Covid-19 Recovery Model: Recognise, Respond, Link

Model References

  • *Hobfoll S. E, Watson P, Bell C. C, Bryant R. A, Brymer M. J, Friedman M. J, et al. Five essential elements of immediate and mid-term mass trauma intervention: Empirical evidence. Psychiatry. 2007;70:283–315.
  • **Hughes, D.A. (2009) Attachment Focussed Parenting WW Norton: New York

Over the past months we have all experienced different emotions and changes to our routines. Most of the time, we can manage, as we move into recovery we might sometimes wonder, along with everyone else, is this ok?

To help us, a way of working has been developed to support children and adults which focuses on prevention of need and risk.  It is anchored in:

  • The five essential principles of responding to trauma: calm, hope, community, connected, safety.
  • PACE: playfulness, acceptance, curiosity, empathy (Dan Hughes **) This is a framework to help structure conversations.

These build on our partnership way of working through trauma informed practice and motivational interviewing to build resilience and celebrate success.  It is a way of working which draws on person-centered practice to ensure that children and adults are truly listened to and are kept at the heart of all decision-making.

The partnership’s child protection and early help processes for referrals across the continuum of need for children and adult safeguarding have not changed. We have provided advice and guidance on accessing these services in the guide below.

Continuum of need
Children
Adults

Changes in routines, stress and trauma can be seen through emotions, behaviours and physical health. Children and adults should receive the right support when they need it.  The guide will help you as you may sometimes think ….

Is this ok?
The majority of children and adults will be ok. They have demonstrated resilience and you are able to celebrate their success. You can use this guide to reassure they are ok.
Is this still ok?
For some children and families the multi-agency concerns are increasing. You recognise the impact of stress and trauma and you have identified further need and vulnerabilities. Consider Team Around the Family (TAF).
Am I still worried?
For a few children and adults who have experienced previous childhood adversity and trauma, Covid-19 has been traumatic and/or harmful. Recovery and transition to a more usual way of life may need increased multi-agency support.
  • Sleep

    Recognise What you see … Respond What you can say and do … Link Where you can go for further advice,
    support or do next …

    Tiredness, exhaustion, changes to energy levels and poor concentration, irritation, mood swings, unmotivated, shows no interest. This can result from difficulty in getting to sleep and staying asleep.


    Children

    • Self help: mymind
    • Talk with the child/young person  and/or their parent/carer to identify any sleep difficulties for them or wider family members.
    • Has this been a previous concern? If so, how has this been addressed?
    • A number of children with special educational needs (SEN) take medication to aid settling to sleep. Are they using it? Have they started using it? Is it still as effective?
    • Maintaining a balanced sleep pattern will decrease your emotional vulnerability.
    • Ask the young person to start by keeping a sleep diary. For a young child talk to their parent/carer about this.
    • Have sleeping arrangements changed due to bedroom sharing? Are they sleeping in a bedroom, on a sofa, in their own home or in/during lock down with another relative or friend?
    • Does the young person recognise their sleep routine as a problem? Are they awake at the same time as their peers? Is this the time that they can communicate online with their peers?

    Adults

    • Talk to them to identify any sleep difficulties.
    • Keep regular sleep hours.
    • Go to bed when you feel tired.
    • Get up roughly at the same time each day.
    • If lying awake do not force sleep, get up and do something relaxing and go to bed when sleepier.
    • Self help: Live Well: sleep

    Children and Adults

    • Suggest a balanced routine involving physical activity, rest and relaxation.


    Is this ok?

    Children

    Adults

    Is this still ok?

    Children

    Adults

    • If experiencing continued difficulties, consider:
      One you
      Kind to your mind
    • Persistent sleep difficulties contact GP practice.

    Am I still worried?

    Children

    Emotional health and wellbeing concerns:

    • Longer term sleep issues may indicate depression or anxiety contact CAMHS for advice and guidance
    • If you have concerns contact Cheshire and Merseyside Mental Help Crisis Helpline on 0800 145 6485

    Safeguarding concerns:

    Adults

    • Advise to speak to GP practice if prolonged difficulties and may indicate other mental health needs and or contact Cheshire and Merseyside Mental Help Crisis helpline on 0800 145 6485
    • Adult safeguarding concerns contact 0300 123 7034.
  • Nightmares

    Recognise What you see … Respond What you can say and do … Link Where you can go for further advice,
    support or do next …

    Nightmares/dreams and night terrors


    Children 

    • Self help: mymind
    • Has this been a previous concern? If so how has this been addressed?
    • These can all be okay and indicate normal brain processing -try and maintain a good sleep pattern (see section on sleep) and consider the stress management strategies and healthy emotional regulation.
    • Provide reassurance and suggest noting changes over the coming weeks.

    Adults

    • For adults, nightmares are often linked, to stress, trauma or existing mental health needs.


    Is this ok?

    Children

    Adults

    Is this still ok?

    Children

    Adults

    • If experiencing continued difficulties, consider:
      One you
      Kind to your mind
    • Persistent sleep difficulties contact GP practice.

    Am I still worried?

    Children

    Emotional health and wellbeing concerns:

    • Can indicate previous trauma and be an indication of re-traumatisation talk to someone else who knows the child, contact CAMHS/GP for further advice and guidance.
    • If you have concerns contact Cheshire and Merseyside Mental Help Crisis Helpline on 0800 145 6485

    Safeguarding concerns:

    Adults

    • Speak to GP practice if prolonged difficulties and may indicate other mental health needs and or contact Cheshire and Merseyside Mental Help Crisis Helpline on 0800 145 6485.
    • Adult safeguarding concerns contact 0300 123 7034.

