Introduction to Social, Emotional and Mental Health Needs
Updated: Aug 23, 2022
In 2020/2021, over 200,000 children in the UK received either SEN support or an EHCP for Social, Emotional and Mental Health needs (SEMH). Children with SEMH accounted for 17% of all children with SEND in 2019, according to exclusion data, 47% of all children who were excluded in 2019 had SEN, and 60% of those were children with SEMH. According to the SEN Code of Practice, SEMH is defined as;
These may include becoming withdrawn or isolated, as well as displaying challenging, disruptive or disturbing behaviour. These behaviours may reflect underlying mental health difficulties such as anxiety or depression, self-harming, substance misuse, eating disorders or physical symptoms that are medically unexplained. Other children and young people may have disorders such as attention deficit disorder, attention deficit hyperactive disorder or attachment disorder.
Over the past few years, with the COVID 19 pandemic, children have suffered greatly in terms of their social and emotional development, and no doubt the lockdowns had an impact on their mental health as well. As educators, we need to be aware of how children with SEMH needs present, how we can adapt our teaching and support to meet their needs and how we can support them outside of academics.
What do new teachers and TA's need to know about SEMH?
Let's break it down first of all. By examining and understanding each section of SEMH, we can better assess the children we teach and support and can then implement the best strategies to support them.
Like all humans, children are social beings! Many children have the skills to easily form relationships and friends with others, communicate effectively and exist around others relatively problem free (but not totally!). However, children who have communication difficulties, have experiened trauma, have attachment difficulties or other social challenges can find forming relationships with adults and other children extremely difficult. This can not go on to affect their wellbeing, but will also impact on their confidence and ability to access group activities, communicate their thoughts and feelings and feel part of the wider school and local community.
This topic is such a broad one as it covers emotional regulation, recognising and normalising emotions, managing stress, building resilience skills and understanding others’ emotions amongst many many other things. The Mental Health Continuum (shown below) shoes the different positions we can be in with regard to our emotional wellbeing and mental health. This is a useful tool when considering the needs of the child you are working with.
There are many different strategies you can put in place to help children regulate their emotions in the classroom, just check out this blog! Helping children understand what emotions they or others are feeling is a great activtiy, especially for children with autism. Use worksheets such as this one to help them identify emotions and you could then go on to work with each child to devise strategies for when they are feeling a negative emotions. For example, you could create a worksheet for each child and list the things that calm them or make them feel safe and they can then choose one of those things to do if they feel anxious/frustrated/angry. It could be thigns such as 'Go outside', 'Play with fidgets', or 'Go to calm corner' - whatever works for that child, both of you need to know strategies that will help them regulate.
When we talk about mental health in the context of SEMH, we are moving more towards talking about a diagnosable mental health condition or a set of symptoms that might indicate that they need to seek the help of a profressional. Key features of mental health challenges are seemingly irrational fears, obsessional pre-occupations, persistent intrusive thoughts, rumination, safety behaviours and actions/thoughts/feelings that are based on an issue the person may have with how they are processing the world around them.
For example, a highly anxious, perhaps due to past trauma or experiences, child may see threats in every day situations based. Looking at anxiety from a neurological sense, we know that a child who is anxious is not actually learning as their brain is so preoccupied with 'survival' in this moment. Another example may be a child who has a low sense of self worth and this may impact on how they perceive interactions with others or how they tackle school work.
How we think affects how we feel (Mental Health to Emotional). How we feel can affect how we think (Emotional to MH). How we feel can affect how we interact (Emotional to Social). How we interact can affect how we feel (Social to Emotional). How we think can affect how relate to others (Mental Health to Social) and finally how we interact with others can lead to changes in how we think (Social to Mental Health). A child who struggles in one area of SEMH could end up
It is important to understand that there are two main ways in which SEMH can present in terms of behaviour. You can have children with passive characteristics such as withdrawal, school non-attendance, and anxiety. Typically, these characteristics are more common in girls. On the other hand, you have active characteristics which are behaviours such as physical or verbal aggression, struggling to remain in the classroom/school premises and generally being disruptive. These behaviours are more common in boys but both passive and active characteristics can be found in any child.
You must separate the behaviour from the child. Behaviours can be 'bad', but you must not label the child as 'bad'. Behaviour is a way of the child communicating something with you, whether that be their needs, feelings, thoughts, anything but they have not yet found a way to express it in a safe way. All too often I have seen children labelled as 'naughty' or 'problem child' and if you, even subconsciously, treat that child differently to others because they present with challenging behaviour, this will only perpetuate their low self esteem, damage their mental wellbeing and impact on their ability to integrate socially with the rest of the school community.
As we will go on to discuss, relationships and getting to know each individual child is key to unlocking their potential. Children with SEMH can be good at any subject where they feel they have a good relationship with that teacher. Now, let's explore some easy to implement strategies you can use to support children with SEMH.
Proven strategies to help children with SEMH succeed
Every child is unique and every child has different needs which we need to understand. As much as we want to, we may never fully understand what a child has been through or is currently experiencing. All we can do is adapt to their specific needs and make our support and teaching style as suitable as possible.
