Educational and Clinical Psychological Services in County Clare. An integrated approach to supporting the students in your school

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1 Useful contact and referral inmation To communicate with NEPS in relation to children s learning, social, emotional and behavioural difficulties in school, contact: Your school s NEPS Psychologist. Phone: To refer a child or adolescent help with emotional and/or behavioural difficulties, contact your NEPS Psychologist. If these problems occur at home, parents may request a referral from a GP, Area Medical Officer, Hospital Consultant, or Psychologist to: Community Psychology, Willow Unit, St. Joseph s Hospital, Lifd Road, Ennis. Phone: Educational and Clinical Psychological Services in County Clare To refer a child or adolescent help with acute mental health problems such as self-harm, eating disorders, ADHD, severe depression or anxiety, or school refusal, contact NEPS, or parents may request a referral from a GP, Area Medical Officer, Hospital Consultant, or Psychologist to: Clare Child and Adolescent Mental Health Service (CAMHS), Merriott House, 5-6 Henry Street, Limerick. Phone If a parent or professional is concerned because a school-age child or adolescent exhibits difficulties that are times associated with Autistic Spectrum Disorder (ASD), please contact NEPS, or request a copy of the brochure, The ABCs of ASD in Age Children: How, When, and Where in County Clare to find out if your child may have Autistic Spectrum Disorder from: Clare Children s Services, Age Disability Team, Lifd Road, Ennis. Phone: An integrated approach to supporting the students in your school

2 Purpose of this brochure This brochure has been prepared by psychologists from the National Educational Psychology Service (NEPS), Clinical Psychology Service Child and Family Programme, Child and Adolescent Mental Health Service (CAMHS), and Age Disability Team (SADT) to provide inmation to primary schools in County Clare about supports and services available to schools when concerns arise about children s learning, social and emotional development, or behaviour, and the ways service providers work together to support school age children. Page Contents 4 Summary of Main Points 5 Introduction: Children who struggle in school 6 National Educational Psychology Service (NEPS) 8 Other school supports 8 Clinical Psychology Service Child and Family Programme 11 Child and Adolescent Mental Health Service (CAMHS) 12 Age Disability Team (SADT) 13 Collaboration between Educational and Healthcare Psychology Services in County Clare

3 Summary of Main Points NEPS is the primary source of support schools when they have concerns about a child s social and emotional well-being, behaviour, or learning in school. In addition, a range of training and support provided by SESS, Middletown Centre, and PDST as well as books and websites are valuable resources to schools in developing a strong base of knowledge and skills to draw on in supporting children who have difficulties. Other community and specialist child psychology services in Clare have a role to play in supporting children with psychological needs in school. NEPS initiates collaboration with these services when indicated. NEPS and other child psychology services provide support to school age children along a Continuum of, consisting of three levels of support. o All relates to the prevention, or early identification of potential difficulties. Intervention may involve environmental assessment or adjustment. At school this is delivered at the whole-school or classroom level. o Some relates to children who require more focused support, such as teacher or parent consultation or group-based intervention. In consultation with NEPS, this level of support may be delivered at school or in collaboration with community or specialist services. o a Few applies to those students who have very high levels of need. These students benefit from more intensive case consultation and other individualized supports. Services may be delivered in school or in collaboration with community or specialist services. Introduction: Children who struggle in school The types of difficulties children experience, the severity of their difficulties, and how long their difficulties last varies from child to child. NEPS has introduced the Continuum of nationally and locally as an effective, efficient, and equitable way of providing the right support at the right time to children who seem to have difficulty in school. This model may be summarized as a pyramid illustrating that many children benefit from modest levels of support, children require more focused support, and a few children require a more intensive level of support. The Continuum of a few all In County Clare, NEPS psychologists have worked closely with their psychology colleagues in the health services to identify the range of supports that are available from community and specialist services when children have learning, social, emotional, or behavioural difficulties in school. This booklet summarizes the supports available through the school, the community, and the specialist services as they work together to support children who struggle in school.

4 National Educational Psychology Service (NEPS) The National Educational Psychological Service (NEPS) supports the personal, social and educational development of all children through the application of psychological theory and practice in education, having particular regard children with special educational needs. In County Clare, NEPS psychologists provide services to all primary and post primary schools in County Clare. The NEPS Model of Service aims to deliver a comprehensive and integrated school psychological service to improve outcomes all learners using a tiered service delivery system. A Continuum of Services The NEPS operates a tiered service delivery model which aims to support schools in implementing evidence-based practices to promote positive academic and social emotional outcomes all, targeted interventions and programmes at-risk groups and more intensive and individualised supports those with complex needs and difficulties. The NEPS has developed guidelines schools on the provision of a continuum of support which identifies three levels of support: Whole and All, Some and a Few (Table 1). We theree offer a range of services which are responsive to type and level of need and promote an effective continuum of support pupils in schools. Consultation & Data inmed decision making Consultation is a structured approach to problem-solving, in which the NEPS psychologist works with schools, teachers, parents and others. This four-stage process involves joint exploration, inmationgathering and analysis, intervention and review (See Table 2). Educational Psychologists systematically gather inmation including individual pupil characteristics and classroom, school, family and community environments as a foundation effective decisionmaking, intervention, planning and, evaluation. Clients & Focus of Service Our primary clients are pupils. Educational psychologists however recognise the importance of key adults in the pupil s daily life Theree we provide a range of direct and indirect services aimed at improving outcomes. Direct services involve NEPS psychologists engaging in casework working closely with teachers, parents and other relevant adults in a consultative and comprehensive problemsolving process aimed at addressing barriers to learning an individual pupil. Indirect services involve the provision of support and development initiatives aimed at prevention, early intervention and promotion of best practice. These initiatives include providing a consultation service to teachers (individually or in groups) that builds on teachers capacity to respond to concerns they have about meeting the needs of pupils in their classrooms. NEPS psychologists also offer training teachers and schools in implementing and evaluating best practices and evidence-based programmes to promote academic and social-emotional competence. NEPS Continuum of -Problem Solving Process Did it work? Review What is the concern? Starting Point How can we help? Planning and Intervention Why is it happening? Inmation gathering and Assessment

