Healthy Child Wales Programme: for school aged children - Part 5: supporting children through school ages and stages

Why it's important

A key role of school nursing services is to support children as they move through the different stages of school life, such as starting school for the first time, or moving from a primary school to secondary school. Referred to in public services as ‘transitioning’, these key stages in a child or young person’s life are critical opportunities to support ongoing development and wellbeing. The transition points are different for children and young people who are educated in settings other than at school or special schools. However, transition points remain in curriculum or development terms, even though the setting may not change. For example, some children / young people educated at home during primary years may transition to mainstream secondary education.

Therefore, transition points in a child / young person’s education refers to a significant time where a child moves from one educational level and/or setting to another.

Supporting children / young people and parents/carers to think about how they manage their own/child’s behaviour is part of the school nursing services role. They will provide support through a number of approaches, such as:

• group work
• one to one sessions
• class-based activity 

They will deliver public health sessions to discuss these topics and provide information to encourage children and young people to make informed healthier choices through their journey through the school stages, regardless of setting.

We look at the key transition points for school-aged children in the next sections.

Transition can be an exciting time for children, but it can also be a challenging time for some children who may need some additional support as they become more independent from the family and develop their learning potential including how to socialise with others.

Working with other professionals, such as health visitors, will be key to identifying outstanding health needs to ensure seamless transition and flow into school nursing services and make sure continued support is provided to the child and family. This is covered in detail in the school entry health review section of the operating model.

All children aged 5 years old will have a school entry health review, as part of the review delivery will be transferred to the school nursing services from the health visiting service. Services will be provided by school nursing services will be offered through a tiered level of public health interventions based on need.

As children and young people move into and through secondary school age, many of them will be entering puberty. Puberty and the changes that occur during this time, both emotionally and physically, can prove to be particularly challenging. Children and young people may begin experimenting with risk taking behaviours such as:

• vaping
• smoking
• alcohol
• substance misuse
• unhealthy relationships

As they learn to adjust and manage these hormonal changes, they are also more vulnerable to experiencing anxiety, issues with low self-esteem and may begin self-harming behaviours as a coping mechanism.

School nursing services will provide information through a variety of digital channels to all children in year 6 approaching 12 years old. The information will include:

• how to access the specialist community public health nurse (school nursing) at drop-in sessions
• immunisation schedules
• building healthy relationships
• dealing with stress and new environments
• emotional and physical changes through puberty
• hydration and nutrition
• how to reach out to appropriate professionals for advice

School nursing services will provide regular support, information and advice to young people through a number of digital channels to educate, inform and support them to make healthier lifestyle choices.

Upon commencing secondary school education, school nursing services focus will be on supporting children and young people with the transition and healthy relationships. The emphasis will be upon the children and young people taking responsibility for their own health across the following areas:

• emotional and physical changes through puberty
• healthy relationships and lifestyle
• importance of self-examination
• accessing confidential drop-ins

Prior to the young people finishing formal education at 16 years old, information will be shared with young people, aiming to prepare them for their next steps in life. This is key to ensuring that young people are able to take control of their lifestyle choices and understand how to reach out for help. Topics covered include:

• how to access sexual health advice
• consent in relationships
• accessing GP or 111 services for advice and accessing their immunisations records
• accessing mental health support if needed

Some children and young people will require a higher tier of support during school transitional stages. This may be due to existing emotional wellbeing needs, other vulnerabilities, or complex healthcare needs which can increase the impact of changes such as puberty which has been described above.

Within this operating model school nursing services will work in collaboration to assess a child’s need and agree how the public health classroom sessions are delivered across all schools. In special schools, some children and young people may be able to engage in classroom-based sessions with the use of visual materials and adaptations but others will not. Therefore, the delivery will be tailored accordingly based on need from school entry onwards. Nurses working in special schools will work within a team around the child model to support the adjustments required. Liaison with parents/carers is key to this.

Children and young people with complex needs can be more sensitive to changes in faces, structure, routine and environment. Nurses working in special schools will support the school to manage the child / young person’s health and wellbeing needs during school transitions. The care co-ordination role, which the nurse in special schools undertakes, is important to support person centred planning and continuity of care and promote information sharing between services. Meetings should be held at least 8 weeks before a transition takes place (for example, change of a school year) if it is anticipated that the child or young person is going to need additional support.  Multidisciplinary planning is key to providing a better transitional process and reducing anxiety for children, young people and their families and reducing any adverse impact on the child’s health and wellbeing.

As in mainstream settings, the aim as the child / young person reaches puberty is to promote their understanding of risks and empower them to make self-informed healthier lifestyle choices. Supporting the child or young person to develop self-care, adapted to recognise either their healthcare and wellbeing needs whilst improving their independence, is important as they develop into adolescence.

Some young people will require an ongoing care and support package from health or social care services following their 18th birthday. Transition from children to adult services is a complex process and planning should start as early as 14 years old. In line with their care co-ordination remit, it is important for the nurse in special schools to link with the professionals leading on the young person’s transition planning and establish if a transition co-ordinator has been assigned. The young person will be known to local community children’s nursing services or children’s learning disability services and may have an existing social worker with the local authority children’s services.

The specialist community public health nurse (school nursing), will provide confidential drop-in sessions for children at all mainstream secondary schools. These drop-in sessions will be held weekly on a secondary school site during school term and during school hours. These drop-ins provide a confidential space where children and young people can feel comfortable to discuss personal health or emotional concerns. All secondary school children and young people can access this drop-in confidentially. For children educated other than at school, alternative convenient venues will be available for children and young people to access, for example, coffee morning sessions with families, community drop-ins, advertised through digital channels.

School nursing services are trained to have an awareness and to identify where issues may be more complex and be able to support, signpost and refer children and young people to other more appropriate services. This approach fosters trust and encourages open communication, allowing early identification and support to be provided appropriately.

Children and young people have voiced that it is extremely important to have consistency of the same specialist community public health nurse (school nursing), for the weekly drop-in sessions, as they feel this enhances the effectiveness of the support. It builds trusting relationships between the child / young person and the nurse creating a comfortable environment for open communication. This continuity allows the nurse to better understand the child / young person’s needs and provide more personalised support over time. This includes avoiding the need for children and young people to retell their story to multiple professionals, which is often a barrier to young people seeking support in the first place.

Confidentiality within these drop-in sessions is crucial for creating a safe space and information exchange. The specialist community public health nurse (school nursing), working within safeguarding policy and guidance will ensure confidentiality remains, except in exceptional circumstances where there is a risk of harm. This confidentiality helps build trust and encourages children to share their concerns openly with the assurance that their privacy will be observed.

As part of the drop-in sessions, school nursing services will provide support and discussions around sexual health. The nurse will provide valuable information on topics around puberty, relationships, and safe practices. These conversations empower young people to make informed decisions about their health and wellbeing. It is vital through these sessions the nurse provides a safe and non-judgmental environment for children and young people to ask questions and seek advice and guidance. Access to the condom distribution scheme will also be available through the drop-in sessions.

School nursing services will provide a single point of access for parents/carers and families to access advice and support. This approach will enhance efficiency and ensure families are easily connected when the assistance and advice is needed. The single point of access information will be provided to all families through the school entry welcome pack.