Introduction
17% of primary school-going children in England, particularly those with special needs, have been found to have some form of mental health, emotional and social difficulty or challenges (DfE, 2016). The school-going children with SEMH challenges go through disproportionate exclusion levels from school than other students without the problems (Bowman-Perrot et al., 2013). Pupils with SEMH challenges are at risk of multiple exclusions during school life. Eventually, the pupils’ academic attainment is affected negatively. The low achievement also affects their later life as they also struggle in competing favorably in the employment market. It is thus imperative that researchers and practitioners advance their knowledge of school practice to reduce the rate of exclusion that pupils with SEMH challenges go through, and make sure that this vulnerable group of children goes through a rewarding and enriched education (DfE, 2016). This literature review will cover the quality of social, emotional, and mental health (SEMH) interventions in public primary schools from primary school teachers’ perspectives.
Social, Emotional and Mental Health Theoretical Perspectives
This literature review was done based on the bio-psycho-social approach to social, emotional, and mental health that is the current theoretical model most supported by research (Cooper and Jacobs, 2011; Whitcomb and Merrell, 2013). The framework suggests that human emotional wellbeing and behavior throughout a person’s life (childhood and adulthood) result from constant reciprocity of different interactions between their physical make-up, natural abilities, and the contexts or environment where they live. From the biological perspective, there are conditions that are heritable while others are environmentally influenced. An example of one that has a higher heritability chance is Attention Deficit Hyperactivity Disorder, a 60% to 90% chance, while one that is more likely to be environmentally influenced is Conduct Disorders (Cooper and Bilton, 2002).
Social contexts, on the other hand, include geographical regions, cultures, local communities, work, school and family. Therefore, a bio-psycho-social point of view indicates that positive influencers in such contexts like educational and social accommodations at school is critical in causing meaningful change, especially in pupils who are troubled because it acknowledges individual differences. It also facilitates an approach that is trans-disciplinary which can help reach individualized needs of the pupils. Young people and children may go through many emotional and social difficulties that manifest themselves through a wide range of ways. The manifestations may include behaviors such as being isolated or withdrawn, showing disturbing, disruptive or challenging behaviors. The behaviors may be an indication of underlying or hidden mental health challenges/disorders like attention deficit hyperactive disorder, attachment disorder or deficit disorder (Poulou, 2014).
Teachers’ knowledge, viewpoints and experiences on the quality of SEMH
It is indicated that the negative impact seen in pupils with SEMH due to the challenges they experience which lead to low academic attainment can be curbed when practitioners/teachers have sufficient understanding of the kind of practice which can help reduce issues like exclusion. Proper understanding of their problems by the teachers can help provide an enriched and more rewarding education to the children. Schools report that pupils with SEMH challenges create challenges and is a professionally difficult area to handle and that they should be well informed of the relevant evidence needed to provide help (DfE, 2016).
Teachers agree that pupils’ emotional and social health impacts their overall learning and development. Pupils who are healthy mentally are happier and are highly motivated to socialize and learn. These children show a positive attitude and interest in school activities. They are eager to take part in class activities. They also show higher performance in their education compared to their less mentally healthy counterparts (Kostelnik et al., 2014). Pupils that exhibit emotional and social difficulties experience challenges in engaging in class and outdoor learning activities and in following directions. Unlike the healthier pupils, mentally ill pupils may suffer rejection by their classmates and develop low self-esteem. The pupils may also perform poorly in class activities or even be suspended (Kostelnik et al., 2014).
Therefore, teachers believe that it is important to have SEMH interventions which puts children’s emotional and social health at the center this has the capacity to affect their development and life during adulthood. Teachers agree that such an intervention can help them promote children’s emotional and social health in different ways. For instance, it can help them organize material-rich learning places which stimulate and encourage social interactions, create trusting relationships and carry out intentional teaching and learning (Kostelnik et al., 2014).
