Latest news - Emotional First Aid

Starting on Wednesday 24th February, our first 'twilight' EFA training sessions begin. Offering you a centrally located venue - Brookvale, Southampton and a start time of 6pm, this cohort is perfect for those of you who have not been able to attend the daytime sessions.

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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 www.emotionalfirstaid.co.uk for further information and to contact us.









References
1 Every child matters: change for children. HM Government; 2004. Www.dcsf.gov.uk/everychildmatters/

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. http://tinyurl.com/yj58h2k

Emotional First Aid website has been nominated for the 7th Hantsweb Awards.
The Hantsweb Awards celebrate excellence in website design, accessibility
and service. The awards are open to any website based in Hampshire and the
Isle of Wight.
The 7th Hantsweb Awards aims to further raise the standard of quality shown
in previous years. New this year, a Business Innovation category has been
added to recognise the effective ways companies have used the web to drive
business during the recession. Categories of 'Life Changing' and 'Healthy
Lifestyle' also appear for the first time, encouraging entries that promote
wellbeing in Hampshire.



www3.hants.gov.uk/hantswebawards.htm

The EFA team are proud to announce our next round of Train the Trainers and are now accepting applications for Train the Trainers scheduled on Tuesday 1st December & Wednesday 2nd December between 9am – 5pm at the Ashurst Education Centre.

This training is open to all candidates who have completed the Emotional First Aid Training.

So far we already have 22 licensed Trainers within Southampton and you could join them to promote Emotional First Aid amongst your colleagues or even as a private Trainer!

If you would like any further information about the Train the Trainers course please email info@emotionalfirstaid.co.uk

Our next two cohorts have proved incredibly popular with only a few places remaining!

We have 4 places on Cohort 7 and only 2 places left on Cohort 8, please see details below.

Simply, book here to secure your place on the Emotional First Aid Training.

Cohort 7: to be held on Friday afternoons from 12.45pm – 4.30pm on the following dates: 18 September 2009, 25 September 2009, 2 October 2009, 9 October 2009, 16 October 2009 and 23 October 2009.
Closing date for applications: Tuesday 1 September 2009

Cohort 8: to be held on Friday afternoons from 12.45pm – 4.30pm on the following dates: 6 November 2009, 13 November 2009, 20 November 2009, 27 November 2009, 4 December 2009 and 11 December 2009.
Closing date for applications: Thursday 1 October 2009

The Emotional First Aid Training will cost £300 per person.

Written by Jerome Monahan, the following article appeared in Education Guardian Children's services on Tuesday 7 July 2009.

Emotional Rescue

A new scheme trains adults in ‘first aid’ for young people who turn to them in a time of crisis

Lucy is explaining why she didn't go to school today. “I just couldn't get up. I wasn't being lazy. I just felt as if every bit of me has been filled with weighted blocks of sadness.” She is at a point of crisis and has singled you out to tell about her mounting depression. What do you do?

This scenario is one of a number of filmed true accounts of young people's struggles with emotional distress, their sadness, fear, shame and anger - which are a key ingredient in a training scheme being pioneered in Southampton. The idea is to make sure young people get support from the first person they confide in about their troubles.

In most cases, such people will not have specialist medical knowledge. Those who have taken the first Emotional First Aid (EFA) training have included teachers and teaching assistants, youth workers and student support officers.

“The course's aim is not to create experts in adolescent mental health but to help people recognise that they have an invaluable role in assisting young people in need,” explains family therapist Dave Smith, one of EFA's designers. "Sometimes their involvement will be enough, getting the young person back on track, but even if more specialist services have to be mobilised, then there's a part for an EFA-trained adult to play in supporting the young person through the process."

This is an aspect of the training that Paul Jetten particularly appreciates as an outreach worker with the national charity Fairbridge in Solent, his focus being young people whose lives are often already seriously troubled. “I have already seen the EFA training come good in my work with a teenager with anger-management problems. I was honest and explained that I didn't have all the answers, but I was happy to work together with her trying to get them. She has really responded.”




