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									             Commissioning Counselling: Information for Schools

                                March 2011

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           This is one of a series of information leaflets that have been developed by the
           Essex Child and Adolescent Mental Health Service (CAMHS) Partnership and
           the Essex Joint Commissioning Committee to support schools that are in the
           frontline of identifying and responding to the emotional and mental health needs
           of children and young people.

           There are four tiers of provision for emotional wellbeing and mental health:
            Tier 1: provided by practitioners, who may not be mental health specialists,
              working in universal settings such as schools and early years settings,
              offering general advice and support aimed at promoting emotional wellbeing;
              helping children deal with emotional reactions; preventing mental illness.
            Tier 2: services provided by specialist individual practitioners in a range of
              voluntary and statutory agencies working in primary and community settings
              providing assessment, care and interventions for children and young people
              with emerging emotional health needs.
            Tier 3: a specialized, multi-disciplinary service provided by the health sector
              for more severe and enduring, complex or persistent mental health problems.
            Tier 4: essential tertiary level services for children and young people with the
              most serious problems, such as day units, highly specialized out-patient
              teams and in-patient units.

           All these tiers of provision are part of the overall Child and Adolescent Mental
           Health Services. The Essex CAMHS strategy 2011-14 sets out the overall
           approach for meeting emotional and mental health and wellbeing needs across
           Essex. This was developed and approved by all agencies through the Children’s

           This leaflet covers the provision of counselling. Much of the information comes
           from the British Association for Counselling and Psychotherapy (BACP).

           Commissioning CAMHS
           The Commissioning Support Programme (CSP) 20061 suggests that
           ”Commissioning is the process for deciding how to use the total resource
           available for children, young people, parents and carers in order to improve
           outcomes in the most efficient, effective, equitable and sustainable way.”
           The Essex wide CAMHS Joint Commissioning Committee commissions specialist
           Tier 2, 3 and 4 services. Local Children’s Commissioning and Delivery Boards
           (LCCDBs) are commissioning earlier intervention services at Tier 2, focusing on
           interventions that support children and young people with emerging mental health

            Commissioning Support Programme (CSP)’ Training Materials, (2006)

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           As resource is increasingly available directly to schools - individually and
           collaboratively including through Local Delivery Groups (LDGs), they are
           increasingly involved with planning, commissioning and providing a range of
           services, including CAMHS provision particularly at Tier 2 level.

           Schools may decide to provide services directly themselves; to commission
           external providers to deliver services; or to commission services together with
           other agencies. A more coherent, effective and integrated approach will be
           achieved if schools align their commissioning to the overall local and County
           plans or contribute their resource to the partnership resource and commission
           provision collectively through the Local Children’s Commissioning and Delivery

           A number of different therapeutic interventions can be commissioned to meet
           emotional wellbeing and mental health needs.

           A wide range of group programmes are available including those using Cognitive
           Behaviour Therapies (CBT) and Solution Focused Brief Therapy interventions.
           Other agencies can be commissioned to provide these or school staff can run
           them – if qualified. Nurture groups embedded within the school ethos and with
           appropriate provision such as clinical supervision and senior staff engagement
           can be most appropriate to support marginalised children. Peer support and
           mentoring may be appropriate for some children. It may be that family support is
           the preferred and most appropriate provision.

           When individual support for children and young people with emerging needs is
           required, a first stage can be counselling provision by the school.

           Commissioning counselling
           When a school decides to commission counselling, they could employ a
           counsellor or therapist directly themselves or commission another organisation to
           provide this for them.

           To commission another organisation, the school would need to outline the
           requirements and hold a selection process. Further information on these steps of
           commissioning is available in the Commissioning Support Toolkit for Schools:
           Activities and Service Provision which can be found on the Schools Infolink. The
           selected organisation would then be responsible for all aspects of the service,
           including supervision of the staff.

           If the school decides to provide counselling directly, the employing School and
           Governing Body will be wholly responsible for all elements of the appointment
           and ongoing management and supervision of counselling staff and for the
           provision of the service. Information is available separately on supervision.

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           The following information draws on BACP recommendations and is specifically
           focused on the steps to consider when a School/LDG, having checked the
           Commissioning Support Toolkit for Schools: Activities and Service Provision,
           decides to commission counselling or therapy directly itself.