5 Other school-based supports Special Education Service (SESS). The role of the Special Education Service (SESS) is to enhance the quality of learning and teaching in relation to special educational provision. The Middletown Centre Autism. The Centre offers a wide range of excellent training teachers working with children and young people with autism. Professional Development Service Teachers (PDST). The aim of the PDST is to provide high quality professional development and support that empowers teachers and schools to provide the best possible education all pupils/students. All schools can apply to PDST school based support. Books, websites, apps, and other sources of inmation. Clinical Psychology Service Child and Family Programme The Clinical Psychology Service aims to provide a high quality service to children and adolescents, ages birth to 18 years, and their families to facilitate health and social gain through appropriate psychological interventions. The service currently has one full-time Senior Clinical Psychologist, two part-time Clinical Psychologists, and one part-time Play Therapist based in Ennis. Limited services are also provided in Shannon and Kilrush. Referrals are accepted from GPs, educational psychologists, and other health professionals. Approximately 240 new referrals are received every year. Priority 1 cases include children who are involved with the Child Protection and Child Welfare systems, as well as children referred Assessment of Need under the Disability Act Psychologists support these children in a number of ways: Child protection Psychologists work in consultation with parents, social workers, family support workers, foster carers, and others, conducting assessment of emotional needs and parenting capacity. This may also involve working with the Court system. Psychologists also work with family support services to support the child. This may also involve direct therapeutic work with parents and children. Children in care Psychologists provide consultation to social work/foster parents/schools Psychologists provide specific groups to foster carers. On occasion, psychologists provide a special group children in care. Direct therapeutic work with children is primarily relationship-based play therapy with foster parents. Psychologists have identified a need to develop a joint support programme with NEPS to schools of children with attachment disorders Assessment of Need Complete the assessments of emotional and behavioural difficulties the Assessment Officer. In addition to Priority 1 cases, psychologists support children in Primary Care with a wide range of difficulties. Concerns about anxiety, social and emotional difficulties, selective mutism, parenting and behavioural difficulties, and school refusal. Parent/child therapeutic programmes (4-7yrs, 7-9yrs, 9-12yrs) children with social and emotional difficulties, behavioural problems, or anxiety. Teacher/parent programme selective mutism. Incredible Years Project. Individual support children in relation to trauma or complex medical issues, or parental separation. Individual support or parent group interventions adolescents. children discharged from Clare Early Intervention Service (CEIS).

6 Children with complex difficulties. Many of the children referred to the Clinical Psychology Service have experienced disruption to their primary attachments. Children who exhibit social and emotional difficulties, or have difficult relationships may have experienced a lack of attuned or adequate care as infants. Some children may, in addition, have been traumatised. This impacts on their total experience within school, their learning, their relationships with teachers and the other children. These children can present as if they have a different disability, such as ASD, ADHD, or coordination difficulties. In addition, the typical behavioural interventions that work with most children do not always work well with these children. Working with children such as this, whether in a school setting or at home, can present challenges those who work with them. These children often raise our own anxiety and fear systems. We may become attuned to their fear without even realising it. This is normal, although often it is not be helpful as we can end up responding emotionally or out of fear. This is known as a fight-or-flight response. In order to support these children, the people working with them need support and space to reflect on their experience of being in a relationship with this child. Without this we risk getting drawn into their dysfunctional pattern. Intervention these children is the most effective when it is developed in the context of their current relationships. Clinical psychology interventions aim at repairing or improving their relationship with parents and other supports, and/or developing new relationships in situations in which a child goes into foster care. When children with disrupted attachment require help in school, it is not as straightward as helping a child with learning disabilities because, rather than using a specific programme to help, it is in the actual relationship between the teacher and the child where the repair has the opportunity to happen. The HSE Midwest Child & Adolescent Mental Health Service (CAHMS) The HSE Midwest CAMHS service is delivered by multidisciplinary teams in Clare and Limerick, and North Tipperary. Each team comprises the following disciplines: Consultant Psychiatrists, Doctors, Clinical Nurse Specialists/psychotherapists, Clinical Psychologists, Occupational Therapists, Speech and Language Therapists, Child Care Workers and Administration. The Clare CAMHS team sees children and adolescents up to their 16th birthdays. The Limerick CAMHS team see children and adolescents up to their 18th birthday. Referrals are accepted from GPs, Area Medical Officers, Hospital Consultants, and Psychologists. The multi-disciplinary team provides assessment and intervention children presenting with mental health issues. Therapy approaches include play therapy, cognitive-behavioural therapy, family therapy, parenting groups, psychopharmacology, behavioural interventions, individual psychotherapy, group work and other structured therapeutic interventions. Priority is given to young people with acute mental health difficulties including self-harm, thoughts of suicide, and attempted suicide. An emergency CAMHS system operates daily pm, accessed via GP. Referrals accepted by CAMHS include: Self Harm Moderate to Severe Depression / Mood Disorder Anxiety (which is generalized, complex and severe) Obsessive Compulsive Disorder (OCD) and Phobias Post-traumatic Stress Response/Disorder Psychoses Eating Disorders refusal Attention Deficit Disorder (ADD) and Attention Deficit Disorder with Hyperactivity (ADHD)

