Using USO within a school environment – Accrington Academy Pilot

Using Understanding Self and Others (USO) within a school environment: Accrington Academy Pilot
Email: tracpsychological@gmail.com
Website: tracpsychological.co.uk
TRAC Psychological
Jay Graham-Kevan & Eve Russell
TRAC Psychological
August 2019

Acknowledgements i
Executive Summary ii
1. Introduction:
1.1 Literature review and USO 1
1.2 USO pilot 3
Methodology:
▪ Pilot 7
▪ Method 8
2. Results:
▪ Quantitative method 9
▪ Student Feedback 13
▪ Training Feedback 16
2. Discussion 17
3. References 19

CONTENTS

Acknowledgements
We would like to thank Accrington Academy Headteacher Andy O Brien for allowing the pilot to take place. Special thanks for also Lisa Braysford, Dep. Headteacher for driving the pilot, choosing the groups and giving on-going support and feedback to the children and facilitators. Professor Nicola Graham-Kevan for her support of the statistical analysis. Neil Smith, the integrated health and Pennine Lancashire Integrated Care Lead for this pilot.

Executive Summary
▪ USO is a skills-orientated, group-based programme which can be delivered in a range of settings.
▪ In this pilot USO was delivered to three cohorts of secondary school children identified as having problematic behaviour.
▪ Findings included statistically significant improvements in emotional self-efficacy and resilience from pre- to post-programme.
▪ Children reported finding taking part in the USO programme a positive experience and reported using the skills they had acquired to manage a range of difficult emotions and situations.
▪ A one- and two-year follow-up assessment of changes in negative classroom behaviour, as measured by child behaviour points, found significant reductions in these at both one and two years post USO.
▪ Training of staff on adopting a trauma-informed approach was overwhelming well received.
▪ This pilot suggests USO is an effective programme for school-based delivery.

Introduction
Literature review and USO
There is increasing concern around mental health and well-being of children and young people in the United Kingdom. Estimates suggest that approximately 10% of school aged children have a diagnosable mental disorder, with around 20% experiencing mental health problems at some point (BMA, 20060). This suggests that children may benefit from support enhancing their wellbeing. Well-being is “more than the absence of mental illness or distress, but rather a positive state of mind in which the individual has the psychological, social and physical resources to fulfil his or her own potential, cope with the normal challenges of life, can work productively and is able to make a contribution to her or his community”.

Emotional well-being is an important predictor of outcomes across the life course, and a critical factor in academic engagement and success. Indeed, emotional wellbeing is a stronger predictor of adult life satisfaction than either pro-social behaviour or intellectual performance (Layard, Clark, Cornaglia, Vernoit, and Powdthavee’s, 2013).

Schools provide excellent opportunities to promote and enhance children’s well-being (Gutman & Feinstein, 2008; Leitch, 2013). Within the UK schools are expected to support children’s well-being (e.g., providing good pastoral care, anti-bullying policies, etc.). However, for some pupils this is insufficient and therefore additional approaches should be explored.

Although across the UK schoolbased counselling provision is common (Department for Education, 2014; Thompson, 2013), there is a need for additional provision that is based upon enhancing resilience and wellbeing through the delivery of skills orientated sessions for children who fall below the threshold or outside of the remit of school counselling.

Research suggests that children can respond to current difficulties in their lives by both internalising (e.g., becoming withdrawn) and externalising (e.g., being disruptive in class) behaviour. It is the latter that is more likely to be picked up by teachers and externalising behaviour is often met with sanctions (e.g., behaviour points). Research frequently finds boys tend to respond to difficult life experiences by acting-out behaviours, particularly once they have begun secondary school.

Whilst internalising behaviour is more likely to be identified in girls. However, these differences in overall behaviour should not be interpreted as suggesting that reactions to stressors is gendered, as many children will display both internalising and externalising behaviour when under psychological stress. Interventions, therefore should aim to target the drivers of both internalising and externalising behaviour. Equally important is how interventions are delivered. As children age through primary school, they report valuing talking and problem-solving activities, where they have the opportunity to learn self-help techniques and psychological orientated sessions which suggests that these components are likely to be important for effective interventions for secondary school aged children (Kernaghan & Stewart, 2016).

