Anger Management Completion

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					                             TARGETED MENTAL HEALTH IN SCHOOLS

PATHFINDER:                                                     Gloucestershire TaHMS Project


                    UNIT COST OF                                                                COST
                   INTERVENTION                                                               CASE (RISK
                                           PERM       FIXED      NON/POOR           OTHER/   COSTS MINUS
                                                                            TIER 3           TAMHS COST)
                                        EXCLUSION - EXCLUSION ATTENDANCE             TIER4
1 - PRIMARY                       500            1500                                                                    -1000.00
2 - PRIMARY                       575            1500                                                                     -925.00
3 - PRIMARY                       350                                                        2740                        -2390.00
4 - PRIMARY                       500            1500                             580                                    -1580.00
5 - PRIMARY                       550            1500                                                                     -950.00
1 - SECONDARY                     650                                             580        2740                        -2670.00
2 - SECONDARY                    1450                            500              580        2740                        -2370.00
3 - SECONDARY                     450            1500                             580                                    -1630.00
4 - SECONDARY                     950                            500                         2740       36653           -38943.00
5 - SECONDARY                     500                                             580        2740                        -2820.00
                TOTAL ESTIMATED COST AVOIDANCE ACROSS 10 SAMPLE CASES                                                   -55278.00

     N.B.        1) Risk factors would have been evident through assessment at the beginning of TaMHS intervention

                 2) Fixed term exclusion, permanent exclusion, non/poor attendance negative costing are based on the
                 Swindon Family LIFE programme report, 2009

                 3) Average costs of tier 3/4 interventions are based on those calculated for Swindon

                 RISK COLOUR KEY:                                                                                 EST. COST
                 PERMANENT EXCLUSION - Costs are to be estimated proportionately per calendar year,
                 per month of intervention. Therefore assuming that the cost of permanent exclusion from
                 school and the resultant maximum cost of £18,000 per annum for home tutoring the
                 monthly cost will be £1500 per month. If the factor is applicable to a child who is worked    £1500 (per month)
                 with from April to March the total estimated cost will be £18000. If the intervention is from
                 September to December the estimated cost will be £9000 etc.
                 FIXED TERM EXCLUSION - The cost is calculated per event, using comparable costs of
                 similar interventions. The cost also assumes the initiation of a Team Around the Child
                                                                                                                 £500 (per event)
                 (TAC) and completion of CAF at initial intervention and TAC review/action plan review at
                 subsequent exclusions
                 NON-POOR ATTENDANCE - Where the non attendance is over 20% and a TAC is
                 implemented . The cost is estimated at £580 per month or £58 per hour based on the costs            £580 (per
                 of a similar professional practitioner , pro-rata on the basis of 10 hours intervention by an     intervention)
                 Educational Welfare Officer.
                 TIER THREE - This is calculated on the average cost of cases from 2008-09 and 2009/10
                 (based on Swindon's calculation)                                                                   £2,740.00
                 OTHER/TIER FOUR - Tier Four is calculated on the average cost of cases from 2008-09
                 and 2009-10. Other should be calculated per event or average as appropriate.                          TBA


                 Most outcomes have been achieved by working across agency boundaries and working collaboratively with the
                 network around the child or young person. This type of seamless intervention is far more easy to achieve in a
                 school setting where the child or young person is already in situ and parents and carers have easy access to
                 all the practitioners and decision making structures in a non stigmatising setting. Our experince has been that
                 many of the CYP identified by TaMHS have complex needs requiring easy access to specialist expertise on a
                 par with specialist CAMHS and other specialist services. What has been achieved therefore is to deliver
                 specialist interventions at a lower cost because early identification has prevented an escellation of difficulties
                 and the manner of delivery to the network has been more acceptable and influential.

    CASE                                                                                                                       COST AVOIDANCE
1 - PRIMARY   CASE OVERVIEW:       Year 6 pupil at pupil referral unit displaying extreme anger outbursts and lack of social
                                  and emotional skills. On verge of being excluded permanently from the pupil referral unit
                                  because of his anger outbursts being severe and regular.

              QUALITATIVE         1-1 Intensive anger management work and CBT exercises to address anger and
              OUTCOMES:           emotional thinking. His behaviour improved dramatically and he remained at the PRU
                                  He has now settled into mainstream secondary schoolwith no behaviour issues to date

                                                                                                                               COST AVOIDANCE
2 - PRIMARY   CASE OVERVIEW: Year 5 male pupil regularly receiving fixed term exclusions due to behaviour and high risk
                             of permanent exclusion. Difficulties with friendship groups and managing anger. Most
                             difficulties arose at lunch and break times. Often will he would run out of class or school
                             if in trouble and swear at teachers if he is in trouble for his behaviour. Most                    -925.00
                             disagreements happened whilst playing sport with others. Outcomes achieved by
                             combination of 1:1 sessions, consultations with school staff, discussion with mum, small
                             group work
              QUALITATIVE         1-1 Anger management work and self esteem work (6 sessions). Group sessions with
              OUTCOMES:           his peers whom he had problems with at break times to improve relationships and
                                  encourage positive relationships, negotiation skills and team building skills.
                                   Improved peer relationships and no major incidents during break times or exclusions.

                                                                                                                               COST AVOIDANCE
                                  A 7 year old girl was presenting with high levels of anxiety which was preventing her from
                                  The situation appeared to have been triggered by a babysitter allowing her to watch a
                                  horror film.                                                                               -2390.00
                                  Early intervention and the use CBT reduced her anxiety considerably.

