Introduction

NICE (the National Institute for Health and Clinical Excellence) produces public health guidance for England, aimed at promoting good health and preventing ill-health. The guidance is informed by available evidence on the effectiveness and cost-effectiveness of programmes or interventions, using a highly developed and rigorous process. Account is also taken of stakeholders’ views and fieldwork. NHS Health Scotland produces ‘Scottish Perspectives’ on such guidance to enable the action recommendations, adapted or amended if considered appropriate, to be used to support the development and implementation of policy and practice in Scotland. Details of, and electronic links to, relevant Scottish policies, strategies and action plans are provided. The Scottish Perspectives do not constitute formal guidance.

This is the Scottish Perspective on NICE Public Health Intervention Guidance 20 (published in September 2009), which has six numbered action recommendations with the following headings: Strategic framework; Key principles and conditions; Curriculum approaches; Working with parents and families; Working in partnership with young people; and Training and continuing professional development. Each recommendation has a number of action points. NHS Health Scotland has considered the NICE recommendations in a Scottish context and has adopted them for Scotland, with some small additions or other amendments.

A summary of the recommendations for Scotland is presented on page 2, with electronic links to the full recommendations. The full recommendations for Scotland, with any NHS Health Scotland additions or amendments in italics, are set out on pages 3 to 8, colour-coded to match the summary overview. Notes for implementing the recommendations for Scotland are provided on pages 9 to 16.

The original NICE recommendations, and the evidence statements that informed them, can be found in the guidance, at www.nice.org.uk/ph20. The guidance also identifies gaps in the evidence and makes recommendations for research.

Scottish Perspective on NICE public health guidance 20:

Promoting young people’s social and emotional wellbeing in secondary education

February 2010

Summary of the recommendations for Scotland

Recommendation 1 – Strategic framework Enable/help secondary education establishments to:

- adopt an organisation-wide approach to promoting social and emotional wellbeing, with the necessary organisational capacity

- share practical advice- have access to specialist skills, advice and support.

Encourage local authority assessment of progress. Have policies and arrangements to promote the social and emotional wellbeing of

those who work with young people in secondary education.

Recommendation 2 – Key principles and conditions Demonstrate commitment, and ensure social and emotional wellbeing features in

improvement plans, policies, systems and activities. Foster an ethos that promotes mutual respect, learning and successful

relationships, and a culture of inclusiveness and communication. Provide a safe, nurturing and encouraging environment. Systematically measure and assess young people’s social and emotional

wellbeing, and use the findings to plan activities and evaluate their impact. Ensure access to pastoral care and support, and specialist services.

Recommendation 3 – Curriculum approaches Provide a curriculum that promotes positive behaviours and successful

relationships, and helps reduce disruptive behaviour and bullying. Tailor social and emotional skills education to the developmental needs of young

people, building on learning in primary education. Integrate relevant activities into all aspects of secondary education.

Recommendation 4 – Working with parents and families Work in partnership with parents, carers and other family members to promote

young people’s social and emotional wellbeing. Help parents, carers and other family members to develop their parenting skills. Ensure parents, carers and other family members living in disadvantaged

circumstances are given the support they need to participate fully.

Recommendation 5 – Working in partnership with young people Develop partnerships between young people and staff, and have various

mechanisms to ensure that young people can contribute to decisions that may impact on their social and emotional wellbeing.

Provide young people with opportunities to build relationships, particularly those who may find it difficult to seek support when they need it.

Provide young people with information on opportunities for discussing personal and emotional issues, and on their rights on confidentiality.

Involve young people in the creation, delivery and evaluation of training and continuing professional development.

Recommendation 6 – Training and continuing professional development Integrate social and emotional wellbeing within the training and continuing

professional development of practitioners and relevant others involved in secondary education.

Ensure practitioners have the knowledge, understanding and skills they need to develop young people’s social and emotional wellbeing.

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The recommendations for Scotland in full

Recommendation 1 – Strategic framework

Target population Practitioners working with young people in secondary education.