Emotional resilience as a core wellbeing need Exposure to adverse childhood experiences is strongly associated with both externalising and internalising behaviour (Hunt, Slack & Berger, 2017). Such adversities include coping with a chaotic family life, living in poverty, mental health and emotional problems. This presents a challenge for schools as they rarely have the resources to be able to continually provide the support needed to these children. Recent neurobiological, epigenetics, and psychological studies (e.g., Schweizer, Walsh, Stretton, Dunn, Goodyer & Dalgleish, 2016) have shown that traumatic experiences in childhood can diminish concentration, memory, and the organisational and language abilities children need to succeed in school. For some children, this can lead to problems with academic performance, inappropriate behaviour in the classroom, and difficulty forming relationships. Knowledge around the mechanisms that link childhood adversity with psychopathology is now at a point where it can be translated into interventions (McLaughlin, DeCross, Jovanovic & Tottenham, 2019).

Emotion regulation appears to be a key mechanism by which adversity leads to problematic behaviour and life outcomes (e.g., Cloitre, Khan, Mackintosh, Garvert, Henn-Haase, Falvey & Saito, 2019; Espeleta, Brett, Ridings, Leavens & Mullins, 2018; Rudenstine, Espinosa, McGee & Routhier, 2019).

A lack of understanding of the impact of adversity can also result in teachers failing to understand the function of classroom behaviour and hence responding in a punitive manner. Learning about the impacts of trauma and understanding behaviour from an adversity informed perspective can help keep educators from misunderstanding the reasons underlying some children’s difficulties with learning, behaviour and relationships. Trauma-informed approaches support staff in realising, recognising, and responding to the impacts of trauma in ways that promote healing and avoid retraumatisation (Substance Abuse and Mental Health Services Administration [SAMHSA], 2014). In schools, traumainformed approaches provide knowledge of trauma to frontline staff to enhance both the school
culture, and systems for student support (McIntyre, Baker & Overstreet, 2019).

USO pilot

Aim: To improve Resilience and wellbeing, through promoting emotional awareness and emotional regulation self-efficacy (the belief that one can manage their own emotions effectively), and resilience through group work, guided relaxation and mindfulness practice, using evidence-based practice.

The stated outcomes of USO.
Understanding and Responding to Adverse Childhood Experiences. These children encompass the full spectrum of needs and backgrounds within the school/community. When compared to their peers, those experiencing adversity on average have a range of challenges including: weaker language and communication skills; more frequent behaviour difficulties; and these children are less likely to believe they can control events that affect them. Addressing these complex needs presents significant challenges to organisations within the existing provision.

Research has found that increasing resilience and emotional self-efficacy in this population can help the children to see themselves as being able to make a positive difference in their own lives and the lives of others. “Developing the social and emotional skills which give young people the resilience,
persistence and motivation to deal with the stresses and the rebuffs of everyday life are key to being able to move up the social ladder” (Ofsted). Research has found that resilience can be enhanced with the use of evidenced based interventions, improving self-efficacy and well-being.

About USO
USO is a new trauma informed, intervention programme designed to build and enhance resilience, emotional self-efficacy and effective coping. Drawing on the current empirical evidence, this programme addresses these areas of need using proven responsive techniques. The programme was written by Mr Matthew Russell, an experienced teacher and group facilitator, and Professor of Psychology, Nicola Graham-Kevan. The programme is modular in structure and can be adapted to suit the needs of individual schools/establishments. The sessions are designed to be run in a small group setting with approximately eight to ten children, depending on needs.

Who is it for?
Many students may benefit from attending programmes such as USO, as evidenced by the high levels of anxiety and stress reported by many students. However, due to resource issues, targeting those most likely to need additional support is a more realistic option. Pupils who would benefit from USO include both those who show externalising behaviour such as aggression and antisocial behaviour, and those who show internalising behaviour such as anxiety and shyness.