Furthermore, children learn and develop in an environment where relationships can easily be established. A caring and trusting child-teacher relationship is important for a child’s optimum development and growth (Raikes and Edwards, 2009). These authors opine that quality interventions are those which encourage trusting relationships between children and teachers, an environment where SEMH challenged pupils can ask questions freely, attempt new tasks or activities, express themselves and solve problems. Teachers who encourage close relationships with pupils agree that such children often develop positive emotional and social health. For instance, they learn to express themselves and their feelings using words. Palermo et al. (2007) say that children benefit academically, emotionally and socially when teachers create trusting and close relationships intentionally. These researchers claim that systems which encourage teachers to consistently offer care, respect, affection and warmth easily help establish this important trusting child-teacher relationship.
Teachers agree that effective SEMH interventions are those which contribute to the establishment of secure children-adults relationships and offer a framework of good or gentle behavior, a model that is linked with a child’s ability to have positive interaction with other children (Twardosz, 2005). Teachers who have worked in such environments claim that they have observed the children use kind words and gentle hands and interact positively with their peers. Their emotional and social wellbeing became nourished by the teachers’ affection and warmth, thanks to the effective SEMH interventions. Frameworks which encourage teachers to be active listeners to pupils allow the practitioners to convey their caring nature to the children. As a result, children increasing share their stories, feelings, ideas and thoughts (Twardosz, 2005).
Additionally, research on teachers’ interaction with children experiencing SEMH challenges show that efficient or quality interventions are those which encourage teachers to allow their pupils to reflect their feelings. A good intervention is also the one where the teacher accepts their pupils’ feelings (Duffy et al., 2008). When teachers reflect and accept children’s feelings, they exhibit care and sensitivity in a manner which the pupils can understand. The acknowledgment shown by teachers make pupils to feel accepted and heard. Therefore, they feel comfortable and sate to show their emotions because the teachers support them in finding, labelling and understanding the emotions.
Gordon and Browne (2014) agree that good programs are those which promote emotional and social skills to be taught intentionally to teachers who in turn can teach them to pupils to allow the young individuals develop the skills. These authors argue that teachers play a major role in training children to develop emotional and social competence. They can support the development of this competence using books, coaching, planning activities, providing cues, modeling relevant behaviors and praising pupils after completing tasks successfully.
Lastly, evidence shows that professional training is key in enabling teachers to impact mental health and pupil behaviors. Quality and effective SEMH interventions, according to teachers, are those which help teachers to gain understanding of the challenges which pupils with mental, emotional and social health challenges pass through and how to help them. It is thus imperative to train teachers to gain knowledge and skills concerning school-based mental health care and support (Teachingei.org. 2011).
The effectiveness of the current SEMH interventions
There are many SEMH interventions which help care for children with mental, emotional and social health challenges and are effective both in specialist and mainstream settings. Most effective approaches which are currently being used to help in SEMH interventions are based on the Pyramid framework. This model was created based on the emotional and social early learning foundations which also relies on the public health framework to offer support and services to children. This is a model that is widely accepted in intervention, promotion and prevention. The model comprises of three tired framework. The first tire is the prevention level, a universal phases where all children and families receive continuous support through high quality caregiving and early education, anticipatory guidance, development screening and monitoring. The second tier is secondary prevention which comprise of community programs like home-visits for families at risk, parenting classes, support services, resources for early interventions, awareness activities and community education. The third tier is tertiary prevention that is focused on interventions that are evidence-based and which are accessible immediately a child in need is identified with delays in emotional and social development or with behavioral challenges (Georgetown University Center for Child and Human Development, 2011).
An effective model of intervention is one where focus is given on the policies and systems needed to establish a workforce that can adopt and consistently rely on evidence-based practices. This is a universal framework in which all children are cared for through responsive and nurturing relationships in quality environment. Furthermore, an effective framework is one which has preventive measures and comprise of practices which target emotional and social strategies to protect children from experiencing emotional and social problems. Lastly, an effective framework is one that consist of practices that are individualized and which pay attention to a child’s personal issues to create personalized solutions (Hemmeter ET AL., 2020).