     

  • Appetite

    Recognise What you see … Respond What you can say and do … Link Where you can go for further advice,
    support or do next …

    Changes in weight might be noted along with changes to energy levels and concentration.


    Children 

    • These can all be okay and indicate normal brain processing, provide reassurance and suggest noting changes over the coming weeks as well as:
    • Talk to parent/carer and ascertain if there have been any changes to mealtimes, availability and quality of food.
    • Has this been a previous concern?
    • If so how has this been addressed?
    • Has someone else been shopping/providing the food?
    • Are they reliant upon food banks?
    • Does the young person have any choice/control over the food that they are or are not consuming?
    • Are mealtimes a difficult time in the family household?
    • Is the young person eating alone or having to obtain their own food?
    • Have the weight changes been discussed? Are they planned?
    • Is the young person experiencing a sensory issue? (see below for further information).
    • Explore body image and anorexic thinking using trauma sensitive language.
    • Encourage healthy eating in school and at home.
    • Consider access to breakfast club if available.
    • Self help: healthy food swaps

    Adults


    Is this ok?

    Children 

    Adults

    Is this still ok?

    Children

    Adults

    • If difficulties persist advise to contact GP practice.

    Am I still worried?

    Children

    Emotional health and wellbeing concerns:

    Safeguarding concerns:

    Adults

    • If concerns persist and present acutely concerning emotional and mental health needs advice to contact Cheshire and Merseyside Mental Help Crisis Helpline on 0800 145 6485 and/or GP practice.
    • Adult safeguarding concerns contact 0300 123 7034.
  • Personal Hygiene

    Recognise What you see … Respond What you can say and do … Link Where you can go for further advice,
    support or do next …

    Poor personal hygiene.
    Not washing clothes.
    Excessive/obsessive cleaning and checking.


    Children 

    • Consider using social stories to help start conversations to understand behaviour or personal hygiene, particularly for young children or a good resource for children with Autism Spectrum Disorder (ASD).
    • Has this been a previous concern?
    • If so how has this been addressed?
    • Inform the young person about what you have noticed i.e. unpleasant odour, dirty clothes and ask if they have the ability/facilities to maintain their hygiene.
    • Is their personal hygiene a priority to them? What is their home environment like?
    • Is the young person or child experiencing a sensory issue or trauma response that is preventing them from being able to maintain their hygiene? Use trauma sensitive language to support this conversation. For a younger child talk to their parent/carer about this.
    • Gently ask about routines and generally how they are.
    • Remember motivational interviewing techniques or Next Step cards.
    • Watchful wait.

    Adults

    • Self-help: as above encourage to stay connected
    • Take notice: become aware of present, understand yourself, improve mental wellbeing.


    Is this ok?

    Children

    • Observe and monitor ensuring regular check ins.
    • Can talk to school emotional literacy support assistant (ELSA) and use whole class teaching linked to increase in handwashing routines.

    Adults

    Is this still ok?

    Children

    Adults 

    • If concerns persist encourage to seek support from GP (Social Prescribing) practice.
    • Consider if talking therapy could provide support.

    Am I still worried?

    Children

    Emotional health and wellbeing concerns:

    • If poor hygiene is linked to low mood contact CAMHS. If excessive cleaning/checking does not calm down in four to six weeks contact CAMHS.
    • If you have concerns contact Cheshire and Merseyside Mental Help Crisis Helpline on 0800 145 6485.

    Safeguarding concerns:

     Adults

    • If concerns persist and present acutely concerning emotional and mental health needs contact Cheshire and Merseyside Mental Help Crisis Helpline on 0800 145 6485 and/or GP practice.
    • Adult safeguarding concerns contact 0300 123 7034.
  • Sensory seeking behaviours

    Recognise What you see … Respond What you can say and do … Link Where you can go for further advice,
    support or do next …

    Biting, chewing, tapping, touching, anger/frustration, refusal.

     


    Children 

    • For those children who are non-verbal is this an expression of pain/anxiety? What are they trying to communicate?
    • Ignore if possible or allow time in the day for a ‘sensory diet’.
    • Enquire about the following:
      – has this been a previous concern?
      – if so how has this been addressed?
      – if there are previous behaviours what does the child/young person find useful?
      – what has been effective in the past? Talk to the child/young person/parent/carer if possible.
      – if these are new behaviours do they occur at specific times of the day?
      – are these behaviours distressing to the child/young person? Are they affecting other people?
    • Discuss with the child/young person/parent/carer any possible contributing factors, changes in structure/routine, care provider, current or history of trauma.
    • Talk to the child/young person about adaptive behaviour techniques, engaging in purposeful activities, self-soothing, mindfulness, distraction.
    • These short term solutions will not necessarily meet their core need but will help the child/young person to reduce and or prevent in using sensory seeking behaviours.
    • Consider using:
      mindfulness
      – distraction
    • Consider sensory checklist profiling and develop a shared plan to reduce/increase sensory stimulus.

    Adults

    • Can be a sign of stress or anxiety – encourage to support reducing these feelings:
      Take notice become aware of the present, understand ourselves to support improving mental wellbeing.
      Be active physical activity can improve mental health and support in managing stress and anxiety.
      Stay connected encourage a sense of belonging and self-worth.


    Is this ok?

    Children

    • For children with Autism Spectrum Disorder (ASD) consider social stories at National Autistic Society 
    • Further advice as part of the multi agency map to support emotional health and wellbeing of children and young people (formally behaviour pathway).
    • These behaviours may be due to a sensory deficit or trauma response.

    Adults

    Is this still ok?

    Children

    Adults

    • If concerns persist encourage to seek support from GP (Social Prescribing) practice.

