CCYP article…

Emotional First Aid – Counselling Children & Young People article

Paul Jetten introduces an intervention designed by Southampton CAMHS to empower children’s workers to recognise and respond to immediate emotional needs and offer support while professional help is accessed.

A Year 11 pupil has been late for lessons and skipping school. She is believed to be truanting, and letters are sent home to her parents. This young woman could have been labelled a ‘school refuser’ and as a result her aspirations in life become greatly reduced. Fortunately, a teacher visits her at home and, by getting alongside her and taking the time ane providing the space where she can talk, her parents and the school can finally understand the reasons behind her behaviour. She talks about her experiences of what turns out to be Obsessive Compulsive Disorder, which she had been trying to hide from those around her: ‘I’ll never forget the kindness my teacher showed to me. Having things out in the open made such a difference, and from there onwards things improved.’

How many times does a young person present with challenging or problematic behaviour and it is the behaviour that is dealt with and not the driving force behind it? It may not come as a surprise to counsellors working with young people that this driving force could be emotional distress.

To help frontline staff deveop strategies for working with young people in emotional distress, Southampton CAMHS workers Stuart Gemmell, Jacquie Kelly and Dave Smith developed a training course called Emotional First Aid (EFA). The course teaches that a young person’s behaviour is fulfilling a function for them, whether it is truanting to cope with anxiety, self-harm to feel alive or bullying to feel better about themselves. ‘Presenting behaviour’ in young people is understood as the ‘solution’ that they use to help them cope with their feelings and the situations they are experiencing.

Key resources used in the course are a booklet, Me & U (My Emotions Understood) – a real insight into the emotional experience of a young person today and an accompanying DVD. These were produced from a project undertaken by Solent Youth Action, a youth volunteering project, working with a group of young people who have experienced mental health problems, and who identify what helped them make positive steps towards recovery. Young people’s stories like the one above are used to help those who work with young people learn how to provide support, time, and, where appropriate, encouragement for the young person to seek specialist advice.

National context and legislation
The emotional health and psychological wellbeing of young people lies at the heart of legislation and government guidance, such as Every Child Matters1, Ofsted Standards2, NICE Guidance3 and Healthy Schools’ guidance from the Department of Education and Skills4. Standard 9 of the National Service Framework for Children, Young People, and Maternity Services5 calls for all staff working directly with children to have sufficient knowledge, training and support to promote the psychological wellbeing of children, young people and their families and to identify early indicators of difficulty.

This is no small task given that it is estimated nationally that about one in four children and young people will have a mental health, emotional or behavioural problem sometime in their life. Ten per cent of five- to 15-year-olds have a diagnosable mental health disorder, and around 1.1 million children and young people under 18 would benefit from specialist CAMHS services6.

Besides, the Department of Health’s New Horizons document states: ‘Good mental health is more than the absence or management of mental health problems; it is the foundation for wellbeing and effective functioning both for individuals and their communities. Mental wellbeing is about our ability to cope with life’s problems and make the most of life’s opportunities.’7

For this reason, CAMHS Tier 1 and 2 training is delivered to increase the skills and confidence of frontline workers to promote positive mental health and to work more effectively with children and young people who may experience mental health problems.

What’s different about Emotional First Aid?
‘Emotional First Aid is the initial response given to a young person experiencing emotional distress before specific professional help is sought and obtained.’

Frontline workers with young people may find themselves applying plasters and bandages to the various physical scrapes that young people get into in their day-to-day lives, but emotional cuts and bruises may go unnoticed. When a young person is withdrawn, aggressive or self-harming, professionals can feel out of their depth and distance themselves. EFA is about us being the bandage: we may not be able to make the cut better, but we stay around until it is appropriately attended to.

All of us experience a spectrum of emotions every day, and sometimes these emotions every day, and sometimes these emotions can become stuck. A young person may have less experience of understanding their feelings and new situations, and distress increases if they think they are the only person who feels like this, that there may be something wrong with them. The stuck emotion comes to be seen as a behavioural problem, as attention seeking or as a mental health problem.

We all know the link between bullying and poor self-esteem, between lack of confidence and withdrawal later on in life, how anxiety can develop into panic attacks or severe clinical depression, how loss of control I people’s lives can lead to anorexia. But what if we could interrupt this process?

