1 Recommendations

This document constitutes the Institute's formal guidance on promoting the social and emotional wellbeing of children in primary education. Primary education refers to all educational settings serving children aged 4–11 years.

Children's social and emotional wellbeing is important in its own right but also because it affects their physical health (both as a child and as an adult) and can determine how well they do at school. Good social, emotional and psychological health helps protect children against emotional and behavioural problems, violence and crime, teenage pregnancy and the misuse of drugs and alcohol ('Systematic review of the effectiveness of interventions to promote mental wellbeing in children in primary education' Adi et al. 2007).

This guidance complements existing national initiatives to promote social and emotional wellbeing. It should be considered in the context of the Healthy Schools programme (Department for Education and Skills 2005c) and related community-based initiatives. These all stress the importance of enabling children to participate fully in the development of such programmes to ensure their views are heard.

Depending on local service configuration and capacity, all those cited under 'Who should take action' could be involved in implementing the recommendations.

The evidence statements underpinning the recommendations are listed in appendix C. The evidence reviews, supporting evidence statements and economic appraisal are available on the Institute's website.

Comprehensive programmes

Recommendation 1

Who is the target population?

Professionals working with children in primary education.

Who should take action?

Commissioners and providers of services to children in primary education including those working in: local authority education and children's services, schools, healthcare, child and adolescent mental health services and voluntary agencies.

What action should they take?
  • Develop and agree arrangements as part of the 'Children and young people's plan' (and joint commissioning activities) to ensure all primary schools adopt a comprehensive, 'whole school' approach to children's social and emotional wellbeing. All primary schools should:

    • create an ethos and conditions that support positive behaviours for learning and for successful relationships

    • provide an emotionally secure and safe environment that prevents any form of bullying or violence

    • support all pupils and, where appropriate, their parents or carers (including adults with responsibility for looked after children)

    • provide specific help for those children most at risk (or already showing signs) of social, emotional and behavioural problems

    • include social and emotional wellbeing in policies

    • offer teachers and practitioners in schools training and support in how to develop children's social, emotional and psychological wellbeing. The trainers should be appropriately qualified and may be working in the public, voluntary or private sectors. In the public sector, they may be working in: children's services, healthy schools teams, educational psychology or behaviour support, community nursing, family support or child and adolescent mental health services (at tiers one and two – for example, primary mental health workers).

  • Put in place and evaluate coordinating mechanisms to ensure primary schools have access to the skills, advice and support they need to deliver a comprehensive and effective programme that develops children's social and emotional skills and wellbeing (see recommendations 2–3).

  • Schools and local authority children's services should work closely with child and adolescent mental health and other services to develop and agree local protocols. These should support a 'stepped care' approach to preventing and managing mental health problems (as defined in the NICE guideline on depression in children and young people). The protocols should cover assessment, referral and a definition of the role of schools and other agencies in delivering different interventions, taking into account local capacity and service configuration.

Universal approaches

Recommendation 2

Who is the target population?

Children in primary education (aged 4–11 years), their parents or carers and teachers.

Who should take action?
  • Head teachers, teachers and practitioners working with children in primary education.

  • Those working in (and with) local authority education and children's services (including healthy schools teams), primary care (including school nurses), child and adolescent mental health services (tiers one and two) and voluntary agencies.

What action should they take?

Provide a comprehensive programme to help develop children's social and emotional skills and wellbeing. This should include:

  • A curriculum that integrates the development of social and emotional skills within all subject areas. (These skills include problem-solving, coping, conflict management/resolution and understanding and managing feelings.) This should be provided throughout primary education by appropriately trained teachers and practitioners.

  • Training and development to ensure teachers and practitioners have the knowledge, understanding and skills to deliver this curriculum effectively. The training should include how to manage behaviours and how to build successful relationships.

  • Support to help parents or carers develop their parenting skills. This may involve providing information or offering small, group-based programmes run by community nurses (such as school nurses and health visitors) or other appropriately trained health or education practitioners. In addition, all parents should be given details of the school's policies on promoting social and emotional wellbeing and preventing mental health problems.

  • Integrated activities to support the development of social and emotional skills and wellbeing and to prevent bullying and violence in all areas of school life. For example, classroom-based teaching should be reinforced in assemblies, homework and play periods (in class as well as in the playground).

Targeted approaches

Recommendation 3

Who is the target population?
  • Children in primary education (aged 4–11 years) who are showing early signs of emotional and social difficulties, in particular, those who are:

    • showing early signs of anxiety or emotional distress (for example, children who have poor peer relations, low self-esteem, are withdrawn or have behavioural problems)

    • at risk of developing (or who already display) disruptive behavioural problems.

  • Parents or carers of children aged 4–11 years who are showing early signs of emotional and social difficulties.

Who should take action?
  • Teachers and practitioners working with children in primary education.

  • Those working in (and with) local authority education and children's services (including healthy schools teams), primary care (including school nurses), child and adolescent mental health services (tiers one and two) and voluntary agencies.

What action should they take?
  • Ensure teachers and practitioners are trained to identify and assess the early signs of anxiety, emotional distress and behavioural problems among primary schoolchildren. They should also be able to assess whether a specialist should be involved and make an appropriate request. Children who are exposed to difficult situations such as bullying or racism, or who are coping with socially disadvantaged circumstances are at higher risk. They may include: looked after children (including those who have subsequently been adopted), those living in families where there is conflict or instability, those who persistently refuse to go to school, those who have experienced adverse life events (such as bereavement or parental separation), and those who have been exposed to abuse or violence.

  • Identify and assess children who are showing early signs of anxiety, emotional distress or behavioural problems. Normally, specialists should only be involved if the child has a combination of risk factors and/or the difficulties are recurrent or persistent. The assessment should be carried out in line with the Common Assessment Framework (to ensure effective communications with the relevant services) and using other appropriate tools.

  • Discuss the options for tackling these problems with the child and their parents or carers. Agree an action plan, as the first stage of a 'stepped care' approach (as defined in the NICE guideline on depression in children and young people).

  • Provide a range of interventions that have been proven to be effective, according to the child's needs. These should be part of a multi-agency approach to support the child and their family and may be offered in schools and other settings. Where appropriate, they may include:

    • problem-focused group sessions delivered by appropriately trained specialists in receipt of clinical supervision. These specialists may include educational psychologists or those working in child and adolescent mental health services (at tiers one and two)

    • group parenting sessions for the parents or carers of these children, run in parallel with the children's sessions.

  • Ensure parents or carers living in disadvantaged circumstances are given the support they need to participate fully in any parenting sessions that are offered. For example, they may need help with childcare or transport.

(See also the NICE guidelines on antisocial behaviour and conduct disorders in children and young people: recognition and management, and attention deficit hyperactivity disorder: diagnosis and management).