           This leaflet includes in Appendix 1 an example from a school of a job description
           and person specification to be tailored to the specific requirements of a school in
           liaison with the school’s Human Resources lead officer.

           Good practice in recruiting counsellors and therapists
           This leaflet provides a checklist of elements considered by BACP to be best
           practice that will help schools implement a quality assured service from a
           counsellor or therapist.

           The Government has future plans to regulate the counselling profession which
           means that those who currently do not work to Quality Assured standards i.e.
           those who do not have formal counselling qualifications or clinical supervision will
           no longer be able to practice. In addition to this the fundamental reasons for
           providing a quality assured service within schools are:
              - To safeguard children and young people from harm and / or abuse
              - To enable children and young people to have a positive experience of
                  accessing emotional health support
              - To ensure that where a mental health issue is identified there is a clear
                  pathway for them to access appropriate support.

           Definition of counselling
           Counselling does not give direct advice or direct a particular action, rather it aims
           to support children and young people during difficult experiences such as family
           break down, bereavement, relationship difficulties, anxiety, bullying, emotional
           and behavioural difficulties and helps to enable them to make their own choices
           and/or changes. Counselling sessions help children and young people explore
           various aspects of their life and feelings. Counselling provides an independent
           safe space for children and young people to talk freely and openly.

           Requirements of qualified counsellors
              Have completed a diploma or degree course in counselling (please note
                 that short certificate skills courses are excellent to increase effective
                 listening and communication skills but are not recognised as providing
                 professional therapeutic counselling)
              Have obtained or are working towards British Association for Counselling
                 and Psychotherapy (BACP), United Kingdom of Register of Counsellors
                 (UKRC), UK Council for Psychotherapy Accreditation (UKCP) or
              Work within strict guidelines such as the BACP Ethical Framework for
                 Good Practice in Counselling and Psychotherapy

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                 Have experience and additional training in working with children and
                  young people.

           Trainee counsellors are only recommended within an established counselling
           service, where they are supported by an experienced salaried counsellor.
           Further guidance on employing a counsellor can be sought from BACP’s
           Information Department on 0870 4435252

           Recording and notes
           Counselling and case records are bound by legislation such as the Data
           Protection Act (DPA) 1998. Counsellors may have personal process notes/
           memoirs to aid their work and use within supervision, however if the practitioner
           is employed directly by the school the necessary permanent records will be
           considered to constitute part of the child’s and young person’s education record.
           It is important to note that the guidelines for the storage and access to
           confidential counselling and psychotherapeutic notes will differ from those of
           education records. If a school chooses to employ their own counsellor the school
           will be responsible for these records and must take into account any potential
           impact with regards to confidentiality and the recording of third party information.
           BACP (2009) state that it is important that the policies and procedures negotiated
           by the school or employer are given careful thought when considering counsellor
           care records and process notes. All notes are to be stored securely in
           accordance to the Data Protection Act 1998 and professional body guidelines.

           Clinical supervision
           The BACP ethical framework specifies there is a general obligation for all
           counsellors, psychotherapists, supervisors and trainers to receive supervision/
           consultative support independently of any managerial relationships. To ensure
           the client’s best interests systematic monitoring, personal development and
           reflection is deemed to inform best practice and thus supervision enhances the
           quality of service and care. This supervision should be at a frequency in line with
           professional body recommendations.

           BACP (2009) highlight that counselling confidentiality is a key aspect of
           therapeutic work in providing space for the children and young people to explore
           difficult issues. The strict boundaries of counselling confidentiality may be in
           conflict with school procedures with regard to sharing information and obtaining
           parental consent, for example the Gillick principle affords confidentiality to young
           people under the age of 16. Along with all staff, counsellors have a duty of care
           to the children and young people and therefore work strictly within the law and
           child protection guidelines. In the case of potential child protection concerns the
           counsellor will take into account their responsibilities towards the child or young
           person and the level of risk of significant harm when considering if a breach of
           confidentiality is necessary. Counsellors encourage children and young people to
           communicate with their parent and carers wherever possible.

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           Sharing of information should firstly be the responsibility of the young person,
           with the support of the counsellor if requested. A school’s confidentiality policy
           should be grounded within the law, taking into account child protection guidelines
           and should state clearly the rights and responsibilities of all people including
           those of the children and young people. It should enshrine and respect the
           children’s right to privacy as well as their right to protection.

