moderate’ level (Support Teacher) The dream was to be able to offer young people, with low income backgrounds, a support for their ongoing issues and provide them with ‘tools’ to manage the issues they were facing. This in turn would allow them to engage better in their education, manage their emotions and improve their mood so that they can see some success in their life.

Why is your project innovative? How is it helping to prepare for the INNOVATION & future? What is happening to help other organisations benefit from your LEADING PRACTICE approach? APPLICATONCOSLA EXCELLENCE FORM AWARDS 2017 04

Currently, Scottish Government has indicated that it will be ‘reviewing counselling and guidance services in schools’. In September 2016 Nicola Sturgeon was quoted in the Scotsman ‘backing plans for access to school counsellors’. Our service needed to be proactive and use the skilled staff we have in front of us. Schools are stretched constantly with budget cuts and staffing shortages, resulting in ‘establishing a school strategy’ being low in priority. On social media there is an abundance of evidence from Scottish Schools wishing for this type of intervention, and schools are moving towards this as a priority for ‘closing the gap’ through the Pupil Equity Funding. Schools in Midlothian have seen the support we offer and the professionalism of our CB Therapist and started the move towards employing counsellors and therapists to narrow the gap and in turn raise attainment. Our service works closely alongside Children’s Services and provides targeted support to children who are either known to them or have gone through the Children’s Hearing system, resulting in a Compulsory Supervision Order. As part of the Multi-Agency Team Around the Child we can offer this type of intervention to support the work carried out by the other services, resulting in a network of support to engage the young person back into education. CBT does not suit everyone or every problem; therefore, an initial assessment is done to ensure suitability. Parents/carers may attend for part of this and some do. This is a confidential service but operates within the framework of Child Protection Guidelines in Scottish Schools. All matters of risk are discussed with the pupil, the counsellor and the guidance teacher. Our therapist works in partnership with guidance staff across Midlothian schools and receives external support and supervision from a qualified BABCP (British Association for behavioural and Cognitive Psychotherapies) supervisor, and is directed towards support from the Depute Head Teacher of Pathways to Success, dependent upon need. Where CBT is not the appropriate therapy our therapist is able to draw upon other counselling modalities as an integrative practitioner to offer support. This has been done for 2 young people in crisis. We also offer bespoke health and wellbeing workshops to Midlothian schools. In session 2015-16 we provided: 4 CBT group-work blocks for anxiety; 4 ‘coping with stress’ workshops; 1 ‘coping with exam stress’ workshop; 4 ‘Mindfulness: an Introduction’ workshops. The workshops align with the mental, emotional and social experiences and outcomes of the Health and Wellbeing aspects of Curriculum for Excellence. In 2016-17 we improved this support to include the introduction (not launched in schools yet, but is running in Pathways to Success) a Personal Wellbeing PSE programme. This will be evaluated and hopefully introduced to schools in session 2017-18 What impact are you having, or expect to have? How are you measuring RESULTS & IMPACT your success? Are you delivering what you set out to achieve? How do you know this? In 2016/17, a total of 110 young people received support from our Therapist, compared to 104 in 2015/16. We are still gathering the evidence/impact of this and examples include: One young person self-referred and said “I want to break the connection between my anxiety and the sad part of my life. I feel my anxiety is around 70% and my sadness 60%”. After the 6 sessions of CBT our Therapist asked the young person to indicate their anxiety and sadness again. “I feel that my anxiety is around 50% now but my sadness everyday has reduced to 30%”. Having discussed this work with both, the Guidance Teacher and the parent, the parent sent an email saying “Lynne is working wonders with...... he feels he is really benefiting from your work together”. The school also reported that “The young person’s attendance had fallen and their anxiety was contributing to this. The Guidance Teacher has noted that attendance has improved since CBT intervention and continues to be sustained. Mum has also related very positive comments about....improved mood at home”. We asked the pupils the following Question: Can you describe what has been positive about your therapy? The young person wrote “It has helped me to speak to my mum about a lot more things and our relationship has got better as a family. I am still struggling with my anger but...... ”

We use CORE Outcome Measures1 to gather data. This is subjective measuring and statements are based on how people have felt in the past week. If therapy is working scores should be lower by the end of therapy. We also use self-report. For example, a pupil might rate their initial anxiety as 80% and by the end of therapy as 30% and be able to evidence this by noting reduction in symptoms,

1 APPLICATONCOSLA EXCELLENCE FORM AWARDS 2017 05 improved coping skills and changes to their thoughts, mood and behaviours. Feedback is given by school staff also, who might note changes in observable behaviour, improved engagement/attendance.

Table of Results of those who returned evaluations in 2015/16 (2016/17 still being collated) No of Pupils Were the CBT Not at all Satisfactory Very Good Excellent Sessions Helpful? 60 (12 Group 0 0 42 18 Work) Did you feel an improvement in the behaviour? 60 (12 Group 12 0 44 4 Work) Were the strategies given useful for you to use? 60 (12 Group 10 2 19 19 Work) How helpful was the counsellor?

60 (12 Group 0 1 14 45 Work

MOVING FORWARD There have been several issues which have arisen from the introduction of the CBT intervention and a number of highlighted points have been considered and need to be implemented as we move forward. 1. Criteria for referrals 2. Clear understanding of our role in relation to MYPAS and CAMHS (Working Group set up Jan 2017) 3. Credibility of the intervention and its impact (continually evaluating) Although we have been extremely successful in this intervention, we are very self-reflective and continually re-designing this service. The landscape changes regularly and the needs across the authority are differing. However, we believe that this is one of our strengths. We can adapt to the changing times and support that we offer and our Therapist is continually training/professionally developing to offer more bespoke interventions.

Please limit your application to 3 pages or less and use font size 11or greater

NEXT STEPS  Have you answered the criteria set out in the guidance?  Is your application form 3 pages or less. (Anything more, including appendices, will be automatically rejected)  Have you discussed your application with the right people in your organisation?  Have you provided contact details for your application?

SUBMITTING YOUR APPLICATION

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