implementing mental health promotion in schools in the uk and learning from dataprev in europe
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Implementing mental health promotion in schools in the UK and learning from Dataprev in Europe. Professor Katherine Weare Professor Melanie Nind University of Southampton Skw @soton.ac.uk Intecamhs meeting Washington November 2010. Aims. - PowerPoint PPT PresentationTRANSCRIPT
Implementing mental health promotion in schools in the UK and learning from Dataprev in
Europe
Professor Katherine WeareProfessor Melanie Nind
University of SouthamptonSkw @soton.ac.ukIntecamhs meeting
Washington November 2010
Aims
To give an overview of what is happening with the promotion of mental health in schools in the UK
To communicate the key findings of the Dataprev project
My roleBackground in Health Promoting
Schools: Mental HealthWrote key document for UK Govt on
‘what works’ in promoting emotional health and wellbeing.
Helped create and monitor primary and secondary “SEAL” programmes
On working party for English “Targeted Mental Health” programme
Part of current “Early Intervention “reviews and policy
Reviewing evidence base for mental health in schools and uncovering programmes for EU: “DataPrev”.
Why schools in Europe are interested in mental health
Focus on positive mental health, wellbeing, prevention, early intervention, social and emotional learning, healthy schools
Long term concerns to reduce problems e.g. stress, anxiety, depression, bad behaviour, violence, disaffection
Changing focus of learning on skills rather than just content: preparing students for lifelong challenges
Improved evidence: knowledge of effective programmes and approaches
Paradigm shift in understanding of the role of mental health and wellbeing in schools in Europe Traditional view For young children Responsibility of the
home/ mental health services
For special needs/ those with problems
Trouble shooting/ prevention
Bolt on extra/low status activity
An art not a science
New view Everyone including adults Everywhere e.g. secondary
schools, workplaces All of us, including ‘without
problems’(?) Positives e.g. growth,
strengths, capacities Central to educational goals –
learning and behaviour Evidence based
Government interventions e.g.
Every child matters framework: wellbeing
4 reviews by National Institute for Clinical Excellence on wellbeing in schools – new one on early years underway
Early years review (ongoing with new govt)
Healthy schools framework – emotional wellbeing
Plus
Work in voluntary sector e.g. Place2Be, Pyramid Trust, Antidote,
Some imported programmes e.g. Paths, Second Step, EL in Middle Schools, Friends
Positive behaviour management
Mental health for
young people
in the UK
England: previous govt programmes e.g. Strong work on Personal, Social and Health
Education/ Enrichment/ Healthy schools SEAL: 2/3 of primary, 10% secondary and
growing Targeted approaches, some through SEAL,
recent DCSF £60mScotland: use frameworks and localised
approaches e.g. Overall “Curriculum for Excellence” Restorative practices, Being Cool in School,
Creating Confident KidsWales Local work on emotional Literacy and SEALNorthern Ireland Mainly through PSHE
Principles behind recent UK approaches to mental health in schools
Evidence based Emphasis on range of benefits including
links with learningTailored to local needsWhole school approach Supportive and balanced ethos and
environmentBalance universal, targeted, indicatedExplicit skill development: integrated into
teaching and learning and curriculumMonitoring and evaluationStaff development
Strong influence of international evidence that well designed programmes improve
Mental health problems - anxiety, depression, stress
BehaviourAttendanceExclusion – social and educationalCultural and racial understanding Teacher retention, performance
and moraleLearning
Summary of results of 207 SEL programmes in US:
11% improvement in achievement tests25% improvement in social and emotional skills10% decrease in classroom misbehaviour, anxiety
and depression (10% in each)
Social and emotional learning (SEL) and student benefitswww.casel.org/downloads/
EDC_CASELSELResearchBrief.pdf
Primary SEAL
Curriculum materials 7 themes, 5 levels Guidance, overview, curriculum
ideas, assembly, whole school opportunities
Evaluation by IoE of pilot very positive – measurable changes in behaviour, attendance, learning, test scores in numeracy and literacy
In 2/3 primary schools
Secondary SEAL Built on learning from SEAL
and others In 1/3 secondary schools Web based Strong whole school approach Guidance on evidence,
implementation, ethos, policy, leadership, links with parents and community, special needs
Learning materials for years 7- Positive evaluations of pilot and
by Ofsted (inspectors) Mixed results of RCT Positive results from schools
which followed guidance
National Institute for Clinical Exellence reviews concluded that universal base is vital
