How and why was the MIAT team created?

School attendance and mental health are well documented to be linked. This has led to the creation of a relatively new term, ‘EBSA’ (emotionally based school avoidance), often used to describe a cohort of children who present with emotional barriers to attending school, where school has been reported to be a contributing factor to poor mental health. Last year,  the Department for Education (DfE) published new guidance for schools, local authorities and parents, setting out for children who are unable to attend school for both physical and mental health reasons should be supported. In Nottingham City, the guidance led the way for thinking differently about how we support children and families when mental health is a barrier to school attendance.

Mental health support teams (MHST’s) are ideally placed to provide intervention for children presenting with anxiety. In Nottingham City, the MHST is commissioned by the integrated care board into the local authority, meaning that mental health and education services sit alongside one another, paving the way for the collaboration of expertise that has developed into the mental health improving attendance team.

Who are the MIAT?

The team consists of qualified children’s wellbeing practitioners, family support workers, a specialist/supervising education mental health practitioner and a team manager, who is an experienced school leader and brings a wealth of knowledge in school systems and ‘whole school approaches’ to helping children feel that they belong in school, and have the appropriate pastoral support to meet their needs. The team is overseen by an Educational Psychologist (me!). The blend of mental health knowledge and experience, alongside family work and understanding of schools, has enabled the team to create a holistic assessment and intervention process, and it’s working! Accountability is shared and attributions are removed from the table, to create meaningfully coproduced progression plans with the child’s voice at the centre. Most importantly, getting the mental health support they need to understand and manage anxiety.

What is the ethos of the MIAT?

1. Collaboration-with children, families and schools. The child is at the centre of the work and team aim to build strong and trusting relationships with families and schools. We do this through removing the blame. Blame is a key barrier to school attendance, when a parent blames the school, when the school blame the parent/carer, when the child is in the middle, or, occasionally, when terms such as ‘low resilience’ are attributed to the child.
2. Build motivation, underpinned by psychological theory:Built on our understanding of motivation, through the work of Deci and Ryan, 2001 (self determination theory) the aim is cantered around fostering the 3 key constructs linked to motivation:
3. Building relationships (Relatedness), through ensuring the child has a key adult relationship in the school, and building on peer relationships, we foster safety and belonging. Children we speak to place relationships at the top of their list when we ask them about what is good in school. Supporting and scaffolding safe and trusting relationships for a child with anxiety is a core component to the work of the MIAT team.
4. Giving the child agency and control over their return to school and having a say in what their support looks like (Autonomy). Through ensuring the child feels in control of steps to reintegration in school, for example, a graded exposure approach with adjustments to lessons, and altered timings to avoid anxiety triggers, we can ensure that nothing is done without consent, and the child has agency over decision making that directly affects them.
5. Competence – when we are good at things, we are much more likely to want to do them! MIAT work with the child, family and school to ensure we ‘work on what works’, starting with what the child ‘can do’ with a solution focused lense and building the systems (schools) and resilience to support the child and family through understanding how the child works best, and what they need to feel the importance sense of being successful.

Evidence based mental health interventions:

Children and parents working with MIAT have a range of mental health interventions, including:

• Behaviour activation for low mood
• Helping your child with fears and worries
• The Homunculi Approach
• Graded Exposure
• Cognitive restructuring

Children, schools and parents report improvements in the child’s mental health, and a significant reduction in anxiety in relation to attending school.

Outcome data so far

Since operations began in November 2024, nearly a year into the intervention starting, the team have worked with 121 children and families. A ‘typical’ mental health intervention will last around 6-8 weeks, perhaps 12-16 if a child is in need of more high intensity therapy. The MIAT team is unique because they do not work to these time schedules, which takes the pressure away from families. Therefore, while not all cases are closed to the team, we have so far seen an 84% success rate in children returning to education, with 58% of those children who have been out of mainstream education for extended periods of time, returning to their mainstream school. The further 26% have re-engaged in education, either in alternative or specialist provision, or with tutoring in the home.

Referrals come from schools and are predominantly children who are in secondary education. The highest percentage of referrals is year 10 , followed by year 9, year 8, year 7, year 6, year 5, year 3, year 4, year 1 and then year 2. Girls are more likely to be referred, with 70 of the 121 being females (57%).

A MIAT case study:

The Challenge

A Year 7 pupil’s school attendance had dropped to just 6% following years of difficulty since the Covid lockdowns. The family felt hopeless about school meeting their child’s needs, while the school struggled to balance support with safeguarding and referrals.

The Approach

The MIAT worked with both the pupil and their family. For the pupil, the focus was on building relationships and emotional literacy through short, structured sessions, gradually increasing time in school. For the parent, the team offered psychoeducation, systemic reflection on parenting, and practical problem-solving strategies.

Collaboration

Key staff – including the SENDCO, safeguarding lead, behaviour assistant, attendance officer, and older sibling’s head of year – worked together. The plan involved phased attendance, starting with 30 minutes twice a week, building toward half days and a long-term goal of full-time schooling. Support was also extended to the older sibling, who was beginning to show similar difficulties.

Outcomes

• Attendance improved steadily with consistent engagement.
• The pupil gained confidence, joined peer activities, and attended after-school football.
• The parent reported greater confidence in managing routines and sought help for their own wellbeing.
• A relapse prevention plan was put in place.

Looking Ahead

Future steps include exploring neurodiversity assessment and ongoing family support to maintain progress, particularly around the older sibling’s needs.

Qualitative feedback:

School feedback:

“We can physically and verbally see the reduction of low mood. YP is holding more communication, dressed and ready.”

Child feedback:

-‘I have liked working with you (MIAT)because you make me feel comfortable, and not just do loads of worksheets. We talk about things to help me. This has helped me go back into school, when I didn’t think I’d ever be able to.’

Drawing by Edith, aged 9, ‘my pathway to school’.

Family feedback: It is great to our daughter interested in day-to-day things again.

-Amazing that they are considering sitting GCSE, let alone going back into school, we are so happy!

-Were going on a family holiday during half term when previously our daughter had not been leaving the house

The future of MIAT

• The team will continue to work with children who experience mental health difficulties that are a barrier to school attendance.
• As we move into 2026, we will continue to work as a specialist MHST pathway, and embed early intervention group work, parental interventions and workshops as part of the MIAT offer.
• We aim to continue to grow our expertise through staff training, by the end of the year all of our practitioners will have completed the dialectical behaviour therapy (DBT) training and be able to offer this to children experiencing intense emotions.
• Based on incoming referral rates, we know that we could grow in size and caseloads would remain at maximum capacity. For now, our wonderful group of 10 will be stable within the LA, and we will continue to share good practise with other LA’s and sectors across the UK.
• We are hoping to produce a manualised intervention based on our experiences of what works in the near future.