Introduction
The aim of this paper/workshop is to discuss with you the experience of creating a school within a medium secure setting. Policy makers usually talk about Every Child Matters, as we have heard cogently described this morning, for students in usual or ordinary social/educational circumstances, but in order to have a better understanding what Every Child Matters entails, it is useful to look at its implications and potential in more extreme circumstances. The needs of young people in secure units have to some extent been marginalised and Every Child Matters seems to me to be an opportunity to bring their needs within the sweep of mainstream education. By examining the ways in which implementing Every Child Matters within such a restricted context may have lessons for the delivery of education within other contexts.
Firstly I describe the setting up of the school within the secure environment together with the educational experience on offer. The focus is on the changes necessary to both practice and the Individual Education Plan in order to reflect the five outcomes of the Every Child Matters agenda. These outcomes are Enjoy and Achieve; Make a Positive Contribution; Stay Safe; Be Healthy and Be Economically Active. In the second and third parts I describe the health and security constraints to the way in which educational practice is experienced by young people in a medium secure environment.
In the last section I expand two of the Every Child Matters outcomes to show in more detail how these can be transformed into aims, targets, processes and practices which make up the life of the school. This will help me re-affirm in the conclusion the radical potential of Every Child Matters even in the most challenging environment.
Education for Life
The focus in education at The Bill Yule Adolescent Unit is on the attainment by the Young People of AS levels, GCSEs, Entry Level awards and AQA Short Courses and Unit Awards and at the same time building into the lessons a strong dose of enjoyment as well as taking time out to celebrate the considerable success achieved by students and staff. The subjects offered at present are English, Maths, Science, PSHCE and Music Technology. ICT is taught across the curriculum and not as a separate subject. The young people are taught in groups of two or three and there are four groups each of whom receive 9.75 hours of education per week. Each student has access to a total of 13 lessons per week consisting of the 4 core subjects plus one lesson of Music Technology per week. There are 5 full time staff and 1 part time peripatetic Music Technology teacher.
As well as academic assessment, using the National Curriculum Levels and reading ages, the Young People are assessed for their general overall abilities including descriptions of their motor skills, cognitive skills, motivation, concentration and attitude to work. All these form part of their Individual Education Plan (IEP). There is a section in the IEP for the Proposed Unit Plan, Learning Aims and Behaviour Aims. Behaviour is further assessed under the following criteria and appropriate targets set, which are tracked and monitored every 6 weeks.
• Behaviour in Class
• Approach to work
• Emotional Reaction
• Attitude to Authority
• Attitude to Self
• Interaction with Peers
• Coping Strategies
Daily lesson targets are further set for Work and Behaviour. These are completed by staff at the end of the day, then photocopied and given to the ward staff to inform their assessment/monitoring of the Young People when they are at school. All of these targets are discussed with the Young Person once per week in a tutorial/pastoral session with their Key Teacher. A wide range of rewards are given for achievements. The attendance rate for the academic year 2005/6 was 93%.
When the unit is full it has 10 male adolescents aged from 13- 19years. They encompass a wide range of ability levels, from those with an IQ of 61 to 130 plus with a Young Person aged 17 years who was unable to read and write upon entry to the unit. Assessment using National Curriculum levels and reading ages shows that the ability level for literacy ranges from the upper levels of P Scales to Levels 7 & 8 in the core subjects. Rea dings ages range from less than 6 to 14+ years. This disparate ability level means that any one young person will, at any one time, be put forward for Entry Level English, Maths, Science & PSHCE; Maths, Science & English GCSE Foundation Tier and Unit Awards in Music. Other students are being entered for Science & English at AS Level and English, Maths, Science & Additional Science, Higher Tier at GCSE. This requires flexibility from teaching staff as well as the ability to teach across a wide range of ability levels. This poses a considerable challenge to teaching staff who must prepare and plan for such a wide range of ability levels.
Asking parents/care givers to participate in the educational decision making process and to support their young person to realise their potential is an important part in raising their attainment. Providing up to date reports and feedback on progress and attainment is a vital component of the education/parent/young person partnership. A significant number of the young people are in care. Attendance at Looked After Children’s Reviews is vital so as to share information with care givers as well as to support the young person to make appropriate decisions about their choices when they leave hospital.
