Empowering School Staff to Support Pupil Mental Health Through a Brief, Interactive Web-Based Training Program: Mixed Methods Study

BACKGROUND

Schools in the United Kingdom and elsewhere are expected to protect and promote pupil mental health. However, many school staff members do not feel confident in identifying and responding to pupil mental health difficulties and report wanting additional training in this area.

OBJECTIVE

We aimed to explore the feasibility of Kognito's At-Risk for Elementary School Educators, a brief, interactive web-based training program that uses a simulation-based approach to improve school staff's knowledge and skills in supporting pupil mental health.

METHODS

We conducted a mixed methods, nonrandomized feasibility study of At-Risk for Elementary School Educators in 6 UK primary schools. Our outcomes were (1) school staff's self-efficacy and preparedness to identify and respond to pupil mental health difficulties, (2) school staff's identification of mental health difficulties and increased risk of mental health difficulties, (3) mental health support for identified pupils (including conversations about concerns, documentation of concerns, in-class and in-school support, and referral and access to specialist mental health services), and (4) the acceptability and practicality of the training. We assessed these outcomes using a series of questionnaires completed at baseline (T1), 1 week after the training (T2), and 3 months after the training (T3), as well as semistructured qualitative interviews. Following guidance for feasibility studies, we assessed quantitative outcomes across time points by comparing medians and IQRs and analyzed qualitative data using reflexive thematic analysis.

RESULTS

A total of 108 teachers and teaching assistants (TAs) completed T1 questionnaires, 89 (82.4%) completed T2 questionnaires, and 70 (64.8%) completed T3 questionnaires; 54 (50%) completed all 3. Eight school staff members, including teachers, TAs, mental health leads, and senior leaders, participated in the interviews. School staff reported greater confidence and preparedness in identifying and responding to mental health difficulties after completing the training. The proportion of pupils whom they identified as having mental health difficulties or increased risk declined slightly over time (medianT1=10%; medianT2=10%; medianT3=7.4%), but findings suggested a slight increase in accuracy compared with a validated screening measure (the Strengths and Difficulties Questionnaire). In-school mental health support outcomes for identified pupils improved after the training, with increases in formal documentation and communication of concerns as well as provision of in-class and in-school support. Referrals and access to external mental health services remained constant. The qualitative findings indicated that school staff perceived the training as useful, practical, and acceptable.

CONCLUSIONS

The findings suggest that brief, interactive web-based training programs such as At-Risk for Elementary School Educators are a feasible means to improve the identification of and response to mental health difficulties in UK primary schools. Such training may help address the high prevalence of mental health difficulties in this age group by helping facilitate access to care and support.

Supporting School Staff: Insights From Employee Health and Well-Being Programs

BACKGROUND

The workplace is an important setting for health protection, health promotion, and disease prevention programs. In the school setting, employee health and well-being programs can address many physical and emotional concerns of school staff. This systematic review summarizes evidence-based approaches from employee health and well-being interventions supporting nutrition and physical activity (PA) in a variety of workplace settings.

METHODS

The 2-phase systematic review included a search for articles within systematic reviews that met our criteria (addressing employee health and well-being programs; published 2010-2018; Phase 1) and the identification of individual articles from additional searches (addressing school-based employee interventions; published 2010-2020; Phase 2). We included 35 articles.

FINDINGS

Across all studies and types of interventions and workplace settings, findings were mixed; however, multicomponent interventions appeared to improve health behaviors and health outcomes among employees.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

Schools can apply this evidence from employee health and well-being programs in various workplace settings to implement coordinated and comprehensive employee health and well-being programs.

CONCLUSIONS

Employee health and well-being programs may be effective at supporting nutrition and PA. Schools can use findings from employee health and well-being programs in workplaces other than schools to support school staff.

Online youth concussion resources for Canadian teachers and school staff: A systematic search strategy

INTRODUCTION

Teachers and school staff (i.e., principals, coaches, trainers, educational assistants, guidance counselors, school healthcare professionals, etc.) are well positioned to support students' return-to-school post-concussion. Teachers and school staff may access concussion resources online as they are readily available; however, their quality and accuracy are unknown.

OBJECTIVE

To identify accurate online concussion resources suitable for Canadian teachers and school staff.

METHODS

A five-phased systematic search strategy was conducted: 1) initial identification of resources; 2) consultation of pediatric concussion experts; 3) inclusion and exclusion criteria; 4) content review; and, 5) material evaluation.

RESULTS

A total of 837 resources were identified initially and 40 resources were included in the final list. Across all resources, 310 (37%) resources were excluded as they were not designed primarily for teachers and school staff. Thirty-four (43%) of 80 resources reviewed for content accuracy were excluded. Among resources reviewed for readability, usability and suitability, six (13%) were excluded.

