How do you assess which children might benefit from going to the school?
This process usually starts with a conversation between a social worker or parent / carer and the head of the family and professional networks team. The school then receives papers that provide historical information about the child's life experiences, presenting difficulties and how they have been understood. If the child seems as though they may benefit from a place at ‘the Bush,' then a more formal process begins. The assessment is made during meetings which involve staff from all the children's services departments, in conjunction with the referring authority and family and of course the child. Visits are made to the school by the professionals and parents / caregivers and then a meeting held in the child's community with representatives of all those who have an interest in his or her future. The director then visits the child at home to make the final decision.
How are you funded?
The school is funded by the fees paid by referring authorities: health, social services and education. These are increasingly now integrated into the children's services departments.
Where do the children come from?
The children come to the school from all over England and Wales. Although some travel a long way, the most important thing is the emotional link developed in the relationship with the school. A child who lives locally but whose relationship between the school and the family or local authority is not good, may as way be a million miles away. Children make best progress when they experience all those interested in their care working closely together.
Who refers them?
Children are referred by their social workers, education departments, psychiatrists or by the courts. Increasingly parents are fighting for their children to be placed at the school through the tribunal system.
What is the involvement of the local authorities?
Local authorities have statutory responsibilities to remain involved and interested in the lives of the children they place at the school. Some carry these out with more energy and commitment than others. Some display their interest in the child's development beyond their statutory responsibilities, others are less supportive. Nevertheless, we are aware of the sometimes overwhelming pressures of caseloads on the referrers.
How long do the children stay at the school?
The children stay at the school on average for three years. We generally find children need a year to settle in, a year to really engage in the work and a year to prepare to leave.
How are children helped at the school?
We offer them a chance to re-experience caring and clear relationships with adults and other children. The adults do this by carefully planning for each child's needs, then using the opportunities that arise through group living to give the child very clear expectations, routines and rules for how to live with and get on with others. The adults work closely alongside the children and help them understand and manage all the experiences of the day — everything from mealtimes to bedtimes. This takes a long time, but as the children start to make sense of this new way of living together, they gradually start to grow and change.
The children are also closely supported in and throughout the educational day. Our education area is welcoming, serious and fun and caters to the children's different and special abilities. With small classes and energetic teaching, the children start to enjoy learning. As a result, they catch up on schoolwork that they previously did not feel confident about.
What is the therapy?
As a therapeutic school, we try to meet children's needs and manage their behavior, so that they start to feel better about themselves. We help children raise their self-esteem in a number of ways. First there is "planned environment therapy." We have to make sure on a day-to-day basis that children who find it hard to think and plan ahead are living in a place where adults can provide safe routines. Then there is the therapeutic value of living together with others in households. Many of our children have found sharing with others very hard in the past. In the households at the school, they are helped to learn to think about the needs of others and to start taking responsibility for their actions. Some children need to be looked after closely, because they are still "little" inside, while others are a bit more mature. Sometimes children need more help, so the school also has a psychotherapy department.
Some of the children have individual psychotherapy, and the staff teams also consult with psychotherapists to develop their understanding of the children. We plan our care, treatment and education to meet the needs of each individual child.
In the film, the teachers sometimes hold or embrace the children while they are in the midst of a tantrum or are upset. In some cases, particularly when the child does not want to be held, the embrace is quite forceful. Can you explain why the technique is used? Is this practice generally accepted as an effective treatment for attachment disorder?
One of the aims of the school is to allow children to have normal experiences and for them not to become more institutionalized through their being in residential care. To that extent staff will be affectionate and caring when children are upset and in distress. However, the staff working with the children are sensitive to each child’s needs and to the context of events and would not force an embrace or physical contact upon a child who does not want or need it. We also have to be aware of a child’s promiscuous affection and/or the pre-existing sexualization of some of the children due to their past experiences of abuse.
At times when children find themselves uncontrollably angry, they may need to be physically stopped and all of the staff are specially trained to be able to do this. At the Mulberry Bush School we use a technique called PRO-ACT-SCIPr which, as well as providing physical and emotional containment, is used to prevent children from hurting themselves and others. Often, understandably, the child does not want to be held but it would be dangerous to let them go before they have calmed and it prevents them from doing harm (which they may also find intolerable to reconcile themselves with after the event). It is the most uncomfortable part of the work for children and staff but is necessary to prevent physical and emotional harm.
How is the staff chosen?