Who should take action?(subject to adaptation to fit Scottish organisational arrangements, etc.) Commissioners and providers of services to young people in secondary

education, including those working in: - children’s trusts - local authorities (in particular, children’s services)- schools and other secondary education establishments- primary care trusts (PCTs)- child and adolescent mental health services- voluntary agencies.

Governors.

What action should they take?(subject to adaptation to fit Scottish arrangements, etc.) Enable all secondary education establishments to adopt an organisation-

wide approach to promoting the social and emotional wellbeing of young people. This should encompass organisation and management issues as well as the curriculum and extra-curriculum provision. The approach should form part of the local children and young people’s plan and joint commissioning. It should also be linked to the local Single Outcome Agreement where appropriate, and to Getting it right for every child (GIRFEC – see www.scotland.gov.uk/Topics/People/Young-People/childrensservices/girfec). It should also contribute towards implementation of the Schools (Health Promotion and Nutrition) (Scotland) Act 2007, and Curriculum for Excellence.

Encourage the appropriate local scrutiny committee to assess the progress made by secondary education establishments in adopting an organisation-wide approach to social and emotional wellbeing.

Help secondary education establishments to develop the necessary organisational capacity to promote social and emotional wellbeing. This includes leadership and management arrangements, specialist skills and resources.

Help secondary education establishments to share practical advice on how to promote the social and emotional wellbeing of young people.

Ensure secondary education establishments have access to the specialist skills, advice and support they require. This may be provided by public, private, voluntary and community organisations. It may involve working with local authority advisory services, personal, social, health and economic education services, educational psychology and child and adolescent mental health services.

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Ensure policies and arrangements are in place to promote the social and emotional wellbeing of those who work with young people in secondary education.

Recommendation 2 – Key principles and conditions

Target population Young people in secondary education, their parents and carers.

Who should take action?(subject to adaptation to fit Scottish organisational arrangements, etc.) Head teachers, governors, teachers, support staff and other practitioners

working with young people in secondary education. Those working in (and with) education, children’s and youth services

(including healthy schools teams) within local authorities, primary care (including school nurses), child and adolescent mental health services and voluntary agencies.

What action should they take?(subject to adaptation to fit Scottish organisational arrangements, etc.) Head teachers, governors and teachers should demonstrate a

commitment to the social and emotional wellbeing of young people. They should provide leadership in this area by ensuring social and emotional wellbeing features within improvement plans, policies, systems and activities. These should all be monitored and evaluated.

Foster an ethos that promotes mutual respect, learning and successful relationships among young people and staff. Create a culture of inclusiveness and communication that ensures all young people’s concerns can be addressed (including the concerns of those who may be at particular risk of poor mental health).

Provide a safe environment, which nurtures and encourages young people’s sense of self-worth and self-efficacy, reduces the threat of bullying and violence and promotes positive behaviours.

Systematically measure and assess young people’s social and emotional wellbeing. Use the outcomes as the basis for planning activities and evaluating their impact.

Ensure young people have access to pastoral care and support, as well as specialist services, so that emotional, social and behavioural problems can be dealt with as soon as they occur. (Specialist services include child and adolescent mental health services.)

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Recommendation 3 – Curriculum approaches

Target population Young people in secondary education, their parents and carers.

Who should take action?(subject to adaptation to fit Scottish organisational arrangements, etc.) Head teachers, governors, teachers, support staff and other practitioners

working with young people in secondary education. Those working in (and with) education and children’s and youth services

(including healthy schools teams) within local authorities, primary care (including school nurses), child and adolescent mental health services and voluntary agencies.

What action should they take? Provide a curriculum that promotes positive behaviours and successful

relationships and helps reduce disruptive behaviour and bullying. This can be achieved by integrating social and emotional skills development within all areas of the curriculum. Skills that should be developed include: motivation, self-awareness, problem-solving, conflict management and resolution, collaborative working, how to understand and manage feelings, and how to manage relationships with parents, carers and peers.

Tailor social and emotional skills education to the developmental needs of young people. The curriculum should build on learning in primary education and be sustained throughout their education.

