The feasibility and acceptability of an approach to emotional wellbeing support for high school students

Selective and indicated UK school-based mental health interventions: a systematic review and narrative synthesis

BACKGROUND

Mental health disorders amongst children and young people pose a significant burden, with a growing emphasis on early intervention. A notable gap exists between the prevalence of these disorders and sufficiently early treatment, emphasising the need for effective preventive measures.

AIMS

This review aims to comprehensively assess and narratively synthesise both quantitative and qualitative literature on secondary preventative (indicated and selective) school-based mental health interventions in the UK.

METHOD

All empirical studies published since 2010, which reported on UK secondary preventative school-based interventions were eligible. Eligible studies were identified by searching the following electronic databases: PsycINFO (Ovid), MEDLINE (Ovid), Scopus (Elsevier), EMBASE (Elsevier), ERIC (EBSCO), and Web of Science (Clarivate). Database searches yielded 3269 results, with 26 articles meeting inclusion criteria. These articles covered 22 unique studies encompassing various study designs. The Mixed Method Appraisal Tool (MMAT) was used to assess study quality, and study findings were synthesised using a single narrative synthesis ('storytelling') approach.

RESULTS

Three central themes emerged: (1) Outcomes for children and young people; (2) acceptability and preferences; and (3) practical considerations. The majority of included studies demonstrated high quality. Studies revealed diverse perspectives on the strengths, limitations, barriers, and facilitators of school-based interventions.

CONCLUSIONS

School-based interventions hold promise in promoting positive mental health amongst young people, emphasising the pivotal role of educational settings in addressing these challenges. Despite encouraging outcomes, this review highlights the need for further research to better understand intervention effectiveness, implementation barriers, and cost-effectiveness; to facilitate the development of tailored and impactful strategies for supporting young people's mental health.

PRISMA/PROSPERO STATEMENT

This systematic review was conducted following Cochrane methodology PRISMA guidelines. The review was registered with PROSPERO in June 2023 (CRD42023431966).

Study protocol for the Multimodal Approach to Preventing Suicide in Schools (MAPSS) project: A regionally based feasibility trial of an integrated response to suicide risk among UK secondary school pupils

BACKGROUND

Suicide is the leading cause of death of children and young people under 35 in the UK, and suicide rates are rising in this age group. Schools are considered an appropriate and logical setting for youth suicide prevention activities, with universal, selective, and indicated approaches all demonstrating efficacy. Given that international best practice recommends suicide prevention programmes combine these approaches, and that to date this has not been done in school settings in the UK, this study aims to evaluate the feasibility of delivering a suicide prevention programme incorporating universal, selective, and indicated components in UK schools.

METHODS

This study is a feasibility cluster-randomised controlled trial (RCT) of an adapted version of the Multimodal Approach to Preventing Suicide in Schools (MAPSS) programme. The programme, initially developed in Australia, involves delivering universal psychoeducation to all pupils, screening them for suicide risk, and delivering Internet-based Cognitive Behavioural Therapy (Reframe IT-UK) to those students identified as being at high-risk for suicide. The programme will be trialled in six secondary schools in Northwest England and will target Year 10 students (14- and 15-year-olds). The primary aims are to assess: 1) the acceptability and safety of delivering MAPSS in a school setting in the UK; 2) the social validity of the MAPSS programme; and 3) the feasibility of delivering a large-scale, appropriately powered, cluster-RCT and economic evaluation of this intervention in the future. Secondary aims are to assess changes over time in mental health and wellbeing outcomes.

DISCUSSION

This study is the first to evaluate a suicide prevention programme comprising universal, selective, and indicated components in UK schools. If the programme is found to be feasible, it could be more widely tested in schools and may ultimately lead to reduced rates of suicide and suicidal behaviour in young people.

Help-seeking processes related to targeted school-based mental health services: systematic review

BACKGROUND

One in seven adolescents globally are affected by mental health conditions, yet only a minority receive professional help. School-based mental health services have been endorsed as an effective way to increase access to mental health support for people at risk, or currently presenting with mental health conditions, throughout adolescence. Despite this, low treatment utilisation prevails, therefore the aim of this review is to contribute insights into the processes related to adolescents' accessing and engaging with essential targeted mental health support within schools.

METHODS

This systematic review extracted qualitative, quantitative and mixed-methods data to determine what processes affect adolescents seeking help from targeted school-based mental health services (TSMS). Searches were conducted in EMBASE, Medline, PsycINFO, CINAHL, ERIC, Web of Science, in addition to manual searching and expert consultations. Data were synthesised following guidelines for thematic synthesis and narrative style synthesis.