    Am I still worried?

    Children 

    Emotional health and wellbeing concerns:

    • Consider consultation or referral to CAMHS if concerns persist
    • If you have concerns contract Cheshire and Merseyside Mental Help Crisis Helpline on 0800 145 6485.

    Safeguarding concerns:

     Adults 

    • If concerns persist and present acutely concerning emotional and mental health needs contact Cheshire and Merseyside Mental Help Crisis helpline on 0800 145 6485 and/or GP practice.
    • Adult safeguarding concern contact 0300 123 7034.
  • Physical presentations of stress

    Recognise What you see … Respond What you can say and do … Link Where you can go for further advice,
    support or do next …

    Other than those mentioned above other physical signs might be noticed – headaches, stomach aches, needing the loo, increase in bowel movement, tight chest, spots, being pale, tics, etc.


    Children

    • Ask about general wellbeing and consider physical illness, share information with parents/carer.
    • Remember those children who are not verbal. How do they communicate they are uncomfortable? Ask those professionals who know the child well to support with this.
    • Self help:
      five ways to wellbeing
      action for happiness
    • Has this been a previous concern, if so how has this been addressed?
    • Talk to the child/young person about health promotion, diet, exercise, mood-altering drugs, relaxation and stress management, sleep, if concerns for a younger child talk to them and their parents/carers.
    • Check out what the child or young person may be communicating to you.
    • Have their circumstances at home changed?
    • Are they living in a home environment which has recently changed/suffered loss or trauma or feels uncertain to them?

    Adults

    • Ask about how they are feeling use trauma informed language, acknowledge you can see they are not themselves.
    • Encourage self-help:
      Take notice: become aware of the present, understand ourselves to support improving mental wellbeing.
      Be active: physical activity can improve mental health and support in managing stress and anxiety.
      Stay connected: encourage a sense of belonging and self-worth.
      Give: encourage to consider different ways to support mental wellbeing and manage stress.

     


    Is this ok?

    Children 

    • Can discuss with school mental health first aider who can signpost if required.
    • Person-centered practices are used with people to make sure that they are truly listened to.
      Person-centered thinking tools

    Adults

    Is this still ok?

    Children 

    Adults

    • If concerns persist encourage to seek support from GP (Social Prescribing) practice.

    Am I still worried?

    Children

    Emotional health and wellbeing concerns:

    • Contact CAMHS if thought to be related to mental health concern
    • If you have concerns contact Cheshire and Merseyside Mental Help Crisis Helpline on 0800 145 6485.

    Safeguarding concerns:

    Adults

    • If concerns persist and present acutely concerning emotional and mental health needs advise to contact Cheshire and Merseyside Mental Help Crisis Helpline on 0800 145 6485 and/or GP practice.
    • Adult safeguarding concern contact 0300 123 7034.

  • Nervousness, worries, anxiety fear and phobia

    Recognise What you see … Respond What you can say and do … Link Where you can go for further advice,
    support or do next …

    Nervousness, worries, anxiety fear and phobia.


    Children

    • Self-help:
      Minded
      Anxiety Canada
      Mymind
    • Has this been a previous concern?
    • If so how has this been addressed?
    • Gently enquire about what specifically is worrying them. Reassure and provide common sense evidence to support the reassurance.
    • Worries are likely to be about their safety or about others not near them – separation worry. Can they identify the ‘worry thought’?
    • Do not excessively reassure. Distract and reflect back times when they are in a different or better mood.
    • Consider using scaling tools to gauge how strong or weak the worry is e.g. Next Step cards
    • Together plan response e.g. breathing, exit card, access to safe place.
    • Plan and co-ordinate approach with family.
    • Model that worries are ok and can be helpful and can be controlled by us.
    • Focus on positive behaviours and engagement. Consider whole school approaches to emotional literacy and regulation e.g. worry box or mood checking boards.

    Adults

    • Encourage self-help: provide assurance. Most people feel worries, anxiety and fear in different periods of their lives it can impact on how you physical feel and mentally respond to situations around you.
      Take notice become aware of the present, understand ourselves to support improving mental wellbeing.
      Be active physical activity can improve mental health and support in managing stress and anxiety.
      Stay connected encourage a sense of belonging and self-worth.

     


    Is this ok?

    Children 

    Adults 

    Is this still ok? 

    Children

    Adults

    Am I still worried? 

    Children 

    Emotional health and wellbeing concerns:

    • Schools: consider consultation with your child and educational psychologist (CEP).
    • Contact CAMHS if thought to be related to mental health concern.
    • If you have concerns contact Cheshire and Merseyside Mental Help Crisis Helpline on 0800 145 6485.

    Safeguarding concerns:

    Adults

    • If concerns persist and present acutely concerning emotional and mental health needs advise to contact: Cheshire and Merseyside Mental Help Crisis helpline on 0800 145 6485 and/or GP practice.
    • Adult safeguarding concern contact 0300 123 7034.
  • Poor concentration

    Recognise What you see … Respond What you can say and do … Link Where you can go for further advice,
    support or do next …

    Poor concentration, shows little interest, disengages and distracted easily

    This might be linked to several of the above issues: worries, anxiety, fear, sensory changes, sleep for example.


    Children
     

    • Has this been a previous concern? If so how has this been addressed?
    • Explore reasons underpinning concentration issues.
    • Routines and regular predictable breaks and changes in activity.
    • Does the child or young person have a history of trauma?
    • Are they living in a home environment which has recently changed/suffered loss or trauma or feels uncertain to them?