Reinforce curriculum learning on social and emotional skills and wellbeing by integrating relevant activities into all aspects of secondary education. For example, such skills might be developed through extra-curricular activities, using projects set for homework or via community-based and individual voluntary work.

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Recommendation 4 – Working with parents and families

Target population Parents, carers and other members of the family of young people in

secondary education.

Who should take action?(subject to adaptation to fit Scottish organisational arrangements, etc.) Head teachers, governors, teachers, support staff and other practitioners

working with young people in secondary education. Those working in (and with) education and children’s and youth services

(including healthy schools teams) within local authorities, primary care (including school nurses), child and adolescent mental health services and voluntary agencies.

What action should they take? Work in partnership with parents, carers and other family members to

promote young people’s social and emotional wellbeing. To help reinforce young people’s learning from the curriculum, help

parents and carers develop their parenting skills. This may involve providing information or offering small, group-based programmes run by appropriately trained health or education practitioners.

Ensure parents, carers and other family members living in disadvantaged circumstances are given the support they need to participate fully in activities to promote social and emotional wellbeing. This should include support to participate fully in any parenting sessions (for example, by offering a range of times for the sessions or providing help with transport and childcare). This might involve liaison with family support agencies.

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Recommendation 5 – Working in partnership with young people

Target population Young people in secondary education, their parents and carers.

Who should take action?(subject to adaptation to fit Scottish organisational arrangements, etc.) Head teachers, governors, teachers, support staff and other practitioners

working with young people in secondary education. Those working in (and with) education and children’s and youth services

(including healthy schools teams) within local authorities, primary care (including school nurses), child and adolescent mental health services and voluntary agencies.

What action should they take? Develop partnerships between young people and staff to formulate,

implement and evaluate organisation-wide approaches to promoting social and emotional wellbeing.

Introduce a variety of mechanisms to ensure all young people have the opportunity to contribute to decisions that may impact on their social and emotional wellbeing.

Provide young people with opportunities to build relationships, particularly those who may find it difficult to seek support when they need it. This could involve developing a peer education or peer mediation approach. Note, young people who act as peer supporters need training and the support of staff and other professionals.

Provide young people with clear and consistent information about the opportunities available for them to discuss personal issues and emotional concerns. Any support offered should take account of local community and education policies and protocols regarding confidentiality. Make young people aware of their rights on confidentiality.

Involve young people in the creation, delivery and evaluation of training and continuing professional development activities in relation to social and emotional wellbeing.

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Recommendation 6 – Training and continuing professional development

Target population(subject to adaptation to fit Scottish organisational arrangements, etc.) Practitioners working with young people in secondary education. Governors.

Who should take action?(subject to adaptation to fit Scottish organisational arrangements, etc.) Those working in (and with) education, children’s and youth services

(including healthy schools teams) within local authorities, primary care (including school nurses), child and adolescent mental health services and voluntary agencies.

Head teachers in secondary education. Organisations concerned with the training and continuing professional

development of those working in secondary education.

What action should they take? Integrate social and emotional wellbeing within the training and continuing

professional development of practitioners and relevant others involved in secondary education.

Ensure practitioners have the knowledge, understanding and skills they need to develop young people’s social and emotional wellbeing. Training may cover:- listening and facilitating skills and the ability to be non-judgemental- how to manage behaviours effectively, based on an understanding of

the underlying issues - identifying and responding to the needs of young people who may be

experiencing emotional and behavioural difficulties- how to access pastoral care based in secondary education or specialist

services provided by other agencies, such as child and adolescent mental health services

- the issues in relation to different medical conditions (such as diabetes, asthma and epilepsy) to ensure young people with these conditions are not bullied, inappropriately excluded from school activities or experience any undue emotional distress

- opportunities to reflect upon and develop their own social and emotional skills and awareness.