CONCLUSIONS

The 40 resources identified in this study can enable teachers and school staff to educate themselves about concussion and how to optimally support a student's return-to-school post-concussion.

Factors that influence food choices in secondary school canteens: a qualitative study of pupil and staff perspectives

Background

Adolescence is recognised as a period of nutritional vulnerability, with evidence indicating that United Kingdom adolescents have suboptimal dietary intakes with many failing to meet dietary recommendations. Additionally, adolescence is a time of transition when they become more independent in their dietary choices and begin to develop their own sense of autonomy and are less reliant on their parent's guidance, which is reported to lead to less favourable dietary behaviours. Reducing the prevalence of poor dietary intakes and the associated negative health consequences among this population is a public health priority and schools represent an important setting to promote positive dietary behaviours. The aim of this school-based study was to explore the factors and barriers which influence food choices within the school canteen and to identify feasible strategies to promote positive dietary behaviours within this setting.

Methods

Thirteen focus groups with 86 pupils in Year 8 (n = 37; aged 11-12 years) and Year 9 (n = 49; aged 12-13 years) in six secondary schools across Northern Ireland, United Kingdom were conducted. Additionally, one-to-one virtual interviews were conducted with 29 school staff [principals/vice-principals (n = 4); teachers (n = 17); and caterers (n = 7)] across 17 secondary schools and an Education Authority (EA) senior staff member (n = 1). Focus groups and interviews were audio-recorded, transcribed, and analysed following an inductive thematic approach.

Results

Using the ecological framework, multiple factors were identified which influenced pupils' selection of food in the school canteen at the individual (e.g., time/convenience), social (e.g., peer influence), physical (e.g., food/beverage placement), and macro environment (e.g., food provision) level. Suggestions for improvement of food choices were also identified at each ecological level: individual (e.g., rewards), social (e.g., pupil-led initiatives), physical (e.g., labelling), and macro environment (e.g., whole-school approaches).

Conclusion

Low-cost and non-labour intensive practical strategies could be employed, including menu and labelling strategies, placement of foods, reviewing pricing policies and whole-school initiatives in developing future dietary interventions to positively enhance adolescents' food choices in secondary schools.

Early Identification of Social, Emotional, and Behavioral Difficulties by School Staff: A Qualitative Examination of Dutch Primary School Practices

About 16% of Dutch children are reported to have social, emotional, and behavioral difficulties (SEBDs). SEBDs generate distress and pose risks for various negative outcomes; thus, their timely identification is deemed important to respond appropriately to children's needs and avoid such negative outcomes. Primary schools are considered convenient places to implement early SEBD identification, but the ways in which schools achieve this in practice may be inadequate, although the issue remains under-researched. Although there are several systematic school-based early identification methods (e.g., universal or selective screening), primary schools predominantly rely on school staff to recognize children at risk for, or experiencing, SEBDs. As differences in identification practices could impact whether and when (signs of) SEBDs are identified, this study aimed to increase our understanding of differences in identification practices used by school staff and their potential implications for early identification effectiveness. Thirty-four educational and clinical professionals working at nine primary schools participated in in-depth semi-structured interviews. We used MAXQDA to thematically code and analyze the data. Our analysis of these interviews illustrated that schools' identification practices differed on three elements: the frequency of observations, maintaining a four-eyes principle, and the utilization of specialist knowledge. We argue that differences in these elements have potential consequences for the timeliness and quality of SEBD identification.

The "Forgotten Grievers": The Impact of Pupil Suicide on Post-Trauma and Grief Symptoms in School Staff

BACKGROUND

The suicide of a pupil impacts survivors greatly, but most studies on the subject do not consider school staff, and do not differentiate between the various professional domains. Our aim was to investigate the existence of differences in symptoms of complicated grief as well as post-trauma symptoms after a pupil's suicide, among school staff in four domains: counsellors, psychologists, principals and home-room teachers.

METHOD

Eighty-four staff members from schools that lost pupils to suicide within the past five years were assessed for symptoms of complicated grief and trauma. All reported their symptoms using self-report scales.

RESULTS

Principals and home-room teachers had significantly higher complicated grief and post-trauma symptoms. The main limitations of this study are that the data were collected via self-report questionnaires, which can introduce bias. Additionally, the sample is relatively small and comprises mainly women.

CONCLUSIONS

School professionals in domains receiving less coping and crisis training, and those with supervisory responsibilities (principals and home-room teachers) show more symptoms of trauma and complicated grief after a pupil's suicide, and require special attention. More preparatory training would surely benefit them and assist them in coping with such crises.

Young people and adult stakeholders' reflections on how school staff should support students who self-harm: A qualitative study

INTRODUCTION

Self-harm is a significant public health issue affecting school communities, students, and families. The school is an ideal environment for early intervention and prevention. This study aimed to explore the views of young people and stakeholders on how school staff should support students who self-harm in the context of developing accessible and acceptable guidelines.