Session delivery
The sessions are run twice a week, lasting approximately one hour each. They can, however, be run over a full morning/afternoon or as full days and be delivered between once to five times per week. The mode of delivery depends upon the needs of the individual and their preferences.

Session content:
There are six modules within USO, each including five to six hours of content. An overview of the modules is listed below. Schools may choose to run the whole programme or may run selected modules depending on the individual requirements.

1. Resilience
• Define and explore the term resilience
• Explore the role of social support in enhancing resilience
• Identify personal strengths and weaknesses to being resilient
2. Emotional Awareness
• To differentiate between behaviour, bodily sensations and emotions
• Explore the range of emotions in terms of valence and intensity
• To develop and enhance emotional vocabulary
3. Emotional Regulation
• Recognise and explore primary and secondary emotions
• The role of emotions in understanding self and others
• Skills to effectively manage emotions
4. Tolerating Difficult Emotions
• Identifying situations that are difficult to manage
• Techniques to sustain emotional wellbeing
• Radical acceptance of difficult situations
5. Stress Management
• Explore factors that increase and decrease vulnerability to experiencing stress
• Explore effective coping skills to manage stress
6. Understanding Self and Others
• Reflect and share skills and techniques to develop and enhance emotional wellbeing
• Develop personal short, medium and long-term goals for the future
• Identify potential barriers to attaining personal goals and ways to overcome them

Method
USO programme delivery
Thirty students from Accrington Academy were identified by school staff who were all displaying high levels of anxiety, stress, shyness, aggression and/or anti-social behaviour. The USO programme was delivered within the school during the normal school timetable. It was delivered by accredited staff from TRAC Psychological and supervised by volunteer school staff members.

The USO was pilot in Accrington Academy involved:
• delivering the full USO programme to three cohorts of children,
• staff awareness session for whole school,
• staff training day to 15 staff members
• pupil mentor training, to enhance the skills of the schools mentoring system, to three cohorts
of pupil mentors.

Three cohorts of students were chosen and assessed by the school and the USO team. Each cohort took part in individual pre-programme assessment and interview, followed by eight group-delivered sessions and ending with an individual post-programme session. The group sessions lasted up to two hours each and were timetabled to fit in with the school’s time table.

Staff awareness and training
To further embed USO into the school, a presentation to the whole school staff was given, explaining the research and methodology of USO and also giving staff a chance to ask questions about the different activities the pupils would be engaging in. Additionally, one full day of training to 15 staff/pastoral members of school staff was delivered covering some of techniques used in groups, as well as presenting the research on the known effects of childhood trauma and how this may present in the classroom.

Peer mentoring
Three full day sessions for peer mentors were delivered, to increase their understanding of emotional awareness/regulation and train the children in key techniques used in USO, to assist them in helping others within their pre-existing mentoring roll within the school.

Outcomes
Two questionnaires were administered pre- and post-programme, these assessed emotional selfefficacy and resilience.

Measures
Emotional Self-Efficacy (ESE). The Emotional Self-Efficacy Scale (ESES) developed by Kirk et al. (2008) comprises of 32 items and was adapted by Dacre Pool and Qualter (2012) to create a youth version. Participants are required to rate how true a statement is for them by selecting a number on a five-point scale, with a ‘1’ indicating ‘not true at all’ and a ‘5’ indicating ‘very true’.

It has four subscales: (1) Using and Managing one’s own emotions (10 items), (2) Identifying and Understanding one’s own emotions (6 items), (3) Dealing with emotions in others (8 items), and (4) Perceiving emotion through facial expressions and body language (3 items).

Resilience Scale (Wagnild & Young, 1987) is a 14 item scale which measures self-perceived resilience to respond to stress and problems. Participants are required to rate how much they agree with each statement using a seven-point scale, with “1” indicating “strongly disagree to 7 indicating strongly agree.

In addition, school staff collated child behaviour points for each pupil who took part in the USO Programme at three time points, before USO, one year post and two years post USO.