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Notes for implementing the recommendations for Scotland

This section is intended to help organisations and individuals to implement the recommended actions for Scotland. It gives important background information from NICE public health guidance 20, including: intended users; how the guidance was developed; and considerations taken into account in considering the reviewed evidence and devising the recommendations – including equality and diversity considerations. It also pulls together Scottish information from various sources, provides a brief overview of relevant aspects of key policies, strategies and action plans, and offers direct electronic links for ease of access to such resources.

General notes

1. For the purposes of NICE public health guidance 20, the term ‘secondary education’ refers not just to secondary schools but to ‘all education establishments for young people aged 11–19, including further education colleges, technology colleges, academies and private sector establishments’.

2. The guidance defines 'social and emotional wellbeing' as encompassing: happiness, confidence and not feeling depressed (emotional wellbeing) a feeling of autonomy and control over one’s life, problem-solving skills,

resilience, attentiveness and a sense of involvement with others (psychological wellbeing)

the ability to have good relationships with others and to avoid disruptive behaviour, delinquency, violence or bullying (social wellbeing).

Different, but related, terms are used in various policies, strategies and activities in Scotland. For example, Curriculum for Excellence refers to mental, emotional and social (as well as physical) wellbeing (see also Scottish contextual point 7, below); and in the work on children and young people’s mental health indicators, led by NHS Health Scotland (see Scottish contextual point 10, below), the term mental wellbeing is used.

3. NICE public health guidance 20 is intended for those who have a direct or indirect role in, and responsibility for, the social and emotional wellbeing of young people in secondary education. These include teachers and other school staff, and professionals with public health as part of their remit, working in education (including the independent sector), local authorities, the NHS and the wider public, voluntary and community sectors. This Scottish Perspective is intended for such individuals, agencies and sectors in Scotland. Like the guidance, it may also be of interest to parents of young people in secondary education, young people themselves and other members of the public.

4. The guidance states that young people’s social and emotional wellbeing is important in its own right and also because it affects their physical health (both as young people and in adulthood). It goes on to say that good social, emotional and psychological health helps protect young people

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against emotional and behavioural problems, violence and crime, teenage pregnancy, and the misuse of drugs and alcohol; and can help them to learn and achieve academically, thus affecting long-term social and economic wellbeing.

5. The guidance points out that young people’s social and emotional wellbeing is influenced by a range of factors, from their individual make-up and family background to the community within which they live, and society at large. Therefore, activities in secondary education to develop and protect young people’s social and emotional wellbeing can only form one element of a broader, multiagency strategy.

6. NICE public health guidance 20 was developed using the NICE process for public health intervention guidance. In developing the recommendations set out in it, NICE’s Public Health Interventions Advisory Committee (PHIAC) considered a commissioned review of effectiveness evidence, an economic analysis (comprising a review of economic evaluations, and a cost-effectiveness analysis), additional evidence, expert advice, stakeholder comments, and fieldwork.

7. The guidance identifies a number of important gaps in the evidence relating to the interventions under examination, including: a lack of UK evidence on the short- and long-term effectiveness of using organisation-wide interventions to promote the social and emotional wellbeing of young people (see also Equality and diversity considerations 6 and 7, below); and a lack of UK evidence to judge whether or not interventions aiming to promote social and emotional wellbeing and reduce problem behaviours in secondary education have any unintended (including negative) effects. Despite the limitations of the evidence, however, PHIAC considered that a number of principles of good practice had been established in progressive secondary education establishments, with strong leadership and good management and organisation appearing to be prerequisites for successful interventions.

8. The guidance is intended to be implemented in a way that recognises local circumstances. It focuses on universal interventions used as part of an organisation-wide approach (that is, interventions that can be used to support all young people). Targeted approaches are outside the scope of the guidance. In addition, it does not consider: the effectiveness of interventions in relation to educational attainment; interventions that address the relationship between social and emotional wellbeing and factors such as physical activity levels and nutrition; or clinical interventions for established mental illness.

9. NICE points out that prevention of abuse is not the primary focus of the document, but states that, since neglect and abuse can lead to mental health problems, the guidance must be used in conjunction with local child protection policies and other procedures to safeguard young people.

