“Teachers Often See the Red Flags First”: Perceptions of School Staff Regarding Their Roles in Supporting Students with Mental Health Concerns

Teachers as first responders: classroom experiences and mental health training needs of Australian schoolteachers

BACKGROUND

Schoolteachers are often the first to respond when a student presents with a mental health issue in the classroom. This places a burden on schools that impacts school staff, healthcare workers and teachers. More broadly, it places a responsibility on the education system to address students' mental health. This study examines Australian teachers' classroom experiences and the training areas identified by teachers as necessary to manage these issues.

METHOD

Interviews were undertaken with 18 in-service teachers between 2020 and 2021 from Catholic, Independent and Public schools. Data were gathered via multiple interviews and analysed using thematic content analysis.

RESULTS

The major mental health issues identified by teachers related to mental disorders, depression, anxiety, and a complex range of negative emotional states. Teachers requested training in child and adolescent mental health, counselling skills, early detection and intervention, and training skills to manage the complex relationship with parents and external health and community personnel. Teachers also reported the need to access mental health resources, support and training, which were differentially accessed along socioeconomic status and postcodes.

CONCLUSION

The data show that teachers are often placed as first responders when a student has a mental health issue but feel inadequately trained to manage these issues in the classroom. We identified mental health issues presenting in Australian classrooms and documented critical features of mental-health training asked for by teachers in order to address those issues. Given the increasing demands on teachers to address the mental health of children and adolescents, we argue that an urgent review of mental health training for teachers is needed.

Implementation of an Electronic Mental Health Platform for Youth and Young Adults in a School Context Across Alberta, Canada: Thematic Analysis of the Perspectives of Stakeholders

BACKGROUND

Youth, aged 15 to 24 years, are more likely to experience mental health (MH) or substance use issues than other age groups. This is a critical period for intervention because MH disorders, if left unattended, may become chronic and serious and negatively affect many aspects of a young person's life. Even among those who are treated, poor outcomes will still occur for a percentage of youth. Electronic MH (eMH) tools have been implemented in traditional MH settings to reach youth requiring assistance with MH and substance use issues. However, the utility of eMH tools in school settings has yet to be investigated.

OBJECTIVE

The objective of this study was to gain an understanding of the perspectives of key school staff stakeholders regarding barriers and facilitators to the implementation of the Innowell eMH platform in secondary schools across the province of Alberta, Canada.

METHODS

Guided by a qualitative descriptive approach, focus groups were conducted to elicit stakeholder perspectives on the perceived implementation challenges and opportunities of embedding the Innowell eMH platform in secondary school MH services. In total, 8 focus groups were conducted with 52 key school staff stakeholders.

RESULTS

Themes related to barriers and facilitators to youth and school MH care professional (MHCP) capacity in implementing and using eMH tools were identified. With respect to youth capacity barriers, the following themes were inductively generated: (1) concerns about some students not being suitable for eMH services, (2) minors requiring consent from parents or caregivers to use eMH services as well as confidentiality and privacy concerns, and (3) limited access to technology and internet service among youth. A second theme related to school MHCP barriers to implementation, which included (1) feeling stretched with high caseloads and change fatigue, (2) concerns with risk and liability, and (3) unmasking MH issues in the face of limited resources. In contrast to the barriers to youth and MHCP capacity, many facilitators to implementation were discussed. Youth capacity facilitators included (1) the potential for youth to be empowered using eMH tools, (2) the platform fostering therapeutic relationships with school personnel, and (3) enhancing access to needed services and resources. MHCP capacity facilitators to implementation were (1) system transformation through flexibility and problem-solving, (2) opportunities for collaboration with youth and MHCPs and across different systems, and (3) an opportunity for the continuity of services.

CONCLUSIONS

Our findings highlight nuanced school MHCP perspectives that demonstrate critical youth and MHCP capacity concerns, with consideration for organizational factors that may impede or enhance the implementation processes for embedding eMH in a school context. The barriers and facilitators to implementation provide future researchers and decision makers with challenges and opportunities that could be addressed in the preimplementation phase.

Implementing a Digital Depression Prevention Program in Australian Secondary Schools: Cross-Sectional Qualitative Study

BACKGROUND

Depression is common during adolescence and is associated with adverse educational, employment, and health outcomes in later life. Digital programs are increasingly being implemented in schools to improve and protect adolescent mental health. Although digital depression prevention programs can be effective, there is limited knowledge about how contextual factors influence real-world delivery at scale in schools.

OBJECTIVE

The purpose of this study was to examine the contextual factors that influence the implementation of the Future Proofing Program (FPP) from the perspectives of school staff. The FPP is a 2-arm hybrid type 1 effectiveness-implementation trial evaluating whether depression can be prevented at scale in schools, using an evidence-based smartphone app delivered universally to year 8 students (13-14 years of age).

METHODS

Qualitative interviews were conducted with 23 staff from 20 schools in New South Wales, Australia, who assisted with the implementation of the FPP. The interviews were guided by our theory-driven logic model. Reflexive thematic analysis, using both deductive and inductive coding, was used to analyze responses.

RESULTS

Staff perceived the FPP as a novel ("innovative approach") and appropriate way to address an unmet need within schools ("right place at the right time"). Active leadership and counselor involvement were critical for planning and engaging; teamwork, communication, and staff capacity were critical for execution ("ways of working within schools"). Low student engagement and staffing availability were identified as barriers for future adoption and implementation by schools ("reflecting on past experiences").