Results
The analysis presented below is based on the self-reports of 32 children, 13 girls and 19 boys. To analyse the change in emotional self-efficacy from pre to post USO a series of paired samples t-test were performed. Consistent and significant improvements were found from pre- to post-USO in three of the four emotional self-efficacy skills.

The significant improvements were in managing own my emotions (t(26)= -2.10, p = .023, d =.50), identifying my own emotions (t(26) = -1.77, p = .044, d= .40), dealing with other people’s emotions (t(26) = -2.60, p = .007, d = .40). There was no significant difference in understanding other people’s emotions from their facial and body language (t(26) = 0.75, p = .47). The total pre- and post- USO scores are shown below in Figure 1.

Changes in resilience was also analysed using Paired samples t-test and found to have significantly increased from pre- to post-USO (t(26) = -1.83, p = .039, d = .40. The mean scores from pre- to post- USO are presented below in Figure 2.

To exploring changes in the children’s behaviour as measured by school staff, behaviour points were used, with higher numbers being indicative of more problematic behaviour. Using Paired samples ttests, it was found that one year reductions in behaviour points were significant (t(24) = 3.30, p = .002, d = .54) as were reductions over two years (t(16) = 2.49, p = .012, d = .43). The pattern, as illustrated in Figure 3 below, is one of an initial reduction in problematic behaviour which was largely maintained across a two-year follow-up period.

Effect sizes are the most important finding of a quantitative study. Although a P value is important to inform whether there is an effect, the P value will not reveal the how large the difference between scores is (i.e., the size of the effect). It is important to report both statistical significance and substantive significance (effect size) (Sullivan & Feinn, 2012). The effect size of the significant differences in pre- to post-USO scores was of a medium size across all measured domains and is very encouraging findings.

Student Feedback
Students were asked for feedback on the USO programme and their experience of it using four questions post group, their responses are listed below by question. Summaries of responses are presented below by question and gender.

Q1. What have you enjoyed about USO?
Boys
“I get to express myself. I like the atmosphere”
“Yes being fun. Being social”
“It was calm and there were sweets, relaxing”
“I liked all of it I guess.”
“Taught us how to calm down, handle situations better, usually when people ask to fight I would, now I say no.”
“I liked when we had to picture things in our head”
“Activities were relaxing, help get your mind off worries”
“It helps with anger issues and it teaches you strategies, helps you to understand what to do when you get angry”
“It’s relaxing”
“It helps you when you struggle in lessons”
“Fun relaxing and you miss French. [facilitators] weren’t like a teacher, helped sort our behaviours and emotions”

Girls
“Everything”
“Like talking about things in a group, what we have done and things we enjoy”
“It was a break to get out of lessons”
“Enjoyed talking.”
“Talking to others that I’ve not spoken too before”
“I could just be me and chill in a calm room”

Q2. How do you think it helped you?
Boys
“I’ve noticed that I can control how I do things a bit more”
“Tt helped me talk a bit more, have been having lunch out in the cafeteria instead of going to Miss C. office”
“It helped calm me down”
“I am able to calm down now with my breaths when I am stressed”
“Yes behaviour, I’ve stopped getting behaviour referrals, it has helped me to control my anger”
“Trying to be more calm and walk away from arguments”
“In general, I don’t kick off as usual anymore”
“I calm myself down when I get angry”
“Sort of, I can stop myself from being angry”
“You get to talk to people who you normally wouldn’t, it gets you out of lessons, you don’t feel alienated it feels like you are at home, at school people think you are weird- but not here”
“Visualisation help to clear the mind calm you down a bit, gather everything in. Before I came to group I got referred every day and shouted at, but then I do my breathing and now not as many referrals”

Girls
“I don’t get in trouble with my science teacher as much”
“It kept me calm and relaxed”
“Yes, it sort of helped me”
“It’s stopped me from fighting, made me look after my mum better”
“Helps you calm down, it’s fun games and stuff”
“It helped me by not getting sent out as much”