1. Understand Adverse Childhood Experiences
There are numerous communities throughout the UK where children encounter various different concerning issues everyday such as crime, drugs, domestic violence, poverty and, increasingly, being raised in a single-parent household. Sadly, I recall a child in my previous class who would come to school and look completely out of it all day, could not engage with activities and would fall asleep in class - turned out that a family member was growing copius amounts of weed in the home and the poor child was essentially stoned 24/7. He had also witnessed multiple drug deals and was aware of tensions between his family and the wider community he lived in. We just never know what could be happening at home. These are all Adverse Childhood Experiences (ACE's) and can have a lasting effect on the development and wellbeing of a child. You can learn more about trauma and complex trauma here.
2. Get to Know Each Child
Nothing will help you support a child more than truly understanding them and their world. You need to understand their background, who are the key people in their life, their likes, their dislikes and, importantly, their behaviours. Changes in a child's behaviour is often the first sign that something has changed in their life or in their mental state. For example, a normally outgoing and chatty child who suddenly becomes shy and withdrawn is a red flag that something may be happening with them. You should also record as and when different behaviours occur and note down any potential triggers that may have caused or influenced that behaviour.
Some great ways to start to understand more about a child's life is to complete an All About Me worksheet with them. These are best done at the start of a school year or term, and can be updated as the year goes on. I highly recommend using elements of their favourite things to make activities more adapted to them and more enjoyable. For example, if a child is particularly interested in space, you could try spelling the names of planets during phonics, calculating rocket speeds in maths or understanding how stars are formed in science. If a child has a particular favourite toy or activity, this can also be used as a way to calm them if they are upset or frustrated.
3. Adapt Your Lessons
You should adapt your lessons so that every child, no matter what their needs are, will achieve something in every lesson. Something that can hold a lot of children with SEMH back is fear and anxiety. It differs from child to child, but typically children with SEMH are so frightened of perceived failure, embarrassing themselves or 'looking silly' in front of their peers that they just won't engage in the activity at all.
One way to potentially overcome this is to give them quick wins at the start of the lesson before you challenge them with more difficult work or new work. If they start with activities they know they can do and do confidently, this will allow them to relax and feel safe and, hopefully, approach a new activity with minimal anxiety.
4. Positivity, Positivity, Positivity.
Many children with SEMH will have a very low self esteem and possibly a poor image of themselves and their abilities. As a teacher or teaching assistant, a huge part of your role is to help them build on their self esteem and believe in themselves. As they grow in confidence, they will feel safer integrating into class activities and taking on new challenges.
You can do this in a number of ways, and they are all super simple to do! Firstly, use positive language as much as you can! There is debate around the ratios of positive feedback to negative feedback, but what it boils down to is the child needs to hear more positive feedback than they do negative. It is important to be specific with your feedback too, so that the child knows which behaviours and/or skills they are demonstrating proficiency in. For example, rather than "Good job!" (although this can still be used for general praise), say something like "I really like how neatly you have written the title, good job!"
Secondly, active listening is so important as it gives the child a sense of importance and that they are heard. Do not dismiss behavioural outbursts - all behaviour is a way of communicating. If the behaviour is not something you want them to be doing, you can tactfully ignore this or redirect them into a behaviour you do want to see, but do not dismiss what the original behaviour meant and try to understand what they were trying to communicate with you. You can then pick this up with them later when they are calm if needed, or be aware of what that particular behaviour could indicate in the future.
Finally, never call out the child for displaying any challenging behaviour or undesirable behaviour in front of the whole class. This will be really embarrassing for the child and you will likely break any trust that had previosuly been formed. Instead, you may want to devise a subtle, private signal system you can use with the child if they start to drift away from an activity or display a behaviour you have agreed is not suitable. This may be a keyword or a physical gesture but it is private between you and the child.
5. Structure & Routine
Ensuring that your days are structured is so helpful for children with SEMH as it will reduce the anxiety they could feel about what is going to come up throughout the day. You could present this as a visual timetable and, before the start of each activitiy, get the child to check the schedule and remove any completed activities before selecting the activity that is next.
When it comes to structuring each activity, we have already spoken about quick wins which will gently ease the child into each activity and allow them to feel safe and confident before moving on to more challenging work. It is also important to give the children tasks with clear goals and timescales. For example, setting lesson objectives is really helpful and then setting a clear task such as 'Can you complete 5 questions in 10 minutes whilst I go and help X?'. You want to make sure that your instructions are clear, short and not too demanding. If you give them lots of of instructions all at once, it can be overwhelming and the tendency for children with SEMH could be for them to either shutdown and do no work or to display more overt challenging behaviour such as leaving the classroom, being disruptive or getting physical.
Whilst structure is important, you also have to be flexible! No lesson ever goes perfectly, and we don't necessarily know how each child will be feeling or responding on each day. You therefore also need to be flexible and have strategies in place if you need to abandon the given lesson or activity in order to help the child regulate themselves. If a child becomes anxious or frustrated, give them space to calm down and simply forget about the lesson. This may take 5 minutes, it could take the rest of the day but what is important is the child's well-being.
The Trauma and Attachment-Aware Classroom: A Practical Guide to Supporting Children Who Have Encountered Trauma and Adverse Childhood Experiences
Mental Health and Well-being in Primary Education: A Practical Guide and Resource