Social Emotional and Mental Health (SEMH) and wellbeing support for education settings

John Bowlby (1969) defined attachment as ‘lasting psychological connectedness between human beings’. He hypothesised that infants instinctively seek closeness to a caregiver in order for survival.

When infants experience stress, such as feeling hungry, thirsty, unwell, frightened, hot or cold, they will initiate proximity-seeking behaviours, such as crying, calling out, putting their arms out and moving towards the caregiver.

When the caregiver consistently provides proximity and safety in times of stress, a secure base is formed, enabling the infant to feel safe and have confidence to explore the world around them.

The infant knows that if they come into difficulty they have somebody who will unconditionally provide support and comfort and reduce their stress. The infant is likely to develop a secure attachment.

For many reasons, the caregiver may be unable to provide this attuned care. Adverse Childhood Experiences (ACEs), for example, may contribute to the caregiver being unavailable.

ACES are highly stressful and potentially traumatic events or situations that occur during childhood and / or adolescence, such as abuse, neglect, parental separation, domestic violence, mental illness within the household, alcohol or drug abuse within the household and the imprisonment of a household member.

Experiencing four or more ACEs has been found to increase the risks of a number of physical and emotional difficulties across the life course (Felitti et al, 1998). If the infant does not receive attuned care as a buffer against these experiences, an insecure attachment style may develop.

Bowlby suggested that the relationship with the primary caregiver becomes the cognitive prototype for all future social relationships and that continual disruption of the attachment between the infant and the primary caregiver could result in long term cognitive, social and emotional difficulties.

There is one secure attachment style and three insecure attachment styles: Avoidant, Ambivalent and Disorganised (Ainsworth et al, 1978).

Louise Bomber (2007) describes these attachment styles as helpful structures for us as teachers, in interpreting why a child may be presenting in a particular way, rather than as a diagnostic tool.

She also explains that children can present with a combination of attachment styles and that we are all on an attachment continuum somewhere. An overview of each attachment style is provided below.

This is a very brief summary of attachment, there is a wealth of literature on this topic, some of which is listed in the references section. I would recommend further reading to gain a deeper understanding on the subject.

Jo Loomes - Lead Practitioner for SEMH and Wellbeing

Secure Attachment

Louise Bomber (2007), describes securely attached children as having learned that ‘they are OK, adults are OK and that the world is OK’. Children with this attachment style generally feel safe to be curious, take risks, explore the world around them, make the most of learning opportunities, work independently, ask for help when they need it and form meaningful relationships. Children with this attachment style are also more likely to have a good self esteem and to be resilient.

The NICE guidelines (2015) add that children who have a ‘secure’ attachment are generally able to be comforted by their caregivers when distressed and to use their caregiver as what is known as a ‘secure base’ from which to explore their environment when they are not distressed.

Insecure Attachment - Avoidant

Louise Bomber (2007) describes an avoidant attachment style as usually being an adaptation to a depressed or abusive caregiver. She describes that children with an avoidant attachment style may present as actively seeking to meet their needs on their own, shut down or distant, difficult to connect with emotionally, socially uncomfortable, task orientated rather than relationship orientated, compliant, reluctant to ask for help, perfectionists and may sometimes have outbursts out of the blue.

The NICE guidelines (2015) add that children who develop an ‘avoidant’ attachment pattern are thought to maintain proximity to their caregiver by ‘down-regulating’ their attachment behaviour: they appear to manage their own distress and do not strongly signal a need for comfort. When reunited with a caregiver after a brief separation, these children may be quite distant, and tend to avoid contact with the caregiver.

Insecure Attachment - Ambivalent

Louise Bomber (2007) describes an ambivalent attachment style as usually being an adaptation to an inconsistent caregiver.

She describes that children with an ambivalent attachment style may present as on edge, attempting to get their needs met by constantly working out how the other is feeling or doing, addicted to trying to get the adult’s attention, sometimes clingy and sometimes rejecting, charming (but this can be fuelled by anxiety about having needs met rather than genuine relationships), constantly chatting or interrupting to keep you connected, suffering from separation anxiety and quick to blame others.

The NICE guidelines (2015) add that children who have a resistant (ambivalent) attachment pattern are thought to maintain proximity to their caregiver by ‘up-regulating’ their attachment behaviour: when they are separated from a caregiver, they may become very distressed and may be angry, and resist contact when the caregiver returns, and not be quickly calmed when comfort is offered.

These children are less confident in terms of exploring their environment and may be wary of strangers.

Insecure Attachment - Disorganised

Children with disorganised attachment can be the most difficult to connect with and support in school. Louise Bomber (2007) describes a disorganised attachment style as usually being an adaptation to experiencing neglect or abuse.

She describes that children with a disorganised attachment style may present as displaying bizarre or distressingly extreme behaviours, erratic, unpredictable, displaying behaviours with a shock element to them, contradictory (perhaps one minute demanding your attention and another telling you to get away from them with terror in their eyes), expecting the worst, attempting to stay in control of everything, not being able to bear being dependent or vulnerable in any way, hyper-vigilant and unable to focus on learning.

She goes on to explain that strategies that work one week may not work the next with children with disorganised attachment.

Key strategies to support children who present as having insecure attachment

Many experts in the field agree that quality relationships are the key strategy for supporting children with insecure attachment. For example, Karen Treisman (2016) advocates that ‘relational trauma requires relational repair’ and Dr Bruce Perry (2006) states that ‘the more healthy relationships a child has, the more likely he will be to recover from trauma and thrive’.

We would recommend the following key strategies for supporting children who present as having insecure attachment to build relationships within school:

• Louise Bomber’s Team Pupil
• Dan Hughes’ PACE
• Bruce Perry’s Regulate, Relate, Reason

References

• Ainsworth et al (1979) Patterns of Attachment: A Psychological Study of the Strange Situation.
• Louise Bomber (2007) Inside I’m Hurting.
• Louise Bomber (2011) What About Me?
• John Bowlby (1969) Attachment and Loss. Volume 1.
• Felitti et al (1998) ‘Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. The Adverse Childhood Experiences (ACE) Study’, American Journal of Preventive Medicine, vol. 14, issue 4, pp. 245 -258.
• DDP Network (2023) What is Meant by PACE? What is meant by PACE? - DDP Network
• National Collaborating Centre for Mental Health (UK) (2015) Children's Attachment: Attachment in Children and Young People Who Are Adopted from Care, in Care or at High Risk of Going into Care. London: National Institute for Health and Care Excellence (NICE); 2015 Nov. (NICE Guideline, No. 26.)
• Perry & Szalavitz (2006). The boy who was raised as a dog and other stories from a child psychiatrist's notebook: What traumatized children can teach us about loss, love, and healing.
• Karen Treisman (2016) Working with Relational and Developmental Trauma in Children and Adolescents.

'Sometimes we hear children’s behaviour described as attention seeking and this is often perceived as a negative behaviour and one that should be ignored or discouraged in children. But let’s take a step back and consider - what could a child be communicating through seeking the attention of an adult?

The NSPCC states that ‘the need for attention, to feel seen and heard, is a natural human instinct. It’s particularly important during childhood, when we are at our most dependant on others to recognise, understand and meet our needs.

All children, on occasion, seek reassurance through their behaviour that the adults in their lives are there for them. But for some children, their behaviour is a way of communicating that something isn’t right. It’s an attempt to get the adults in their life to notice what’s happening to them. Calling a child’s behaviour ‘attention seeking’ risks minimising their needs. And if you ignore or dismiss the behaviour, these needs may continue to go unmet’.

Jo Loomes - Lead Practitioner for SEMH and Wellbeing

I'm seeking my basic needs to be met

Physiological needs such as water, food, warmth and shelter are essential to human survival. Infants come into the world biologically programmed to seek support from a primary carer. The infant seeks support through crying, calling out, putting their arms up etc. If the infant’s needs are ignored, responded to inconsistently or responded to negatively, the infant learns that their needs are not important and that adults cannot be trusted to meet their needs. The infant then learns to adapt their behaviour to get their basic needs met.

For some children this may mean constantly talking to the adult to ensure that the adult remembers them. For others it may mean tuning into the adult’s mood to ascertain when might be the opportune time to try to get what they need. For others it may mean suppressing or trying to cope alone. For others it may mean shouting and screaming to ensure that they get noticed, even if it is for a negative reason. These patterns of behaving can then be transferred on to other relationships throughout the child’s life.

Might the child’s behaviour be communicating that their basic needs are not met? Have they not yet learnt strategies to communicate their needs within trusting relationships where their needs will be responded to consistently? Strategies to support a child to build a trusting relationship where they can begin to trust adults to meet their needs can be found in our Quick Guide to the Key Adult.

