An Evaluation of the Implementation and Impact of England's Mandated School-Based Mental Health Initiative in Elementary Schools

Behavioural and environmental influences on adolescent decision making in personal relationships: a qualitative multi-stakeholder exploration in Panama

Adolescents in Panama face multiple challenges to their sexual health, rights and well-being such as high rates of teenage pregnancy (∼30% of all pregnancies), increased HIV infections and sexual violence. In the absence of sufficient evidence-based data and an ongoing debate in Panamanian society about how to approach adolescents' health problems, the aim of this qualitative study was to explore the perceptions and attitudes of different societal actors, namely governmental employees, NGO employees, academics, members from religious groups, teachers and parents. We conducted in-depth interviews (N = 34) which focused on the behavioural and environmental factors considered to influence adolescents' decision making with regard to love, friendships and family relations. Furthermore, we explored how these stakeholders viewed the role of the education system, and the potential of including social-emotional learning (SEL) in the curriculum to provide skills and capacities, which could encourage adolescents to make better decisions and improve their well-being, in general but also in the context of sexual behaviours. Analysis revealed five central themes, i.e. perceptions towards gender roles and equality, adolescents' love (sexual) relationships, capacity needs regarding prevention of risk behaviours and the role of education, comprehensive sexuality education in schools and the potentiality of SEL in the education system. The findings of the study can enhance understanding on the views of stakeholders regarding the factors influencing adolescents' decision making, as well as regarding the possibilities of introducing SEL in the Panamanian educational curriculum.

Embedding interagency working between schools and mental health specialists: A service evaluation of the Mental Health Services and Schools and Colleges Link Programme workshops

There is increasing focus on the need for schools to work more effectively with specialist mental health providers, but there have been historic challenges in embedding closer interagency working. This article reports the results of a service evaluation of a 2-day workshop designed to facilitate improved working between schools and children and young people's mental health services (CYPMHS). Mental health leads from 255 schools, mental health professionals and other key stakeholders all took part in one of 26 two-day workshops across the United Kingdom. The impact on interagency working was examined using changes in pre- and post-survey results, changes in self-reported aspects of interagency working and 10 local reviews of practice. The pre-post questionnaires showed improvements in interagency working (e.g. 55% of school leads reported being in 'monthly' or 'continuous' contact with the National Health Service (NHS) CYPMHS¹ at follow-up, compared with 24% at baseline). The group-completed CASCADE framework showed an overall increase in collaborative working, although some areas continued to report significant challenges such as in relation to common outcome measures. The local reviews found positive changes in interagency working, in terms of building relationships, improved communication and sharing good practice. This service evaluation of the workshops found some evidence of improved interagency working between schools and CYPMHS, but more controlled research is needed to consider generalisability and scalability.

Differential Effectiveness of a Middle School Social and Emotional Learning Program: Does Setting Matter?

There is a lack of studies in the literature addressing the differential effectiveness of Social and Emotional Learning according to their implementation setting. This study compared the effectiveness of an upper middle school Social and Emotional Learning program applied in two different settings: within school and after-school hours, while controlling for individual and class-level variables. There were 837 students (M_age =12.70; SD = 0.98; 47.6% were female): 246 in the control group, 319 in the after-school intervention group and 272 in the within school schedule intervention group, assessed at pretest, post-test and follow-up seven months later. Multilevel analyses identified more positive intervention results in on self-esteem, self-control, and social awareness for students in the within school schedule groups. Girls gained more in social awareness in both program settings. This study highlights the importance of analyzing Social and Emotional Learning program´s differential effectiveness in order to optimize it.

International approaches to school-based mental health: Intent of the Special Issue

This article provides an overview of the special issue on international approaches to school-based mental health. It introduces the significance of the issues associated with mental health across the world and introduces the reader to the four articles highlighting different aspects of school-based mental health. Across these four articles, information about school-based mental health (SBMH) from the United States, Canada, Norway, Liberia, Chile, and Ireland are represented. The special issue concludes with an article introducing new methodology for examining mental health from a global perspective.

Mental health provision in schools: approaches and interventions in 10 European countries

BACKGROUND

The role of schools in providing community-based support for children's mental health and well-being is widely accepted and encouraged. Research has mainly focused on designing and evaluating specific interventions and there is little data available regarding what provision is available, the focus and priorities of schools and the professionals involved in providing this support. The current study presents these data from schools in 10 European countries.

METHODS

Online survey of 1466 schools in France, Germany, Ireland, Netherlands, Poland, Serbia, Spain, Sweden, UK and Ukraine. The participating countries were chosen based on their geographical spread, diversity of political and economic systems, and convenience in terms of access to the research group and presence of collaborators.

RESULTS

Schools reported having more universal provision than targeted provision and there was greater reported focus on children who already have difficulties compared with prevention of problems and promotion of student well-being. The most common interventions implemented related to social and emotional skills development and anti-bullying programmes. Learning and educational support professionals were present in many schools with fewer schools reporting involvement of a clinical specialist. Responses varied by country with 7.4-33.5% between-country variation across study outcomes. Secondary schools reported less support for parents and more for staff compared with primary schools, with private schools also indicating more staff support. Schools in rural locations reported less student support and professionals involved than schools in urban locations.

CONCLUSION

The current study provides up-to-date and cross-country insight into the approaches, priorities and provision available for mental health support in schools; highlighting what schools prioritise in providing mental health support and where coverage of provision is lacking.