Tier 1: Universal provisions for children experiencing SEMH challenges
Cooper and Jacobs (2011) highlighted the importance of teachers adopting humanistic and non-coercive approaches in their practice. These authors encourage teaching professionals to follow approaches which can benefit SEMH challenged pupils. Later, Beeeman et al. (2015) also found that better emotional and social adjustments of pupils can be projected by increased child-teacher closeness. Additionally, better adjustment in behavior can be predicted when there is positive peer and child-teacher interactions. Another study by Mowat (2010) emphasize the value of more respectful and trusting relationships between pupils and staff. Mowat (2010) claims that this kind of relationship is key both to the success of teachers, their institution and children. This author says that when the relationship or teacher-pupil bond is stronger, a decline is seen in the number of school sanctions.
Achievement for All
This is a two-year cycle program that is evidence-based and targets improving the whole school. It supports improving school outcomes, particularly for the disadvantaged and vulnerable pupils like those coming from low-income households who have emotional, mental and social health challenges. This program started in 2010 is used in more than 2000 schools. The Achievement for All program is created based on the elements of learning, teaching, leadership, carer/parent engagement, opportunities and wider outcomes. This program has had substantial impact on the progress of Maths and English among SEMH pupils. Humphreys and Squires (2011) claim that the program improved the interest of learning among students with mental, emotional and social health challenges. These authors also claim that this intervention is effective in improving positive relationships, attendance and behavior. It also reduced behavior problems and bullying.
Behavior for learning
There are currently three programs which have sufficiently been used to improve children’s behavior. These include: the what works clearing house or the WWCH, the Lions Quest, and Facing Ourselves and History programs. The other program which according to Cooper (2011), demonstrated school wide effectiveness in helping children with SEMH is the School Wide Positive Behavior Support or SWPBS program. The behavior for learning approach is universal approach which considers behaviors as being functional. Soloman et al. (2012) claim that behavior being functional, serves particular purposes for the young children involved. The behavior for learning approach offers schools with a framework to identify children’s behaviors. This allows the schools to plan and come up with appropriate practices for the entire school with the goals of improving both behavior and educational outcomes for the pupils. Kelm, McIntosh and Cooley (2014) found favorable outcomes when behavior for learning was used to deal with bullying, emotional and social issues, concentration and teacher concentration and self-efficacy.
Restorative practices
This programs advocates the value of developing an entire school ethos of shared way of behavior and values. Restorative practice, similar to restorative justices, seeks to solve conflicts which may emerge. It aims to lower or eliminate behaviors like bullying and aggression. Cooper and Jacobs (2011) claim that this approach have shown some benefits in the UK and Scotland both for pupils and staff. Another study by Gregory et al. (2015) in the United States also indicate that teachers who applied greater restorative practices had significantly positive relationships with diverse students. Students in the United States’ schools viewed their teachers as being trusting and respectful. Students also viewed their teachers as individuals who issues less exclusionary disciplinary referrals than those who did not make of use of restorative practices.
The Good Behavior Game
This intervention was introduced for the first time to learning institutions in 1969. It was found to have considerable success in different settings and in the classroom. Flower et al. (2014) found it useful in dealing with challenging behaviors, particularly in curbing disruptive behaviors, out-of-seat behaviors, shouting out, aggression and off-task behavior. Besides the authors finding this approach very effective in primary school settings, researchers like Kleinman and Saigh (2011) found it to be equally effective in high schools, cultural contexts and different regions.
Social and emotional literacy or SEL
SEL interventions have also shown progress and benefits for low attaining and disadvantaged pupils when implemented properly with fidelity. According to Lendrum, Humphrey and Wigelsworth (2013), SEL interventions always improves both attitudinal and emotional outcomes and are effective in improving the pupils’ attainment. These authors opine that SEL interventions become more successful when they are embedded into a school’s educational practices and when support is given through staff training and professional development. A study conducted by Durlak et al. (2011) found that SEL interventions are effective in improving emotional and social skills, academic performance, behavior and attitudes in pupils.
Why Try?