I'm seeking safety

Maslow’s Hierarchy of Needs illustrates that safety is our primary need once our physiological needs are met. However, when children have experienced trauma and loss, their autonomic nervous system is often in an alert state and they can experience faulty neuroception, a bias towards detecting danger when there is none.

This can cause the fight (shouting, hitting, kicking, throwing, insulting, swearing, demanding), flight (running, hiding, avoiding, restless, fidgeting), freeze (mind going blank, not being able to answer questions, staring, hiding, not being able to complete tasks) response to be activated more regularly than in their peers.

Might the child be communicating that they feel unsafe through their behaviour? Might there be a safeguarding risk? Strategies to support a child in school to feel safe, to reduce perceived threat and to co-regulate when they feel unsafe can be found in our Quick Guides to PACE and Regulate, Relate, Reason.

I'm seeking connection

After safety, Maslow’s Hierarchy of Needs tells us that the next human need is connection. When children have experienced developmental trauma they may be forced to adapt their behaviour in order to achieve a connection. For some children this will mean constantly talking or interrupting to ensure that they are noticed and remembered. For other children this will mean seeking physical closeness to an adult.

For other children it will mean seeking connection with the adult through negative behaviour because they know this will mean that the adult will spend time with them. For other children they may turn away from relationships and reject them before they can be rejected themselves, protecting them from the pain of rejection.

Might the child be communicating that they are seeking connection through their behaviour? Strategies to support children to build trusting relationships can be found in our Quick Guide to the Key Adult.

Further reading

Louise Bomber - Inside I’m Hurting
Why language matters: in need of attention, not ‘attention seeking’ | NSPCC Learning
Attention Seeking versus Connection Seeking | Psychologies

The United Nations Convention on the Rights of the Child highlighted that children have a right to express an opinion and to have that opinion taken into account in any matters affecting them. It can sometimes feel difficult to gather the child's voice if a child seems reluctant to engage in a conversation or with direct questioning.

It is our job as educators to be creative in finding ways to ensure that the child's voice is gathered, heard, valued and incorporated into their Personal Education Plans, in a way that feels comfortable for the child.

Child's voice work often works best when completed with an adult that the child has a relationship with and feels comfortable with, in a space where they feel comfortable and able to speak freely. The work should not feel rushed, it should feel valued.

It is helpful for the adult to explain to the child what the child's voice work is for and ask the child if they are happy for their views to be shared, with the usual safeguarding caveats applied. It is best practice for the child’s voice to be recorded using their actual words, rather than paraphrasing, wherever possible.

Below are some ideas for gathering the child's voice, some techniques may work brilliantly for one child and not for another. It is important to get to know the child and try techniques that you think may engage them best. Sometimes more than one activity may be needed to get a full picture.

It can be helpful to vary the techniques used to prevent the activity feeling like a tick box activity every term - oh not this again! Sometimes no techniques are required and we have the best conversations while sharing a relaxed and enjoyable activity e.g. colouring, baking, crafts, kicking a football around.

Jo Loomes - Virtual School Lead Practitioner for SEMH and Wellbeing

Card based techniques

• sentence completion cards - Spread out a range of sentence completion cards, such as Dr Karen Treisman's A Therapeutic Treasure Deck of Feelings and Sentence Completion Cards, face down and take it in turns with the child to choose one and complete the sentence. Sentence starters include 'I'm happiest and feel good when...', 'Things that bug me are...', 'I keep myself safe by...', 'If I could go back in time to one moment I would go to...', 'My home is...'
• feelings cards - Spread out a range of feelings cards, such as the feelings cards in the resource above or John Veeken's The Bear Cards: Feelings, face up. Start with yourself and the child choosing the card that best illustrates how you are each feeling today, discuss why you are feeling that way. Take it in turns to choose other cards, label the feeling and discuss times that you each might experience that feeling.
• red, amber and green traffic light cards - The child holds up one of the cards to represent their views on a range of topics e.g. subjects at school, times of day at school, different activities. Discuss why they may feel that way.
• card sorting - Use a selection of cards depicting different aspects of school life e.g. lunchtime, friendships, arriving at school, home time, assembly, working in a group, working on my own, asking for help, changing my work if I’ve made a mistake, being praised for good work, having someone to talk to, busy places, quiet places, reading, writing, maths for the child to sort into a thumbs up hoop and a thumbs down hoop. Discuss as the child sorts. This could also be done as a cutting and sticking activity.
• strengths cards - Draw around the child’s body, encourage the child to choose which strengths cards represent them, and which do not, and stick them inside the body outline. There are a range of strengths cards available for download online. Discuss specific examples of when they may have shown some of the qualities.

Active techniques

• walking and talking - Take the school dog (if your school has one) for a walk and chat while walking. I have had some of my most insightful conversations walking the school dog and using them as an example e.g. Ted loves his walks with you, he is happiest at school when he is walking on the field or having behind his ears rubbed. I wonder when are you at your happiest at school? Oh that loud noise frightened Ted a bit, did you see him jump? I bet his heart is racing. I wonder if anything ever makes you feel like that?
• hop scotch - Have sentence starters written in chalk on a hop scotch template, finish the sentence that you land on.
• ball bounce - Read a selection of cards e.g. reading, writing, maths, arriving at school, home time, assembly, friends, playtime and ask the child to bounce the ball into a green, orange or red hoop depending on how they feel about each aspect of school life.

Written techniques

• the three schools template from ePEP - the child writes things that would be included in their school of worries, school of good things and school of dreams on the template.
• the fairy or wizard template on ePEP - the child writes their worries, things that help them escape their worries, wishes and things that are going well on the template.
• the Makaton questions on ePEP - the child chooses the image that answers each question.
• Pip Wilson and Ian Long’s Blob Trees - write your name in a blob that you feel a connection with and discuss why. Discuss how other blob’s might be feeling in the picture and if either of you have ever felt that way.
• three things I’d like to keep the same, three things I’d change - discuss / write these down for different scenarios e.g. school, home, with friends.
• maps - Have a map of the school and ask the child to colour each area in red, amber or green depending on how they feel in that area e.g. lunch hall, playground, specific lessons, assembly. Discuss why they may feel that way in some of the areas.
• one page profile - support the child to create their own one page profile with information they would like people to know about them e.g. what makes me happy, who is important to me, what is important to me, how I’d like to be supported, how I do not like to be supported.
• self report scales - feelings scales for school, home, friends, particular lessons, times of day etc. Scales with faces or numbers can be coloured in. Some children enjoy sing stickers to stick onto the scale.
• use online questionnaires - these may be useful for some older children, if they are reluctant to talk face to face.

Creative techniques

• the miracle question - ask the child if something magical happened overnight and everything in your world was fantastic, what would have changed? Ask the child to draw or paint their fantastic world and talk with them about the picture as they do so.
• a perfect day, a typical day, a bad day - Draw or create collages for each of these. Discuss while you create the images.
• an ideal school and a not ideal school - Draw or create collages for each of these. Discuss while you create the images.
• parts artwork - Louise Bomber discusses parts language, we are not simply one type of person, we are made up of many parts, some that are strengths and others that we might like to hide (Bomber, 2011). Use a body template split into jigsaw pieces - talk about parts of yourself e.g. a caring part, a creative part, a forgetful part, an impatient part and give examples of times when you have shown this part. Then encourage the child to think about their own parts and when they experience those parts. Represent each part in one of the jigsaw pieces.
• all about me collage - Provide the child with a selection of images and materials to create a collage that represents everything they would like people to know about them. Add words
• a feelings pie chart - Dr Karen Treisman recommends making a feelings pie chart representing how much of the day is spent experiencing each emotion and decorated with expressive materials to represent each emotion. Talk while creating this about what they feel may be triggering each emotion.
• feelings TV - Dr Karen Treisman suggests discussing if you turned on the TV and saw the happy / sad / angry / disappointed channel, what would you see? And the child drawing each channel in a TV template.
• sculptures of different emotions - what does anger look like, what does joy look like, what does sadness look like and talking while you sculpt about when each of you may have felt that way.

Play based techniques

• free play - Observing a child engaged in free play can give an insight into their likes and dislikes, how they express their emotions, what soothes them, what upsets or excites them, whether they seek support or reassurance from any particular adults, peer relationships etc. It can be helpful to observe over several sessions in different situations.
• puppets - A child may feel more comfortable talking to a puppet than to an adult.
• small world - Let the child choose from a wide selection of small world figurines to represent the people in their life e.g. parents, siblings, carers, teachers, social workers, peers. Discuss why the child has chosen specific figurines to represent that person e.g. Dr Karen Treisman describes a child choosing a clock to represent their father who had a prison sentence looming and an octopus to represent their mother as she was very busy (Treisman, 2018). Use these figurines in small world play together.