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10. It is stated in the document that NICE guidance can help ‘local NHS organisations, local authorities and other public sector partners benefit from any identified cost savings, disinvestment opportunities or opportunities for re-directing resources’. A costing statement in support of implementing NICE public health guidance 20 is available at www.nice.org.uk/nicemedia/pdf/PH20CostingStatement.pdf

11.NICE public health guidance 20 complements, but does not replace, the earlier NICE public health guidance on: social and emotional wellbeing in primary education (number 12); promoting physical activity for children and young people (17); school-based interventions on alcohol (7); and reducing substance misuse among vulnerable young people (4). Similarly, this Scottish Perspective should be used in conjunction with the previous NHS Health Scotland ‘Commentaries’ on these pieces of public health guidance. In addition, the Commentaries on the NICE public health guidance on behaviour change at population, community and individual levels (6) and on community engagement (9) are of relevance to this Scottish Perspective. All of these Commentaries are available at www.healthscotland.com/scotlands-health/evidence/NICE.aspx

Equality and diversity considerations

1. NICE points out that implementation of the guidance is the responsibility of local commissioners and/or providers. It reminds commissioners and providers that it is their responsibility to implement the guidance, in their local context, in light of their duties to avoid unlawful discrimination and to have regard to promoting equality of opportunity. It emphasises that nothing in the guidance should be interpreted in a way that would be inconsistent with compliance with those duties. These points also apply when acting on this Scottish Perspective.

2. NICE public health guidance 20 indicates that children and young people who are exposed to difficult situations such as bullying or racism, or who are coping with socially disadvantaged circumstances, are at higher risk of experiencing emotional and behavioural difficulties. It states that such children and young people may include: looked after children those who have experienced adverse life events (such as bereavement

or parental separation) those who have been exposed to abuse or violence those with chronic health problems (such as diabetes and asthma) and

disabilities.

3. PHIAC took account of the fact that secondary education establishments have a clear role to play in promoting social and emotional wellbeing within a broader national strategy. The guidance states that other elements of this strategy will include, for example, the development of policies and partnerships to improve the social and economic circumstances of young people living in disadvantaged circumstances.

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4. When developing the recommendations, PHIAC adopted an holistic approach to promoting social and emotional wellbeing within secondary education establishments. Such an approach emphasises the importance of a supportive and secure environment; promotes an ethos that avoids stigma and discrimination in relation to mental health and social and emotional difficulties; and supports students who have additional support needs, including those who have long-term health conditions and disabilities.

5. An action point in Recommendation 2 for Scotland refers to creating a culture of inclusiveness and communication that ensures all young people’s concerns can be addressed – including the concerns of those who may be at particular risk of poor mental health (see also Equality and diversity consideration 2, above). Recommendation 4 includes an action point relating specifically to parents, carers and other family members living in disadvantaged circumstances. Recommendation 6 includes reference to young people with medical conditions such as diabetes, asthma and epilepsy.

6. As indicated in General note 8 (above), NICE public health guidance 20 focuses on universal interventions. It can reasonably be deduced from the important evidence gaps cited in General note 7 that there is a lack of UK evidence on differences in effectiveness of such interventions in relation to the various equality and diversity strands (see Equality and diversity consideration 7, below).

7. Not least given the existence of such gaps in evidence, it is suggested that care should be taken when acting on this Scottish Perspective to:a) minimise the risk of widening health inequalities relating to age,

disability, gender (including transgender), language, marital status, race/ethnicity, religion or belief, sexual orientation, or social origin/socioeconomic factors

b) maximise the potential to reduce such inequalities.

Scottish contextual points

1. This Scottish Perspective is of relevance to a number of the National Outcomes set out by the Scottish Government in the National Performance Framework, and to the following National Indicators (see www.scotland.gov.uk/About/scotPerforms): Increase the proportion of schools receiving positive inspection reports. Increase the proportion of schools leavers (from Scottish publicly

funded schools) in positive and sustained destinations (FE, HE, employment or training).