This intervention program, comprising of some SEL aspects, is also an emerging, evidence-based intervention, used internationally since it was first implemented in 2011 in almost 42 post-primary learning institutions in Ireland (Mac Cobb, Fitzgerald, and Lanigan-O’Keeffe, 2014). This strength-based program was created to help young individuals to overcome their issues and improve performance in areas of behavior, academics and truancy. The intervention follows a Solution Focused Brief Therapy approach that rely on emotional and social intelligence, as well as the multi-sensory learning concepts/principles. The intervention is thus critical in contributing to a child’s wellbeing and health. Mac Cobb and colleagues (2014) claim that this alert program is an active and structure learning program which uses an analogy engine to tackle self-management of pupils’ behaviors, especially those who experience difficulties. In their study, these researchers found positive results for pupils with challenging behaviors, particularly those from socially deprived regions of Ireland.
Friends for life youth program
This program, which is based on its cognitive behavioral framework, has been found useful in supporting pupils’ wellbeing in learning institutions (Higgins and O’Sullivan, 2015). This program was first developed for treating depression and anxiety for individuals and groups. However, it has also been found effective as a whole school approach to preventing mental health challenges. These authors found a significant increase in sensitivity and empathy towards individuals with mental health challenges after teaching pupils about how to appreciate each other.
The attachment aware schools
This is initiative is a UK based program for the whole school which provides emotion coaching developed by attachment specialists, professionals from different universities and colleges like Bath Spa University Bath, the National College for Leadership and Teaching, North EAST Somerset Council and other professionals from schools. This approach comprises training of whole schools based on the attachment theory. It also comprises of emotion coaching which was first started in the United States. Evidence shows that this approach has been effective in reducing SEMH among secondary school children (Kelly, Watt and Giddens, 2020).
Tiers 2 and 3 interventions for SEMH challenged pupils
The Repeated Reading Program
This program, meant for young people and children with disabilities have had positive impacts for this category of people in reading comprehension. However, it has had no actual effects on phonics, reaching achievement and reading fluency for children with learning challenges. This approach has been found to be very effective for small groups of people and reduces in effectiveness as the group size increases past five individuals. Garwood et al. (2014) examined the impact of this reading intervention for EBD challenged pupils in resource or self-contained settings. These authors found average to large impact sizes for literacy skills in pupils.
Anger management and social skills groups
These group interventions have been found to be vital for helping pupils experiencing SEMH challenges (Wilhite and Bullock, 2012; Mikami, Jia and Na, 20214). A study by these researchers on training pupils suffering from ADHD on social skills indicated increased pupil and parent satisfaction due to the significantly positive results. This program increases pupils and parents participation in the social skills training increasing their understanding and knowledge on how to provide appropriate support to the children and to help the children generalize new skills gained.
Resource-Base provisions and nurture groups
Majorie Boxall, an educational psychologists, started nurture groups in the 1960s with the aim of improving children’s emotional wellbeing by passing them through different restorative attachment situations/experienced. Longitudinal and rigorous research has been conducted in primary school settings to assess the impact of these groups. An example is that of Hughes and Schlösser (2014) which found that nurture groups are useful in improving pupils’ emotional wellbeing, particularly those experiencing SEMH challenges. These authors found this approach to be helpful in supporting children’s transition and preparing them emotionally and physically for learning, enhancing social skills and encouraging friendships.
The Support factors which contribute to SEMH interventions
High Quality Resources
Quality SEMH interventions require available and accessible resources for schools. High on schools’ agenda is the mental health of pupils. Enough resources are needed to smoothly implement appropriate and quality SEMH interventions. One major way to support educators in the implementation of interventions is equipping the learning institutions both with high-quality resources and knowledge concerning SEMH. This way, educators can meet the needs of children and show how the children are flourishing or making progress in education (Hannaghan, 2019).
Policies on Training
Provisions which offer constant or regular training to the teaching fraternity concerning mental health can result in better outcomes, particularly for the vulnerable pupils (Storebø et al., 2011). It is evident that supporting SEMH pupils is not an easy task and requires high level of competency, skills and knowledge from teachers. This level of competence can be achieved by through training. These professionals have especially been affected by funding cuts and overwhelming demand by some pupils who need a lot of care. The shortfalls have often left educators with the work of filling the gaps of children waiting for medical professionals or individuals who are qualified to prescribe appropriate support for the mentally ill pupils. Training educators in this area will make them proactive enough to offer the vital help in a much responsive way. Additionally, policies should be created to provide sufficient resources and help schools meet or satisfy their budget needs. The policies should also encourage screening of pupils’ wellbeing. Screening processes like the emotional and social profile questionnaires, the Boxall Profile and the Difficulty and Strength Questionnaires should be put in place to identify pupils in need and put in place appropriate measures to help them (Simpson, Peterson, and Smith, 2011).