           Any complaint regarding alleging a breach of professional standards should be
           carried out in accordance with the procedures outlined by the counsellor or
           therapist’s professional body or organisation. It is also important that clear
           procedures are included in any job descriptions and policies.
           Questions                                          Checked      Details
           Do they have a counselling diploma or
           What relevant experience or training do they
           Is the therapist currently registered with a
           relevant Professional body? (BACP /
           UKCP/BAAP/ HPC)
           Clinical supervision
           Does the therapist have appropriate clinical
           supervision in place?
           Have you confirmed that the Clinical
           Supervisor has the relevant supervision
           Child Protection
           Do they have an up to date enhanced CRB
           clearance for work with children?
           Is the therapist aware of Essex County
           Council Child Protection policies?
           Has the therapist undertaken relevant Child
           Protection Training?
           Is there a confidentiality agreement between
           the school and counsellor?
           Does the organisation or therapist have public
           or professional liability insurance?
           Parental consent
           Is there a process in place for obtaining
           parental consent (particularly relevant for
           primary schools)

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           Risk Management
           Is there a policy in place for helping manage
           any allegations made by a child or young
           person accessing the service?
           Are there protocols in place for escalating
           concerns about a child or young person’s
           mental health?
           Has an appropriate room been allocated for
           the therapy to take place for all planned
           Does the room protect the safety of the child
           or young person and the therapist?
           Referral policy
           Is there a referral mechanism in place within
           the school for identifying accessing the
           appropriate therapy?
           Monitoring and evaluation
           Is there a process for monitoring and
           evaluating the therapeutic intervention?
           Finance and contracts
           Is there a service level agreement between
           the organisation and therapist?
           Has funding arrangements been agreed?
           Continuing support
           Are there continuation plans if required for
           when the therapy ends or is suspended (i.e.
           school holidays)?

           Where to go for further information – resources available

                 NSPCC Service Framework – Schools Counselling and Support Services
                  and Peer Support Schemes

                 Cooper, M (2004) Counselling in schools project: evaluation report.
                  Glasgow: University of Strathclyde.

                 British Association for Counselling and Psychotherapy; BACP House, 15
                  St Johns Business Park, Lutterworth, LE18 4HB. Telephone: 01455

                 Good Practice Guidance for Counselling in Schools, BACP, (2009)
                  ISBN: 978-905114-16-0

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           Appendix 1
                               EXAMPLE JOB DESCRIPTION - SCHOOL COUNSELLOR

           Post:               School Counsellor

           Grade:              LGS Band (this could be from 3 onwards depending on
                               qualification and experience)

           Hours:                        (insert hours here)

           Responsible to:     (insert the name of the school person responsible for line

           Purpose of the job:       To support young people aged ( ) referred by the
                              school, who present with emotional and psychological

           Duties and responsibilities:

            To attend at the school to hold counselling sessions with referred students;

            To maintain a caseload and keep clinical-related records in a secure location;

            To share all relevant information with the line manager in line with BACP
             confidentiality guidance;

            To share all Child Protection concerns with the designated Child Protection

            To take part in any group intervention sessions deemed desirable, or make
             necessary referrals to external agencies when indicated, working
             collaboratively with other agencies and healthcare professionals;

            To meet on a monthly basis with a designated supervisor to discuss current
             caseload and gain advice and guidance;

            To be aware of and abide by relevant school policies including Child
             Protection, Behaviour, Special Educational Needs, Safe Working Practice for
             the Protection of Children and Staff in Education, Data Protection and the
             school's Code of Conduct;

            Other duties which may become relevant to the post.

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                         Essential                                           Desirable
  Training &              Diploma level (or equivalent) qualification in     Specialist
  Qualification            counselling, psychotherapy, or counselling-         Qualification on
                           psychology which has been accredited by a           Counselling Young
                           recognised professional body (BACP, BPS,            People
                           UKCP or similar)
                          Member of BACP or equivalent.
                          Hold or be working towards BACP
                           accreditation as a counsellor.
                          Additional Training or experience in working
                           with young people
  Experience              Experience of working with clients or young        Possess relevant
                           people presenting with mild to moderate             experience in a
                           psychological difficulties.                         helping profession,
                                                                               either paid or
  Knowledge &             Knowledge and awareness of the issues              Awareness of
  Skills                   relevant to working within an educational and       presentation of
                           learning context.                                   psychiatric difficulties.
                          Ability to work to a system of processes and
                           procedures, recording and providing                Awareness of the role
                           information accurately and promptly when            of CAMHS Teams,
                           required.                                           Voluntary Agencies
                          Ability to organise own clinical/administrative     etc.
                          Ability to work within a context of evidence-       IT literacy, email,
                           based counselling, performance evaluation            internet and keyboard
                           and monitoring                                       skills.
                          Ability to monitor own competency and
                           limitations and the ability to seek appropriate
                           advice at an early stage.