2. Towards a Mentally Flourishing Scotland: Policy and Action Plan 2009-2011 (TAMFS) (Scottish Government 2009 – www.scotland.gov.uk/Publications/2009/05/06154655/0) identified mentally healthy infants, children and young people as a strategic priority, and set out five Commitments in that regard (see also Scottish contextual

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point 10, below). This Scottish Perspective is a contribution to delivering on TAMFS Commitment 3: ‘There are many effective interventions for mental health improvement among infants, children and young people; however, many of these are not in general use. NHS Health Scotland will initiate a programme in 2009 to disseminate the evidence base for mental health improvement and support its use through practitioner briefings and narratives to present the case to decision makers and planners.’ TAMFS referred to the Scottish Government’s continuing to implement The Mental Health of Children and Young People: A Framework for Promotion, Prevention and Care (see Scottish contextual point 5, below). It identified school education as a basis for lifelong learning, and stated that mental health problems can significantly disrupt the educational and emotional development and physical health of students. TAMFS indicated that Learning and Teaching Scotland would host a Mental and Emotional Wellbeing post to facilitate mental health improvement in schools. It also acknowledged the role of the Scottish Further Education Unit (now Scotland’s Colleges) in supporting mental health improvement. Scotland’s Colleges has been proactive in rolling out Scotland’s Mental Health First Aid training to college staff and developing an online resource that provides information on supporting student mental health and wellbeing (see www.ssmh.ac.uk).

3. Equally Well: Report of the Ministerial Task Force on Health Inequalities (Scottish Government, 2008 –www.scotland.gov.uk/Publications/2008/06/25104032/0) identified improving mental wellbeing as a priority, and its recommendations included the following to which this Scottish Perspective may be of practical relevance or vice versa: Recommendation 11: Curriculum for Excellence should take a holistic

approach to health and wellbeing outcomes, including active and healthy lifestyles, supported by the new school health team approach. It was indicated that this should cover learning in mental, emotional, social and physical health to promote resilience, confident, independent thinking, and positive attitudes.

Recommendation 15: Each NHS Board should assess the physical, mental and emotional health needs of looked after children and young people and act on these assessments, with local partner agencies. A similar expectation was expressed in Action 15 of the Looked After Children and Young People: We Can and Must Do Better Ministerial working group report (Scottish Executive 2007 – www.scotland.gov.uk/Publications/2007/01/15084446/0). The Scottish Government’s CEL 16 (2009) (www.sehd.scot.nhs.uk/mels/CEL2009_16.pdf) requested NHS Board Chief Executives to implement the recommendations arising from that report, including a requirement to ensure that a mental health assessment is offered to every looked after child or young person.

4. Better Health, Better Care: Action Plan (Scottish Government, 2007 – www.scotland.gov.uk/Publications/2007/12/11103453/0) gave a commitment to increase healthcare support for schools and

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teachers, starting in those areas with the highest concentrations of vulnerable children. The Scottish Government’s Health and Wellbeing in Schools Project reflects that commitment (see www.scotland.gov.uk/Topics/Education/Schools/HLivi/health-care/aims).

5. Some of the recommendations for Scotland in this Scottish Perspective are of relevance to actions identified in The Mental Health of Children and Young People: A Framework for Promotion, Prevention and Care (Scottish Executive, 2005), developed to assist agencies in planning and delivering integrated approaches to children and young people's mental health across the continuum of promotion, prevention and care. It is intended for everyone who has a responsibility for children and young people, and for professionals working in adult services, who have a responsibility to consider the needs of clients’ children (see www.scotland.gov.uk/Publications/2005/10/2191333/13337).

6. Legislative drivers relevant to implementing this Scottish Perspective include: Schools (Health Promotion and Nutrition) (Scotland) Act 2007 (for

guidance see www.scotland.gov.uk/Publications/2008/05/08160456/0) Education (Additional Support for Learning) (Scotland) Act 2004 (for

implementation support see www.scotland.gov.uk/Publications/2007/02/27143228/0)

Scottish Schools (Parental Involvement) Act 2006 (for guidance see www.scotland.gov.uk/Publications/2006/09/08094112/0).