METHODS

The study was nested within a larger Delphi study conducted in New Zealand. Two panels were asked to provide reflection in open text boxes in two questionnaires on how school staff can support students who self-harm. The youth panel included 22 participants between 16 and 25 years, and 81.8% identified as female and 18.3% as male. The stakeholder panel (e.g., school staff) included 27 participants over 25 years, and 63.0% identified as female, and 37.0% as male. The data were analyzed using thematic analysis to identify key themes.

RESULTS

Eight themes were identified; (1) an approach that prioritizes trust, (2) an approach that recognizes students' agency, (3) an individually tailored approach, (4) a whole-school approach, (5) an approach that recognizes role boundaries, (6) an approach that prioritizes safety, (7) a nonpunitive approach, and (8) an appropriately-resourced approach.

CONCLUSION

The eight themes identified highlighted ineffective practices in response to self-harm in schools. The eight themes provide solutions to these practices. Our findings highlighted four recommendations that address ineffective management approaches in response to students who self-harm. These recommendations included using a student-centered approach, a whole-school approach, avoiding punitive approaches, and providing adequate resourcing to schools.

Adaptation of a school-based mental health literacy curriculum: from Canadian to English classrooms

BACKGROUND

School-based mental health literacy (MHL) interventions are increasingly trialled outside of the country in which they were developed. However, there is a lack of published studies that qualitatively explore their cultural adaptation. This study investigated the reasons for adaptations made and suggested to a Canadian MHL curriculum (The Guide) within the English school context.

METHOD

Semi-structured interviews were conducted with 11 school staff responsible for the planning and/or implementation of The Guide across three schools in the South East of England, as part of the Education for Wellbeing (EfW) feasibility study. Transcripts were analysed using a hybrid, deductive-inductive thematic analysis.

RESULTS

Adaptations made and suggested included dropping and emphasising content, and adapting language, examples and references. Most adaptations were proactive and related to The Guide's implementation methods, including developing more interactive and student-led approaches. Staff Capacity and Expertise, Timetabling, and Accessibility of Resources were identified as logistical reasons for adaptations. Philosophical reasons included Consistency of Messages, Student Characteristics, Reducing Stigma and Empowering Students, National and Local Context, and Appropriate Pedagogic Practices.

CONCLUSION

Overall, recommendations were for immediately implementable lesson plans informed by teachers' knowledge about best pedagogic practices in England. Adequate training, attended by both senior leadership and those implementing, was also emphasised. While ensuring that the core components are clear, MHL interventions should be developed with a necessary level of flexibility to accommodate contextual characteristics. Future research should ensure that adaptations are captured through process and implementation evaluations conducted alongside efficacy trials.

The Efficacy of Workplace Interventions on Improving the Dietary, Physical Activity and Sleep Behaviours of School and Childcare Staff: A Systematic Review

There is a need for effective interventions that improve the health and wellbeing of school and childcare staff. This review examined the efficacy of workplace interventions to improve the dietary, physical activity and/or sleep behaviours of school and childcare staff. A secondary aim of the review was to assess changes in staff physical/mental health, productivity, and students’ health behaviours. Nine databases were searched for controlled trials including randomised and non-randomised controlled trials and quasi-experimental trials published in English up to October 2019. PRISMA guidelines informed screening and study selection procedures. Data were not suitable for quantitative pooling. Of 12,396 records screened, seven articles (based on six studies) were included. Most studies used multi-component interventions including educational resources, work-based wellness committees and planned group practice (e.g., walking groups). Multiple outcomes were assessed, findings were mixed and on average, there was moderate risk of bias. Between-group differences in dietary and physical activity behaviours (i.e., fruit/vegetable intake, leisure-time physical activity) favoured intervention groups, but were statistically non-significant for most outcomes. Some of the studies also showed differences favouring controls (i.e., nutrient intake, fatty food consumption). Additional robust studies testing the efficacy of workplace interventions to improve the health of educational staff are needed.

Elementary school staff knowledge about management of traumatic dental injuries

Aim

This study investigated the knowledge of elementary school staff regarding the management of traumatic dental injuries (TDIs) in children.

Methods

The present cross-sectional study analyzed data collected between September 2016 and April 2017. The sample consisted of 2,027 elementary school staff members in Riyadh, Saudi Arabia. A stratified cluster random sampling technique was used to select the required sample. Those who agreed to participate in the study completed a 4-part self-administered questionnaire comprising questions regarding demographic data, knowledge on management of tooth fracture, and avulsion using photographs of TDI cases.

Results

The majority of the school staff showed inadequate basic knowledge regarding the importance of saving the broken piece of the tooth and identifying the tooth involved in the trauma (67% and 66.3%, respectively), P<0.05. However, they had a significantly high number of correct responses regarding the immediate management of TDIs for the 2 case scenarios presented in the questionnaire (P<0.05), and the majority (41%) reported normal saline as a suitable storage medium (P<0.01).