Q3. If you were to recommend it to a friend what would you tell them?
Boys
“It can be a good atmosphere, you can get along with people”
“If you ever feel like you need to talk someone come here”
“It’s calm it helps you if you have trouble. Makes you feel calm when it’s quiet”
“It’s good and fun”
“That it will help them to calm down and be a better person and that they can change”
“You do breathing techniques which help so you don’t flip out, it’s good to talk”

Girls
“It’s good. It helps you”
“it’s good and relaxing, you can talk about things that you wouldn’t tell anyone else”
“If they were bad behaved I would recommend it because it helps with behaviour”
“It’s good to talk about your feelings”
“It’s a good place to go, you don’t get shouted at”
“It’s a good group and helps with your emotions”

Q4. Is there anything you would have liked to do/more less of?
Boys
“Nothing”
“More sessions”

Girls
“Wouldn’t change anything”
“It’s good, all of it”
“More groups”

From the above comments it appears that the children felt they benefitted from USO. They noted hat they appreciated that the environment where it was delivered was a place where they could feel calm, talk about things and be in a relaxing environment. The many of the participants really believed that they were managing situations in a much calmer and pro-social way.

Staff training on the impact of adversity and understanding behaviour from a trauma informed perspective.
Fifteen school staff from a range of roles, including head of year and support staff, attended a training day where the empirical research supporting the USO approach was explained. The staff were also trained in understanding behaviour from a trauma-informed perspective where a case example was worked through as a group. Following the sessions feedback sheets were completed where staff were asked the extent to which they agreed with the following statements:

4. The overall training, I received was high
5. It has changed the way I may approach my work in the future
6. This training was beneficial to me in the performance of my job.
7. The content delivery was appropriate for the course.
8. The course material was easy to understand and helpful.
9. The topics were presented in a clear logical order.
10. The vocabulary used in the delivery was clear to understand
11. The course covered the material I expected
12. The facilitators were knowledgeable and effective
13. The course met the training the training objectives

All staff agreed with each of the questions, suggesting the training was appropriate, effective and impactful.

Discussion
USO was successfully delivered in Accrington Academy to 32 students with no attrition, with the exception of one pupil who moved school. This is likely due to the perception of the children that USO was enjoyable and delivered in a calm and quiet environment. The participants’ belief that they could effectively identify and manage their own emotions, and could more effectively manage other people’s emotions all increased significantly from pre- to post-programme.

There was no change in their perception that they could better understand facial and body language of others, and this could be addressed in subsequent pilots.

There were significant improvements in the participants’ self-reported resilience from pre to post-programme. Enhancing the children’s belief in their abilities to self-regulate and ‘bounce back’ from stressors is important in helping them to remain in the classroom and benefit from their education. A male student summed up this well when he said “I enjoyed the learning how to calm yourself down a bit more and knowing when I’m going to get into trouble. I always used to make problems up and say things weren’t my fault when really it is, made me realise I blame other people and people around me like teachers and its helped me to accept responsibility. I’m not as annoyed by things and I feel happier” (Male participant)

This is consistent with the staff assessed changes in behaviour. There were significant reductions in child behaviour points from pre- to post USO, with these reductions being largely maintained over the two-year follow-up period. Although data on academic outcomes were not measured, participants did comment on how it assisted in helping them, for example: “Whenever I feel stressed about exams I know what to do to help myself calm down like distract myself, give myself some time to do breathing exercises, or go to my safe place. Its helped me to understand my emotions more when I’m feeling stressed and anxious” (Female participant).

The training of staff was very well received and suggests that brief training may be a cost-effective approach to helping schools to enhance their knowledge around the impact of adversity and how this may present in school children. Future research should explore this in terms of longer term wellbeing of both staff and children welfare and school culture. The peer mentoring was well received but there is no data regarding the outcome of this aspect and so this strand of the pilot requires further exploration.

Conclusion
USO was successfully delivered within Accrington Academy and produced very positive results in terms of significant increases in emotional self-efficacy, resilience and significant reductions in problematic classroom behaviour. Both the children who participated and the staff who attended were overwhelmingly positive. A skills-based and empirically informed programme that addresses core needs in children who are likely to be facing significant adversity appears to be an appropriate option for UK secondary schools.

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