The staff are very carefully chosen. They are our most valuable resource. The vast majority of the staff is very well qualified with relevant higher educational qualifications. However we need staff to be good at relating to challenging children and to be emotionally and physically very resilient. The recruitment process is carefully designed to test applicants in these areas. We know that this sort of work is not for everyone and that staff is pushed to their limits and beyond.
What kind of staff do you have? What qualifications do they need?
All our staff are professionally qualified for the roles that they fulfill: teachers, psychotherapists, social workers, school nurse, family therapists and play therapists. We also have many staff with psychology degrees, who are nurse trained, who have master's degrees in therapeutic child care, organizational consultancy and so on. We also have many staff who do not have many paper qualifications but who are enthusiastic and passionate about the work. All our staff have regular training from our training department.
How long does the staff stay?
We ask for staff to give a three-year commitment to working at the Bush, so as to avoid too many transitional relationships for the children, most of who have experienced far too many losses or broken relationships.
How do you measure the success of the school?
We try to remain open minded as to what success is. We collect a considerable amount of data and know that the children's incidents of aggression drop by 95 percent during their stay, that 100 percent of leavers are able to access learning at school whereas before they came only 8 percent could do so. We also know that 84 percent of children, who were unable to be placed long term with a family when they arrived, were fosterable when they left.
We know that Ofsted (the Office for Standards in Education) rate us as "Outstanding."
We also know from ex-pupils that sometimes it is years later that individuals understand what the school did for them. One student wrote us:
"I used to be a pupil at your school, from 1976 to 1981. I have never forgotten how the school shaped my life. I am now a senior associate within a large architectural practice."
What happens to the children when they leave?
We work hard to ensure children move on to somewhere that will best meet their needs. This depends on the individual child and their family circumstances. The majority of children return to a stable home base and attend a local school. Some children move on to another residential school with more frequent home visits.
What work do you do with the children's families?
We have a families and professional networks team who work with the families. They aim to help develop the understanding in the family of the difficulties they are facing and join us in find ways forward together. The team comprise social workers and a family therapist. We also work with parents / caregivers in groups and provide some family therapy.
Have the children been abused?
Many of the children at the school have been neglected and abused, either sexually, physically or emotionally. Others have seen or experienced awful things. Sometimes these things have happened when the children were very young, or even babies. When neglect or abuse happens before a child has learnt to speak, they still carry the memory of what happened but find it almost impossible to put it into words. Instead they ‘act it out' and one of our aims is to try to understand the underlying meaning of their complex behavior and feelings.
Which children receive psychotherapy?
All children received a story stem and psychotherapy assessment during the first twelve weeks of their stay and then at the end of their penultimate year. This helps us to assess their inner world and gauge how they have grown. About a third of the children also receive individual psychotherapy once or twice weekly. The school's internal treatment team refers them if it is felt they would both benefit and make use of the additional help.
What support is the staff given?
High levels of staff support are essential in enabling the staff to both survive and make sense of the children's behavior. All staff attend meetings each week which focus on developing an understanding of the children and attributing meaning to the behavior. This is supported by regular training sessions that are underpinned by psychodynamic theory. All staff attends weekly ‘reflective space' meetings that are facilitated, and allow exploration of the emotional impact of the work. There are regular spaces to meet with the consultant psychotherapist and her team. The treatment team for each child has regular meetings to review the work being done with the child and ensure a consistent understanding of the therapeutic intent behind it.
What are the aims of the school?
The school aims to be in partnership with an actively involved referring authority, to equip each child with age appropriate personal, emotional, social and learning skills to cope in a family and in a local school and community.
How does the staff deal with the challenges?
It is important when dealing with challenges that the children experience the staff as calm, thoughtful, caring but authoritative. The children need to know that what they are doing is wrong, and then what they could do differently.
How many children are diagnosed with mental health problems such as depression, ADHD, etc.?
Approximately half the children at the school are diagnosed with some form of attachment disorder or have a mental health diagnosis prior to referral.
How can children's mental health problems be avoided?
Children learn about their feelings when their parents/caregivers help them understand and cope with the normal ups and downs of life. If children experience many separations, have been abused and/or witnessed very frightening things then they will need the adults to give them lots of help in making sense of the world. It can be extremely difficult for these children if the adults have not been able to help them in this way.
Are there schools for older children like this?
Yes there are schools that work along therapeutic lines for secondary aged pupils.
Why are there no girls in the film?
The children in the film were really identified by two main criteria. Those for whom we had permission to film and those who were happy to be filmed or who were comfortable in front of the camera. It just so happened that this led to no girls being included, which was a shame.
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