References

• Bomber, Louise. (2011) What About Me? Wiltshire: Worth Publishing
• Long, I. & Wilson, P. (2018) The Big Book of Blob Trees. Oxfordshire: Taylor & Francis
• Treisman, K. (2017) A Therapeutic Treasure Deck of Feelings and Sentence Completion Cards. London: Jessica Kingsley Publishers
• Treisman, K. (2018) A Therapeutic Treasure Box for Working with Children and Adolescents with Developmental Trauma. London: Jessica Kingsley Publishers
• Veeken, J. (2012) The Bear Cards: Feelings. Victoria, Australia: Q Cards

Children and young people who have experienced loss and / or relational trauma can have difficulties with focus and attention for many reasons.

For example, they may be hyper-vigilant and scanning the room for danger, they may have difficulties with sensory processing and not feel comfortable to settle to learn, they may have difficulties transitioning from one activity to another, they may have difficulties regulating emotions, they may have difficulties with planning and organising.

Whilst there are many reasons that a child or young person may find it difficult to focus their attention, there are some broad strategies that may support them in this area which we have detailed below.

Joanna Loomes - Virtual School Lead Practitioner for SEMH and Wellbeing

Safety considerations

Does the child feel safe to focus their attention on a task or are they in a fight / flight / freeze state? How can we help them to feel safe in the classroom to focus on a task?

• support the child to build a trusting relationship with the adults who they are working with. Spend time with the child, find out about their interests, remember things about them to show that you hold them in mind e.g. how was football club last night?, share little things about yourself, have moments of fun together.
• it can benefit some children to know when a trusted adult will check in with them again e.g. in five minutes I will come and check in with you to see how you are doing.
• talking to the child about where they prefer to sit can be helpful. Some children will feel safer sitting at the back where they can see everyone, others near an adult for reassurance, others near the door so they can easily leave for a break when needed. Sitting against a wall or high backed chair can feel grounding for some children.
• provide predictability and routine - use visual timetables, one page profiles to introduce adults and social stories to detail any changes to routine.
• explicitly narrating things in school that keep everybody safe can help to remind the child that the school takes safety seriously and that it is a safe place e.g. Mrs Brown is locking the gates now that everybody is in school, Mr Smith is going to clean Fred's knee now and make sure that he is ok.

Task Considerations

• using the child's name before instructions can be helpful for some children to gain their attention initially. Give clear instructions and discreetly ask the child to explain the instructions back to you. Simplify the language you use and chunk verbal information. Pause between chunks to give children processing time.
• consider the child's current attention level and pitch tasks at an achievable length. Start with short tasks and build up duration gradually.
• chunking tasks into manageable chunks with regulation breaks between chunks can be helpful.
• start with tasks that are slightly too easy and build up difficulty gradually.
• make learning irresistible where possible e.g. linked to a child's interests, multi-sensory resources, introduced using an exciting event.

Sensory Considerations

Sensory Circuits

Sensory Circuits is a 10 to 15 minute circuit of activities designed to create a level of alertness that is optimum for learning. They are usually done at the start of the day and sometimes after lunch too. Sensory Circuits consist of 2 or 3 activities from each of the following sections, in the following order:

Alerting – this section provides vestibular stimulation, where the head moves position rapidly e.g. bouncing on a trampette, bouncing on a space hopper, skipping, star jumps, bunny hops, hop scotch, spinning chairs, action rhymes e.g. row your boat, head, shoulders, knees and toes.

Organising – this section involves motor challenge, balance and timing e.g. balancing along a beam, throwing beanbags at a target, blowing a paper ball to a target, blowing bubbles, throwing and catching, balancing on a wobble board, a timed challenge to collect beanbags and putting them in a hoop, balancing on one leg, walking on stepping stones.

Calming – this section calms and provides proprioceptive input e.g. wall press ups, chair push ups, massage, rolling on or under an exercise ball, weighted blankets.

Alerting and calming activities can also be helpful throughout the day if you notice that the child is losing focus due to becoming lethargic or over-aroused.

Regulation Breaks

Dr Bruce Perry recommends that repetitive, rhythmic, relational (offered by a safe adult), relevant (linked to developmental age, not actual age), respectful, rewarding (pleasurable) activities are calming for children who have experienced trauma, when you see signs of them becoming dysregulated or to prevent dysregulation.

He suggests that these calm the brainstem, where the fight, flight, freeze response is based. These activities may include walking, running, deep breathing, a sequence of yoga movements, massage, dancing, bouncing, drumming, tapping, listening to rhythmic music and stroking a pet.

Sensory support in class

Sensory items such as fidget toys, resistance bands to push feet on while listening or working, weighted blankets and wobble cushions on chairs can support some children to focus.

Consider the child's seating (does the child focus better when working seated, standing or laying on their stomach?), lighting, temperature, noise levels, smells etc.

Low Distraction Environments

• research by Durham University (2017) found that children focused on the teacher more, displayed fewer off task behaviours and achieved higher learning scores when there was no displays, compared to when the teacher had a busy display behind them. It is worth considering the classroom environment and whether displays can be minimised to be less distracting.
• keeping work areas clutter free can help with focus and attention.
• some children can benefit from working at a distraction free workstation for some activities.

Prompts and Reminders

• visual prompts and checklists for the child to refer to during the task can be helpful for some children e.g. a visual timetable to show 10 arithmetic questions, movement break, 3 reasoning questions, movement break, check answers.
• now and next visuals can help some children to focus on a task, with a rewarding activity on 'next'.
• simple voice recorders can be useful for children to replay instructions if they require the instruction repeating or reassurance about the task.
• timers can help to show how much time is required on a task before a movement break or before it is finished.

Workstation Tasks

Workstation tasks can be helpful to support a child to specifically build independence, attention and concentration with low demand tasks. These tasks can also be calming and soothing for some children. Activities should be simple enough for the child to complete independently and should include sorting, categorising and hand eye co-ordination. The tasks should be set at an appropriate length for the child's current concentration span, so that they can experience success, and increase in length gradually.

Workstation tasks consist of 3 tasks in individual baskets or zip wallets, labelled 1, 2 and 3, placed to the child's left. The child should have a 'finished' tray on their right. The child should complete the tasks in order and put each one in the finished tray when it is complete.

An adult should teach the child the tasks on Monday and ensure that the child can complete each task competently without support. The child should then complete the tasks independently daily for 1 to 2 weeks before new tasks are introduced. The complexity and length of the tasks should be increased gradually when the child is experiencing success consistently. A timer may be added for some children for additional challenge.

Here are some examples of workstation tasks:

• sorting objects or pictures by category e.g. colour, size, initial sound, rhyming, food type
• cutting skills activities
• continuing patterns e.g. threading, peg boards, Lego, plastic shapes, colouring, drawing
• jigsaws
• using instructions or a photograph to make a Lego model
• sorting coins
• sorting upper and lower case letter cards
• sequencing picture cards e.g. making a cup of tea, brushing your teeth, building a snowman
• ordering objects by height
• pencil control activities
• odd one out activities
• phonics activities
• letter formation activities

Celebrating Successes

• use specific praise to celebrate focus e.g. Wow, you worked for 5 minutes on that on your own, I'm so proud of you.
• use success books to celebrate the child's achievements. These might include copies of work, messages from staff, stickers, certificates etc. Refer back to the book regularly to remind the child of the previous success that they have experienced.  

PACE was developed by clinical psychologist Dr Dan Hughes, over 20 years ago, as a way of thinking, feeling, communicating and behaving that aims to make children and young people feel safe. PACE stands for playfulness, acceptance, curiosity and empathy and is based on the way that adults would interact with an infant.

PACE can be particularly effective for building trusting relationships with children and young people who have experienced trauma and may have missed out on quality early interactions with adults. Dr Dan Hughes describes PACE as a ‘way of being’ rather than an intervention, it can shape every interaction that we have with the children in our care.

The different elements of PACE may be appropriate in different situations at different times, for example, playfulness may not be appropriate when a child is extremely distressed or upset. It is the adult’s role to get to know the child and which approaches work best for that child in different scenarios.

Responding PACEfully takes time and practice, we may not always get it right, and it can feel like you’re not responding to tricky situations in a way that we traditionally might. However, responding PACEfully can reduce threat, tension and pressure and can prevent escalation.

This can calm the ‘feelings brain’ so that the tricky situation can then be talked through when the child is regulated and able to access their ‘thinking brain’ to reason and learn from the conversation (see Dr Daniel Siegel’s Hand Brain Model for more information about the feelings brain and thinking brain).

Jo Loomes - Lead Practitioner for SEMH and Wellbeing

Playfulness

Playfulness is about enjoying being together and about having fun. It can be incorporated into many aspects of the day e.g. joining a game at playtime, sharing a joke, laughing about a funny situation together. Incorporating playfulness into your interactions with children helps to create a light atmosphere.