Early intervention
Studies of psychosis have shown that early intervention during the prodromal (or early symptom) stage can either reduce the likelihood of a psychotic symptoms and their duration. Indeed, some of the symptoms and their duration. Indeed, some of the symptoms exhibited in this early stage, such as feeling low, irritable, anxious or acting out of character, can be feelings we all experience, usually as transient states associated with developmental stages or circumstances. But it’s important not to ignore them.

As an example of this, in the DVD for the course, Freddie, a young man who begins to experience auditory hallucinations, is too frightened to seek help from his GP and parents. They initially put his distress down to growing pains. Yet when he withdraws from his social network and drops out of college, his girlfriend and parents become concerned and seek help from the local Early Intervention in Psychosis Team. They link him in with a youth project, Fairbridge Solent, where he is able to rebuild his confidence and make plans to return to education.

In the same way, EFA challenges the way we look at mental health/illness, and acknowledges its gradual build-up. Nobody wakes up one morning to find themselves in severe depression; there are always contributing situations and emotional processes, and decisions they have made to try to deal with them. Early detection and intervention by those the young people know well and trust, people who work with them every day, can interrupt the process of escalation. The Emotional First Aider is there to help the young person develop their own enabling strategies to help them deal with their emotions and to move forward. If specialist referral is appropriate, that worker can support them to help them reach that service, reducing the ‘pillar-to-post’ referrals that young people often endure, which, for someone experiencing emotional distress, only adds to their anxiety.

Theoretical context
EFA is built upon humanistic and systemic ideas. It highlights the importance of being with a young person through their emotional distress, and draws on the Rogerian core conditions of empathy, unconditional positive regard and congruence. Many trainees have already had some counselling training. Some are qualified, experienced counsellors, with the skills of engaging with a young person and listening to and supporting them already at the core of their practice. But the course also encourages trainees to understand a young person’s behaviour in context, including their family, friendship network and the professionals involved, and to think systemically about their own role as an Emotional First Aider in the context of the organisation they work in and their own referral networks.

Training delivery
The EFA course is delivered over six weekly, half-day sessions. This structure encourages reflection on practice and personal development between sessions. Trainees are encouraged to form their own support network and each cohort meets at two further sessions over a year to review skills in practice. To date, the EFA course has been delivered to 11 cohorts consisting of 111 professionals from health, education, social care, and the voluntary sector. We are currently booking places on cohort 13 to run in January 2010, cohort 12 being fully booked, also to run in January 2010.

Examples of feedback indicate the enthusiasm with which the course has been received:

‘You really need this course but you won’t realise how much you needed it until you have done it.’

‘The rest of my team needs to come on the course – it needs to be rolled out over the city/country so that we are all thinking in the same way and aren’t blind to young people’s emotional stuckness.’

‘Young people may present with one problem but may be hiding another.’

‘I have taken more time to look beyond the behaviours and the outward signs of emotional “aggression” etc to try and see if there is an underlying issue.’

In Southampton, we have also run a ‘Training for Trainers’ course and now have 22 licensed trainers from a wide range of backgrounds who can deliver the EFA course material within their own organisations. Ongoing course evaluation is being carried out by Solent University.

We are currently at the stage of rolling out the course nationally and welcome enquiries from schools, health organisations, youth services and voluntary agencies to create a network of EFA-trained staff and trainers to maintain the momentum of the course in other areas. If you would like Emotional First Aid to be delivered in your ogranisation, or would like to attend a course and go on to become a trainer yourself, please contact us.

Paul Jetten is EFA co-ordinator/trainer and trainee counsellor; Jacquie Kelly is EFA co-author/trainer and counsellor, Southampton CAMHS; Stuart Gemmell is EFA co-author/trainer and CAMHS Strategic Lead for Primary Mental Health; and Dave Smith is a family therapist. Visit for further information and to contact us.

1 Every child matters: change for children. HM Government; 2004.

2 Ofsted. Healthy minds: promoting emotional wellbeing in schools. London: Ofsted; 2005.

3 NICE Public health guidance 20. Promoting young people’s social and emotional wellbeing in secondary education. London: National Institute for Clinical Excellence; 2009.

4 Health Development Agency. Promoting emotional health and wellbeing through the national healthy school standard (NHSS). Department of Health; 2004.

5 National Service Framework for Children, Young People, and Maternity Services. Department of Health. 2004.

6 Mental Health Foundation. Bright futures. Promoting children and young people’s mental health. MHF;1999.

7 Department of Health. New horizons executive summary towards a shared vision for mental health consultation. 2009.

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