Coaching Models of School-Based Prevention and Promotion Programmes: A Qualitative Exploration of UK Teachers' Perceptions

Effective Teacher Professional Development for School-Based Mental Health Promotion: A Review of the Literature

Teachers are critically involved in the delivery of school-based mental health promotion (SMHP) interventions in school, though pre-service teacher education often leaves teachers feeling underprepared in this area. Thus, understanding how best to build teachers' capacity for delivery through effective professional development (PD) is essential for teachers to fulfill their role as delivery agents to achieve SMHP outcomes. This systematized review focuses on identifying components of high-quality teacher PD for SMHP and examining the empirical support for these components. In a two-phase analysis, we examined the descriptive literature regarding teacher PD for SMHP to identify common elements. This resulted in the identification of components relevant to training (interactive, guided by staff input) and technical assistance (TA), including the goals (skill development, motivation, generalization/adaptation), approach (collaborative, individualized, data-driven, strengths-based), and activities (modeling, performance feedback, reflection, problem solving) involved. A second phase focused on the examination of empirical evidence for these PD components. While the empirical evidence for these components was limited, the identified components represent a current standard of practice in teacher PD for SMHP, based on the existing research. These components may provide a framework for practical use in planning teacher PD related to SMHP and for designing future research into effective capacity building in this area.

The impact of universal, school based, interventions on help seeking in children and young people: a systematic literature review

Reviews into universal interventions to improve help seeking in young people focus on specific concepts, such as behaviour, do not differentiate between interpersonal and intrapersonal help seeking, and often report on statistical significance, rather than effect size. The aim of this review was to address the gaps highlighted above, to investigate the impact of universal, school-based interventions on help-seeking in children and young people, as well as to explore longer term impact. Four databases were searched. Data were extracted on country of origin, design, participant, school, and intervention characteristics, the help-seeking concept measured (e.g. knowledge, attitude/intention, behaviour), the duration between baseline and each follow-up (if applicable) and effect sizes at each follow-up. Quality assessment of the studies was undertaken using the Effective Public Health Practice Project (EPHPP) quality assessment tool. Overall, 14 different interventions met inclusion criteria. The majority of the studies were rated low in the quality assessment. Three constructs were most frequently reported a) intrapersonal attitudes towards help-seeking, b) interpersonal attitudes towards help-seeking and c) intrapersonal intended help-seeking. Findings around intervention effect were mixed. There was tentative evidence that interventions impacting interpersonal attitudes produced small effect sizes when measured between 3 and 6 months post intervention and that when effect sizes were initially observed intrapersonal attitudes, this remained at 3-6 month follow-up. Further work should pay attention to implementation factors, understanding the core ingredients needed to deliver effective interventions and whether embedding mental health education could help sustain or top up effect sizes from help-seeking interventions.

Considering the implementation research-to-practice gap: An experimental evaluation of intervention-general methods for assessing and supporting intervention fidelity through coaching

Implementation support through coaching-such as with embedded fidelity assessment, performance feedback, modeling, and alliance building-has been empirically supported as a way to increase and sustain interventionists' fidelity levels. However, education research consistently shows that practitioners struggle to monitor and improve interventionists' fidelity using implementation support strategies. One explanation for this type of implementation research-to-practice gap is that evidence-based coaching strategies have significant limitations with respect to their usability, feasibility, and adaptability. This study is the first to experimentally evaluate an evidence-based set of adaptable materials and procedures designed to assess and support the intervention fidelity of school-based interventions. Using a randomized multiple-baseline-across-participants design, we examined the extent to which these materials and procedures would influence intervention adherence and quality of an evidence-based reading intervention. Across all nine interventionist participants, data revealed that the implementation strategies meaningfully improved intervention adherence and quality, and high levels of intervention fidelity maintained 1 month after removing the support procedures. Findings are discussed with respect to how these materials and procedures address a critical need within school-based research and practice as well as how they may help to inform and address the implementation research-to-practice gap in education.