7. Curriculum for Excellence (www.ltscotland.org.uk/curriculumforexcellence/) aims to achieve a transformation in education in Scotland by providing a coherent, more flexible and enriched curriculum from ages 3 to 18. It expands the concept of the curriculum to include the ethos and life of the school as a community as well as curriculum areas and subjects, interdisciplinary learning, and opportunities for personal achievement. Curriculum for Excellence shifts the focus away from inputs towards experiences and outcomes, set out under eight curriculum areas. Within the health and wellbeing curriculum area there is a specified set of mental, emotional, social and physical wellbeing experiences and outcomes (see www.ltscotland.org.uk/curriculumforexcellence/healthandwellbeing/index.asp). Mental, emotional, social and physical wellbeing are viewed as inextricably interlinked and essential for successful learning. It is stated that the mental, emotional, social and physical wellbeing of everyone within a learning community should be positively developed by fostering a safe, caring, supportive, purposeful environment that enables the development of relationships based on mutual respect.

8. Getting it right for every child (GIRFEC – see www.scotland.gov.uk/gettingitright) has been established as the foundation for work in Scotland with all children and young people, and is also of relevance to practitioners in adult services who work with parents or carers. It is a fundamental, child-centred, way of working to improve outcomes for children and young people, and threads through all existing

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policy, practice, strategy and legislation affecting children, young people and their families. GIRFEC encourages practitioners to look at the child’s needs as a whole and identify where additional support can contribute to improving outcomes for the child. Many of its 10 core components are of relevance to this Scottish Perspective’s recommendations for Scotland –particularly in respect of the references to: a shared understanding of wellbeing; an integral role for children, young people and families in assessment, planning and interventions; high standards in co-operation, joint working and communication; maximising the skilled workforce within universal services to address needs and risks at the earliest opportunity; and a confident and competent workforce across all services for children. The wellbeing of children and young people is at the heart of GIRFEC. Eight ‘Well-being Indicators’ – healthy, achieving, nurtured, active, respected, responsible, included, and safe – are seen as the basic requirements for children and young people to grow, develop and reach their full potential.

9. Valuing Young People: Principles and connections to support young people achieve their potential (Scottish Government 2009 – www.scotland.gov.uk/Publications/2009/04/21153700/0) is intended as a practical resource for anyone making decisions that affect support given to young people, or anyone involved in delivering services to them. It draws on GIRFEC and a range of related policies, and sets out common principles agreed by partners. It also pulls together nine delivery ‘pillars’, including Curriculum for Excellence and youth-friendly health services.

10.NICE public health guidance 20 refers, in the context of England, to a lack of data to assess the positive dimensions of young people’s social and emotional wellbeing, with most available information emphasising measures of poor social and emotional wellbeing (e.g. prevalence of mental health problems, school exclusions associated with conduct disorders). Recommendation 2 for Scotland in this Scottish Perspective includes: ‘Systematically measure and assess young people’s social and emotional wellbeing. Use the outcomes as the basis for planning activities and evaluating their impact.’ TAMFS stated (as Commitment 4): ‘NHS Health Scotland will work with key stakeholders to develop a national set of indicators for children and young people’s mental wellbeing, mental health problems and related contextual factors by 2011’ (further information on that work can be found at www.healthscotland.com/scotlands-health/population/mental-health-indicators/children.aspx). Learning and Teaching Scotland (LTS) and partners are working together to consider the most appropriate framework for measuring progress against Curriculum for Excellence health and wellbeing outcomes at a local level.

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11.Resources of relevance to implementing recommendations for Scotland in this Scottish Perspective include: mental health link persons for schools, resulting from Commitment 10

in Delivering for Mental Health (Scottish Executive, 2006 – www.scotland.gov.uk/Publications/2006/11/30164829/0)

LTS’s 'Positive Behaviour' website (www.ltscotland.org.uk/positivebehaviour/about/index.asp)

the HandsOnScotland Toolkit (www.handsonscotland.co.uk), designed to help anyone working with children or young people to respond helpfully when a child or young person is troubled.