    Adults

    • Encourage and support mental wellbeing exploring a number of different approaches:
      Take notice become aware of the present, understand ourselves to support improving mental wellbeing.
      Be active physical activity can improve mental health and support in managing stress and anxiety.
      Kindness strengthens relationships, develops community and deepens solidity.
      Learn try learning something new, keeps the mind active, enhances self-esteem, encourages social interaction.


    Is this ok?

    Children 

    • Can discuss with school mental health first aider who can signpost if required.
    • Can talk to school emotional literacy support assistant (ELSA) who can signpost/advise as required.

     Adults

    Is this still ok?

    Children 

    Adults

    Am I still worried?

    Children

    Emotional health and wellbeing concerns:

    • Consider consultation with your  child and educational psychologist (CEP).
    •  Consider CAMHS consultation.
    • If you have concerns contact Cheshire and Merseyside Mental Help Crisis Helpline on 0800 145 6485.

    Safeguarding concerns:

    Adults

    • Contact Cheshire and Merseyside Mental Health Crisis Helpline on 0800 145 6485.
    • Adult safeguarding concern contact on 0300 123 7034.
    • Contact GP practice.

     

  • Changes in emotion

    Recognise What you see … Respond What you can say and do … Link Where you can go for further advice,
    support or do next …

    Presentation and regulation vary from person to person and over time, often this is most visible through our behaviours for example from excitement (especially for young children) to sadness, feeling low and a sense of loss.


    Children

    • With all behaviours it is important to try and find the meaning – what message/messages are being conveyed?
    • Remember to try different ways depending on the normal way a child communicates. Is this by visuals, signing or by showing crying/laughing? Use the member of staff they communicate with best or the one who understands them most.
    • Ask if this has been a previous concern? If so how has this been addressed?
    • For schools supporting children and young people into new routine and new school environment may show different behaviours and emotions that may not be ‘compliant or containable’ but reflect how they are processing the changes around them.
    • Consider PACE and how this could support your conversations and work with them.
    • Consider motivational interviewing or Next Step Cards to explore change.
    • Thoughtful observation, can you see any patterns or triggers, consider the impact of trauma and take a trauma informed approach
    • What makes it better or worse?

    Adults

    • You may notice different emotions at different times and not a consistent regulated response, these can range from for example, increased alertness, denial, panic, avoidance, difficulties in managing change.
    • Apply thoughtful observation, can you see any patterns or triggers, consider the impact of trauma and take a trauma informed approach
    • Support the person to:
      Stay connected encourage a sense of belonging and self-worth.
      Take notice become aware of the present, understand ourselves to support improving mental wellbeing.
      Learn try learning something new, keeps the mind active, enhances self-esteem, encourages social interaction, provides distraction.


    Is this ok?

    Children

    • Can discuss with school mental health first aider who can signpost if required
    • Can talk to school emotional literacy support assistant (ELSA) who can signpost/advise, as required for calming relaxation techniques
    • Person-centered practices are used with people to make sure that they are truly listened to.
      Person-centered thinking tools

    Adults

    Is this still ok?

    Children

    Adults

    Am I still worried?

    Children

    Emotional health and wellbeing concerns:

    • Contact CAMHS if thought to be related to mental health or contact Cheshire and Merseyside Mental Health Crisis Helpline on 0800 145 6485.

    Safeguarding concerns:

    Adults

    • If concerns persist and increase concerning emotional and mental wellbeing contact Cheshire and Merseyside Mental Health Crisis Helpline on 0800 145 6485 and/or GP practice.
    • Adult safeguarding concerns contact 0300 123 7034.
  • Withdrawn behaviours

    Recognise What you see … Respond What you can say and do … Link Where you can go for further advice,
    support or do next …

    Withdrawn behaviours, for example do not talk like they used to and prefer their own company, reluctant to leave their room or home, socially withdrawn, increasingly more isolated from day to day activities.


    Children

    • Has this been a previous concern?
    • Were they reluctant to go to school and now this is much worse?
    • Consider attachment difficulties if a parent has been unwell.
    • If so how has this been addressed?
    • How long has the child been withdrawn?
    • Have other members of the family/ school noticed?

    Adults

    • If adult – have other members of family, friends or work colleagues noticed?
    • Support the person to:
      Take notice become aware of the present, understand ourselves to support improving mental wellbeing.

    Children and adults


    Is this ok?

    Children

    • Consider how you can help them come to terms with the event. What seems to help? When is the child not or less withdrawn?
    • Can discuss with school mental health first aider who can signpost if required.
    • Person-centered practices are used with people to make sure that they are truly listened to.
      Person-centered thinking tools

    Adults

    Is this still ok?

    Children

    Adults

    Am I still worried?

    Children

    Emotional health and wellbeing concerns:

    • Consider consultation with CAMHS or Starting Well
    • Contact Cheshire and Merseyside Mental Health Crisis Helpline on 0800 145 6485.

    Safeguarding concerns:

    Adults

    • If concerns persist and increase concerning emotional and mental wellbeing advice contact Cheshire and Merseyside Mental Health Crisis Helpline on 0800 145 6485 and/or GP practice.
    • Adult safeguarding concerns contact 0300 123 7034.
  • Sad and low in mood

    Recognise What you see … Respond What you can say and do … Link Where you can go for further advice,
    support or do next …

    Sad and low in mood people may find their minds are preoccupied with negative memories,  a bleak view of the future or negative thoughts about themselves or their current situation. They might withdraw from others, lack motivation or  energy and feel like nothing is enjoyable. They might be tearful and experience thoughts of hurting themselves but equally the sadness might present as irritability or detachment or putting on an act that it’s all OK.


