Summary of the impact

Coppock's original research has impacted upon children's workforce development strategy and child/adolescent mental health services in England - specifically in workforce up-skilling to provide inclusive, child-centred mental health services. Coppock's research provided intellectual and empirical underpinning for a highly successful training programme 'Mad, Bad or Misunderstood? Interactive Multimedia Training for Professionals Working with Children and Young People' (MBM Training). MBM Training has been delivered to over 4,000 participants including: teachers/social workers/health workers/police officers/residential care staff/parents/carers/foster carers and volunteers and is recognised by the Child and Maternal Health Observatory (ChiMat) as an important tool in mental health promotion and tackling stigma.

Underpinning research

Between 1994 and 1996 Coppock (Reader in Social Sciences, from 4.11.91 to present) was funded by Edge Hill University to undertake a research project investigating contemporary theory, policy and professional practice in child and adolescent mental health services (CAMHS) in England, from a children's rights perspective.

In her previous career as a psychiatric social worker in CAMHS and through her ongoing involvement with a wide range of children and young people's agencies and services, Coppock had observed significant weaknesses in the theoretical models and conceptual tools that shaped professional understanding of, and interventions in, the lives of children and young people presenting to children's services as `disturbed' or `disturbing'.

The aim of the research was to investigate, identify, critically analyse and raise awareness of these potential structural weaknesses in theory, policy and practice with the objective of developing new insights in order to positively influence how practitioners interpret and respond to mental distress in children and young people in the future.

The research involved a meta-analysis of existing research data in the field alongside documentary analysis of law, policy, reports and other practice-based documentation.

The research findings:

• Identified and problematised the dominance of the medical model in child and adolescent mental health theory, policy and practice and exposed limitations in terms of its reliability and validity as a framework for understanding and responding to mental distress amongst children and young people
• Identified arbitrary and inconsistent conceptual framings of `disturbed' and `disturbing' behaviour in children and young people amongst adults/practitioners, resulting in inconsistent institutional responses and pathways to service provision which, in turn, had differential consequences for children and young people's rights
• Identified the significant trend towards increasing numbers of children and young people receiving and being treated for mental health diagnoses and highlighted the actual and potential negative consequences of such practices for children and young people in distress
• Identified how professionally-led responses to children and young people in mental distress were characterised by a deep-rooted paternalism that was inconsistent with the core principles and spirit of the UNCRC, 1989, The Children Act, 1989 and the Code of Practice to the Mental Health Act, 1983.
• Provided examples of emerging, innovative approaches to service provision from the voluntary sector, grounded in child-centred methodologies; premised on dialogue with children and young people and their perspectives on what they want from mental health services
• Evidenced the potential benefits of mainstreaming these child and young person-centred understandings of mental distress as a basis for future CAMHS policy and practice.

The research findings were initially published in the peer reviewed journal article `Mad, Bad or Misunderstood? A Critical Analysis of State Responses to Children and Young People Who are Defined as `Disturbed' or `Disturbing' (Coppock, 1996) and the analysis was developed further in subsequent publications (Coppock, 1997; 2005 - full references provided in section 3 below).

References to the research

All items available on request.

Details of the impact

Coppock's original research has directly impacted children's workforce development strategy in England, providing the intellectual and empirical underpinning for the development of a one-day training course for practitioners - Mad, Bad or Misunderstood? Interactive Multimedia Training for Professionals Working with Children and Young People in Liverpool (MBM Training). The impact began in Liverpool 2005, extended to the North West region in 2008, nationally in England from 2009, and is ongoing.

In 2005, Coppock was approached by Corroborator 3 for permission to use her original research `Mad, Bad or Misunderstood?' as the basis of a collaborative project to develop mental health awareness training for children and young people's practitioners in Liverpool. The intention was to mainstream the core messages from her original research into the practice arena - specifically, the need to challenge stereotyping and pathologising practices with children and young people; to understand children and young people's behaviours as a form of communicating their distress; and to develop new skills of listening and responding to children and young people in distress (Corroborator 3).

Coppock acted as a Consultant/Adviser for the project (along with personnel from Liverpool Mental Health Awareness and Liverpool CAMHS/Children's Services Partnership). MBM Training launched in May 2006, training 1,000 participants in its first year (Corroborator 1) and was profiled in The Guardian (Tickle, 2007) and Young People Now (Lloyd, 2007) featuring interviews with Coppock in 2007 on the challenges of Every Child Matters vis-à-vis children's workforce development needs. Both features highlighted the development of MBM Training as an exemplar of good practice.

MBM Training draws directly on the theoretical framework, analysis and practical insights from Coppock's original research (outlined in 2 above: Corroborator 1). Specifically, it encourages practitioners to develop child-centred understandings of mental distress and place the needs of children and young people at the centre of their service. In particular, they are asked to consider the popular assumptions that lead to pathologising the challenging behaviour of children and young people as `mad' or `bad'. The training manual is available at: http://www.chimat.org.uk/tacklingstigma/liverpool

Facilitated workshops offer:

• a holistic model of mental health, integrating sociological and psychological perspectives
• an understanding of children and young people's behaviour as a means of communicating about deeper issues
• an opportunity to develop strategies with children and young people to achieve greater emotional literacy and resilience, self-esteem, empowerment and life opportunities
• the skills to develop a child-centred perspective, within the framework of the Five Outcomes of Every Child Matters and the UN Convention on the Rights of the Child.

Between January 2008 and July 2013, MBM Training has been co-ordinated and managed through the Mental Health Promotion Project of Merseyside Youth Association (MYA) (www.mya.org.uk/index.php?p=205).

The training is now commissioned by Liverpool Commissioning Group (formerly Primary Care Trust) and forms a central strand of its workforce development and early intervention in its mental health and emotional wellbeing strategy (Corroborator 1).