You may ask why I have chosen to focus on credentialing pathways for the Young People at the Bill Yule Adolescent Unit. All courses of study from AQA Unit Awards through to AS Level subjects awarded by WJEC (Welsh Board Joint Education Committee) are formally accredited with the respective Examining Boards. Within the school itself, certificates are awarded for achievement in individual subjects, for personal best and for attendance. The reasons range from the philosophical, namely it is their human right to be educated to the level commensurate with their ability, to the more functional as well as a tangible way of raising self esteem. The length of stay at the unit varies with the individual and ranges from about 6 months to 2 plus years. In the academic year 2005/6, one student achieved GCSE grades within the A-C range in English, Maths, and Double Science whilst another gained a Pass grade in GCSE Maths.
At some point the Young People will be re-integrated into the community. It is easier for them to succeed if they have achieved something which they can build on within a community setting such as in a job or a College place. Education enables this to happen. Education is a tangible way of raising the self esteem of these young people. This, together with the community links formed through work or education helps to reduce their re-offending. Gaining credentials through education can never be taken away from them and it demonstrate that the individual is capable of attending regularly; can work to deadlines; has covered a coherent body of work; is disciplined; can work independently and can work under pressure. All the Young People demonstrate these positive attributes whilst at the same time managing a psychiatric illness as well as their involvement with the Youth Criminal Justice system.
Health – The RAMBO* Principle
Education does not occur in a vacuum, but occurs alongside the contributing parameters and practices made by health/therapy. This consists not only of treatment by medication but by a cognitive behaviour programme run by the Consultant Psychiatrist, nursing and care staff.
The admission criteria for a place at the Bill Yule Adolescent Unit include involvement with the Youth Criminal Justice System and a diagnosis of a psychiatric illness. Since the unit has opened there have been admissions from Feltham Young Offenders Institution, Private Psychiatric Hospitals, Accident and Emergency Units, GP referrals, and from the Psychiatric Adolescent Unit of an inner London General Hospital. The commissioning group is known as NSCAG, (the National Specialist Commissioning Agency), which is the national body responsible for the placement of suitable young people throughout the five national forensic units. Some of the adolescents admitted to the ward also have indeterminate legal immigration status or are actually illegal immigrants.
Many of the young people present with degrees of psychoses, some of which are drug induced, schizaffective disorders, bi-polar disorder and Aspergers Syndrome. The young people usually have a history of psychiatric disorder and/or forensic involvement over time. Almost all are receiving some form of medication upon admission. As well as medication, the young people are expected to participate in the cognitive behavioural programme RAMBO, Risk Assessment and Management/Monitoring Behavioural Outcomes.
It consists of a programme which identifies 63 risk/protective factors which are anti-social, dangerous, offending or self harming. These can be individual, or involve the family, peer, school and society. They may arise out of childhood adversity, substance misuse, or psychopathology. The risk factors are sensitive to change and are scored before and after participation in the programme.
There are modules which focus on one topic that can address several risk factors. The sessions can be active involving role play, quiz games, music drawing, newspaper, TV or magazine reviews and sport. The sessions are solution focussed. Some of the factors in the histories of the young people which show positive correlations with RAMBO risk factors are as follows:-
• Greater than 3 convictions
• Onset of violent behaviour at less than 11 years
• Lack of remorse
• Friends involved in criminal activities
• Special Educational Needs
• Substance misuse.
There are 5 levels through which the young people can progress, each level having its own rewards, privileges and restrictions. By participating in all the programmes on the unit, including Education, the young people can work their way up the levels gaining the benefits or if they choose not to participate, then the sanctions came into play. This can include the loss of a daily pass to the hospital grounds for example.
*Work of Dr Theo Mutale, Consultant Child Psychiatrist, The Bill Yule Adolescent Unit, The Bethlem Royal Hospital.
Prisoner to Patient – The World Inside
Admission for treatment
Opportunities for the young people to engage in a wide range of educational opportunities, particularly those involving exploration the world outside the hospital, are constrained by the type of Section under which they are detained within the Mental Health Act of 1983. These are described in ascending order of severity with the least restrictions applying to Section 3 and the most severe being combinations of Sections 47, 48 & 49.