    Children
    and Adults

    • Has this been a previous concern?
    • If so how has this been addressed?
    • Explore with the person what might be leading them to feel low. If they can identify reasons those reasons may indicate  a problem that can be solved/ something they can change or something they need help to cope with.
    • Self help:
      Children – Mymind
      Adults – Wellbeing, Self Help and Apps
    • Children – Have regular check ins with consistent staff members.
    • Adults – Do they have a supportive friend, family member or support person they can talk to?
    • Do not overly use rating tools.
    • Encourage development of a self-help plan – exercise, mindfulness, journaling.
    • Ask if they are having active thoughts about suicide and consider safeguarding, talk to your designated safeguarding lead in your organisation.
    • Reflect and note times when mood lifts – do more of what works.

     


    Is this ok?

    Children 

     Adults

    Is this still ok?

    Children

    Adults

    Am I still worried? 

    Children

    Emotional health and wellbeing concerns:

    • Contact Cheshire and Merseyside Mental Health Crisis Helpline on 0800 145 6485.
    • CAMHS referral if issues endure or have significant impact on engagement in school.
    • Consider a multi-agency admission prevention meeting. If they have a diagnosis of Autism Spectrum Disorder (ASD) and/or learning disabilities and still at risk after this consider a Care, Education and Treatment Review (CETR)
    • CAMHS training available through Safeguarding Children Partnership.

    Safeguarding concerns:

     Adults

    • If concerns persist and increase concerning emotional and mental wellbeing contact Cheshire and Merseyside Mental Health Crisis Helpline on 0800 145 6485.
    • Speak to your GP Practice
    • Western Cheshire IAPT: Further information and support
    • Western Cheshire IAPT:  Self-Referral and How to get help
    • Number 71: A safe space for people struggling with emotional and psychological distress.
    • If the person you are concerned about (or someone they care for) has additional needs or vulnerabilities, e.g. maintaining continence; staying safe or preparing food, they may benefit from an assessment under the Care Act and should contact Cheshire West and Chester, Adult Social Care,  Community Access Team: Community Access Team
    • Adult safeguarding concerns contact 0300 123 7034.

     

  • Loss and grief

    Recognise What you see … Respond What you can say and do … Link Where you can go for further advice,
    support or do next …

    Feelings of loss, grief, isolation and sadness.

    Feelings of loss are strongly associated to Covid-19. The magnitude of loss is broad and deep from loss of a loved one, school routine and structure, unexpected endings, not taking exams, a job, not able to be with family and friends.

    Many behaviours and experiences can be associated with loss and grief. It changes mood, presentation and behaviour (age related):

    • Struggles eating and sleeping or comfort eating and sleeping a lot.
    • Presentation of separation anxiety.
    • Presentation of social anxiety – worried about going out and meeting others.
    • Jumping in and out of feelings of loss, sadness and grief.
    • Worried about illness and death.
    • Some regressive behaviours.
    • Presenting angry, aggressive and controlling (presenting subdued and disconnected).
    • Reluctant to talk about feelings.
    • Engaging in risky behaviours.


    Children

    Talking to children about the impact of Covid-19:

    • Lots of national and local support
    • Have the child/young person and their family experienced loss and grief previously? Consider how this could be impacting further on them now.
    • Prepare children before they return to school by using social stories.
      mainstream classroom
      comic strips
    • Children’s understanding of death at different ages
    • Consider what supported them previously and if this would be appropriate to draw on again?
    • Provide:
      re-assurance
      – routine, structure and boundaries in place (knowing what to expect)
      – warmth, comfort
    • “Normalising” feelings of loss and grief.
    • Engaging children and young people in activities or with key people.
    • Talking openly, naming the feelings and connections.
    • Offering safe spaces to share, express, talk about feelings – personalise to child/young person’s needs (be creative: play, art, drama, dance, music, journaling, physical release, exercise, mindfulness, grounding).
    • Talking factually about what’s occurred and impact (age appropriate).
    • Allow short term dependence, regression.
    • Encourage time with friends. 

    Adults

    • Positive role-modelling.
    • Engage in activities mentioned above.
    • As and when helpful or needed support the adult in the above.

     


    Is this ok?

    Children

    Adults

    Is this still ok?

    Children

    Adults

    Am I still worried? 

    Children

    Emotional health and wellbeing concerns:

    Safeguarding concerns:

    Adults

  • Angry behaviours

    Recognise What you see … Respond What you can say and do … Link Where you can go for further advice,
    support or do next …

    Angry behaviours including shouting, hitting out, kicking.


    Children

    • Has this been a previous concern for the child or young person?
    • If so, how has this been addressed?
    • How long has the child or young person been angry for?
    • Have other members of the family/ school noticed?
    • Can you link the start of this angry behaviour to a specific event?
    • Can you ask them how they feel?
    • Can they tell you how they feel?

    Adults

    • Have other family members, friends, work colleagues noticed anything?
    • Take notice: become aware of the present, understand ourselves to support improving mental wellbeing.
    • Draw on trauma informed practice and consider root causes to anger considering childhood experiences, what is happening a person’s life in the present and what has happening in the past.
    • Consider what has triggered the anger, encourage to discuss with someone they feel safe with.
    • Is anger directed towards others or self?
    • Does this place others or themselves at harm?
    • Ensure that the person and those around them remain safe.
    • If you have concerns talk to your safeguarding lead and follow safeguarding policies and procedures for children and adults.


    Is this ok?

    Children

    Adults

    Is this still ok?

    Children

    Adults

    Am I still worried?

    Children

    Emotional health and wellbeing concerns:

    • Anger may indicate issues with emotional regulation and mental health, consider consultation with CAMHS.
    • Contact Cheshire and Merseyside Mental Health Crisis Helpline on 0800 145 6485.

