The implementation of evidence-based SEMH interventions by teaching assistants
In a recent webinar for the Federation of British Schools in Asia (FOBISIA), Real Training Educational Psychologist Dr. Hannah Fairall discussed the implementation of evidence-based Social, Emotional & Mental Health (SEMH) interventions by Teaching Assistants (TAs). The topics covered included how the rise of teaching assistants can be leveraged to deliver crucial support to pupils with SEMH needs, how universal targeted and specialist evidence-based approaches can be used to deliver targeted interventions in the classroom on a 1:1 or small group basis, and the importance of effective implementation.
With the current pandemic, SEMH needs amongst school-aged children have become a central concern, addressing issues such as anxiety, depression, isolation, and grief management. Even prior to this, 1 in 10 pupils aged 5-16 suffer from a clinically significant mental health illness, and 1 in 7 have less severe problems that nonetheless interfere with their development and learning.
The rise of Teaching Assistants, and how to maximise their impact
The rise of Teaching Assistants in classrooms has been meteoric since 2000, with 35% of staff in primary schools and 15% of staff in secondary schools being TAs in 2015. This rise, coupled with the governmental efforts to raise educational standards and reduce teacher workloads, leads naturally to the question of how to effectively leverage this workforce, particularly in the field of SEN. Blatchford et al (2015) found lower levels of progress amongst pupils receiving most support from TAs. The proposed explanation was that TA resource was not being effectively utilised, possibly because TAs were used as an alternative to ‘teacher time’, and that those with greatest need were often taught by the least qualified to do so.
Interventions for supporting SEMH and the three-tiered structure
According to Carroll & Hurry (2018), there are three ‘tiers’ of approach when it comes to SEMH support within schools:
Carroll & Hurry, (2018)
- Universal – whole-school initiatives which foster an environment of emotional wellbeing; for all students
- Targeted – small group or one-to-one support inside or outside of the classroom; for some students
- Specialist – intensive one-to-one which can involve contact with professionals from different agencies; for few students
Universal Interventions
Universal initiatives are those such as the PACE model, developed by Dr Daniel Hughes. This aims to enable staff to engage with children who have experienced neglect, abuse and trauma. Although there is little research of its use in isolation, there is considerable practice-based evidence from parents, staff and professionals of its use as part of a wider intervention.
The PACE model contains four elements:
The PACE Model (Dr. Daniel Hughes)
Another possible universal-level intervention is mindfulness. The aim of this is to learn to be aware of thoughts and bodily sensations in order to be able to better cope with daily emotions and challenges. This has shown promising impacts on wellbeing, aspects of cognition, physical health, and academic grades.
Targeted Interventions
Targeted, one-on-one or small group interventions, delivered by TAs, have the potential to deliver tangible positive effects on the mental health of children in the classroom. Six evidence-based interventions are discussed:
Emotional Literacy Support Assistant Training (ELSA) – This training enables TAs to deliver 1:1 or small group interventions in several areas of need, including managing emotions, social skills, and bereavement. This covers all age groups.
The Homunculi Approach – this flexible cognitive behavioural therapy is a 10-week programme and seeks to identify emotions and social situations to build social and emotional resilience. This can be especially appropriate for children who have high-functioning ASD.
LEGO-based Therapy – here, children work collaboratively to create models. This approach works well with ASD or other social communication difficulties at primary and secondary levels.
Nurture Groups – supported by two members of staff, groups of between 6 and 12 spend part of the school day in a nurture group setting. This has been seen to have a positive impact on emotional, behaviour, and learning.
Circle of friends – a support network developed around individuals in the school community that helps with social skills and friendships. There is evidence this approach has positive benefits, which are likely impacted by teacher attitudes, classroom climate and school ethos.
CBT Programme approaches – Books such as ‘Starving the Anger’, ‘Gremlin’ and ‘Think Good Feel Good’ are widely available, and help children to understand emotions and physical responses. The efficacy of CBT is supported by a strong evidence base.
The importance of implementation
Dr Fairall points out that understanding the implementation of these approaches is key. Implementation is the process by which an intervention is put into practice, and concerns what an intervention consists of when delivered and thus the enactment by school staff. This highlights the importance of proper training for educational staff involved in this implementation. Implementation is linked strongly to the intervention’s outcomes, thus the chances of success.
Educational Endowment Foundation (2019)
The process is four-fold. It begins with identifying the priority and exploring the available practices to best address this within the school setting. After this adoption decision, a clear, logical plan is outlined and the readiness of the school to deliver is considered and staff and infrastructure prepared. Once delivery has begun, implementation data is used to drive adoption and adaptation, reinforcing initial training with follow-on support to solve problems that might arise. Finally, the stable use of the intervention is established, scaling up begins, and good implementation practices are rewarded.
Finding the optimal conditions through which to deliver effective implementation is key. School staff must be aware and committed to the intervention. Those delivering the intervention must be properly supported through the process. Additionally, the wider ethos and climate of the setting must be conducive to the intervention being implemented effectively.
Furthermore, research from Humphrey (2013) suggests three elements that influence outcomes of SEMH interventions:
- Participant reach is crucial for equality of access to interventions. Educational settings should consider how students are referred, and that the correct interventions are available to all those who could benefit from them.
- Fidelity is the extent to which critical components of a programme are present. This may manifest itself in such ways as schools adapting interventions to suit their setting, which can lead to positive outcomes for students.
- The number of sessions, much like a medicinal dosage, should be sufficient to encourage the intended positive outcomes. Those schools that deliver the required number of sessions achieve better outcomes than those who do not.
Implementation of Emotional Literacy Support Assistant Training (ELSA) (Fairall, 2020)
Finally, Dr. Fairall presented her own doctoral project on the implementation of the ELSA programme. It was found that schools can implement the programme in different ways, and there was a range of factors at different stages of implementation which supported effective implementation.
An implementation resource has been created for schools, which draws on the findings of the present research in conjunction with implementation literature. This resource is aimed at Senior Leadership/SENCOs, and may also be discussed in conjunction with the ELSA. The resource aims to provide guidance and support specific to the stage of implementation the school are in. This resource can be adapted in light of further research into this area.
Conclusion
In summary, with the correct training, implementation, and support in the teaching space, TAs can be more than capable of delivering evidence-based SEMH-related interventions that have tangible positive effects on the pupils who take part. In line with the Educational Endowment Foundation guidance, TAs can be effectively used to deliver 1:1 targeted interventions, and are a largely untapped educational resource that can be better utilised for the betterment of the educational setting at large. It is possible to support student’s SEMH needs through the tiered approach, and TAs are a key part of the successful delivery of these interventions. In order to achieve the best results, it is important to school staff understand and are fully behind the interventions, and understand the practice behind effective implementation.
Find out more
You can find out more about this topic through our Social, Emotional and Mental Health Needs SEND Programme module. Alternatively, our sister company Dyslexia Action has a short level 5 CPD course The Emotionally Connected Classroom. Please don’t hesitate to contact us at info@realgroup.co.uk or on +44 (0)1273 35 80 80 if you have any questions.
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