7 The Age Disability Team (SADT) The Age Team provides support children and young people with a range of diagnosed disabilities who attend school in County Clare when their needs are complex and cannot be met by their local primary care services. The Team is made up of health professionals who work together with families, school staff, and others to develop and implement evidence-based strategies that will help each child and young person to reach his or her potential. The Team currently includes 1.6 Speech and Language Therapists, 2.8 Occupational Therapists, 1.8 Physiotherapists, 3 Psychologists, and a shared Social Worker. These 9.2 clinicians work with the families of about 500 children who have physical, intellectual, or sensory disabilities or ASD. In addition, the psychologists on the Team coordinate screening and assessment children who attend school in County Clare and are suspected of having Autistic Spectrum Disorder (ASD.) They are based in Ennis, and also provide services in Kilrush and Ennistymon. s provided by psychologists on the SADT include: Parent groups, including: Understanding ASD Behaviour, Emotions, and Self-Esteem (BESE) Meltdowns and Other Challenging Behaviours Groups children and adolescents Monthly talks Skills workshops and clinics Parent and school staff appointments in Psychology Clinic Facilitate major transitions, such as to secondary school and adulthood. Participate in more intensive SADT team-based supports a number of families with unusually high levels of need. ASD Screening and Assessment Service The Continuum of as a Framework Collaboration between the Educational and Healthcare Psychology Services in Clare All the child psychology services in Clare have roles to play in supporting school age children. The Continuum of provides clarity about how to help children who have learning, social, emotional, or behavioural difficulties in school. NEPS is the main support schools in relation to children s learning, social, emotional and behavioural difficulties in school. Other mal and inmal supports are available to schools including SESS, Middletown, PDST, and numerous books, websites, and other resources. NEPS collaborates with other psychology services in Clare including Clinical Psychology, CAMHS, and the Age Disability Team (SADT), and will facilitate referrals to these services if indicated. NEPS will initiate joint work if indicated with children who are involved with other psychology services. The Continuum of is an efficient, effective, and equitable way psychologists from both the education and health sectors to work together to support school age children in Clare. If a school has concerns about a child s learning, social and emotional development, or behaviour, one or more of the psychological services in Clare may offer support at a level consistent with the Continuum of. In many cases support will initially be offered at the and All level. Concerns that a child requires a higher level of support may be discussed with NEPS, and other services may become involved as needed. Examples of supports available along the Continuum of by school-based, community based, and specialist services are illustrated below.

8 National Educational Psychology Service (NEPS) Child & Adolescent Mental Health Service (CAMHS) a few Complex Case Consultation COS Student File a few Mental health services, including inpatient, children with moderate & severe mental health difficulties. Teacher Consultation Case Consultation COS Student file Literacy Interventions Friends Life Assessment & intervention with children with mental health problems, complex EBD, attachment based difficulties & family system challenges. all Teacher Consultation BESD & SEN Continuum of COS Student File IY TCM (& Classroom Dina) (Friends Life-2014/15) all Group & individual psycho-education via parent/child groups (anger mgt; NVR); positive mental health promotion via public talks Primary Care Clinical Psychology Service Age Disability Team (SADT) a few Assessment of Need Children at risk-assessment and Intervention Family/Systemic Children in Care-Therapeutic Intervention Specialist therapeutic intervention a few Complex Inter-agency Case Consultation in relation to children with diagnosed disability Intensive SADT Team-based s ASD Diagnostic Assessment Service Screening and Advice parents Specific Group-Based Parent & Child Programmes Selective Mutism Parent/Teacher Programme Parent Groups Monthly Talks and Workshops Skills Clinics Transition Workshops parents and young people Psychology Clinics parents & teachers ASD Diagnostic Screening Service all Talks parents Springboard & Parenting Programmes (Clarecare, with access to consultation from Clinical Psychology Service) all Brochure: The ABCs of ASD (inmation on How, When, and Where in County Clare to find out if a child has Autistic Spectrum Disorder)