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                         Essential                                           Desirable
  Personal                Approachable, have good listening skills and
  Qualities                a manner that encourages a climate for safe
                           and trusting relationship
                          Enthusiasm for working with children and
                           young people.
                          Patience, tolerance and sensitivity
                          A mature and non-judgemental outlook
                          Possess an understanding of the key issues
                           impacting on young people’s lives today
                          Ability to liaise with, work with and alongside
                           other services and agencies in a collegial
                           manner, whilst maintaining appropriate levels
                           of confidentiality, to help effect positive
                           change based on the issues raised by clients.
                          Awareness of need for professionalism at all
                           times, in behaviour, maintaining
                           confidentiality, appropriate dress, punctuality
                           and reliability
  Other                   An enhanced CRB disclosure will be                 Driving licence with
                           required.                                           access to own vehicle.

  Physical, mental, emotional and environmental demands of the job

  The post-holder must:
      Be able to cope with the occasional unpleasant behaviour including physical and verbal
        aggression and have strategies to deal with this
      Utilise standard keyboard/IT skills
      Be able to undertake clinical sessions with young people.
      Have observational skills and concurrent intellectual analysis under pressure

                                             Mental effort
         Sustain concentration for long periods of time on information from a number of sources,
          such as clinical sessions with clients, clinical meetings, service planning meetings,
          telephone consultation with staff and other professionals
         Use good time management skills, requirement to change subject focus frequently and
          without prior notice.
         Be flexible as workload can be unpredictable e.g. attendance at meetings is often
          required at short notice and at times, clients or staff may need to be seen urgently.

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         Frequently deal with highly distressing, chronic and /or deteriorating conditions, where
          progress may be very slow and require long term commitment.
         Deal with clients and families distressed by the effects of severe physical or mental
          health problems
         Deal with young people exhibiting high levels of distress and describing in detail
          harrowing and traumatic life events.
         Deal with Psychological problems in young persons experiencing adverse life
          experiences, irresolvable life circumstances and intractable life problems.
         Access appropriate support to ensure that the effects of any such exposures are not
          detrimental to an effective clinical role.
         Help other professionals, care staff and relatives deal with highly distressing situations.
         Expect some exposure to hazards such as verbal and face to face physical aggression
          but should have strategies to deal with this occasional occurrence.

            The Governing Body is committed to safeguarding and promoting the welfare of
             children and young people, and expects all staff and volunteers to share this

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           This leaflet was commissioned by the CAMHS Joint Commissioning
           Committee and supported by the CAMHS Partnership. The membership of
           these groups includes representatives from the 5 PCTs, Essex County Council,
           the mental health service providers, early years and healthy schools
           representatives and others.

           The leaflets were developed and written by a Task and Finish Group whose
           membership was:

            Organisation            Representative Name        Job title

            ECC                     Lonica Vanclay             Lead CAMHS
            NHS South West          Deborah Malster            Health Improvement
            Essex Community                                    Specialist
            ECC                     Peter Everett              Healthy Schools Link
            ECC                     Chris Scalzo               Tier 2 CAMHS Team
            ECC                     Raj Singh-Gill             County Senior Education
            South Essex             Anne Possamai              SEPFT clinician
            Foundation Trust
            ECC                     Anne-Marie Garrigan        Extended Services

           Special Thanks to Kathryn Evans from Beauchamps School and Chris Fluskey
           from Harlow Education Consortium for providing helpful comments and to
           Kathryn for providing the outline job description.

           Editorial responsibility for this leaflet: Deborah Malster
           Overall editorial responsibility for the series: Lonica Vanclay

           Other leaflets in the series:
               Promoting emotional health and wellbeing

           Please note this information is intended for information purposes only and is in no
           way exhaustive. This information should be considered alongside all other legal
           requirements and as a result Schools are encouraged to seek their own legal
           advice when organising activities or commissioning goods or services.

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