All the Young People are detained under one or more of the sections of the 1983 Mental Health Act. Admission to Hospital can be undertaken within Sections 3 which is for treatment for up to 6 months initially. This provides the authority for someone to be detained in hospital for treatment. It requires an Application which is based on two Medical Recommendations. This Section may be renewed for a further 6 months and then for a year at a time. This section of the Mental Health Act is sometimes used to detain adolescents at a Forensic Unit.
The conditions for the Application stated in the Act are that a person:
• is suffering from mental illness, severe mental impairment, psychopathic disorder of mental impairment and his mental disorder is of a nature or degree which make it appropriate for him to receive medical treatment in a hospital; and
• in the case of psychopathic disorder or mental impairment, such treatment is likely to alleviate or prevent a deterioration of his condition; and
• It is necessary for the health or safety of the patient or for the protection of other persons that he should receive such treatment and it cannot be provided unless he is detained under this Section.
Further admissions may be made as a result of criminal proceedings.
Hospital Orders Made by the Courts
Section 37 allows a Court to send a person to hospital for treatment when otherwise the outcome might have been a prison sentence. The order is instead of imprisonment, a fine or probation.
The Court has to be satisfied of the following:-
• that the person has at least one of the four types of mental disorder, on the basis of evidence supplied by two doctors, with both doctors agreeing on at least one of the types and
• that the mental disorder is of a nature or degree which make it appropriate for the person to be detained in hospital for medical treatment and, in the case of psychopathic disorder or mental impairments, that the treatment is likely to alleviate or prevent a deterioration of the person’s condition and
• that making a Section 37 Order is the most suitable way of dealing with the person, bearing in mind all relevant matters and
• that a specific hospital is willing and able to admit the person within 28 days.
The person detained under Section 37 will have been convicted by a Crown Court of an offence which should be punished with imprisonment, except in the case of murder, where the Court has to impose a mandatory life sentence in all cases, the tariff for which is 15 years. It can happen that a person may have been convicted by a Magistrates Court of an offence which could be punished with imprisonment. It is also possible that a person may not have been convicted but may be before a Magistrates Court charged with an offence which could lead to imprisonment if the person were to be convicted. The Court can nevertheless make a Hospital Order under Section 37 if the person has a mental illness or severe mental impairment and the Court is satisfied that the person did what they are accused of doing.
The initial period of detention under Section 37 is 6 months, beginning on the date of the Order. It can be renewed under Section 20 for 6 months and then annually. There are other restrictions in place under Section 37, namely that a relative cannot discharge the patient and an appeal to the Mental Health Review Tribunal cannot be made within the first 6 months. Otherwise, discharge takes place at the end of the sentence period or otherwise determined by the Mental Health Tribunal.
Interim Orders under Section 38
Sections 37 & 38 are usually in tandem. Prior to deciding whether to make a Hospital Order under Section 37 or whether to deal with an offender in some other way, a court may decide to make an interim or temporary Hospital Order. The person concerned must have been convicted of an offence, other than murder, for which imprisonment is a possible penalty and the Court must be satisfied that the offender has one of the four forms of mental disorder and that there is reason to suppose that it may be appropriate for a Section 37 Hospital Order to be made as well as a specific hospital being willing to admit the offender within 28 days. In these circumstances, the offender remains under the control of the Court and she/he cannot be discharged under Section 23 and has no right of appeal.
Sections 47/48 & 49 Transfer from Prison to Hospital
People Serving Prison Sentences – Section 47
The Home Office, using powers given to the Secretary of State can make a Transfer Direction to transfer a prisoner to hospital for treatment where she/he has at least one of the four types of mental disorder on the basis of reports from two doctors and the mental disorder is of a nature or degree which makes it appropriate for the person to be detained in hospital for medical treatment. It makes further conditions for this transfer to occur, where the mental condition would be alleviated or prevented from deteriorating. This Section can come to an end 24 days after it is made if the transfer to hospital does not in fact take place.