              QUALITATIVE         Both the young person and her mother reported that she was sleeping better
              OUTCOMES:           Her anxiety reduced without the need to refer her to CAMHS.
                                  Seen on day of referral
                                                                                                                               COST AVOIDANCE
4 - PRIMARY   CASE OVERVIEW: This 9 year old boy did not want to attend school and when he was there his volatile and
                             aggressive behaviour was putting him at risk of permenant exclusion. It transpired that
                             he wanted to be at home in order to protect his mum from another family member.
                             Following my assessment I was able to refer the family to Social Care. Outcomes                   -1580.00
                             achieved by combination of direct 1:1 sessions and indirect sessions with school staff
                             and professionals in the network.

              QUALITATIVE         The boy’s attendance has improved
              OUTCOMES:           The boys behaviour and concentration has improved

                                                                                                                               COST AVOIDANCE
5 - PRIMARY   CASE OVERVIEW: Year 1 boy who had two fixed term exclusions and was at risk of permanent exclusion.
                             He had problems with controlling his temper and severe anger issues. He took a part in
                             10 weeks anger management group program run by PMHW in school from September
                             2009. He hasn't been excluded since completion of the programme and is able to control             -950.00
                             his anger now.

              QUALITATIVE         10 weeks anger management group intervention. The intervention prevented either
              OUTCOMES:           another 15 days fix term exclusion or permanent exclusion.
                                                                                                                               COST AVOIDANCE
1 - SECONDARY   CASE OVERVIEW:       Year 8 girl referred to camhs for low mood some suicidal thoughts and anger issues, not
                                    accepted by camhs and referred to Tamhs team.
                                    Poor attendance due to low mood, poor self esteem and family difficulties. EWO
                                    concerned re attendance.                                                                      -2670.00
                                    Regular detentions in school, being rude to teachers, difficult friendships.

                QUALITATIVE         1-1 work using person centred counselling, cbt and some solution focussed work .
                OUTCOMES:           Direct work with parents to help them to support and cope with her moods, behaviour
                                    more positively and consistently
                                    Improved self esteem and peer relationships
                                    Very few detentions now in school and attendance is no longer an issue
                                    Better coping strategies for anger and much improved family relationships.

                                                                                                                                  COST AVOIDANCE
2 - SECONDARY   CASE OVERVIEW: Year 8 boy with learning disability and Aspergers . Having difficulties with peer
                               relationships and understanding relationships often resulting in him hitting out and
                               displaying extreme anger outbursts. Often upset and mum very worried as he did not like
                               coming to school and would often fake illness. Concerns re attendance                              -2370.00
                               Anger outbursts often resulting in detentions and difficulties in the classroom and
                               playground. Considering fixed term exclusion or alternatives

                QUALITATIVE         1-1 work looking at feelings, understanding facial expressions and body language. Work
                OUTCOMES:           on friendships, social skills and anger management. Problem solving and developing
                                    coping strategies and support network at home and school
                                    1-2 Much improved social awareness
                                    1-3 Enjoys attending school – no attendance issues
                                    1-4 No incidents of anger outbursts – not at risk of exclusion.
                                    1-5 Improved self esteem
                                    1-6 Has friends
                                    1-7 Parents happy about progress.

                                                                                                                                  COST AVOIDANCE
3 - SECONDARY   CASE OVERVIEW: This 15 year old boy was refusing to attend school or college. He was spending most of
                               his time with older friends, who were not in education or employment. When at school he
                               was prone to extreme outbursts of anger which were putting him at risk of permanent
                                    Engaging him in activities such as golf, visiting him at his grandparent’s home rather than
                                    at school, providing him with and book to help him with his reading and finding an anger
                                    management programme he could relate to prevented him from being excluded.

                QUALITATIVE         He was not excluded and went on to attend a pre- 16 course at college.
                                                                                                                     COST AVOIDANCE
4 - SECONDARY   CASE OVERVIEW: A 15 year old girl was presenting with challenging behaviour both at home and school
                               and had symptoms of a depressive illness. She was lacking in confidence, was
                               neglecting her personal hygiene and was said to be very naive and vulnerable.
                               The relationship between her and her mother had broken down resulting in mum making
                               a self referral to Social Services who were considering a care placement. School were -38943.00
                               considering a fixed term exclusion
                               CBT with the girl and 1:1 work with her mother has helped to improve her mood, her
                               relationships and her self-confidence. She did not become a LAC
                QUALITATIVE         This work prevented a referral to specialist CAMHS and an exclusion
                OUTCOMES:           The girl is currently taking her GCSE’s
                                    She is currently going through the Army selection process.
                                                                                                                                  COST AVOIDANCE
5 - SECONDARY   CASE OVERVIEW: A Year 7 boy had a poor attendance (50%). He was anxious to come to school. He was
                               bullied in school and had low self esteem.

                QUALITATIVE         1. One to one sessions – self esteem building and solution focused intervention. A.S.
                OUTCOMES:           was able to indentify the bullies. A.S.’s self esteem improved and he was confident to
                                    come to school and go to lessons again.
                                    2. School was able to address bullying
                                    3. Attendance improved to more than 85%. and referral to specialist CAMHS avoided

                       COST PER
     INTERVENTION                  HOURS    COST

AVERAGE INTERVENTION         £58       10     £580
DOES NOT IMPROVE             £58       10     £580
ISSUED (6 MONTHS)            £58       26   £1,508
ISSUED (12 MONTHS)           £58       52   £3,016

Description: Anger Management Completion document sample