High quality implementation of 4Rs + MTP increases classroom emotional support and reduces absenteeism

School-based social and emotional learning (SEL) programs are associated with improvements in children's SEL and academic outcomes, and the quality of classroom interactions. The magnitude of these effects increases at high levels of program implementation quality. This study aimed to (1) identify teachers' profiles of quality of implementation, (2) explore teachers and classroom characteristics contributing to their propensity to comply with high quality of implementation, and (3) examine the relations between school assignment to an SEL program, quality of classroom interactions, and child SEL and academic outcomes at different levels of teachers' compliance propensity. This study drew upon data from a cluster-randomized controlled trial evaluating the efficacy of 4Rs + MTP, a literacy-based SEL program, on third and fourth grade teachers (n = 330) and their students (n = 5,081) across 60 New York City public elementary schools. Latent profile analysis indicated that measures of teacher responsiveness and amount of exposure to implementation supports contributed to the differentiation of profiles of high and low quality of implementation. Random forest analysis showed that more experienced teachers with low levels of professional burnout had high propensity to comply with high quality of implementation. Multilevel moderated mediation analysis indicated that 4Rs + MTP teachers with high compliance propensity were associated with higher classroom emotional support and lower children's school absences than their counterparts in the control group. These findings may inform debates in policy research about the importance of providing the supports teachers need to implement SEL school programs with high quality.

The Impact of a Universal Mental Health Intervention on Youth with Elevated Negative Affectivity: Building Resilience for Healthy Kids

Objective

In response to the rise in mental health needs among youth, a school-based resilience intervention was implemented for sixth graders at an urban middle school. The goal of this analysis is to examine improvements in key mental health parameters among students who endorsed negative affectivity at baseline.

Method

A total of 285 11-12-year-olds (72% white, 18% Hispanic, 55% female) participated in a single-arm, non-randomized 6-week 1:1 school-based coaching intervention, Healthy Kids. Youth completed validated surveys at baseline and 6-week follow-up assessing depression/anxiety symptoms, bullying, self-efficacy, academic pressure, grit, and resilience. Participants were determined to have elevated negative affectivity if they reported mild-to-severe symptoms for both depression and anxiety symptoms. General linear models examined differences between groups for each mental health parameter, as well as change in outcomes from baseline to follow-up.

Results

A third of participants (38%) at baseline endorsed negative affectivity. Youth who endorsed negative affectivity were more often female (71% vs 29%; p < 0.001) and identified as victims of cyberbullying (25% vs 8%; p < 0.001). Youth with baseline negative affectivity scored lower for self-efficacy (total 70.5 vs 86.8; p < 0.0001). Baseline negative affectivity was a significant moderator for change in mental health parameters. Post-intervention, those who endorsed baseline negative affectivity, medium effect sizes were observed for self-efficacy (g = 0.6; 95%CI 0.3, 0.9; p < 0.001) and anxiety symptoms (g =  - 0.70; 95%CI - 1.0, - 0.4; p < 0.001). Among all youth, there were significant medium intervention effects in resilience (g = 0.5; 95%CI 0.3, 0.7; p < 0.001) and self-efficacy (g = 0.7; 95%CI 0.4, 0.9; p < 0.001).

Conclusions

A universal resiliency program may improve self-efficacy and symptoms of anxiety among youth experiencing negative affectivity, while improving resilience and self-efficacy among all youth. Our findings suggest a universal school-based coaching program benefits all youth, while also specifically targeting the needs of youth with negative affectivity who are most at risk for mental health concerns.

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.

Supporting South African High School Teachers' Implementation of a Prevention Program via Abridged Consultation: Outcomes and Moderators

Research is lacking on consultation support for school-based evidence-based programs (EBP) intended to prevent youths' risky behaviors in schools in low-resourced settings like high schools surrounding Cape Town, South Africa. Thus, this study's objective was to examine implementation outcomes and moderators of an abridged consultation condition for supporting teachers in better implementing HealthWise, an EBP for preventing youth risky sexual and substance use behaviors. Twenty-one schools with 33 teachers receiving abridged consultation (i.e., three consultation meetings, text message reminders, lesson plans, and support kits) were compared to 26 schools with 41 teachers that did not receive any consultation. Teachers with abridged consultation self-reported delivering more HealthWise content. Moderation analyses found teachers with lower educational degrees, who received abridged consultation reported more student interest in HealthWise. When there was higher school-level risk, teachers who received abridged consultation marginally self-reported adapting HealthWise more. Findings suggest consultation support that is abridged or a lower dose than is typical can be feasible in such a low-resourced, overburdened setting while still being associated with EBP coverage, student interest, and adaptation. However, moderation findings suggest contextual factors should be considered to match teachers/schools to the implementation support that best suits them.