Improving the performance of SEMH interventions
According to Breeman et al. (2015), supporting pupils with can be very challenging. Many educators are not trained on offering mental health support and the access to the right support needed by specific students is difficult because it is restricted both by funding cuts and overwhelming demand. Higher tier support has been forced to raise the seriousness or severity of cases to get accepted and be prioritized within the highest need level. A large school population section has been left with serious mental health challenges which find difficulty in getting the right support. There are many SEMH intervention improvements which can help make a difference in the SEMH challenged pupils without necessarily spending a lot of money.
Barnes, Smith and Miller (2014) say that one of the ways of improving SEMH interventions is providing or recruiting enough school counsellors. This can be quite costly yet necessary. Interventions in schools can be improved by providing schools with enough counsellors. These staff can be useful in providing specialist help to those pupils who need first priority attention. This approach can help meet the set threshold indicated in top tier services. These authors claim that this is one of the fastest response approach to offer help when dealing with mental health issues in schools. These services can be acquired from local charities or by directly recruiting counsellors. This author claim that it is important for the counselling to be done by qualified professionals who are recognized by the law. However, schools can still make use of counsellors with basic qualifications to help them meet low level work of helping students under the support of course tutors. This offers a chance for schools to improve their SEMH interventions and the counseling provisions.
Another way of improving the SEMH interventions in schools is through external psychotherapeutic firms. Schools can refer their students directly or support the young individuals in getting self-referrals to external firms. This can allow pupils/students to access support which may not be available in schools. It can also reduce the pressure schools experience when they have inadequate SEMH strategies of interventions (Johnson et al., 2020).
Schools can also make use of self-help resources. This approach involves the use of worksheets and books focusing on typical and easily identifiable problems like low mood and excessive worry. This approach can be used to improve and support the existing SEMH strategies. It is an effective and low cost intervention strategy which do not require expensive and trained professionals to implement. Through this approach, educators can find important information useful in identifying mental health issues and how to solve them before they get out of hand. Besides being useful to educators, the books can also be given to students or parents and can be employed individually or in groups. This approach can help increase awareness, for instance in how to manage stress levels (Policy, 2020).
SEMH interventions in schools can also be improved by adding areas or facilities to be used by pupils with mental, emotional and social challenges (Norwich and Eaton, 2014). An example is creating quiet rooms or spaces which are made availed for the pupils to have some social times, a critical pre-emptive intervention tool. Some students have many different needs and find the normal unstructured breaks like lunch times very stressful. These pupils may need quiet time to decompress from the hectic daily school routines. Besides the other intervention strategies, schools may create simple quiet rooms or areas to help towards reducing the stress pupils in need have. Schools can create no noise policies and provide comfortable seating rooms with cushions, lambs and low lighting. It can also have calming music in the background to further enhance the environment into a place where a stressed pupil can calm down and relax. Materials for this kind of environment can be financed through donations or other funding sources and staff volunteers can help manage the rota to establish appropriate serenity. These quiet rooms can be used as referral points for pupils suffering from anxiety and stress (Norwich and Eaton, 2014).
According to Reeves and Bailey (2014), active strategies can be put in place by schools to support the existing SEMH intervention approaches. Evidence demonstrates that exercise or physical activities can help relieve stress and improve mental health. Staff members can be encouraged to come up with different social activities relevant for different students according to their needs to make them physically active. This can include physical clubs which engage students or pupils in various physical activities or exercises and allow them to learn different new skills. The clubs can also allow pupils to follow what they are interested in and boost their self-esteem, generally improving their physical and mental wellbeing.
Evidence shows that giving pupils the chance to share their concerns or worries is a good way to assess the main stressors and the challenges they experience outside and inside school. Creating a safe place where pupils can freely and comfortably speak out about their concerns is also a good way to support the existing SEMH intervention approaches, especially in identifying children who are suffering from mental health problems. This can be done in non-verbal methods like through writing, making the process as accessible as possible (Abouammoh, Irfan and AlFaris, 2020).