Being playful isn’t about being funny all the time or making jokes when a child feels sad, but playfulness can help to diffuse some tense situations because you are showing that you are no threat, preventing the ‘feelings brain’ from moving into the fight / flight / freeze response. It is helpful to use a light tone and storytelling voice, rather than a lecturing or irritated tone.

Playfulness may reduce the shame that a child may feel about their behaviour being addressed, preventing negative internal working models from being reinforced e.g. I am bad, that’s why bad things happen to me. The tricky situation can still be addressed, in a calm way, once the situation is diffused and the child is regulated and able to access their ‘thinking brain’ for problem solving and reasoning.

Scenario: A child is beginning to get frustrated with their work and has made a hole in the paper.

Instead of: Why have you done that to your work? You’ll have to stay in at break time to do that again now!

A playful response might be: Oh my goodness it looks like my dog has snuck in and taken a bite of this. Did he sneak in without me seeing?

Acceptance

Showing that we accept the child’s thoughts, feelings, perceptions and wishes without judgement is core to the child’s feeling of safety. This does not mean that we accept behaviour, limits can still be put on this, or that we agree with their thoughts, feelings, perceptions or wishes.

It can be difficult not to challenge a child’s feelings or perceptions that we do not agree with e.g. nobody likes me, but it is important to accept the child’s perception with curiosity and empathy e.g. I’m sorry that you feel that nobody likes you, you must feel really lonely, I wonder what would help you to feel less lonely.

Through experiencing acceptance, the child begins to understand that although their behaviour may be criticised, their sense of ‘self’ will not be, challenging negative internal working models.

Scenario: A child is beginning to get frustrated with their work and has made a hole in the paper.

Instead of: Why have you done that to your work? You’ll have to stay in at breaktime to do that again now!

An accepting response might be: Sometimes work can be really difficult and make us feel frustrated and our lids begin to wobble. Shall we take a walk to get that lid firmly back down before we come back to this? (The lid referenced here relates to Dr Daniel Siegel’s Hand Brain Model)

Curiosity

Curiosity, without judgement, shows that you have a desire to understand the child e.g. I wonder what was going on for you when that happened, I wonder what that was about, I wonder how you felt when that happened. Using ‘I wonder’ and avoiding ‘why’ can remove pressure from your interactions, as it implies that you are not anticipating an answer, even though you may still get one.

Curiosity must be communicated without annoyance or irritation in your voice in order to feel genuine to the child. This can help to reduce defensiveness in the child’s responses, as you are not placing demands on them, and can help to calm the ‘feelings brain’.

When children experience curiosity it can help them to become more reflective about their own inner life and to start to understand themselves. If adults are truly curious about why something may be happening this can also help to reduce their own frustration around a situation.

Scenario: A child is beginning to get frustrated with their work and has made a hole in the paper.

Instead of: Why have you done that to your work? You’ll have to stay in at breaktime to do that again now!

A curious response might be: Usually you really enjoy maths, I wonder what is different about today.

Empathy

Empathy involves being in the moment and trying to look at a situation through the child’s eyes. It can be helpful to match the child’s facial expression and their tone of voice, to show that you understand how they are feeling and you feel it with them.

This can help the child to understand that they do not have to manage upset or distress alone and that you want to be with them through the hard times. Showing empathy can be emotionally draining so it is important to look after yourself when you’re needing to show a lot of empathy towards others.

Scenario: A child is beginning to get frustrated with their work and has made a hole in the paper.

Instead of: Why have you done that to your work? You’ll have to stay in at breaktime to do that again now!

A empathic response might be: I think this might feeling hard for you today. It’s making my brain hurt and my lid wobble a bit too. I’m here to sit with you. Let’s take some deep breaths. It’s horrible when you’re not sure what to do.

Regulate, Relate, Reason is an effective model, developed by Dr Bruce Perry, for engaging a person when their stress response is activated and they are experiencing fight, flight or freeze. It is especially useful for children who have experienced trauma.

Dr Daniel Siegel and Dr Tina Payne Bryson explain that when a child is in fight, flight or freeze, they are likely to be operating within their ‘downstairs brain’ (the areas of the brain linked to survival) and their ‘upstairs brain’ (the areas of the brain linked to reasoning, learning, language, relating and other higher level thinking skills) is less likely to be engaged.

Dr Perry’s model explains that the child will need support to regulate and relate with an attuned adult to calm the ‘downstairs brain’ before they can engage their ‘upstairs brain’ in order for reflecting, reasoning and learning to take place.

Dr Chris Moore likens the Regulate, Relate, Reason model to a high rise building, explaining that to reach the top floor where reasoning happens, we need to work our way up, ensuring that children are regulated and relationally supported first.

However, when we have worked our way up, it doesn’t mean that we don’t revisit the earlier floors of the building, each needs revisiting regularly for the model to be effective.

Jo Loomes - Lead Practitioner for SEMH and Wellbeing

Regulate

When a child is in fight, flight or freeze their ability to listen, learn, cope and relate to others is likely to be impaired. The child needs supporting to regulate and feel calm and safe before anything else. Louise Bomber explains that we need to be stress regulators rather than behaviour managers when children are experiencing fight, flight or freeze.

Dr Bruce Perry explains that brain stem calming activities are repetitive, rhythmic, relational (offered by a safe adult), relevant (linked to developmental age), respectful and rewarding.

Louise Bomber adds that in order to teach children to soothe and quiet the lower parts of their brains, they must first experience co-regulation so these activities should be done alongside an attuned adult who has built a relationship with the child.

Then, over time, the hope is that the child will learn to use these as self-regulation strategies.

Regulating activities may include:

• deep breathing, particularly if the exhale is longer than the inhale - rectangle breathing, where the child traces the outline of a rectangle and inhales on the short sides and exhales on the long sides can be helpful to support this
• walking, jogging or running
• jumping
• bouncing a ball
• rowing on a machine or cycling
• tapping, drumming or stomping
• listening to music with a strong beat
• dancing
• heavy work, such as digging, sweeping, stacking chairs, giving out books, delivering fruit
• squeezing putty or a stress ball
• hammering
• colouring
• drinking through a sports bottle or chewing something chewy

Trying these activities when a child is regulated at first can be helpful to gauge whether they help to calm or alert the child. Not every activity will work in the same way for every child or even in the same way for the same child in different circumstances, so there is an element of trial and error in finding out what works best for each individual child.

It can also be helpful to build in regulation breaks throughout the day to prevent escalation to fight, flight, freeze (see Quick Guide to Regulation Breaks).

Relate

When the child is beginning to regulate, it is important to connect with them to remind them that they are safe, understood and supported. A key adult, who has developed a safe and trusting relationship with the child at a time when they were regulated, is best placed to do this. Louise Bomber explains that it is important for the adult to be physically and emotionally present, attentive, attuned and responsive.

Dr Dan Hughes’ PACE model (see Quick Guide to PACE) is a useful way of thinking, feeling, communicating and behaving to help the child to feel safe and to build and maintain relationships. Responding PACEfully helps to show that the key adult is no threat, that they accept and care about the child’s feelings, feel the emotion with them and are there to be with them in the hard times.

Dr Dan Hughes also suggests matching a child’s affect (their facial expression, tone of voice and intensity of emotion) to show that you really understand how they are feeling.

Some behaviour policies involve isolation in a reflection or ‘time out’ space, however Dr Dan Hughes explains that when relational withdrawal is routinely used as a discipline technique, attachment security can be compromised which could lead to further behavioural problems and distancing within relationships.

Relational withdrawal may also exacerbate the shame response and a child feeling that they are bad and unworthy of relationships. ‘Time in’ is important when children are dysregulated, especially for those who have experienced trauma.

Reason

When the child is regulated and relationally supported, we can then support them to reflect, reason and learn from a situation.

Louise Bomber advocates being curious about what happened and paying a lot of attention to the child’s perspective, acknowledging and validating their thoughts, feelings and viewpoint.

She then suggests pausing and offering other possible motives, intentions and perspectives of others involved in the situation, using the phrase ‘what if...?’ Comic Strip Conversations can also be useful to look at situations and the possible perspectives of all involved.

Louise Bomber also suggests using parts language, to reduce the shame response when reasoning e.g. I could see you were using your swearing part and I wondered where your respectful part had gone, I know it’s there as I saw you using it with the Headteacher this morning. This reinforces that we are made up of many parts and an incident does not make us bad as a person.

Psychoeducation can be useful to help a child to understand their own response to a situation. Teaching a child about Dr Dan Siegel’s hand-brain model or using a book such as Help! I’ve got an Alarm in my Head can be useful in teaching about what was happening in their brain when they were dysregulated and underpinning conversations about what strategies could be used in the future if a similar situation arises.

