A holistic approach to supporting young people's health is led by the school-based health adviser at Newall Green School, Manchester, who embraces the whole child and the family. Neil Wilson, headteacher, discusses
Newall Green High school (NGHS) is an 11-16 successful urban comprehensive serving the Wythenshawe estate in South Manchester. Against a background of very challenging circumstances it offers excellent contextual value added for students, has gained a grade 1 (outstanding) from Ofsted (May 2007), has three subject specialisms in arts, science with mathematics and applied learning. The school is currently entering a hard federation with a feeder primary and enjoys very good links with other main partner primaries. This allows the multi-agency team in school – a social worker and assistant social worker, school health adviser, five learning mentors, school attendance and improvement officer and a team of special needs teachers led by an assistant headteacher – to offer intensive support including early intervention support. The core delivery model for extended school provision also involves the senior manager for finance and administration, the deputy head teacher for pastoral and five heads of year. The team also engages with agencies and voluntary bodies in the local community in a number of ways.
The work of the health adviser
Our health adviser, Lindsey Shaffer, is based for the majority of working time at NGHS. Her role is principally funded by the Primary Health Care Trust (PCT) but she is also now on the school payroll for two days a week. A significant part of her work is dealing with routine medical interviews and offering regular emotional support, as well as being available for immediate concerns. Staff may log health issues about particular students with her and students also self-refer.
Lindsey’s fervent belief is that, on occasions, students need someone to turn to ‘in the moment’ when they have a concern about physical or mental health. It is clear from even informal exchanges between her and students that they trust her and value her presence. A significant aspect of the NGHS culture is not passing judgements on students or staff and this is reflected in the poster on the health adviser’s door: ‘Here to listen, not to tell.’ She works to a health practitioner code with strict confidentiality clauses that are well understood by young people, including the safeguards linked to child protection issues, and she feels that the school’s code of confidentiality is compatible with her own professional code.
The core purpose of her work is to support students through their physical, emotional and moral development. Like all other aspects of NGHS extended provision, the health service focuses on the totality of the young person and on the family setting. It explores potential causes rather than seeking immediately to treat symptoms; additional needs are looked into and solutions draw on the full range of resources available through extended schools provision.
The range of professional contacts and networks Lindsey has developed is wide and there is a high measure of respect for her role from local fellow health professionals. She receives information not only from health colleagues but from sources such as the community alcohol team, domestic violence team and the police, which helps inform ongoing work and may identify the need to offer support. In school, she coordinates the work of the multi-agency team and chairs our weekly meetings where we discuss referrals and potential referrals, and also review existing cases.
The NGHS health focus has led to the development of a very productive partnership with child and adolescent mental health services (CAMHS). This has taken the form of regular meetings every six to eight weeks with a consultant clinical psychologist and consultant psychiatrist. These have resulted in more comprehensive assessment of need, greater involvement of parents or carers, better explored and argued cases for referral and increased levels of external support. In addition, an 18-month CAMHS project explored mechanisms for identifying vulnerable children, with training for staff to help them use screening measures. The project also provided valuable professional development to help staff such as the school nurse or learning mentors to take on the role of primary mental health worker. We have now become the city hub for the school nurses’ CAMHS programme offering training in this very important area of provision.
The health adviser has also developed particularly close liaison with a local consultant paediatrician. For a number of years, the community-based paediatric service has held clinics at NGHS, particularly but not exclusively for the students served by the school’s barrier-free provision. Appointments enable the paediatrician to discuss with parents or carers, in school, the history and progress of their child’s medical case. Discussion can also take place with parents about support networks. The consultant paediatrician sees a number of important benefits in this practice. They include:
- pupils losing less educational time because they are seen on site
- the opportunity to pool information about the child, as parents and the learning support worker are present at the consultation, meaning that well-grounded decisions can be made
- the development of good communication networks: with the parents’ permission, a copy of the clinical findings are available to the school, allowing any educational implications to be considered in future planning
- being able to feed full and accurate health information into the annual review for children with a statement of special educational needs
- having continuity built into the process: links can be made with the Connexions adviser to consider the health implications of post-16 transition – an area of concern for many students and families.
What is more, in response to local health statistics on teenage conception rates, the health adviser has an extended role in planning and delivering sexual health services in school. She offers private consultations with young people where she can offer pregnancy tests or chlamydia checks, for example, and she is also involved in delivering the sex and relationship education programme in school. This in-school work, which is approved by the governing body, complements her role in running the sexual health clinic at a local community centre in her capacity as a family planning nurse. This provision offers easy access to sexual health services, which is excellent for local young people, especially when we know that young people tend not to go to their GP as they often find negotiating appointments difficult and are unsure about confidentiality.
The following is a summary of some of the impacts of Lindsey’s other work:
- her close links with GPs, health visitors and district nurses speed up access to these services and promote well-informed medical decisions about individual students’ cases
- close relationships with adult health services that support cases of drug and alcohol abuse mean that the school is kept informed of the impact on the lives of families and of students
- collaborative work with drug and alcohol services for young people has led to group work and workshops in school for students and families
- access to services that are often hard to reach, notably NHS dentistry and chiropody, is facilitated
Our health adviser also plays an important role in promoting staff health and wellbeing (perhaps as many as 85% have sought her advice over time). She has also set up a structured staff health programme, with health targets. Participation in three elements of the programme – for example attending exercise or relaxation classes or undergoing health screening – leads to one half-day release from school. This model mimics the practice of health bank days for NHS employees.
Collaboration reaps rewards at many levels. However, there are potential tensions between the operational modes that best support a school-based health adviser and the practices that a PCT employee would employ, and these do require consideration. Some of these tensions are around the need in some instances for an urgent response in a school context and a need to rapidly re-schedule priorities, in ways that may seem less acceptable or feasible outside school. For our health adviser, this has meant that on occasions, she has felt it necessary to challenge the practice of her peers.
Outcomes for service users
The benefits to young people at NGHS, and their families, are wide-ranging and often well demonstrated through case studies of individuals. For the multi-agency approach to supporting families and young people to be successful, developing good professional relationships is paramount. The importance of this is highlighted in the case study account from the health adviser (see box, below).
Case study from the school health adviser
One recent incident involved a mother who contacted me in a very distressed state, having hit her older adult daughter. She had been very drunk and had been arrested by the police.
She asked me for support. She recognised that she was mentally unstable and needing support to address her alcohol misuse. I knew her well, as she had attended a parent course I had facilitated the previous year. I had also supported her younger daughter, who was becoming disengaged with school and was finding her mum’s drinking difficult to cope with. The mother was struggling to parent this young girl. However, after she attended the parenting course, their relationship had improved and, when contacted recently, the girl reported that things had improved at home.
This mum was acutely distressed and needed an urgent psychiatric assessment. I was able to contact her GP, who supported my professional assessment and arranged to see her urgently. He contacted me following this consultation and we agreed on a support plan. A phone call to the Community Alcohol Team generated an urgent appointment to address her alcohol problems.
Some final comments
Through a holistic approach built around collaboration with key partners, young people and families are now getting the targeted support needed, when they need it. The work of our multi-agency team is certainly helping students stay engaged and, in some cases, to re-engage in learning, which is wonderful for young people and their families, and of course for the school. Few people could deny that working in a challenging urban school environment involves long hours and potentially stressful situations. However, our health adviser finds the school-based nature of the job highly rewarding.