Providing education about mental health is another method of enhancing the existing SEMH interventions. Students and pupils can be educated about their mental health. This is key in making the current SEMH intervention methods in schools successful. Through this approach, pupils are made to understand how their mind works and the main signs which may show that they need help. Educating pupils about their mental health will make them aware of how to differentiate between normal feelings and stress. They also learn how to identify mood shifts and worry, depression and chronic anxiety. These skills are crucial in making sure that students get the right help in a quick manner. This approach is important because it allows pupils to know how to identify, report problems and seek help promptly. They can also learn how to help one another and be good friends to those who need help (Sánchez et al., 2020).
(Site) point out that staff mentoring through training is one of the methods which can help improve existing intervention. Training staff and equipping them with low level support skills can benefit pupils with SEMH challenges. This can be done by availing trusting staff and members who can work together to reduce depression or stressors in pupils. This mentoring can be provided by using self-help resources and dedicated procedures which can support students who need help in schools. Pupils with increased levels of stress often require support in organizing themselves and their lives to reduce or eliminate the stressors significantly. Staff mentors are vital in reducing stressors by training others on organizational and stress management skills. They can also help overcome challenging situations, for instance, the individuals who are struggling with bad or toxic relationships. Staff can use this opportunity to advise pupils on how to avoid stress inducing people and relationships.
Sloan et al. (2020) highlight the relevance of nurture groups as a means of supporting pupils with behavioral, emotional and social difficulties at home and at school. The government can introduce or enhance nurture groups which link mental, behavioral, and social challenged. Using evidence-based approaches, the groups help teach pupils about emotional and social skills and how to remove learning barriers to make pupils ready to learn. The nurture provisions, delivered in many methods in secondary and primary school settings, can support students with me mental, emotional and social health needs through measureable and impactful approaches.
Schools can also encourage classroom mindfulness and across the entire school environment. Evidence has shown that mindfulness is effective in lowering stress levels within these environments. Mindfulness activities before lessons commence, can make a pupils mind to focus and relax. Avoiding distracting narrative in a pupils mind before the start of lessons have been found to improve learning, particularly in pupils with SEMH challenges. Students can be trained on how to be mindful and use their time to help one another to be in control of their worry and stress. Students can also be given time and be trained on meditation exercises. These skills can also be acquired from books which show how to perform different SEMH intervention exercises which improve focus and reduce stress or anxiety (SEMH, 2020).
According to Maggin et al. (2011), there are also in class strategies which can help support build relationships and emotional health. Small things like greeting each other through check-ins and check-outs, can help achieve these. Teachers can also allow some time to talk and explore their feelings while in class. Additionally, educators can encourage students/pupils to establish one-to-one support within the classroom, offering help especially to the classmates who are experiencing mental, emotional and social health challenges. Relationship building can be done through the establishment of circle-of-friends, and appointing playground leaders, ambassadors of pupil wellbeing and forming of social skills teams/groups. Pupils’ voices can also be collected, particularly that which encourage others to form friendships, respect each other and work together in helping those who are in need.
Schools can also come up with protected time for pupils when they can work with more experienced adults in getting the right advice on how to overcome mental health challenges. This time can be used to allow pupils to gain emotional literacy through support assistant. This is also the time when school-based counsellors can come in to help the pupils who are in need of social, emotional and social health intervention. For example in the United Kingdom, some schools have in-school bereavement time and support for pupils. Others have registered therapists who train children music, drama and art as a means of relieving stress and improving focus for those who experience SEMH problems. Examples of bereavement support in the UK are Winston Wishes and Bereavement UK (Whitman, 2017).
Conclusion
Indeed there are many interventions which can help offer support to pupils who experience mental, social and emotional challenges. Teachers play a critical role in helping these pupils and it is vital that they have sufficient knowledge and skills in this area because it is a challenging task. Besides improving these pupils mental, social, and emotional and literacy skills in this aspect, it is important to improve the existing interventions through policies, provision of relevant and sufficient resources and training of the educators.