Repair

Louise Bomber adds a fourth ‘R’ to Dr Bruce Perry’s model, repair. This is particularly important when relationships are ruptured during a dysregulated moment.

She sets out 6 principles for repair: keep possible stressors low, keep shame possibilities low, remain warm, open and engaged, keep the number of people involved as limited as possible, ensure the key adult is actively involved in the repair alongside the child, repair 2:1 when the time is right with the individual who got offended or hurt.

Louise Bomber suggests repairing using visuals (such as a sorry card or picture created alongside the key adult), random acts of kindness (such as making a cup of tea, watering somebody’s plants, putting some flowers in somebody’s office) or payback time (such as paying the caretaker back for the time it has taken them time to clear up the mess made by the child when they were dysregulated by offering to sweep leaves, collect the bins etc).

All of these things should be done alongside the key adult to reduce feelings of isolation and shame. This is not a time for lecturing or going over the incident again, learning from the situation has taken place during the reason phase, this is a time for rebuilding relationships.

When repair has taken place, it may then be necessary to increase structure and supervision related to the trigger for the dysregulation e.g. structuring playtimes rather than allowing spontaneous play for a period. This should be communicated as a supportive measure to help the child to regulate, rather than as any kind of punishment.

Further reading

• Dr Bruce Perry and Oprah Winfrey - What Happened to You?
• Louise Bomber - Know Me to Teach Me (Differentiated discipline for those recovering from adverse childhood experiences)
• Dr Daniel Siegel and Dr Tina Payne Bryson - The Whole Brain Child
• Dr Dan Hughes - Attachment Focused Parenting
• The Three R's (beaconhouse.org.uk)
• The Constellation of Regulation: Part 1 of the 3 Rs (epinsight.com)
• Relational Routes: Part 2 of the 3 Rs (epinsight.com)
• The High-Rise of Reason: Part 3 of the 3 Rs (epinsight.com)

'The Equality Act 2010 maintains that education settings must make reasonable adjustments, including the provision of auxiliary aids and services, to ensure that disabled children and young people are not at a substantial disadvantage compared with their peers. This duty is anticipatory - it requires thought to be given in advance to what disabled children and young people might require and what adjustments might need to be made to prevent that disadvantage.

The definition of disability in the Equality Act is: a person has a disability if they have a physical or mental impairment and the impairment has a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities. A physical or mental impairment includes learning difficulties, mental health conditions, medical conditions and hidden impairments such as specific learning difficulties, autism, and speech, language and communication impairments. Government guidance on the Equality Act defines ‘substantial’ as ‘more than minor or trivial’ e.g. it takes much longer than it usually would to complete a daily task like getting dressed. The guidance defines ‘long-term’ as ‘lasting 12 months or more’ or ‘likely to last 12 months or more’ e.g. a breathing condition that develops as a result of a lung infection.

The SEND Code of Practice 2015 states that schools should assess each pupil’s current skills and levels of attainment on entry, building on information from previous settings and key stages where appropriate. At the same time, schools should consider evidence that a pupil may have a disability under the Equality Act 2010 and, if so, what reasonable adjustments may need to be made for them.

The SEND Code of Practice 2015 goes on to explain that in practical situations in everyday settings, the best early years settings, schools and colleges do what is necessary to enable children and young people to develop, learn, participate and achieve the best possible outcomes irrespective of whether that is through reasonable adjustments for a disabled child or young person or special educational provision for a child or young person with SEN.

Perhaps for this reason, the term reasonable adjustment is often used in relation to any child with additional needs, despite it relating only to children with disabilities within the law.

This quick guide aims to provide some guidance on what reasonable adjustments schools may expect to make to support Children in Care to achieve the best possible outcomes.'

Jo Loomes - Lead Practitioner for SEMH and Wellbeing

What is reasonable

The Equality Act 2010 does not provide a definition of what is reasonable, however the following factors are listed in the Equality and Human Rights Commission Guidance for Reasonable Adjustments for Disabled Pupils as factors that might be considered when deciding what is reasonable:

• the extent to which special educational provision will be provided to the disabled pupil under part 3 of the Children and Families Act 2014
• the resources of the school and the availability of financial or other assistance
• the financial and other costs of making the adjustment
• the extent to which taking any particular step would be effective in overcoming the substantial disadvantage experienced by a disabled pupil
• the practicability of the adjustment
• the effect of the disability on the individual
• health and safety requirements
• the need to maintain academic, musical, sporting and other standards
• the interests of other pupils and prospective pupils

Many adjustments are low cost, easy to implement and can make a big difference to the child’s learning, participation and achievement so are reasonable.

Commonly used reasonable adjustments for children in care

Some common reasonable adjustments that are used to support children who have experienced trauma and loss are listed below. This list is not exhaustive and not every reasonable adjustment would be suitable for every child; reasonable adjustments should be considered according to the individual child’s needs.

Key Adult

Providing a Key Adult who builds a trusting relationship with the child and providing access to this Key Adult when required. Providing a meet and greet or daily check in with the Key Adult. Using the Key Adult to have challenging conversations in a supportive way e.g. the Key Adult having a chat about uniform rather than every adult stopping the child in the corridor about an untucked shirt, which may push the child into fight, flight or freeze.

Safe space

Providing a safe space in school for the child to use when required; this space should be mutually chosen and needs to be a space where the child feels safe and wants to go.

Time out card

Ensuring that the child is able to leave the classroom when they need to and that they are not stopped in the corridor when they do so as this can pose a threat and exacerbate the fight, flight or freeze response.

Seating considerations

Some children who have experienced trauma and loss prefer to sit near an exit so that they can leave if they need to, near the back so that they can scan the room or near a safe adult. It can be helpful to discuss seating plans with the child to ascertain where they feel most secure.

Reducing threat in interactions

Reducing threat that may exacerbate the fight, flight or freeze response through approaches such as PACE, Regulate - Relate - Reason - Repair or Emotion Coaching.

Adaptations to the behaviour policy

Using strategies that promote connection before correction, such as Regulate - Relate - Reason - Repair and Emotion Coaching. Producing personalised behaviour plans with adapted strategies e.g. not issuing detentions for forgotten equipment if a child has poor executive functioning skills, completing reintegration meetings over the phone the night before a reintegration so the new day doesn’t start with a threatening interaction, completing reintegration meetings before a holiday or weekend to prevent anxiety building.

Shame

Children who have experienced trauma and loss may experience toxic shame; a feeling that they are bad, rather than that their actions are bad. Avoiding practices such as putting a child’s name on red, amber or green or on the cloud and sunshine or sitting a child outside the Head teacher’s office are important to prevent the child’s feelings of shame being exacerbated. Reintegration meetings over the phone can also support the child to feel less shame. Use of Regulate - Relate - Reason - Repair or Emotion Coaching support behaviour modification through supportive relationships and reduce the possibility of reinforcing feelings of shame. Children who experience shame may avoid answering questions in front of the class for fear of getting the question wrong and their feelings of inadequacy being reinforced; other methods may be more helpful such as talk partners, online tools or answers on whiteboards.

Psychoeducation

Using approaches such as the Hand Brain Model and Zones of Regulation to teach about how the brain works and strategies that the child may find calming. Trialling these strategies together and producing a calm box or calm menu with the strategies that the child finds helpful.

Predictability

Predictability can support a child who has experienced trauma and loss to feel safe as they feel prepared for what may happen. Visual schedules, predictable routines, social stories to prepare for changes, one page profiles for staff and consistent language and scripts can all help with making a child’s school day more predictable.

Sensory support

Dr Bruce Perry recommends rhythmic, repetitive movement for calming the areas of the brain responsible for detecting threat; this part of the brain is often on high alert in children who have experienced trauma and loss. Strategies such as sensory circuits, movement breaks, stress balls, doodling, fiddle toys, walking, deep breathing etc. can all be helpful in supporting a child to feel calm.

Executive functioning

Providing task lists, providing equipment lists, providing visual schedules, using predictable routines, promoting note taking, enabling voice notes, supporting with homework diary management, breaking instructions down into smaller chunks, allowing extra processing time, breaking tasks down into smaller chunks and gradually extending these, checking understanding of a task.

Adapting homework

Adapting homework to support filling specific gaps due to missed learning.

What might other reasonable adjustments look like

Some examples of other reasonable adjustments have been provided below, according to the area of need. This list is not exhaustive and reasonable adjustments should be considered according to the individual child’s needs.