People NOT Serving Prison Sentences – Section 48
This Section makes provision for prisoners serving a sentence to be transferred to a hospital. Section 48 simply extends this to prisoners who have not been convicted, such as those remanded in custody by a magistrates’ court and people suspected of being illegal immigrants. The additional/different conditions are that the person has a mental illness or severe mental impairment, but the other two forms of mental disorder by themselves do not qualify and that the person is in urgent need of the treatment which is to be provided. Sections 47 & 48 often run in tandem. Section 48 usually comes to an end when the Court makes a final decision about the outcome of the case. Otherwise, discharge is under the same conditions as Section 37.
Restriction Directions under Section 49
A Restriction Directions prevents discharge being made under different Sections of the Mental Health Act. It comes unto play in conjunction with a Section 47 Transfer Direction or one made under Section 48 where the person has been remanded in custody by a Court.
In the case of people who have been sentenced and are subject to Sections 47 & 49 the Restriction Directions will come to an end at the earliest date upon which the person could have been released from prison if she/he had not been transferred to hospital. If the Home Office is informed before this date that the person no longer needs treatment, or that there is no effective treatment to be given then the person can be either returned to prison or released.
Definitions of Mental Illness within the Mental Health Act 1983
The definitions of mental health within the Mental Health Act are legal rather than medical and the definition of Mental Disorder is split somewhat arbitrarily into 4 types, namely Severe Mental Impairment, Mental Impairment, Psychopathic Disorder and Mental Illness.
The Mental Health Act clearly states that people must not be deemed to have any form of Mental Disorder because they behave in a promiscuous way, or engage in any other form of immoral conduct, are sexually deviant or dependent upon alcohol or drugs. This is important because in the past, women have been brought into the psychiatric system because, for example, they have had a child out of marriage, or they engaged in certain sexual practices. This statement in the 1983 Act is an important safeguard against abuses of this sort being perpetrated against vulnerable individuals.
Patient & Prisoner - from Deviance and Social Control to Ensuring Every Child Matters
EVERY CHILD MATTERS
It is useful to return to the link between the Every Child Matters agenda, especially the five outcomes and the day to day educational aims of a unit such as The Bill Yule. In fact I elaborate on only two outcomes, Enjoy and Achieve and Making a Positive Contribution. In part this is because these two particularly, make a direct contribution to raising self esteem in young people in secure environments.
ENJOY & ACHIEVE
Ethos
-school celebrates achievement of all types and values learning in all aspects of life
-school has an explicit ‘can do’ culture
-school models positive and optimistic attitudes
-school promotes the value of learning through enjoyment and achievement
-school has high expectations appropriate to each individual
Environment
-school environment is pleasant, cared for and respected
-the learning environment is flexibly organised to encourage learner independence
-learning resources cater for different abilities
-displays of work celebrate the learning process as well as end results
-displays of work show stages of learning as well as end results
Curriculum
-Learning Pathways blend academic, vocational, personal, social, creative and work-based opportunities
Delivery
-school provides individually tailored programmes of study
-teaching styles promote greater/increasing learner levels of autonomy
-learners are given challenging tasks
-perseverance is developed through learning challenges
-learners are challenged to take risks
-learning tasks support learners to become absorbed in their learning
-school provides opportunities for creative & imaginative activities including off timetable events
-learners are routinely encouraged to resolve learning struggles by other adults or their peers
-formative assessment enables learners to know what they need to learn
-learners know their targets and are able to track their progress both short & long term
-pastoral support focuses on learning, progress and achievement
-individualised learning enable learners to use appropriate learning habits
Parents & Carers
-parents & carers receive information on progress, achievement, well being, and progression every 3 months
-consultation sessions celebrate a diversity of achievements
Partners & Services
-school works in partnership with multi-professionals to enrich & extend learning provision
-school participates in multi-agency support for vulnerable and cared for young people
-school aids continuity & progression through Connexions & other agencies
-school ensures accurate tracking of learner attainment and value added
Monitoring
-the school curriculum and procedures monitor the extent to which:-
• Provision & practice meet the needs of all learners
• Provision is broad and balanced
• There are opportunities for cross curricular links
-school enacts equal opportunities which ensure that:-
• SEN & TAG practice & provision meet identified learner needs
• All groups of learners make progress in line with expectations
• The needs of looked after children are met so that they participate fully
