Mental wellbeing and emotional support for children with complex needs

Posted on 5th Jul 2016 in RNIB, School news

Fiona Minion and Cynthia Skelcher share the success of their work tackling an unseen problem...

“The best way to overcome undesirable or negative thoughts and feelings is to cultivate the positive ones.”
William Walker Atkinson

One in ten children aged between 5 and 16 years (three in every classroom) has a mental health problem, and many continue to have these problems into adulthood. Half of those with lifetime mental health problems first experience symptoms by the age of 14. 

This number rises significantly for those with a vision impairment, learning disability, autism and other complex needs. (Until quite recently, it was thought that people with learning disabilities did not have the same range of feelings and emotional needs as other people. It is now realised that it is very common for young people with learning disabilities to experience mental health issues.) 

At RNIB Pears Centre for Specialist Learning, we offer individually-tailored education, care and therapies to children and young people with multiple disabilities and complex health needs who are blind or partially sighted. Due to their complex needs, the young people we support may have trouble understanding and controlling or interpreting thoughts and feelings. This often leads to challenging behaviours which may disrupt learning.

Our in-house Disability Nurse brought together a group of staff who wanted to look at behaviours and what they mean to our young people. For example, what are they communicating? What are their emotions at any one time? How can we find out why they are having problems? 

We set up emotional support sessions to help a young person to understand their feelings. We humans have six basic emotions – happiness, surprise, sadness, anger, fear and disgust. We also experience more complex feelings such as embarrassment, shame, pride, guilt, envy, joy, trust, interest, contempt and anticipation. 

The aim of our work and sessions with some of our young people is to help them realise their sense of wellbeing, and to try and understand their feelings. Realising that being able to communicate with others can help ease, or solve any problems, lesson their anxieties and hopefully to manage their inner feelings of self-control. 

Working alongside a Consultant Psychologist, the group started to look at Positive Psychology, as we all felt we should make a firm commitment to the emotional, mental and physical wellbeing of young people. We needed to look at their personal experiences and life history; and recognise the emotional upheaval of moving from place to place.

Looking at the Seligman’s PERMA Model which has 5 core elements of psychological wellbeing and happiness, and using the mental health plan from trauma response within positive psychology, we have adapted the paperwork and information required to suit the needs of our unique young people here at RNIB Pears Centre. We have called it the ‘Pears Positive Mental Health Plan’. The aims are:

• to see the whole person

• find out what positive emotions and engagement mean to the individual

• explore how can we assist them to form good relationships with those that are important to them

• understand what they perceive to be a meaningful existence.

Rebecca’s story (Name changed to protect identity)

Rebecca has Optic Nerve Hypoplasia and is registered blind, this a congenital condition in which the optic nerve is underdeveloped. She has a multi diagnosis of Attention Deficit Disorder (ADHD), Autistic Spectrum Disorder (ASD) and Obsessive – Compulsive Disorder. She also has a Cognitive development delay. Rebecca displays challenging behaviour and engages in severe self-injurious behaviours.

Rebecca’s placement in long term foster care had broken down; this we believe led to feelings of bereavement and uncertainty in her life. When Rebecca came to live and learn at RNIB Pears Centre she displayed self-injurious behaviours ranging from head banging on hard surfaces to biting her hands; the latter being so severe that Rebecca’s hands needed reviewing by the paediatric plastic surgeons teams every fortnightly. She wore a helmet to protect her face and head and both hands were bandaged this restricted the use of her fingers. She verbalized loudly when anxious and had short bouts of screaming. It was also noticed that Rebecca has good learning and engagement skills.

Shortly after coming to live at RNIB Pears Centre ‘a team around the child’ was formed. This team included a Behavioural Nurse Specialist, Occupational Therapist, Teacher and Team leader from the bungalow where Rebecca lived. Other staff, who were beginning to build a relationship with Rebecca, were also involved. A Consultant Psychologist was also commissioned for advice. 

Advice was also sought from CAHMS Consultant Psychiatrist in Learning Disabilities (Children and Adolescents) team. 

We decided to enable teams that support Rebecca to work proactively and, in collaboration, a Pears Positive Mental Health Plan was created to incorporate trauma response prevention, crisis intervention and positive identity development.

It was decided that emotional management for Rebecca is vital and should be an integral part of her day. This includes a set therapy session within her weekly school timetable. This gives Rebecca some ‘talk time’ allowing her to chat about her personal and previous experiences.

Rebecca may also need time to understand her feelings and develop appropriate responses to these, supported by staff who she trusts.
Our occupational therapist also developed a sensory diet that was incorporated throughout Rebecca’s day. This includes:

• regular deep pressure activities, the use of a bear hug/ weighted lap pad or blanket.

• not overloading Rebecca with too many noises.

• providing a safe quiet area if noise became too much.

A Positive Mental Health Plan was written. This gave staff working with Rebecca a deeper understanding why she displayed behaviours and self harmed. It also showed staff what activities Rebecca liked for enjoyment and engagement; how they could integrate enjoyable activities into Rebecca’s day.

Rebecca has now been at RNIB Pears Centre for about 18 months. In that time she has developed immensely. The main area of concern for staff, Rebecca’s self-injurious behaviour, has seen a significant reduction, particularly in her injuring her hands. We have been able to remove the bandages on one hand whilst the other hand is still bandaged but she can use her fingers functionally. She will still bang her head but this is now used more for a communication or attention rather than hurting herself.

Rebecca’s behaviour has improved greatly, however this is still work in progress and Rebecca will continue to have all the support required to enable her to grow into a confident and happy young woman.

Fiona Minion is Registered Nurse Learning Disabilities (RNLD) and Behaviour Specialist; and Cynthia Skelcher is Therapies Assistant at RNIB Pears Centre for Specialist Learning. For more information about RNIB schools, see their page on this website.