Communication and interaction

• using pictorial labels and signs around school
• using consistent images around school
• use of communication aids e.g. communication boards, tablets
• providing a visual timetable
• providing task lists
• use of social stories
• breaking instructions and information down into smaller chunks
• using the child’s name before giving an instruction
• allowing extra processing time
• additional time

Cognition and learning

• providing visual and memory aids
• use of pre-teaching or intervention groups
• providing scaffolding
• breaking information and activities down into smaller chunks
• use of coloured overlays
• enabling different methods of recording e.g. written, drawing, use of a laptop, speech to text, voice recording, a scribe
• allowing extra processing time
• additional time
• providing word banks
• providing equipment check lists or equipment kept in the classroom
• providing check lists for routines e.g. getting ready for the lesson, getting ready for home time.

Social, emotional and mental health difficulties

• providing a Key Adult relationship and access to the Key Adult when needed
• meet and greet
• entering the building a different way or at a slightly different time to avoid crowds
• emotional check-ins
• ensuring consistent routines and expectations
• use of a safe space
• use of a time out card
• providing regular movement breaks
• preparation for changes e.g. visual timetables and social stories
• trialling regulation strategies with the child and supporting the child to choose strategies that calm them to produce a personalised calm box or calming visual menu e.g. stress balls, colouring, heavy work, sensory circuits, walking, deep breathing
• employing strategies that promote connection before correction and reduce threat in interactions e.g. PACE, Regulate - Relate - Reason, Emotion Coaching
• use of psychoeducation
• adaptations to the behaviour policy
• considering seating - where does the child feel safest?
• offering choices or forced alternatives
• social skills interventions
• a smaller area to complete assessments

Physical or sensory needs

• sitting a pupil close to the teacher to support a visual or hearing impairment
• reducing classroom noise
• providing enlarged print or Braille
• keeping learning spaces free from clutter
• providing adjustable desk heights
• use of slanted boards
• providing adapted eating support
• providing extra space for moving around the classroom
• use of ramps
• entering the building a different way or at a slightly different time to avoid crowds
• enabling regular movement breaks
• providing sensory circuits
• providing ear defenders
• use of a quiet space or sensory room
• changing lighting
• use of a fiddle toy
• use of a wobble cushion or a resistance band around the legs of the chair
• adaptations to uniform

Child's voice

Often, the person who knows best about what reasonable adjustments the child needs is the child! Involve children by asking them what helps them to learn best or providing them with options. Trial agreed strategies and then ask for the child’s feedback. Did the strategy help them? Did it not help? Does it need adapting in some way? It will not always be possible to provide exactly what the child feels is right for them but it is important for them to know why and what other options could be provided instead. For ideas on how to gather the child’s voice, please see the Virtual School Quick Guide to the Child’s Voice.

Further reading

• Equality Act 2010
• SEND Code of Practice 2015
• Reasonable Adjustments for Disabled Children - Equality and Human Rights Commission
• Disability: Equality Act 2010
• What are reasonable adjustments and how do they help disabled pupils at school? - The Education Hub (blog.gov.uk)
• Adjustments in Education (barnardossendiass.org.uk)
• What is meant by PACE? - DDP Network
• What Happened to You - Bruce Perry and Oprah Winfrey
• Know Me to Teach Me - Louise Bomber
• An Introduction to Emotion Coaching (gottman.com)

We all need breaks to help us to focus on tasks and prevent us from becoming overwhelmed by demands. It can be useful to build regular regulation breaks into a child or young person's day to support them to focus, control impulses and regulate emotions.

They can also be used when you spot the first signs of a child losing focus, becoming restless or dysregulated to prevent escalation.

You don’t need a lot of time or space! Many of these regulation breaks can be incorporated in the classroom or in the corridor. Some might be useful for the whole class to do, others for individual children who need them.

It can be helpful to think about a child's sensory regulation using a sensory ladder. Where is the child on the ladder? Do they need alerting or calming activities to return to calm and alert?

Example steps of a sensory ladder:

• shut down
• over-alert
• calm and alert
• under-alert
• sleep states

The activities that a child finds regulating (whether calming or alerting) will be individual to the child and to the situation, as will the frequency that they are required.

Observe the child carefully and keep a record of what times of day they begin to become restless or lose focus, or within which lessons, and pre-empt these with regulation breaks.

Observe which activities help the child to calm and which alert them. It is also useful to talk to the child about the sensory ladder and about which activities they find calming, which they find alerting, which they enjoy and which they do not. A menu of calming and alerting activities can then be produced, which is individual to the child.

Here are some examples of some possible regulation breaks:

• taking a note to the office / another class
• a walk / running on the spot / running to touch the wall and back
• a burst of fresh air
• carrying a stack of books / giving the books out in class
• squeezing stress balls / playdough / putty
• fidget toys
• fine motor activities e.g. threading, peg boards, finding beads in putty, ripping up paper
• using a resistance band around the legs of a chair to push their feet on
• chair pushes, wall push ups, palm pushes
• bouncing a ball
• bouncing on a mini trampoline / exercise ball
• throwing and catching
• crossing the mid-line e.g. right elbow to left knee
• moving arms in small circles and big circles
• massage
• weighted blankets, lap pads, shoulder wraps
• deep breathing
• stretches
• chewing, drinking through a straw or sports bottle

For children who have experienced trauma, Dr Bruce Perry recommends repetitive, rhythmic, relational (offered by a safe adult), relevant (linked to developmental age, not actual age), respectful and rewarding activities as he suggests that these calm the brainstem where fight / flight / freeze is activated.

Here are some examples of this type of activity:

• walking
• running
• jumping
• dancing
• tapping
• drumming
• singing
• deep breathing
• a sequence of yoga movements
• stroking a pet

Sensory Circuits can be useful to help children to feel calm and alert before school and after lunch. These involve a 10 to 15 minute sequence of two or three physical activities from each of the following areas:

• alerting - this section provides vestibular stimulation, where the head moves position rapidly e.g. bouncing on a trampete, bouncing on a space hopper, skipping, star jumps, bunny hops, hop scotch, spinning chairs, action rhymes e.g. row your boat, head, shoulders, knees and toes.
• organising - this section involves motor challenge, balance and timing e.g. balancing along a beam, throwing beanbags at a target, blowing a paper ball to a target, blowing bubbles, throwing and catching, balancing on a wobble board, a timed challenge to collect beanbags and putting them in a hoop, balancing on one leg, walking on stepping stones.
• calming - this section calms and provides proprioceptive input e.g. wall press ups, chair push ups, massage, rolling on or under an exercise ball, weighted blankets.

The Sensory Circuit aims to support children to regulate and organise their senses to achieve the optimum level of alertness required for effective learning. Sensory Circuits: A sensory motor skills programme for Children by Jane Horwood is a useful guide to use to set up a Sensory Circuit.

For more specialist support, a sensory assessment with an Occupational Therapist can be helpful to develop an individualised programme for a child or young person.

'Shame is an emotion that involves negative self-evaluation, believing that you haven’t lived up to perceived standards and feeling unworthy or inadequate as a result.

Shame is a normal human emotion. As infants we experience shame as a mechanism for keeping us safe and teaching us socially acceptable behaviours. The parent will tell the infant ‘no’; the infant will feel shame but will associate this with them being bad rather than the behaviour being bad. An attuned parent will notice this, comfort the child, repair the temporary break in the relationship and explain why a behaviour was dangerous or unacceptable. As the child develops, the child will begin to experience guilt related to behaviour, rather than shame related to their sense of self when something goes wrong, and attempt to repair breaks in relationships themselves.

Louise Bomber explains that in healthy attachment relationships, the use of shame is limited and the parent ensures that the child only feels short bursts of shame when there are issues around safety or social acceptability and then repairs the relationship. However, when shame is experienced for prolonged periods, or without attuned care to support us to overcome feelings of shame, it can lead to toxic shame, a constant feeling of inferiority, inadequacy and being unworthy of connection. This can impact on behaviour, self-esteem, relationships and learning.

Children in Care can be particularly vulnerable to persistent feelings of shame and toxic shame. Louise Bomber states that ‘for many children who have experienced trauma and loss, shame will be their constant companion’. Early experiences of abuse, neglect or rejection may lead them to believe that bad things have happened to them because they are a bad person and that they are inadequate, unlovable or unworthy of connection.'

Jo Loomes - Lead Practitioner for SEMH and Wellbeing

Toxic shame

If a child experiences shame occasionally, they are usually able to recover with an attuned caregiver repairing the temporary break in the relationship but if they are exposed to persistent experiences of shame or shame without repair this can lead to toxic shame: chronic feelings of being inadequate, unlovable and unworthy of connection and a negative self-concept. This is often a result of childhood abuse, neglect and other traumatic experiences.

Betsy de Thierry explains that these long-term feelings of not being good enough can limit confidence to take risks in learning and pollute relationships, because children can feel fearful about experiencing further shame and so withdraw, struggle with anxiety, fail to recognise controlling behaviours in relationships or display controlling behaviours themselves. Children can become preoccupied with the nagging possibility of shame and this can impact upon their behaviour.