Conclusion

This study revealed a lack of knowledge in certain aspects of TDIs among elementary school staff.

Increasing Knowledge, Skills, and Confidence Concerning Students' Suicidality Through a Gatekeeper Workshop for School Staff

Introduction: Around one-third of adolescents in Germany report a lifetime history of suicide ideation. School staff (e.g., teachers or school social workers) can serve as gatekeepers to identify adolescents at risk and transfer them to appropriate mental health professionals. The aim of this study was to evaluate a gatekeeper training for school staff. Methods: A total of N = 603 school social workers, school psychologists, and teachers participated in one of 33 1.5-day workshops. Knowledge, attitudes, confidence in skills, and perceived knowledge were assessed at pre and post workshops and at 6-month follow-up (FU). Behavioral changes were assessed via self-report at FU. Results: Knowledge, perceived knowledge, and confidence in own skills concerning suicidality increased significantly from pre- to post-assessment and was still significantly increased at 6-month FU. Attitudes toward suicidal adolescents were neutral to positive before the workshop and remained un-changed at FU. Overall, participants were very satisfied with the workshop. Although participants stated to be motivated to make behavioral changes at 6-month FU, they reported obstacles such as lack of resources and support from school administration. Discussion: This 1.5-day gatekeeper workshop was effective in enhancing knowledge and confidence in school staff regarding suicidality. Future workshops would benefit from ongoing supervision and inclusion of school administration in order to facilitate long-term changes on a behavioral level.

THE INFLUENCE OF INFORMATION AND RELIGION ON ORGAN DONATION, AS SEEN BY SCHOOL TEACHERS IN BOSNIA AND HERZEGOVINA

Introduction:

Transplantation of organs is the treatment of choice for severe organ failure worldwide.

Aim:

The aims of the present study were to determine the influence of religion on attitudes towards organ donation among staff at schools in Tuzla.

Material and Methods:

In the Tuzla region there are 42 schools and 1580 school staff. A total of 21 schools were selected randomly, which were stratified by geographical location. 499 employees were invited to participate in the study, and 475 agreed to participate. According to the definition of their attitude towards religion the subjects were divided into three groups: non-religious, only religious and practical believers.

Results:

None of the subjects possesses a donor card. To the question whether the subjects support the idea of organ transplantation, most replied that they support the idea of donating organs both during life and after death. Regarding this question there is a significant difference between the groups (p = 0.0063). To the question whether they are prepared to donate an organ of a deceased family member, most replied that they would consent to donating an organ, whilst a significant number also replied that they were not sure. The results show that there is no significant difference between the replies given by the groups (p = 0.7694). To the question regarding to whom they were prepared to donate an organ, most said they were prepared to donate one to a member of their family, then to a close relative, whilst the least would donate to a stranger. The results show that there is a significant difference between the groups (p = 0.0002).

Conclusion:

In order to reduce the wide disparity between the need and organ donation amongst other things a more active relationship is necessary between health workers, religious officials and school staff.

Effectiveness of the workshop "adolescent depression: what can schools do?"

INTRODUCTION

Adolescent depression is associated with serious consequences. School staff is in a unique position to screen and refer adolescents with depression in a timely manner, and can collaborate with healthcare teams to assist in the proper management of the disease. The objective of this paper is to describe the results of a workshop that aims to improve the knowledge of adolescent depression among school staff.

MATERIALS AND METHODS

This was a single-arm trial with a pre-post design. Six workshops were conducted in four cities in Chile. Each workshop lasted 4 h. Participatory methodology was used. A 26-item knowledge questionnaire about adolescent depression, with the alternatives "I agree," "I disagree," and "I don't know," was administered to the participants, before and after the workshop.

RESULTS

A total of 152 people participated in the trial. Of these, 74.3% were female, and 44.7% were school psychologists, 25.0%, teachers, 17.8%, school counselors, and 5.3%, social workers. On average, there were 69.6% (SD 21.3) correct responses on the initial test, and 91.8% (SD 8.0) on the final test. All items had an increase of correct answers and a decrease of "don't know" answers. There were notable increases of correct responses on statements dealing with myths: "Antidepressants for the treatment of depression in adolescents must be avoided because they produce dependence" (59-96%), and "Depression in adolescence is better defined as a weakness of character than as a disease" (75-95%). School psychologists scored higher than the other participants on the questionnaire both before and after the workshop.

CONCLUSION

The workshop: "Adolescent depression: What can schools do?" can improve school staff knowledge of this topic, especially aiding to dispel myths regarding the disease and its treatment. This can help bring about timely case detection and improved collaboration with health team for proper handling of adolescent depression.