A Cluster Randomized Trial of Promoting Alternative Thinking Strategies (PATHS®) With Swedish Preschool Children

The preschool edition of Promoting Alternative THinking Strategies (PATHS^®) is a school-based, teacher implemented universal intervention developed in the United States designed to promote social emotional competence (SEC) in children as a foundation for improved mental health. PATHS is delivered as a curriculum and it is based on theories and research regarding SEC, brain development, and optimal school environments. A majority of children in Sweden attend preschool, which is government-subsidized and follows a national curriculum focusing on both academic and social emotional learning. However, there is not so much focus on formal instruction nor manual-based lessons. The purpose of this study was to assess the short-term (pre- to post-test) effects of PATHS in the Swedish preschool setting. Using a two-wave cluster randomized trial with multi-method and informant assessment (N = 285 4 and 5-year-old Swedish children; n = 145 wait-list control; n = 140 intervention; K = 26 preschools; k = 13 intervention; k = 13 control) we assessed changes in child emotional knowledge, emotional awareness, social problem solving, prosocial play, inhibitory control, and working memory using structural equation modeling (SEM). We included schools with at least one classroom of 4–5-year-old children from three municipalities. We excluded open preschools, parent cooperative preschools, and family day homes. After random assignment, schools were informed of condition assignment. Research team members were not blind to assignment. We hypothesized that relative to children in control schools, children in intervention schools would evidence improvements in social emotional competence as well as other outcomes. Children in PATHS, relative to children in the control, evidenced improvements in working memory and prosocial play, but also showed an increase in hyperactive behaviors. Girls in PATHS, relative to girls in the control, showed improvement in emotional knowledge and reduced anxiety. These results are considered in light of efforts to promote positive development and mental health. The trial registration number at ClinicalTrials.gov is NCT04512157. Main funding was from Swedish Council for Working Life and Social Research, the Swedish Research Council, Formas, and VINNOVA (dnr: 259-2012-71).

Implementation support practitioners - a proposal for consolidating a diverse evidence base

BACKGROUND

Workforce development for implementation practice has been identified as a grand challenge in health services. This is due to the embryonic nature of the existing research in this area, few available training programs and a general shortage of frontline service staff trained and prepared for practicing implementation in the field. The interest in the role of "implementation support" as a way to effectively build the implementation capacities of the human service sector has therefore increased. However, while frequently used, little is known about the skills and competencies required to effectively provide such support.

MAIN BODY

To progress the debate and the research agenda on implementation support competencies, we propose the role of the "implementation support practitioner" as a concept unifying the multiple streams of research focused on e.g. consultation, facilitation, or knowledge brokering. Implementation support practitioners are professionals supporting others in implementing evidence-informed practices, policies and programs, and in sustaining and scaling evidence for population impact. They are not involved in direct service delivery or management and work closely with the leadership and staff needed to effectively deliver direct clinical, therapeutic or educational services to individuals, families and communities. They may be specialists or generalists and be located within and/or outside the delivery system they serve. To effectively support the implementation practice of others, implementation support practitioners require an ability to activate implementation-relevant knowledge, skills and attitudes, and to operationalize and apply these in the context of their support activities. In doing so, they aim to trigger both relational and behavioral outcomes. This thinking is reflected in an overarching logic outlined in this article.

CONCLUSION

The development of implementation support practitioners as a profession necessitates improved conceptual thinking about their role and work and how they enable the uptake and integration of evidence in real world settings. This article introduces a preliminary logic conceptualizing the role of implementation support practitioners informing research in progress aimed at increasing our knowledge about implementation support and the competencies needed to provide this support.

Game On-Complier Average Causal Effect Estimation Reveals Sleeper Effects on Academic Attainment in a Randomized Trial of the Good Behavior Game

To examine the efficacy of the Good Behavior Game (GBG) in improving children's reading attainment, and the extent to which this varies as a function of cumulative intervention intensity (dosage) and timing of outcome measurement. A 2-year cluster-randomized controlled trial was conducted. Seventy-seven primary schools from three regions in England were randomly assigned to intervention and control groups. Children (N = 3084) aged 67 at baseline were the target cohort. The GBG is an interdependent group-contingency behavior management strategy used by teachers in elementary schools. Reading attainment was assessed via national teacher assessment scores at baseline, and the Hodder Group Reading Test at post-test and 1-year post-intervention follow-up. Dosage was assessed using a bespoke online GBG scoreboard system. Multi-level intent-to-treat (ITT) and complier average causal effect (CACE) estimation were utilized. At post-test, no effects of the GBG on children's reading attainment were found in either the ITT or CACE models. At 1-year follow-up, results remained null in the ITT model, but a significant intervention effect was found among moderate compliers (Δ = 0.10) in the CACE model. The GBG can produce measurable improvements in children's academic attainment, but these effects may take time to become apparent and are contingent upon implementation dosage falling within an optimal range. The project was supported by funding from the Education Endowment Foundation and the National Institute for Health Research. ISRCTN: 64152096.