Louise Bomber explains that for children who have experienced trauma and loss, our intentions can easily be misunderstood. When a child is told that they have made a mistake, they may interpret this as ‘you are bad’. Children can begin to hate themselves. They can sabotage relationships and situations because they believe that they are not worthy of them.

The Shield of Shame

Feelings of shame can be extremely painful and can trigger the fight, flight, freeze response. Children may shout or hit (fight), they may run or hide (flight) or they may look like a rabbit in headlights and be unable to respond (freeze). Children can subconsciously develop behaviour strategies to protect themselves from the painful feeling of shame. Kim Golding and Dan Hughes describe these strategies as The Shield of Shame.

Deny

“It wasn’t me, I didn’t do it!”
Children may lie about things that they have done to prevent others from sharing their negative self-perception that they are ‘bad’ and to avoid feelings of shame.

Blame

“He made me do it!”
Children may blame others to avoid feelings of shame. They may also project things that they hate about themselves onto others e.g. “you are horrible!”

Minimise

“It wasn’t that bad.”
Children may minimise their role in a situation or minimise the impact on another person. They may laugh awkwardly to brush it off.

Rage

“You always blame me!”
Children may become angry and react to situations in a way that seems irrational.

Perfectionism

This can also be a behaviour strategy developed to protect a child from feelings of shame. If you work hard to comply and please everybody then nobody will see the inadequacies that you perceive yourself to have. Children may do anything to avoid mistakes or failure. They may be reluctant to make decisions or to share an opinion for fear of rejection. This can be exhausting for the child and can prevent them from taking risks to develop themselves further due to a fear of failure, which may confirm their inadequacies in their mind.

How can we prevent or reduce feelings of shame in school

One of the most helpful things that we can do is build caring, attuned, empathic relationships with children and show that we value them. Daniel Hughes’ PACE model can be helpful in building relationships through playfulness, acceptance, curiosity and empathy and without shame (see Virtual School Quick Guide to PACE).

There are some practices that take place in some schools where shame is used on a regular basis. For example, being made to sit outside the Head teacher’s office, being told to stand up in assembly for talking or behaviour systems where the child’s name is moved to amber or red or from the sunshine to the cloud. These practices rely on shame as a quick way of making children comply. However, for children who are experiencing toxic shame, these practices can reinforce already strong feelings of inadequacy, worthlessness and that they are ‘bad’.

Approaches that focus on ‘connection before correction’ such as Bruce Perry’s Regulate-Relate-Reason (and with Louise Bomber’s fourth ‘R’, Repair) or John Gottman’s Emotion Coaching can be ways of responding to behaviour that do not evoke shame in a child, but support them to regulate and modify their behaviour within supportive relationships.

Reducing threat in all of our interactions can be helpful, using approaches such as PACE, Regulate-Relate-Reason-Repair and Emotion Coaching. It can also be helpful to use less threatening assessment for learning methods than direct questioning in front of the class e.g. answers on whiteboards and the teacher moving around the class to glance at whiteboards, talk partners with the teacher moving around the class to join in conversations.

Recognising and discussing feelings of shame in a non-judgemental, accepting and empathetic way may be helpful for some children. Betsy de Thierry gives the following example ‘I wonder if you feel bad inside and maybe so embarrassed that you wanted to hide or run away? When I feel that sometimes it can feel like it’s all useless and I’m stupid but actually it’s just because I feel confused inside about why I did something silly. But we all do things we don’t mean to don’t we?’

Louise Bomber advocates using ‘Parts Language’ for children who may be experiencing toxic shame. She explains that rather than being all good or all bad, each of us is a combination of parts. She recommends an attuned adult drawing the child’s attention to their different parts e.g. I saw you use your patient part just now waiting for the glue stick. You are using your swearing part right now, I’m wondering where your respectful part has gone, I know it’s there as I saw you use it with Mr Brown earlier.

Further reading

• Inside I’m Hurting - Louise Bomber
• The Simple Guide to Understanding Shame in Children - Betsy de Thierry
• Creating Loving Attachments - Kim Golding and Dan Hughes
• What Happened to You? - Bruce Perry and Oprah Winfrey
• What is Emotion Coaching? (emotioncoachinguk.com)

During a child’s school life, there will be many significant transitions, such as starting school, moving year group and moving school. These transitions can be particularly difficult for children who have experienced developmental trauma and attachment difficulties.

These transitions involve loss and uncertainty and inevitably cause an increase in anxiety. They can trigger powerful feelings of loss, abandonment and rejection unless managed in a careful way.

Below are some practical ideas for supportive transitions, taken from the work of Louise Bomber and good practice that we have seen within our schools.

The focus of these strategies is forming relationships, maintaining relationships and ending relationships in a supportive way, as we know that relationships are central to helping a child to feel safe and underpin all learning.

We understand that it may not be possible, or appropriate for every child, to implement all of these strategies but one or two extra ideas can sometimes make all the difference.

Joanna Loomes - Virtual School Lead Practitioner for SEMH and Wellbeing

Starting School

• suggest that the parent or carer walks or drives past the school frequently with the child before they start and talks about the school.
• enable visits to the school, with the parent or carer, at quiet times and at busy times, look at all areas that the child will use when in school.
• arrange for the child to meet the teacher and key adult with their parent or carer and look at the classroom together.
• encourage the child to use the toilet in school when the parent or carer is there, checking that the child can lock and unlock doors and manage the taps.
• develop a social story with photographs of key members of staff and key areas in school e.g. classroom, lunch hall, toilets, playground, pegs so that the parent or carer can re-read this with the child regularly prior to starting.
• provide a one page profile about the teacher and the key adult, for the child to look at over the Summer holidays.
• develop a series of transition activities where the child will visit the school with their peers for short amounts of time, building up to longer periods e.g. stay and play with parents and carers, stay and play without parents and carers, transition morning.

Moving to a New Year Group within Primary School

• where possible, the key adult in the child's team moving to the next year group with the child is ideal.
• explain to the child what will be happening in plenty of time e.g. in June.
• mark the ending and say goodbye with an activity such as sharing a cake with the class and discussing your memories together as a class, sharing things that you have all got better at during the year etc.
• if applicable, explain that you are saying goodbye but that the child will still see you around school from time to time and that you will think of them, even when you are not together every day.
• give the child a visual image of their current teacher and key adult, such as a class photograph or photo of the three of them together.
• introduce the new teacher and / or key adult with a one page profile with information about them. Encourage the parent or carer to re-read this regularly with the child over the Summer break.
• develop a social story with photographs of key members of staff and key areas of the school that the child will be using e.g. classroom, lunch, hall, toilets. Some of these areas may be familiar to the child but some may be new. Encourage the parent or carer to re-read this regularly with the child over the summer break.
• enable the child to meet their new teacher with their key adult or parent or carer, without other children at first.
• encourage the new teacher to ask the child about themselves e.g. likes, dislikes, where they like to sit, how they like to be supported. It may be useful to write a one page profile for the child together.
• provide a note from the new teacher and key adult e.g. I am looking forward to working with you in September. Enjoy the Summer break. I will be here to meet you on your first day at school. Take care until I see you.
• provide the child with a calendar to count down the days until they start in their new class.
• ensure that a thorough hand over happens between the current and new teacher and / or key adult, discussing strategies that work, those that don't, triggers etc.
• include the new teacher and / or key adult to the child's Summer Term PEP.