    Safeguarding concerns:

    Adults

    • Contact GP practice as this may indicate concerns for mental health and emotional wellbeing.
    • If concerns persist and increase concerning emotional and mental wellbeing advice contact Cheshire and Merseyside Mental Health Crisis Helpline on 0800 145 6485 and/or GP practice.
    • Adult safeguarding concerns contact 0300 123 7034.
  • Self injury and harmful behaviours

    Recognise What you see … Respond What you can say and do … Link Where you can go for further advice,
    support or do next …

    Harmful behaviours might include cutting, burning or overdosing and may actively be behaviour which is helping the person manage difficult emotions and stressors. They may not be willing or able to stop. It may also include risk taking activity such as using  alcohol or illicit substances (see below).

    It’s important for anyone who self-harms to see their GP. They can treat any physical injury and recommend further assessment, if necessary.


    Children and Adults

    •  Consider safeguarding policy as a priority and talk to the  designated safeguarding lead in your organisation.
    • Do they require urgent specialist support to address suicidal thoughts and or their immediate physical wellbeing need attending to? (see Link column – Am I still worried?)
    • Do they require intervention to clean the self-harm wounds?
    • If they are willing to talk, gently engage using motivational interviewing approaches in your  conversation, talk to them about how they are coping, explore the thoughts behind the behaviour including suicidal thoughts.
    • Try not to make assumptions about the behaviour but be alongside to support if change is being considered.
    • Suicidal thoughts need referral to partners in health (see advice in Link column).
    • Has this been a previous concern?
    • If so, how has this been addressed?
    • If they are previous behaviours what did they find useful?  What has been effective in the past?
    • Are these new behaviours?
    • Do they occur at specific times of the day?
    • Consider family and friend support.
    • Are these behaviours distressing for them?
    • Are they affecting other people?
    • Discuss with them and those that support/provide care for them any possible contributing factors, changes in structure/routine, care provider?
    • Have they experienced trauma in the past or currently experiencing trauma, stress, changes, pain and or loss?
    • Consider if they  have a sensory need that is not being met?
    • Talk to them about how they could start to change some of their ways of managing their pain and emotions through adaptive behaviour techniques, engaging in purposeful activities, self-soothing, mindfulness, distraction.
    • These short term solutions will not necessarily solve the deep root of their pain and meet their core need but will help them to reduce/prevent harmful behaviours.
    • Try and develop a shared safety plan with them.
    • See each episode as new and re-assess for risk, try not to make assumptions from previous experiences, modify and update the risk plan and be mindful of confidentiality and preserving dignity.
    • Children: Monitor and check in regularly and access supervision and consultation with CAMHS/safeguarding.
    • Adults: Do they have a supportive friend, family member or support person they can talk to?

    Self help:

     

     


    Is this ok?

    Children  

    Adults

    Is this still ok? 

    Children 

    Adults

    Am I still worried?

    Children

    Emotional health and wellbeing concerns:

    • Does the child/young person require urgent specialist support to address suicidal thoughts and behaviours?
    • Cheshire and Merseyside Mental Health Crisis Helpline 0800 145 6485.
    • It’s important for anyone who self-harms to see their GP. They can treat any physical injury and recommend further assessment, if necessary.
    • CAMHS consultation and referral when associated with changes in the behaviour e.g becoming more frequent or when accompanied with suicidal thoughts.

    Safeguarding Concerns:

    Adults

    • If concerns persist and increase contact Cheshire and Merseyside Mental Health Crisis Helpline on 0800 145 6485.
    • It’s important for anyone who self-harms to see their GP. They can treat any physical injury and recommend further assessment, if necessary.
    • If the person you are concerned about (or someone they care for) has additional needs or vulnerabilities, e.g. maintaining continence; staying safe or preparing food, they may benefit from an assessment under the Care Act and should contact Cheshire West and Chester, Adult Social Care,  Community Access Team: Community Access Team
    • Adult safeguarding concerns contact 0300 123 7034.

     

     

     

  • Caring for someone close to you

    Recognise What you see … Respond What you can say and do … Link Where you can go for further advice,
    support or do next …

    This could be young carers caring for a parent, sibling, family member,  or an adult caring for a partner, their child, sibling, parent or older adult.

    Many people who are caring for someone wouldn’t describe themselves as carers but as a wife, husband, mother, father, son, daughter, close relative, good neighbour or friend. Looking after each other is something they do.

    Caring can be very rewarding, but can also be challenging, especially at the moment during the Covid-19 outbreak when many people are spending more time caring than usual. Many carers are feeling overwhelmed by the current situation. Without the right support caring can be tough and can have a negative impact on physical and mental health, work, finances and relationships.


    Children

    • Take a ‘Think Family’ approach:
      Talk to the child/young person.
      – Talk to wider family members.
    • Understand the whole family situation:
      – Consider who else is in the family home?
      – How is the child/young person managing in their caring role?
      – Do they need any additional support?
      – Consider if local services could offer support.

    Adults

    • A carer’s assessment can enable carers to connect to a range of local help, support and advice. It can also help  practically with equipment,  support for their own wellbeing and can also arrange a break from caring.
    • Top tips for carers:
      • Tell your manager you are a carer and read the employer guidance on supporting you with your caring responsibilities
      • Call the carer helpline for help and support – 0300 102 0008
      • Make sure you’re accessing all the benefits/grants that you are entitled to
      • Connect with your community
      • Ask your local authority about a Carers’ assessment
      • Look after yourself – your physical mental health and wellbeing are important
      • Know your rights as a carer
      • Tell your GP you’re a carer
      • Remember, if you juggle work with looking after someone at home, you are still a carer!