CONCLUSIONS

Four superordinate themes pertaining to the program, implementation processes, and implementation barriers were identified from qualitative responses by school staff. On the basis of our findings, we proposed a select set of recommendations for future implementation of digital prevention programs delivered at scale in schools. These recommendations were designed to facilitate an organizational change and help staff to implement digital mental health programs within their schools.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1136/bmjopen-2020-042133.

Implementation of a School Mental Health Learning Collaborative Model to Support Cross-Sector Collaboration

Facilitating success for students with behavioral health challenges requires effective collaboration among professionals from traditionally disparate systems (e.g., education, health, and mental health). The current investigation describes a case-study implementation of a school-based learning collaborative model and explores its effectiveness in promoting knowledge, skill, efficacy, and systems-related improvements in cross-sector collaboration. The learning collaborative (LC) was offered to school teams over the course of a year and consisted of a combination of didactic and experiential learning opportunities, guest speakers, district-specific improvement goals, peer learning and support, and individualized consultation support. Evaluation efforts included evidence demonstrating the efficacy of the LC, improvement in person-centered knowledge skills and competencies, and generation of concrete changes in school systems. Respondents consistently shared that the quality of the LC was high that the topics were highly useful for their day-to-day practice, and that they would recommend the LC to their colleagues and peers. In turn, this process fostered improvement in educators' knowledge, skills, and confidence, and generated systemic improvement in districts to support children with behavioral health needs and their families. Specific components of this model that best account for changes are discussed, along with implications for application and next steps.

Australian School Staff and Allied Health Professional Perspectives of Mental Health Literacy in Schools: a Mixed Methods Study

Schools are an ideal setting to base mental health literacy programs as the learning environment is already established. Mental health literacy represents how to obtain and maintain good mental health and should be incorporated into the school curriculum. Collaboration with key stakeholders in youth mental health, such as school staff and allied health professionals, is critical in ensuring needs are addressed, and programs are sustainable. This study aimed to understand the perspectives of school staff and allied health professionals towards mental health literacy within Australian schools. An exploratory qualitative and quantitative survey was completed by 88 participants across Australia. Results indicated that school staff feel less competent to deliver mental health literacy content and perceive their training did not address mental health education compared to allied health professionals. Most mental health programs reported to be implemented within schools were social and emotional learning programs. School staff viewed mental health programs to strengthen academic performance less than allied health professionals. Thematic analysis of qualitative data identified that participants viewed mental health knowledge, where and how to seek help, and coping skills as vital content to cover in a school-based mental health literacy program. This study reveals that school staff need sufficient training and resources to address youth mental health literacy. Though mental health literacy is lacking in the Australian school system, the perspectives of school staff and allied health professionals in this study provide key ideas and considerations for the future development of school-based mental health literacy programs for youth.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10648-023-09725-5.

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.

Promoting Mental Health Help-Seeking Behaviors by Mental Health Literacy Interventions in Secondary Education? Needs and Perspectives of Adolescents and Educational Professionals

Mental health literacy (MHL) interventions in secondary schools may help to improve competencies that adolescents require to stay mentally healthy and seek help if mental health problems arise. These MHL interventions should be tailored to the needs of adolescents and educational professionals (EPs) to reach sustainable implementation and long-term effectiveness. However, evidence is lacking on these needs. Thus, our aim was to explore their experiences with, and perspectives on, mental health help seeking and needs regarding MHL interventions. We performed online focus group discussions and interviews with adolescents (n = 21; 13-19 years) and EPs (n = 12) and analyzed the data using directed content analysis. We identified three themes related to mental health help seeking: (1) Limited MHL competencies of adolescents, (2) Limited competencies of EP to provide mental health support, and (3) Limited mental health promotion in the school environment. We further identified three themes regarding MHL interventions: (1) Addressing basic mental health knowledge and skills, (2) Interactive and easily accessible, and (3) Sustainable implementation. Improving the MHL competencies of adolescents and EPs, and creating a mental health-literate school environment can promote adolescents' mental health help seeking. Our findings highlight the importance of developing MHL interventions that are tailored to both adolescents' and EPs needs.

Teachers' views and experiences of student mental health and well-being programmes: A systematic review

Background: In schools, teachers are often tasked with implementing mental health and well-being programmes. However, little is known about teachers' views on and experiences with implementing these programmes.Aim: The aim of this systematic review was to explore teachers' views and experiences of mental health and well-being intervention programmes developed to promote and protect student mental health.Methods: A systematic review of the empirical literature was conducted using the following databases: Academic Search Complete, APA PsycArticles, APA PsycInfo, British Education Index, Education Full Text (H.W. Wilson), ERIC, Social Sciences Full Text (H.W. Wilson), and SocINDEX with Full Text.Findings: Seven papers met the inclusion criteria. Teachers reported several challenges to the successful implementation of mental health and well-being programmes, including a lack of time allotted in the curriculum, insufficient training, and inadequate interagency support. There was evidence of conflicting opinions regarding the role of teachers in supporting students.Conclusion: It is recommended that mental health and well-being are viewed as central to schools' ethos and that teachers are adequately prepared to implement programmes.