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School health and wellbeing

School health and wellbeing

What: Case study about supporting a young person with anxiety

Who: Ashley Witnall, School Staff Nurse, Warwickshire School Health and Wellbeing Service


What is the initiative and or project you are involved in?

As a school staff nurse one of my roles involves me supporting children and young people on an individual basis. This case study outlines some work I undertook with a young person who was referred to me.

What prompted you to do this work? 

The young person was referred into Warwickshire School Health and Wellbeing service by the school’s Welfare Lead. They considered that the young person had issues around social anxiety and felt that support by a Public Health nurse would assist the individual.

How did you initiate the work?

I invited the young person to meet with me in school to discuss the issue of anxiety. In preparation I gathered together a list of useful websites, a list of SMART phone apps, and the ChatHealth texting teen line number.

When I met with the young person, they reported that they had a problem with social anxiety, and they were able to describe physical and emotional symptoms of anxiety such as; being unable to concentrate, pounding heart, breathing fast, sweaty palms and churning stomach. These symptoms resulted in the young person reporting that they were unable to speak in class to peers or to the teacher. The young person felt that their grades were suffering as they were struggling to concentrate in class.

What have the challenges to implementing the service/intervention been? And what has enabled the implementation of the service/intervention?

I provided the young person with anxiety support over three sessions. During the first session we explored the young person’s symptoms and possible triggers and I directed them to some self-help emotional health websites and mobile phone applications. During the second session we discussed strategies that could be tried to relieve anxiety such as breathing techniques and relaxation and I also discussed the importance of exercise on mental wellbeing. At the final session we explored whether the suggested strategies and self-help resources had been helpful. The young person felt that the support I had provided had been valuable and useful.

However I got the impression that there remained an underlying concern which the young person hadn’t yet revealed to me. Through gentle use of probing questioning the young person acknowledged that they did have a concern which we hadn’t yet discussed. Through gentle use of open ended questioning and active listening I found that the young person gradually chose to share their innermost concern with me. Over a period of time the young person revealed that they were transgender and considered herself as male, rather than female.

This disclosure enabled me to assist the young person in a more specific way. 

  • I completed a child and adolescent mental health (CAMHS) referral with the young person’s consent
  • We discussed the anxiety the young person was feeling about being transgender
  • We discussed and jointly researched support options/groups specific to LGBT (Mermaids UK and Proud Youth Warwickshire)
  • We discussed how they could inform their parents and we role played how they could go about this

Has the initiative or project made a difference to patients/service users and or staff?

The care provided by me as part of the Warwickshire School Health and Wellbeing Service, ensured that the emotional health and wellbeing issues presented by the young person were appropriately addressed and supported. Without this intervention by there is a likelihood that the young person would have continued to struggle with anxiety, affecting school and social life and may not have sought support as a transgender young person.

This would have had a further negative impact on the young person’s educational attainment and emotional health and wellbeing. As a consequence this could have spiralled into emotional harm as there is evidence that transgender young people are more likely to suffer depression, self-harm and go on to commit suicide. The interventions I provided have enabled the young person to take control of his emotional and mental wellbeing and access the support of appropriate services.

The young person now presents as a happier and more confident person and has even found the courage to tell their mother. Through deciding to change hair style they have begun the transition to becoming male. With encouragement from me, the young person has taken the step of approaching the GP for hormone blocker medication. The young person has had his assessment with CAMHS in June 2018 and is excited about what the future holds for him.

What are the long-term aims for the work?

School Health and Well-being have now completed the work with the young person. Through the support we have provided this young person is now accessing the most appropriate specialist support.

As a service we are aware of the importance of supporting children, young people and families around transgender issues. At our annual service Away Day we received update training from Proud Youth Warwickshire. This has enabled the all practitioners to become more knowledgeable about LGBT+ issues and now have a greater understanding on how to support a young person who discloses that they are a member of the LGBT+ community.

Professional learning:

As a relatively new School Staff Nurse I felt privileged to have been able to support this young person. The School Nursing team responded promptly to the referral from the school and therefore we were able to swiftly respond to this important health concern. As School Health works across professional agencies I was able to meet with the young person in an environment which was convenient and familiar to them. This enabled me to quickly build rapport and trust. I am proud that the School Health is able to provide such a professional service to support children and young people.
Nurses 4 public health

Nurses 4 public health

The RCN has been working with members on a series of case studies which help showcase the variety of ways nurses are currently working to improve public health. 

If you would like to submit a case study, please complete this template and email it to helen.donovan@rcn.org.uk. To fill out the template, you will need Adobe Acrobat Reader, which you can download here