    Is this ok? 

    Children

    Adults

    Is this still ok? 

    Children

    Adults

    Am I still worried? 

    Children

    Emotional health and wellbeing concerns:

    • Contact Cheshire and Merseyside Mental Health Crisis Helpline on 0800 145 6485.
    • Mymind: crisis

    Safeguarding concerns:

    Adults

    • Cheshire and Merseyside Mental Health Crisis Helpline on 0800 145 6485.
    • If the person you are concerned about (or someone they care for) has additional needs or vulnerabilities, e.g. maintaining continence; staying safe or preparing food, they may benefit from an assessment under the Care Act and should contact Cheshire West and Chester, Adult Social Care, Community Access Team: Community Access Team
    • Adult safeguarding concern contact 0300 123 7034.

     

     

     

  • Domestic abuse

    Recognise What you see … Respond What you can say and do … Link Where you can go for further advice,
    support or do next …

    Children

    Children and young people may show us how they are feeling in different ways through their behaviour for example:

    • May have nightmares, bed wetting, complain of physical symptoms such as tummy aches.
    • Feeling confused, withdrawn, low mood, anxious, angry, afraid, isolated, ashamed, guilty, low self esteem.
    • Be unable to concentrate and struggle in achieving in school.
    • Be used to threaten the adult victim  (threats to harm children or have them taken into care).
    • Protective of family members.
    • Risk getting hurt  by being caught in between parents.
    • Not have their own needs fully met by a parent who is struggling to cope with being abused.
    • Be directly abused by the person who is harming the adult.
    • Showing signs of trauma being in fight or flight.
    • Develop ways of coping that could hurt them and show their distress e.g. running away or using substances.

    Contact

    Contact arrangements may have changed or there may be conflict regarding contact.

    You may notice changes in parenting due to the impact of domestic abuse.

    Adults and Family

    There is a difference between an unhealthy relationship and domestic abuse. Domestic abuse is defined by one person having more power and control over another. There is likely to be disharmony and adults having arguments due to the stress of COVID-19

    Isolation

    If you have not seen a person you would normally see for a period of time, they may be isolated or they change how they contact you like using text or emails instead.

    You may notice behaviour changes, less contactable, will ignore you on the street, no eye contact, wearing different clothes, long sleeves on a hot day

    You may notice that the victim is always with the abusing adult and presents with different behaviours in their presence.

    You may observe injuries

    You may be aware that a victim or abusing adults’ mental health is deteriorating

    Finance

    Financial situation may change due to controlling and coercive behaviours, especially if the abusive partner has been furloughed or made redundant from work.

    You may notice a victim using foodbanks or requesting additional benefits or financial assistance from agencies.

    Alcohol and Drugs

    You may see an increase in the use of alcohol or substances for the victim, abusing adult or young person

     

     

     

     


    Children

    • Has this been a previous concern? If so, how has this been addressed?
    • Talk to the child/young person to understand what it is like for them, using motivational interviewing to support this. This can be done through an activity together, talking, drawing or writing.
    • Try and develop a safety plan with the child/young person, which includes where to get help in an emergency.
    • Consider family and friends they have for support.
    • Take a ‘Think Family’ approach.
    • Tell the young person about The Hideout.

    Advice for working with parents and adults

    • If there are children involved the person harming may use child contact to further control and abuse.
    • If court orders are in place which are not being followed advise to contact the solicitor or police to enforce them. 
    • Be supportive of a person experiencing abuse who may be implementing their own safety plan while isolating with an abusing adult and for some may be managing parenting. 
    • For parents offer parenting advice but acknowledge that the parenting style is indicative of the situation.
    • Offer early help support if there is an indication of impact upon the children/young person that is not safeguarding. (see more detail in LINK column).
    • Advise to take regular breaks, walk around any outside space they might have, read a magazine, get the kids involved in an online exercise class.
    • Show understanding regarding the stress caused by COVID-19 and offer advice and guidance regarding how to manage arguments.

    Safety Planning 

    Basic principles:

    • Keep a mobile phone charged and with credit.
    • Call 999 in an emergency.
    • Have a bag packed for emergencies that includes, important docs, money and clothes. 
    • Use the silent solution if needed.
    • Encourage attendance at appointments to see professionals.
    • Stay in touch with someone you trust, family/friends ask them to check in on you if safe.
    • Use the you are not alone campaign safe nets at supermarkets ( details on open the door).
    • Have a code word for safety.
    • Can your employer offer you support?
    • Use the Bright Sky and Hollie Guard apps. (see LINK column)
    • Use safelives and women’s aid resources for safety planning information. 
    • Contact the Domestic Abuse Intervention and Prevention Service for support.
    • Offer support regarding how to access additional funds.
    • Support with opening own bank account if safe to do so.
    • Utilise time at food banks if safe to contact domestic abuse services.


    Is this ok?

    Children

    Adults

    Is this still ok?

    Children

    Adults

    • Silent solution
    • Bright Sky App
    • Hollie Guard App 
    • Freephone 24h National Domestic Abuse Helpline: 0808 247 2000
    • LGBT+ Domestic Abuse Helpline: 0800 999 5428 help@galop.org.uk
    • Men’s Advice Line: 0808 801 0327  info@mensadviceline.org.uk
    • Karma Nirvana, UK Helpline for ‘honour’-based abuse and forced marriage: 0800 5999 247

    Am I still worried?

