TARGETED MENTAL HEALTH IN SCHOOLS
SOUTH WEST PATHFINDERS - SAMPLE NEGATIVE COST AVOIDANCE
PATHFINDER: Gloucestershire TaHMS Project
A) NEGATIVE COSTING TOOL
UNIT COST OF COST
CASE TAMHS RISK FACTORS AT TIME OF ENGAGEMENT - NEGATIVE COSTS AVOIDANCE PER
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
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
B) PROJECT LEAD'S COMMENTS
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.
C) QUALITATIVE PROJECT OUTCOMES
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
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
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.
3 - PRIMARY CASE OVERVIEW:
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
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
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.
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.
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.
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.
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.
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 OF EWO INTERVENTION RE SCHOOL NON ATTENDANCE
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