12.Partnership working is a central theme of this Scottish Perspective. HM Inspectorate of Education (HMIE) has published ‘Journey to Excellence’ professional development packs on various topics, including working with partners (see www.ltscotland.org.uk/journeytoexcellence/resourcesandcpd/cpdresources.asp).

13.Current Scottish activities of relevance to implementing this Scottish Perspective’s Recommendation 6 for Scotland (on training and continuous professional development) include the following: The Scottish Government’s Support for Learning Division is developing

materials to help secure the entitlement (set out in Curriculum for Excellence Building the Curriculum 3: A Framework for Learning and Teaching – www.scotland.gov.uk/Publications/2008/06/06104407/0) of each child and young person to support that will enable them to gain as much as possible from Curriculum for Excellence.

NHS Health Scotland is planning a mapping and review of the range of mental health awareness-raising training being delivered, which will include a focus on the education setting.

The Scottish Government’s Mental Health Delivery and Service Unit is working with NHS Education for Scotland (NES) to devise a three year training development plan for Child and Adolescent Mental Health Services (CAMHS) staff, and to refresh the widely-used New-To-CAMHS Teaching Package.

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Background to this Scottish Perspective

The National Institute for Health and Clinical Excellence (NICE) in England produces guidance on public health topics: public health intervention guidance (interventions being defined as involving single measures, for example GP advice to patients to be more active) and public health programme guidance (on broader activities, such as strategies for smoking cessation). In Scotland, such guidance has no formal status but attracts interest and is a valuable source of reviewed evidence and evidence-informed recommendations. As part of its role in promoting and supporting evidence-informed action for health improvement in Scotland, NHS Health Scotland produces Scottish Perspectives on NICE public health guidance where considered appropriate. These are intended to help relevant organisations, professionals and others make use of the guidance, adapted or amended as appropriate, in a Scottish context. The Scottish Perspectives do not themselves constitute formal guidance.

The NHS Health Scotland lead officers for this Scottish Perspective were Ms Debbie Sigerson, Public Health Adviser (Evidence for Action – Young People & Local Government), and Dr Joanna Teuton, Public Health Adviser (Evidence for Action – Mental Health Improvement). The sign-off officer was Dr Andrew Tannahill, Head of Evidence for Action.

Advice on various aspects of the document was gratefully received from: Ms Rachel Barrie, Policy Officer, Support for Learning Division, Schools Directorate, Scottish Government; Ms Margo Fyfe, CAMHS Nurse Adviser, Mental Health Delivery and Service Unit, Mental Health Division, Primary and Community Care Directorate, Scottish Government; Ms Wendy Halliday, Health Improvement Programme Manager (Mental Health), NHS Health Scotland; Mr Cyril Hellier, Strategic Officer, Post-School Psychological Services, Enterprise and Employability for Young People Division, Lifelong Learning Directorate, Scottish Government; Ms Anne Lee, Health Improvement Programme Manager (Education), NHS Health Scotland; Ms Susan Leslie, Development Officer (Health and Wellbeing Team), Learning and Teaching Scotland; Ms Laura Meikle, Policy Officer, Support for Learning Division, Schools Directorate, Scottish Government; Dr Jane Parkinson, Public Health Adviser (Mental Health Indicators), Public Health Observatory Division, NHS Health Scotland; Ms Nicola Radley, Policy Officer, Mental Health Improvement, Mental Health Division, Primary and Community Care Directorate, Scottish Government; Mr Iain Ramsay, Team Leader, Learning and Teaching Scotland; and Ms Ruth Thomson, Head of Health Promotion and Support in Schools Teams, Support for Learning Division, Schools Directorate, Scottish Government.

This Scottish Perspective will be made available in the 'Evidence' pages of NHS Health Scotland's website, at www.healthscotland.com/scotlands-health/evidence/index.aspx

For further information about it, or to give feedback, please contact joanna.teuton@health.scot.nhs.uk

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