    Children

    Emotional health and wellbeing concerns:

    • Does the child/young person require urgent specialist support to address suicidal thoughts and behaviours?
    • CAMHS consultation and referral when associated with changes in the behaviour e.g becoming more frequent or when accompanied with suicidal thoughts.
    • Consider Accident and Emergency Department (999 or ensuring safe travel there) or Cheshire and Merseyside Mental Health Crisis Helpline on 0800 145 6485.

    Safeguarding Concerns:

    Adults

    • Contact the Cheshire West Domestic Abuse Intervention and Prevention Service on 03001237047 option 2.
    • Cheshire and Merseyside Mental Health Crisis Helpline on 0800 145 6485.
    • Adult safeguarding concerns contact 0300 123 7034.
  • Drugs and alcohol

    Recognise What you see … Respond What you can say and do … Link Where you can go for further advice,
    support or do next …

    Children

    Young people may try drugs and/or alcohol for a number of different reasons:

    • Peer pressure
    • For fun
    • Low mood
    • Curiosity
    • To help them to forget
    • Self-medicate
    • Boredom
    • Lack of confidence

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     


    Adults

    People use alcohol/ drugs for lots of reasons:

    • To socialise
    • To ‘escape’
    • To fit in
    • To experiment

     Look out for:

    • The person often feeling their need to have an alcoholic drink/ use drugs.
    • Getting  into trouble because of drinking/ drug use.
    • Others  warning them about how much they are  drinking/ using drugs.
    • The person themselves  thinks their drinking/ drug use is causing  problems.


    Children

    Is this something you were concerned about before?

    Is the young person receiving professional support? Do they need to receive this?

    Self-help: WDP (Westminster Drug Project)

    Signs to look for-

    Is the Young Person-

    • Mixing with new friends
    • Experiencing moods swings
    • Poor sleep patterns.
    • Being secretive or evasive about where they’re going and what they’re doing
    • Red-rimmed eyes and/or a runny nose
    • Drowsiness
    • Poor hygiene or appearance
    • Loss of appetite
    • Big increase in appetite
    • An uncharacteristic loss of interest in school, hobbies and friends
    • Money going missing regularly for no apparent reason
    • Smelling of smoke or alcohol
    • Returning home late and displaying unusual behaviour
    • Slurred speech or rapid speech
    • Dilated pupils
    • Sudden dramatic weight Loss
    • Health concerns/signs-

    -Frequent sickness

    -Nosebleeds

    -Skin abrasions/bruises

    -Sores around the mouth

    -Headaches

    How to respond- advice for parents/carers

    • Talk to the young person open and honestly without judgement.
    • Be a responsible role model.
    • Set clear boundaries, structure and routines.
    • Help your young person learn to make safe and healthy decisions.
    • Support the young person to strengthen their sense of wellbeing in healthier ways – exercise, sport, music.
    • Find out what you can about illegal drugs, their names, their effects, so that you can be well informed.
    • Allow plenty of time, don’t rush the conversation.
    • Respect what they have to say – don’t lose your temper,
    • Let them know you’re there for them and that they can talk to you about drugs.
    • If they are using, don’t confront them when they’re high.
    • Seek professional support: WDP (Westminster Drug Project)

    Adults

    Understanding why  people use alcohol/ drugs helps us in our response:

    • Some people use alcohol/ drugs occasionally to have fun, socialise and relax.
    • Taking substances might not become a problem for these people, and they’ll probably stop when they’re ready to.
    • You can appropriately  make  them aware  that some drugs are illegal and can affect their physical and mental health.
    • For some it is a way of escaping difficult feelings that they’re struggling to cope with.
    • Some people take substances to fit in, or because they feel  under pressure to do so by their friends. Talk to  them and explore what interests and activities  they enjoy that don’t involve alcohol/ drugs?
    • Some people are just curious. They might try drugs once or twice to see what it’s like and then decide to leave it. Remember that most people who try drugs don’t continue using them.
    • They might be feeling depressed, anxious, insecure and  use alcohol/ substances/ to cope and manage their feelings. This will make these feelings worse for them.
    • If you think this, talk to them, in an open and clam way,  using trauma informed language and think about how motivational interviewing could support this conversation. Look out for ways to help them think about why they’re using alcohol/ drugs and ways they can manage without them. If necessary, suggest that they look for professional help.

    Advice:

    • Watch  their  alcohol consumption.
    • The Government recommend for both men and women to have 2 alcohol free days a week and  not to regularly drink more than  14 units a week.  14 units is equivalent to six pints of average strength lager ( 4% ABV) , or six medium size glasses of wine (175ml, 12% ABV).
    • Seek support from a trusted person
    • Find more: WDP (Westminster Drug Project)

    ​​


    Is this ok?

    Children

    WDP Young People: Cheshire West and Chester Young People’s Drug and Alcohol Service

    Live Well Cheshire West and Chester – sign post drug and alcohol services 

    Adults

    NHS Live-Well Alcohol Support

    NHS Live-Well Healthy Body

    Alcoholics Anonymous

    Live Well

    Is this still ok?

    Children

    Find out how other services can help: WDP Young People: Cheshire West and Chester Young People’s Drug and Alcohol Service

    Adults

    Contact GP Practice they can offer advice and advise on the right treatment, this could be at the practice or a local service.

    Contact WDP (Westminster Drug Project) the local service to help those affected by alcohol and substance misuse.(self-referrals or referrals by professionals  can be made to this service)

    Am I still worried?

    Children

    Emotional health and wellbeing concerns:

    • Contact Cheshire and Merseyside Mental Health Crisis Helpline on 0800 145 6485.

    Safeguarding concerns:

    Adults

Development of this model has been led by the West Cheshire Children’s Trust, supported by the Safeguarding Children Partnership and Local Safeguarding Adults Board.