Moving to a New School

• prepare the child for what will be happening in more time than if moving from year group to year group within the same school e.g. May.
• mark the ending and say goodbye (as described in the previous section).
• create a memory book with the child about their time at the current school with contents such as photos of them with key staff in school, photos of significant places in school, comments written by staff, successes (photos, pieces of work etc), a list of areas they’d like to get better at, best memories, favourite activities, a time line of their time in the school. This can be created over a period of several weeks. Encourage the child to make choices about what they’d like in the book.
• ensure that a thorough hand over meeting happens between staff at the current school and the new school and let the child know that this is happening. Ask them if there's anything in particular that they'd like the new school to know and invite them to part of the meeting, if they would like to attend. Share key documents and dates of reviews, involvement with professionals etc. Share strategies that work, those that don't and any triggers. Try to incorporate familiar strategies that work well at the new school, where possible.
• include the new Designated Teacher and key adult to the child's Summer Term PEP (this may be incorporated with the meeting in the previous point), it can also be useful for the current school to then attend the Autumn Term PEP at the new school to ensure a smooth transition and answer any queries.
• look at maps of the new school and the prospectus or website together.
• arrange visits to the new school, with the key adult and ensure that the child meets adults that will be within their team and sees all key areas that they will use. Some children will prefer this to be in school time, other's will prefer it to be before or after school. Discuss this with the child.
• write a list of questions together about the new school and discuss these with a staff member or pupil during one of the visits.
• at the end of each visit to the school help the child to find their way back to a secure base that they can go to if they feel overwhelmed or need support. Explain to the child that this is where they will find members of their team.
• decide who will be in the child's team and who their key adult will be in advance and provide the child with one page profiles for all adults who will be within their team. Create a one page profile about the child together for them to share with their team.
• for some children it may be useful to visit the new school for lunch with the key adult and a peer, as unstructured times can sometimes be a source of anxiety.
• encourage the parent or carer to practise the journey to the new school with the child.
• if possible, encourage the new key adult to visit the child at their current school to get to know them.
• encourage the child to take something of theirs e.g. a piece of art work to give to the new key adult on one of the visits. The new key adult should put this up somewhere e.g. on their notice board and let the child know that it will remind them of the child coming in September when they look at it.
• encourage the new school to give the child a note or postcard to say they are looking forward to seeing them in September.
• the teacher and key adult in the current school should let the child know that they will think of them often and how they are getting on at their new school and give them a card wishing them all the best.
• meet and greet the child with a member of their team when they start.
• provide the child with a timetable with the names of staff and rooms that they will be in as early as possible.
• timetable regular check in slots to build the relationship with the key adult, allow time for moments of fun together.
• think about after-care, sometimes a child can benefit from their key adult visiting them in September or October to show that they still think of them.

Moving to a New Year Group within Secondary School

• provide the young person with one page profiles for any new adults that they will be working with.
• where possible, the key adult and as many adults in the team as possible should remain the same.
• ensure that the child is informed of any changes. Ensure that all staff working with the young person are aware and reminded of their needs, strategies that work, those that don't and any triggers. Update the young person's one page profile and share with staff.
• provide the young person with a timetable with the names of staff and rooms that they will be in as early as possible.
• timetable times for check ins with the key adult.
• remind the young person of who their team is and who they can go to if they feel overwhelmed or need support.

Moving on to Further Education

• invite ex-pupils back to talk about their experiences at college and to answer questions.
• build an honest and accurate picture of what college will be like in the first couple of weeks.
• build an honest and accurate picture of what college will expect of a young person and how this differs from school.
• facilitate group sessions to talk about what young people are looking forward to and any concerns they may have and discuss these.
• normalise the range of feelings that young people may feel in the first weeks at college.
• help young people to build resilience by reminding them of the success of difficult transitions in the past and the coping strategies they used then.
• any small anxieties about college when a young person leaves school, will invariably have grown when they are thinking about attending or going to enrol. Consider the strategies you can equip them with that will ameliorate these anxieties.
• consider who can support a young person to practise the trip to college. Start with support, end without support. What’s the best form of travel, bike, bus, walk etc? Not just for ease but for anxiety reduction, we want them to arrive!
• enrolment, is a big deal and daunting, who can support a young person? Remember, even if a young person says they don’t want support, they will probably need it.
• it is important a young person knows who the college staff are who can support them, and what to do if these staff aren’t available (they are often busy and in demand).
• support young people in understanding the services that are there to support them at college and how they can access these e.g. student support services, student counsellors.  

'At the Virtual School, one of the primary strategies that we recommend to support Children in Care is Louise Bomber’s Key Adult approach. This quick guide is a brief overview of the approach; we would recommend that any staff taking on the Key Adult role read Louise Bomber’s Inside I’m Hurting for an in depth explanation of the approach.

The aim of the Key Adult is to provide an additional attachment figure in school for children with attachment related difficulties (see Virtual School Quick Guide to Attachment for more information about attachment difficulties). Through a trusting and genuine relationship with the Key Adult, the hope is that children learn that adults can be trusted and can help to meet their needs. Louise Bomber states that ‘in the presence of a ’good enough’ other...new and more sophisticated neural pathways can be formed in the child’s developing brain, and new patterns of relating and behaving can emerge’. Karen Treisman agrees, stating that ‘relational trauma requires relational repair’ and Bruce Perry goes on to explain that ‘the more healthy relationships a child has, the more likely he will be to recover from trauma and thrive.

Relationships are the agents of change and the most powerful therapy is human love’. The Key Adult aims to provide this ‘good enough’ other relationship within school to support the child to heal from the trauma that they may have experienced.'

Jo Loomes - Lead Practitioner for SEMH and Wellbeing

The role of the Key Adult

The primary role of the Key Adult is to build a genuine, trusting relationship with the child, to support them to feel safe and accepted and to support regulation. When a child feels safe and supported they are less likely to experience fight, flight or freeze responses as often and more able to regulate, with support, when they do experience dysregulation.

One of the building blocks for a strong relationship is trust. It is important for the Key Adult to show that they are trustworthy and do what they say they will do. It is essential that they respond in a consistent way. If there is ever a time where they cannot do what they said they will do it is important for them to be open and honest with the child, explain that they made a mistake and explain what will happen instead. Visual schedules and social stories can support in this area.

Another building block for a strong relationship is connection. It is helpful for the Key Adult to learn about the child and their interests and incorporate their interests into the activities that they do together. Learning about the child’s interests can also help the Key Adult to demonstrate that they hold the child in mind when they are not together e.g. I thought of you when I saw the Chelsea score last night; I thought I bet Bob is happy tonight! It can also be helpful for the Key Adult to share appropriate parts of themselves e.g. stories about their pets or hobbies.

Dan Hughes’ PACE approach can be very helpful when building relationships through playfulness, acceptance, curiosity and empathy (see the Virtual School Quick Guide to PACE). Responding to a child in a PACEful way can reduce threat in interactions, preventing fight, flight or freeze, and support a child to feel accepted and understood.

Bruce Perry’s Regulate - Relate - Reason approach, with Louise Bomber’s additional ‘R’: repair, can be very helpful in supporting the Key Adult in understanding how to respond when dysregulation does occur (see the Virtual School Quick Guide to Regulate - Relate - Reason). It is important for the Key Adult or adult that the child knows well to respond during times of dysregulation, as the child requires attuned care that can only be found within a trusting relationship.

Will introducing a Key Adult make a child dependent on the adult

Louise Bomber advocates that children need to experience relative dependency before they can become independent and that this is a stage of development that some of our children in care have missed due to their Adverse Childhood Experiences. The Key Adult should respond to a child according to their developmental age, rather than their chronological age, and this may mean responding in a way that an adult might respond to a younger child: maintaining close proximity, using exaggerated facial expressions and using lots of repetition. Louise Bomber advocates that building dependency should not be frowned upon in schools; children are supposed to be dependent on adults and many children in care have had to depend on themselves far too early. It is important for children to experience relative dependency as a stage in development for them to then build true independence.

Who should take the role of the Key Adult

The Key Adult should be somebody who has time to spend with the child on a one to one basis and who is available to respond when the child requires support e.g. a teaching assistant, inclusion mentor or pastoral staff. The amount of time that is required will depend on the child’s needs, some children may need a 10 minute check in every day, whereas others may need full time support.

The Key Adult should be somebody experienced in relating to children with social, emotional and mental health difficulties and who has the resilience to not take rejections personally. They should be somebody who is able to balance nurture and structure, who is empathic, consistent, calm and genuine. Being flexible, imaginative, resourceful and having a good sense of humour are also important attributes!

It is important that the Key Adult is somebody who is likely to be available in school long term e.g. not on a temporary contract or planning to leave shortly.

In secondary school, it can be useful for the child to have some input into who their Key Adult may be.

Team Child

Louise Bomber recommends that the Key Adult operates within Team Child, a team of adults who are all involved with the child, but to a lesser degree than the Key Adult e.g. class teacher and form tutor, Designated Teacher for LAC, SENCO. All of Team Child should be aware of the child’s needs, strategies that are working well and those that should be avoided. Team Child should meet regularly to share successes, discuss areas of difficulty and problem solve together.

Team Child may also include a back-up adult, who also builds a relationship with the child, this can be useful if the Key Adult is unavailable for any reason e.g. they are unwell or on training.

Supporting the Key Adult

Being a Key Adult can be an emotionally demanding role. Often, children with attachment related difficulties will push adults away and reject them before they are rejected themselves. Key Adults may also experience secondary trauma when supporting a child who has experienced trauma. It is important to support the Key Adult through regular supervision with either a trained member of staff or an outside professional. The Key Adult should also be able to lean on members of Team Child for support and advice.

Further reading

• Louise Bomber - Inside I’m Hurting
• Bruce Perry - The Boy Who Was Raised as a Dog: And Other Stories from a child Psychiatrist’s Notebook
• Bruce Perry and Oprah Winfrey - What Happened to You?
• Karen Treisman - A Therapeutic Treasure Box for Working with Children and Adolescents with Developmental Trauma: Creative Techniques and Activities