Barbara Inkson, children and adolescent mental health manager for Southampton's city primary care trust, says: “EFA needs to be seen in the context of a broader policy of trying to ‘roll-back’ help for young people so that they get the early interventions they often need to stop their problems developing into severe kinds of illness.”

The trust has championed a multi-agency scheme offering young people a short burst of specialist counselling - often all they need to turn their lives around. For seasoned campaigners such as Dr Andrew McCulloch, head of the Mental Health Foundation, the scheme is an exemplary means of alleviating some of the “referrals congestion” that besets most children and adolescent mental health services nationwide. Young people are saved the agony of long waits for appointments - crucial time lost, during which their mental health often deteriorates.

McCulloch is also impressed by EFA: “It is essential to help young people before they get stuck, and equipping those adults that young people might turn to first for help is a sensible step.”

His use of the word “stuck” is significant. “Among the most important lessons we teach,” says Stuart Gemmell, strategic lead for primary mental health in the town and one of the creators of the approach, "is that young people's behaviour, however distressing, is often their solution to their problems. We also emphasise the notion of ‘stuckness’ - the fact that self-harm, not eating or drug-taking may offer temporary relief, and there is a danger that they come to dominate a young person’s life.”

For Linda Tanner, the special education needs co-ordinator at St George Catholic voluntary aided college in Southampton, this aspect of the EFA training has already borne fruit. “Thanks to that simple word ‘stuck’, I have been able to move a huge distance with a young boy who is very withdrawn,” she says. “The concept seemed to click with him and he started to open up to me. I don't think I would have had the confidence to address this with him had I not had the EFA experience.”

Gemmel says there is a responsibility for institutions, too, to offer staff the kind of support workers in health services receive in the form of proper “supervision” - the chance to discuss their case load. “Without the proper structures in place, there's a real danger people can be left exposed when it comes to the kinds of powerful two-way transference that can go on in any human interaction, but particularly so in a counselling situation.”

The EFA training devotes one of its six two-and-a-half hour sessions to addressing the importance of the adults looking after themselves.

“Among our next moves,” says Gemmell, “is to provide the EFA training to new audiences such as carers or those working with certain minorities.”

NHS Innovations South East is working to develop EFA into a national brand. Karen Underwood, a spokeswoman for the organisation, says a recent posting advertising the next round of EFA training brought 300 applicants in just a few hours: “We don't see that level of enthusiasm for something new in the NHS every day.”

guardian.co.uk

We are pleased to announce a new addition to our Emotional First Aid team!
On a 9 month secondment from the charity organisation Fairbridge Solent, Paul Jetten joined the team from July 2009 as our new Emotional First Aid Co-ordinator for CAMHS, Southampton Community Healthcare.



Paul will be a real asset to the Emotional First Aid team as he brings with him a wealth of experience working with young people. Prior to working at Fairbridge Solent, Paul was a volunteer mentor for young people leaving care for a project called “On the Level”.

Over the last three years, Paul has been a 1:1 Support Worker for Fairbridge Solent, which is a national organisation that supports young people from disadvantaged areas to work on skills such as confidence and motivation to help them turn their lives through personal development and setting meaningful goals.

A core belief that both Fairbridge Solent and Emotional First Aid share, is that a presenting behaviour is a solution a young person has employed to meet certain needs or as a solution to emotional distress. We need to look behind this presenting behaviour to see what is driving it, and then we can work more effectively to bring about positive change.

In his spare time, Paul is currently studying for a diploma in Gestalt Counselling and hopes to go on to train as a psychotherapist using Art.

After completing the Emotional First Aid course in September 2008, Paul went on to complete the Trainers course in April 2009 and was successfully accredited as an Emotional First Aid Trainer. Paul hopes to use the secondment to promote the message of Emotional First Aid within Southampton, and assist in rolling it out on a national level.