RESULTS

The search resulted in 22 articles reflecting 16 studies with participant sample sizes ranging from n = 7 to n = 122. Three main themes were identified: 'access-related factors', 'concerns related to stigma', and 'the school setting'. These findings elucidate how help-seeking processes are variable and can be facilitated or hindered depending on the circumstance. We identified disparities with certain groups, such as those from low-socio economic or ethnic minority backgrounds, facing more acute challenges in seeking help. Help-seeking behaviours were notably influenced by concerns related to peers; an influence further accentuated by minority groups given the importance of social recognition. Conflicting academic schedules significantly contribute to characterising treatment barriers.

CONCLUSIONS

The findings of this review ought to guide the delivery and development of TSMS to facilitate access and promote help-seeking behaviours. Particularly, given the evidence gaps identified in the field, future studies should prioritise investigating TSMS in low- and middle-income settings and through quantitative methodologies.

REGISTRATION

The protocol for this systematic review was registered on PROSPERO (ID CRD42023406824).

Implementation of a school-based social and emotional learning intervention: understanding diffusion processes within complex systems

Sporadic and inconsistent implementation remains a significant challenge for social and emotional learning (SEL) interventions. This may be partly explained by the dearth of flexible, causative models that capture the multifarious determinants of implementation practices within complex systems. This paper draws upon Rogers (2003) Diffusion of Innovations Theory to explain the adoption, implementation and discontinuance of a SEL intervention. A pragmatic, formative process evaluation was conducted in alignment with phase 1 of the UK Medical Research Council's framework for Developing and Evaluating Complex Interventions. Employing case-study methodology, qualitative data were generated with four socio-economically and academically contrasting secondary schools in Wales implementing the Student Assistance Programme. Semi-structured interviews were conducted with 15 programme stakeholders. Data suggested that variation in implementation activity could be largely attributed to four key intervention reinvention points, which contributed to the transformation of the programme as it interacted with contextual features and individual needs. These reinvention points comprise the following: intervention training, which captures the process through which adopters acquire knowledge about a programme and delivery expertise; intervention assessment, which reflects adopters' evaluation of an intervention in relation to contextual needs; intervention clarification, which comprises the cascading of knowledge through an organisation in order to secure support in delivery; and intervention responsibility, which refers to the process of assigning accountability for sustainable delivery. Taken together, these points identify opportunities to predict and intervene with potential implementation problems. Further research would benefit from exploring additional reinvention activity.

Student help seeking from pastoral care in UK high schools: a qualitative study

BACKGROUND

Little is known about high school students' perceptions of school-based pastoral support. This study aimed to explore this in the context of a high school-based emotional support project.

METHODS

Qualitative interviews explored perspectives on help seeking of students (N = 23) and staff (N = 27) in three UK high schools where a pastoral project was introduced. Data were analysed thematically.

RESULTS

Student peer groups perceived help seeking as a sign of weakness. However, students valued learning skills in managing emotions and friendships. Staff expressed concerns about students' ability to help seek proactively, and highlighted organisational influences on pastoral support.

CONCLUSIONS

Increasing student control over the process, and involving trusted staff, could encourage help seeking in high school. It is possible to access the views of students who do not help seek, to improve understanding of help-seeking behaviour.

Developing a model of mental health self-care support for children and young people through an integrated evaluation of available types of provision involving systematic review, meta-analysis and case study

Background

The mental health of children and young people (CYP) is a major UK public health concern. Recent policy reviews have identified that service provision for CYP with mental health needs is not as effective, responsive, accessible or child-centred as it could be. Following on from a previous National Institute for Health Research (NIHR) study into self-care support for CYP with long-term physical health needs, this study explored self-care support’s potential in CYP’s mental health.

Objectives

To identify and evaluate the types of mental health self-care support used by, and available to, CYP and their parents, and to establish how such support interfaces with statutory and non-statutory service provision.

Design

Two inter-related systematic literature reviews (an effectiveness review with meta-analysis and a perceptions review), together with a service mapping exercise and case study.

Setting

Global (systematic reviews); England and Wales (mapping exercise and case study).

Participants (case study)

Fifty-two individuals (17 CYP, 16 family members and 19 staff) were interviewed across six sites.

Main outcome measures (meta-analysis)

A measure of CYP’s mental health symptomatology.

Data sources (literature reviews)

MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, All Evidence-Based Medicine (EBM) Reviews, Applied Social Sciences Index and Abstracts (ASSIA) and Education Resources Information Center (ERIC).

