Dr Lynda Dawson of the University of Westminster carried out a pilot study that looked at how a Social Prescribing link worker might be beneficial to children in schools.
Here, for the College of Medicine, she reflects on why she embarked upon the research. You can scroll down to read the full Executive Summary below…
Why carry out the research?
Recent evidence shows a marked decline in the mental health and wellbeing of young people at school. The crisis with young people’s health is unprecedented, with record numbers of young people seeking to access NHS and mental health services such as CAMHS, giving rise to increasing pressure on the health service.
In addition, one in five GP appointments are for non-clinical issues. These fractured services have had a ‘knock-on’ effect on teachers with having to deal with poor attendance levels and behaviour has deteriorated.
Furthermore, the cost-of-living crisis has affected many families, and it seems that young people are bearing the brunt of it all. This pilot study research was undertaken to evaluate whether a social prescribing plan put in place by a Link Worker could make a difference to the wellbeing of young people in the school setting. In addition, whether there was a level of demand for social prescribing services in schools.
The first phase of the pilot study culminated with a report, ‘Everything falls Apart’. This research took place in three different schools in the UK with social prescribing Link Workers employed by each school. The research commenced in the aftermath of the covid pandemic and data gathering was impeded and therefore limited, as access became increasingly restricted.
However, there were positive signs that the Link Worker in each school performed a valuable role. It was noted that many of the issues experienced by young people in school were compounded by the pandemic.
Students were not alone in experiencing problems, as arising from this data was evidence of issues for key stakeholders associated with the schools. It was decided therefore to continue a second phase of the social prescribing research, ‘Only Connect’. This pilot study took place in two different schools in the UK which had commissioned the services of an external Link Worker.
Reflections on key findings
Image: Pixabay/BiancaVanDijk
The focus will be on three reflections on the key findings. The emergent findings portrayed the shadow cast by the pandemic as far reaching and had worsened the lives of many within the school community.
Notably highlighted was that the poor mental health and wellbeing of young people in school had worsened post pandemic. There was a marked increase in social media use with readily accessible sites such as suicide ideation, deliberate self-harm and eating disorders. Two years of disrupted education meant that attendance and behaviour had deteriorated.
There was an increase in school referrals to CAMHS, social and primary care, but these services were overstretched and waiting lists were huge. Voluntary and community groups, such as charity and youth groups, had been closed over the pandemic.
Secondly, there was a feeling of deep disconnection within the wider school communities. For example, key staff and local GPs felt under pressure and families were struggling. Parents felt helpless and frightened and often lashed out at school staff.
The findings laid bare the thoughts and feelings of all the participants, with anger, frustration and despair spilling out of the data.
School staff noted that since the pandemic, the needs of the students had escalated significantly, and that they ‘were the ones holding the child’.
One teacher noted that: ‘I’m not a social worker, a doctor or police – I’m just a history teacher’ They felt that many parents assumed that they could continue with online learning.
Some parents took out their frustrations on the teachers. Others could not get their children out of bed to go to school.
‘Everybody is stretched and everybody is overwhelmed…but there is just not the support’ One GP stated that the health services were at ‘breaking point’ and that society was becoming more disconnected. There was a chronic lack of funding for services.
This third reflection was that on a positive note, the Link Worker did appear to be of enormous help to the young people at school.
The findings highlight the ways in which the young people have been supported by the Link Worker and how their challenges were addressed.
The Link Worker put forward bespoke activities which built self-confidence, new skills and the opportunity to meet new friends in the community.
She also performed a counselling and preventative role and felt that there was ‘no magic wand…it’s getting up, getting out, getting active and building resilience’.
Not only did the Link Worker help the students but also helped other participants too.
They saw their role as more of ‘umbrella support’, by supporting the families as well as the young person. Parents were usually more receptive to the Link Worker who had links with community groups.
The Link Worker also helped with ‘school refusers’ and eased the situation for school staff and school and medical services.
Teachers felt that the Link Worker ‘can really help those young people who really lack the self-confidence and have little self-worth and one remarked ‘You know mental health and wellbeing is the biggest it’s ever been and it’s crazy if we can’t tap into that’.
The Link Worker was not an educational nor medical practitioner, but independent. However, the findings showed that the multiply connected nature of their role meant that they were able to forge social links and relationships for the individual with wellness, medicine, education, leisure and charitable services and school services which benefitted the wider community.
EXECUTIVE SUMMARY
ONLY CONNECT – A PILOT STUDY EVALUATING THE ROLE OF A SOCIAL PRESCRIBING LINK WORKER IN TWO SCHOOLS IN ENGLAND
Context
This pilot study took place in two schools in the rural south of England over an academic year. The schools had commissioned the services of a social prescribing external Link Worker.
Aims
- To explore which issues were most challenging for young people in school and to consult them and key stakeholders related to the school.
- To examine their perceptions of a social prescribing plan put in place by an external Link Worker, to evaluate whether this had made a difference to their lives, and, if so, what worked and what were the barriers?
- To find out whether there was a level of need and demand for a social prescribing service in schools.
Sample
- Six students on the social prescribing pathway
- Two members of teaching staff
- Two GPs
- The Link Worker
Methods
- The qualitative approach focused on the perspectives of students in school on the social prescribing plan by way of face-to-face, semi-structured interviews.
- The interviews took place at least three times over the year to hear student views and evaluate the social prescribing journey put in place.
- In addition, key staff, local GPs, and the Link Worker were also interviewed to hear their stories on the issues in school, the progress of the students, and what helped.
- This collection of qualitative data was bolstered by objective feedback in the form of education markers such as attendance, behaviour, and academic progress.
Main Findings
- The recent pandemic had cast a shadow over students and the situation in our schools was reported to be difficult.
- Post-pandemic, mental health issues had worsened in the schools. Overstretched health and social services such as CAMHS, primary care, and social care had long waiting lists.
- Behaviour and attendance had deteriorated.
- Teachers were under pressure and families were struggling.
- The findings from the case studies and stories were positive in that they indicated that the Link Worker had helped the students by listening and advising and linking them to local activities and services.
- The key stakeholders also found the Link Worker role to be beneficial.
Conclusions
The consensus was that this Link Worker was an asset to these schools and connected individuals to the wider community. It was key that she was not employed by the schools and her approach and networking skills were appreciated. The challenges were a lack of funding and geographical barriers with few accessible services and limited resources, such as public transport. Social prescribing is difficult to evaluate as intrinsic outcomes and wider determinants of health are more difficult to capture.
Recommendations
Our children and young people should be a priority and this pilot work suggests that Link Workers can be trialled and evaluated in more schools, perhaps leading to research on a larger scale. In particular, Link Workers can be safely trialled to prevent the exclusion of vulnerable groups in schools. Greater investment is needed for school health and social services and community assets.
Dr Lynda Dawson
University of Westminster