• Barriers to participation are identified and eliminated
-school has learning and teaching practices and monitors the extent to which
• Learners understand how to learn as well as what to learn
• Diverse ways of learning are accommodated in classrooms
• Teaching & learning leads to high achievement
• Attitudes to learner are positive
-school continually monitors attainment and progress against NC targets set for Key Stages and GCSE
-assessment for learning is continually monitored to ensure that:-
• Tracking is used to assure progress
• Informs planning and teaching
• Underpins progress reports
• School adds value so that students progress beyond expected targets
MAKE A POSITIVE CONTRIBUTION
Ethos
-school culture values personal responsibility and collective involvement
-school has an inclusive rewards culture that models the value of everyone’s contribution
-everyone’s contribution is valued
Environment
-learners respect and make contributions to their environment
-school is a learning resource for the community
-displays signal the high value given to involvement with activities in the school
Curriculum
-citizenship programmes & PSHCE enable learners to understand their community, wider society and their roles within them
-equal opportunities issues are mapped within the curriculum so that learners are aware of their importance to the conduct of an inclusive society
-the curriculum enables learners to experience democratic processes
Delivery
-learners increasingly take responsibility for their own learning
-developing collaborative learning skills is integral to curriculum delivery
-learners have opportunities to participate in community projects
-learners are involved in a wide variety of roles and hence develop self confidence
-activities are linked to a range of cultures
-learners experience a variety of belief systems
-learning nurtures sensitive responses to complex social, moral, political and cultural issues
-pastoral support encourages learners to take responsibility for their own learning
-school offers role models who can share their experiences of contributing to their community
Parents & Carers
-parents and carers receive reports every 3 months
-school follows up on parents/carers who do not voluntarily engage with school
Monitoring
-teaching styles are conducive to effective dialogue and expression of opinion
-school monitors the extent to which:-
• Bullying is reduced/non existent
• Racist attitudes are reduced/non existent
• Prejudice is reduced
• Equality of opportunity is independent of race, age, disability, gender
-school continually monitors learners involvement in contributing to the
life of the school
-school monitors the extent to which it:-
• Liaises with other agencies
• Assures progression & continuity
• Provides opportunities for disadvantaged and vulnerable learners
-inclusion is central to the school and that:-
• Learners of all abilities and of all social and racial backgrounds are accorded equality of opportunity
• All resources are used effectively and appropriately
Conclusion
This expansion of just two of the five outcomes (the others being Stay Safe, Be Healthy and Be Economically Active) of the Every Child Matters agenda shows its radical potential. It is interesting that in the outcome for school achievement, enjoyment is placed first. So, there is a call for schooling to be enjoyable which would seem at odds with national curriculum targets, grades A-C for more pupils in Maths, English and Science at the expense of other subjects e.g. Media Studies, Drama, Music or Art and a proposed reduction in coursework for GCSE subjects. Nevertheless, having put forward those caveats, Every Child Matters is a brave attempt to square just such a circle. It also gives further support for not only the value of education for a vulnerable, potentially disaffected and disadvantaged group such as those young people held in medium secure settings, but that it is a vital component of their successful re-integration back into the community.
The radical potential is embodied in the fact that the Every Child Matters agenda puts the child at the centre of the educational experience. It could even be said that it is a return to child centred education, for it continually asks educators to do `what is in the best interests of the child’. This is further reinforced in Every Child Matters which endorses practices which promote increasing levels of student autonomy and risk taking in learning within individually tailored programmes of study. The outcomes and practises embodied and implied within Every Child Matters seem to be moving away from initiatives in mass education which have previously been conceptualised within a paradigm akin to deviance and social control when they have not actually been purely functional in nature.
The young people can be seen as a `captive’ audience, but experience at The Bill Yule Adolescent Unit shows that attendance at school is excellent. Making Incentives, rewards such as certification and celebrations of success a major part of this contributes directly to their continued links with mainstream society as well as valuing their achievement. Over time, the increase in self esteem gained from participation in education together with these tangible rewards builds success which in turn becomes a virtuous circle. In this way, it is possible to maintain the motivation of young people in secure settings to attend, enjoy, achieve and make a positive contribution for themselves as well as to the wider community.
Bronwen Jones
November 2006