MYA estimates that MBM Training has reached 4,000 practitioners since 2008 (Corroborator 3). MYA Annual Reports (which include only programmes delivered directly by MYA) indicate:

650 professionals trained in 2008-09
(http://www.mya.org.uk/userfiles/file/mya_annual_report_0809.pdf Page 7)

659 professionals trained in 2009-10
(http://www.mya.org.uk/userfiles/file/mya_annual_report_0910.pdf Page 13)

508 professionals trained in 2010-11
(http://www.mya.org.uk/userfiles/file/mya_annual_report_1011.pdf Page 26)

388 professionals trained in 2011-12 (MYA Annual Report, 2011-12. (Page 17)

A core philosophy and aim of MBM is that all those who work with children and young people should have access to mental health awareness training. This is rooted in Coppock's research finding that, when asked, children and young people say they prefer to seek and receive support in the ordinary, everyday contexts of their lives. MBM's reach to professionals and volunteers across a wide range of contexts is testament to its success in meeting that core aim. For example, the 317 professionals who completed MBM Training via 18 courses delivered by MYA between 1 April 2012 and 31 March 2013 included social workers from both children's and adult services, teachers and allied education practitioners (primary, secondary and special needs), child health practitioners, CAMHS workers, Connexions workers, youth workers, Children's Centre practitioners, housing officers, volunteers and community football coaches (Corroborator 2).

MYA undertakes evaluation exercises for each cohort attending the programme, providing a rich source of evidence on its positive impact on the mental health awareness of participants and their attitudes towards children and young people in distress. Corroborator 2 comments: "Over the past two years that I have been delivering MBM I have seen first-hand the enjoyment, skill, knowledge and confidence of its participants grow. It seems to re-ignite a passion within to support, nurture and care for those who need it - especially our young people".

Illustrative feedback from MBM participants (Corroborator 2) confirms this observation. Practitioners commented: "It has enhanced my awareness that can be used in my job and cascaded down to team members"; "We need to look at the child in context of their wider environment, not labelling"; "It has given me an understanding of looking at behaviours as a small part of what may be a bigger problem".

Young people involved in the delivery of MBM commented: "As young people we spend the majority of our time in school, surely it's there that things should be recognised and picked up on. MBM highlights this to those taking part and shows how important it is to listen"; "I would like to think that doing this means no other young person has the same experiences I had during college". Beyond Merseyside, MBM Training has received both regional and national recognition as best practice. For example, the North West Centre of Excellence rolled out MBM Training throughout the region via a `Train the Trainers' approach, with a print run of 33,000 MBM Training Manuals and DVDs disseminated (Corroborators 1 and 3). The training has also been used in many of the national Department for Education `Targeted Mental Health in Schools' (TaMHS) Programmes - including primary, secondary and special educational needs schools (Corroborators 1 and 2)

MBM Training has also achieved national recognition as an important tool in tackling stigma (Barham & Smith, 2011; www.chimat.org.uk/tacklingstigma/liverpool). The Child and Maternal Health Observatory (ChiMat) promotes MBM Training - the manual is available to download directly from its Knowledge Hub Resources Database
(www.chimat.org.uk/resource/item.aspx?RID=96510) (795 downloads between January 2009 and 31 July 2013).

Demand for MBM Training continues to be strong and its core content remains grounded in Coppock's research. It has also influenced the development of programmes such as: `Inside Out', a `follow-on' Level 4 accredited programme that builds on the themes of MBM Training; the `PEER schools award', a quality award that begins with staff training based on MBM with the aim of working towards achieving a whole school approach to mental health; CAMHS master classes based on the core ideas from MBM (Corroborator 2).

Sources to corroborate the impact

Personal statements/corroborators (see cross-references in Section 4):

1. CAMHS Commissioner, Liverpool PCT, Personal statement, 18 December 2012 - addresses role of research in shaping MBM Training (MBMT); numbers of staff undergoing MBMT and continued use by Liverpool Commissioning Group; its roles in approach to workforce development and strategy for early intervention in mental health and emotional well-being; regional roll-out of MBM Training; use of MBMT in TaMHS Programmes.
2. Mental Health Promotion Trainer, Merseyside Youth Association (MYA), Personal statement and report, 31 July 2013 - addresses range and number of professionals/volunteers undergoing MBM training, impact on trainees; use in TaHMS programmes; impact on other programmes.
3. Principal Development Manager, Merseyside Youth Association (MYA), Personal statement, 17 June 2013 - addresses use of, and rationale for using, underpinning research in development of mental health awareness training for children and young people practitioners. Number of practitioners undergoing MBM Training since 2008. Regional roll-out of MBM Training.

Other:

1. Barham, J. & Smith, N. (2011) Tackling Stigma Framework Pilot: Evaluation Update Report. A Report to National CAMHS Support Service. Birmingham: ECORYS UK Ltd. Available at www.chimat.org.uk/resource/view.aspx?RID=105356 (citation pages 4/5)
2. ChiMat (Child and Maternal Health Observatory) Knowledge Hub Resources Database. Available at www.chimat.org.uk/resource/item.aspx?RID=96510
3. ChiMat (Child and Maternal Health Observatory) Tackling Stigma. Lessons from the Pilot Sites: Liverpool Pilot Site. Available at www.chimat.org.uk/tacklingstigma/liverpool
4. Lloyd, T. (2007) `Resources: Workplace - A guide to mental health needs' Children and Young People Now, 27 April 2007. Available at http://www.cypnow.co.uk/ypn/news/1066280/resources-workplace-a-guide-mental-health
5. Tickle, L. (2007) `Child-centred Universities' The Guardian, 3 April 2007. Available at http://www.guardian.co.uk/education/2007/apr/03/highereducation.children