Review methods

Titles and abstracts of papers were screened for relevance then grouped into studies. Two independent reviewers extracted data from studies meeting the inclusion criteria. A descriptive analysis and meta-analysis were conducted for the effectiveness review; descriptive analyses were conducted for the perceptions review. These analyses were integrated to elicit a mixed-methods review.

Results

Sixty-five of 71 included studies were meta-analysable. These 65 studies elicited 71 comparisons which, when meta-analysed, suggested that self-care support interventions were effective at 6-month [standardised mean difference (SMD) = −0.20; 95% confidence interval (CI) −0.28 to −0.11] and 12-month (SMD = −0.12; 95% CI −0.17 to −0.06) follow-ups. However, judged against Cochrane criteria, the studies were mostly low quality. Key elements of self-care support identified in the perceptions review were the acquisition of knowledge and skills, peer support and the relationship with the self-care support agent; CYP also had different perceptions from adults about what is important in self-care support. The mapping exercise identified 27 providers of 33 self-care support services. According to the case study data, effective self-care support services are predicated on flexibility; straightforward access; non-judgemental, welcoming organisations and staff; the provision of time and attention; opportunities to learn and practise skills relevant to self-care; and systems of peer support.

Conclusions

Mental health self-care support interventions for CYP are modestly effective in the short to medium term. Self-care support can be conceptualised as a process which has overlap with ‘recovery’. CYP and their families want choice and flexibility in the provision of such interventions and a continued relationship with services after the nominal therapy period. Those delivering self-care support need to have specific child-centred attributes.

Future work

Future work should focus on under-represented conditions (e.g. psychosis, eating disorders, self-harm); the role of technology, leadership and readiness in self-care support; satisfaction in self-care support; the conceptualisation of self-care support in CYP’s mental health; and efficacy and cost-effectiveness.

Study registration

PROSPERO number (for the effectiveness review) CRD42012001981.

Funding

The NIHR Health Services and Delivery Research programme.

Service user perspectives of multiagency working: a qualitative study with children with educational and mental health difficulties and their parents

BACKGROUND

Recent policies recommend effective joint working between health and education; however, the views of service users are underrepresented, particularly opinions of young children.

METHOD

The project was operational from 2005-2008 when interviews were conducted with parents and children. The children were attending CAMHS for mental health and educational difficulties.

RESULTS

Results indicated that they had a positive view of multiagency working. They consider that joint working is limited by a number of problems and make recommendations for improvement.

CONCLUSIONS

Findings indicate that more effective communication between agencies is needed and this should be provided for parents in an accessible language. This has implications for training professionals together.

Social and emotional aspects of learning (SEAL) for secondary schools: implementation difficulties and their implications for school-based mental health promotion

BACKGROUND

Increasing concern about adolescent mental health problems has resulted in schools being identified as central sites for their prevention (PsycInfo; ERIC 2000-2012). In this context, SEAL for secondary schools was launched in 2007.

METHOD

The implementation strand of the national evaluation of secondary SEAL comprised longitudinal case studies of nine schools and used multiple methods and data sources, including interviews, observations and document review.

RESULTS

Implementation was variable, both within and between schools; barriers were identified at programme, teacher and school levels.

CONCLUSIONS

Implementation issues identified have implications for SEAL and school-based mental health prevention and promotion interventions more generally.

Young people's preferences for emotional well-being support in high school--a focus group study

PROBLEM

Schools have been identified as a suitable setting for the delivery of emotional well-being (EWB) support, but in the United Kingdom there is little empirical evidence from young people that can inform the development of appropriate school-based interventions.

METHODS

Fifty-four students (11-16 years) from three U.K. high schools discussed the content, delivery, and evaluation of acceptable, school-based, EWB support. Focus group methods were matched to the school setting and sensitive topic.

FINDINGS

Participants identified emotional difficulties in school, home, and with peer relationships. They said that some problems were too sensitive for them to seek help in school setting. They valued confidentiality, support, and effective help that were offered by people they experienced as friendly, trustworthy, and skilled. Teachers and peer mentors were not thought to fit these criteria, although trusted adults in mentor roles could meet their criteria. Participants recognized that they could hide their emotions, so their EWB would be difficult to assess. They described how the effect of emotional distress on their behavior is idiosyncratic, and therefore their EWB should not be judged simply on their behavior.

CONCLUSION

The way in which EWB support is delivered in school is an important aspect of the role of practitioners and educators attempting to provide it. Because young people are sensitive to the personal qualities and skills of people offering them help, programs to train school staff in emotional support roles are important to ensure trust and an environment open to students seeking assistance. Interventions for school-based EWB support need to consider subjective well-being as well as behavioral change.