Effectiveness of a pragmatic school-based universal intervention targeting student resilience protective factors in reducing mental health problems in adolescents

Worldwide, 10-20% of adolescents experience mental health problems. Strategies aimed at strengthening resilience protective factors provide a potential approach for reducing mental health problems in adolescents. This study evaluated the effectiveness of a universal, school-based intervention targeting resilience protective factors in reducing mental health problems in adolescents. A cluster randomised controlled trial was conducted in 20 intervention and 12 control secondary schools located in socio-economically disadvantaged areas of NSW, Australia. Data were collected from 3115 students at baseline (Grade 7, 2011), of whom 2149 provided data at follow up (Grade 10, 2014; enrolments in Grades 7 to 10 typically aged 12-16 years; 50% male; 69.0% retention). There were no significant differences between groups at follow-up for three mental health outcomes: total SDQ, internalising problems, and prosocial behaviour. A small statistically significant difference in favour of the control group was found for externalising problems. Findings highlight the continued difficulties in developing effective, school-based prevention programs for mental health problems in adolescents.

TRIAL REGISTRATION

ANZCTR (Ref no: ACTRN12611000606987).

Use, acceptability and impact of booklets designed to support mental health self-management and help seeking in schools: results of a large randomised controlled trial in England

Mental health booklets may provide a low-cost means of promoting mental health self-management and help seeking in schools. The aim of the study was to assess the (a) use, (b) acceptability and (c) impact of booklets for students in primary (10-11 years) and secondary school (12-13 years) alone and in conjunction with funding for targeted mental health support. This was a 2 × 2 factorial cluster randomized controlled trial, in which 846 schools in England were randomly allocated to receive/not receive: (1) booklets for students containing information on mental health self-management and help seeking, and (2) funding for mental health support as part of a national mental health initiative. 14,690 students (8139 primary, 6551 secondary) provided self-report on mental health, quality of life (baseline and 1 year follow-up) and help seeking (follow-up). (a) Approximately, 40 % primary school students and 20 % secondary school students reported seeing the booklets. (b) Of these, 87 % of primary school students reported that the booklet was 'very helpful' or 'quite helpful', compared with 73 % in secondary school. (c) There was no detectable impact of booklets on mental health, quality of life or help seeking, either alone or in conjunction with additional funding through the national mental health initiative. Lack of discernable impact of booklets underscores the need for caution in adopting such an approach. However, it is feasible that the impact was obscured by low uptake or that booklets may be more effective when used in a targeted way.

A cluster randomized controlled trial of the Promoting Alternative Thinking Strategies (PATHS) curriculum

This randomized controlled trial (RCT) evaluated the efficacy of the Promoting Alternative Thinking Strategies curriculum (PATHS; Kusche & Greenberg, 1994) as a means to improve children's social-emotional competence (assessed via the Social Skills Improvement System (SSIS); Gresham & Elliot, 2008) and mental health outcomes (assessed via the Strengths and Difficulties Questionnaire (SDQ); Goodman, 1997). Forty-five schools in Greater Manchester, England, were randomly assigned to treatment and control groups. Allocation was balanced by proportions of children eligible for free school meals and speaking English as an additional language via minimization. Children (N=4516) aged 7-9years at baseline in the participating schools were the target cohort. During the two-year trial period, teachers of this cohort in schools allocated to the intervention group delivered the PATHS curriculum, while their counterparts in the control group continued their usual provision. Teachers in PATHS schools received initial training and on-going support and assistance from trained coaches. Hierarchical linear modeling of outcome data was undertaken to identify both primary (e.g., for all children) and secondary (e.g., for children classified as "at-risk") intervention effects. A primary effect of the PATHS curriculum was found, demonstrating increases in teacher ratings of changes in children's social-emotional competence. Additionally, secondary effects of PATHS were identified, showing reductions in teacher ratings of emotional symptoms and increases in pro-social behavior and child ratings of engagement among children identified as at-risk at baseline. However, our analyses also identified primary effects favoring the usual provision group, showing reductions in teacher ratings of peer problems and emotional symptoms, and secondary effects demonstrating reductions in teacher ratings of conduct problems and child ratings of co-operation among at-risk children. Effect sizes were small in all cases. These mixed findings suggest that social and emotional learning interventions such as PATHS may not be as efficacious when implemented outside their country of origin and evaluated in independent trials.

Survey of schools' work with child and adolescent mental health across England: a system in need of support

BACKGROUND

With evidence of rising need around mental health in young people, cuts in specialist health provision and increasing recognition of the central role of schools in supporting young people with mental health problems, it is important to understand the provision of mental health support currently available in schools, the nature of the relationship with health and other providers of child and adolescent mental health (CAMH) services, and what are the key barriers to accessing support.

METHOD

The study was a convenience sample survey of 577 school staff from 341 schools in England. Participants completed an online survey about the provision of specialist mental health support in their school, including what support is available, who provides it, and perceived barriers to supporting the mental health of young people. Data were linked to publicly available data on school characteristics.

RESULTS

Over two thirds of schools reported having some specialist support available, with specialist provision more common in secondary schools. Staff training and whole-school approaches were the most frequently employed specific approaches. Support was most often provided by educational psychologists, followed by counsellors. School staff particularly valued support and feedback within the schools context. The most frequently cited barrier to mental health support was the limited capacity of specialist CAMH services.

CONCLUSIONS

The results suggest a need to enhance the availability of specialist support for mental health both within schools and in CAMH services.