Less stigmatising Problems are widespread,
on a continuum, connected
Same processes which help everyone help those with problems – ‘more’ not ‘different’
Provides educated ‘critical mass’ of people to help those with problems
But also need targeted and early interventions
Targeting - start early and keep goingSome brief interventions
work with mild problems but most effective programmes take time
Involve parentsTarget the youngestAddress problems earlySpiral approachRevisit learningIntegrate with rest of school
Some demonstrably effective approaches
Long term programmes on social and emotional skills – reinforced in all interactions with children
Conflict resolution programmesPlay based approachesNurture groupsParenting skills Social skills and cognitive
behaviour therapy type mix
Targeted mental health in schoolsNational programme:
£60 million‘Pathfinders’Joined up workingMust link with SEALEvidence based approachNot yet evaluated
Key challenge – motivating staff What has this got to do with education? Overload“Too many initiatives” Cannot see the point (“our results are
good- why do we need it?) “Job of parents- not us” Too stressed Threatened, lack of skills, time, guilt Clarifying roles and expertise Need to involve all the SMT Lack of input into initial teacher education
Barriers to developing mental health in schools in the UK
Academic critics- ‘therapeutic education’ seen as harmful, creating dependency, threatening
Media scorn: silly, ‘nanny state’Target led nature of education,
especially secondaryNew government: focus on subjects,
back to basics, ‘peripheral issues’ will not be subject to inspection
Negative results of RCTs
Where next for the UK?
Use different language e.g. ‘resilience’ and ‘grit’ not emotional literacy
Emphasise links with learning
Involve private enterprise e.g. in early intervention
New areas e.g. mindfulness
Role of the EUEU - strong role in public health. Mental health key areas for action, and
children and youth are one of the five priority areas
Sequence of meetings, conferences, research projects, documents to guide practice and policy
Evidence in EuropeNo strong tradition of evaluation- unlike USReviews have found that projects not
robustly designed or evaluated – mostly process evaluation, before and after, or case study
No networks to pull it together unlike CASEL and SAMSHA in the US
Some databases established but not systematic, or not in English (e.g. Dutch)
The Dataprev projectReviewing evidence base systematically in 4
key areas: parenting, schools, workplace, the elderly
Identifying good practice: database of effective approaches
Aim: assist policy-makers with guidance and training on transferability of specific approaches and programmes to different countries and cultures
Improving lines of communication between researchers and policy-makers.
Schools workpackage: identifying and obtaining reviews Systematic search of wide
range of databases, websitesDirect contacts with known
experts Reference list from known
reviewsAssessing for qualityPost 1990
Found49 systematic reviews10 evidence informed
Some key sources of evidence
US – widespread broad frameworks e.g. ‘character’, ‘social and emotional learning’, ‘mental health’. 20 positively evaluated programmes- some heavily promoted in the UK
Australia – widespread frameworks e.g. Health Promoting Schools, ‘Resilience’ – ‘Kidsmatter’ and some positively evaluated programmes e.g. ‘Friends’
Europe – Health Promoting Schools – other key initiatives not so important e.g. EU, anti-bullying in Scandanavia
Programmes found in Europe-
15 Large named US programmes that pass systematic review
7 smaller European programmes3 European programmes that not yet in
systematic review but which would be eligible
2 larger national programmes that currently being evaluated
Quality of the evidenceStrong group of programmes/ approachesClear impact on anxiety, stress, Some impact on depression, behaviour, crimeSome impact on +ve mental health and academic
learningFew adverse effectsEffects cannot be relied on even in country of
originMost that are robustly evaluated originate in the US
– few trials in EuropeA few programmes that are European in origin
Quality of the evidence: problems
Heterogeneity – comparison difficultNot many programmes have long term
evaluation“Poor” design – e.g. randomisation and
blinding almost impossible Systematic review methods not well suited
to multi-modal long term school interventions- may be missing some features
But on the whole the results of the reviews support the qualitative work
What appears to make implementation more effective
Consistent implementationWhole school - multiple modalities,
positive school ethos, integration Skills development – CBT/ social
skills, developmentally appropriate, integrated with general curriculum
Inclusion of parents, teachers, and peers – supported by training
Longer time frame
Tailoring balance
UK and Europe generally suspicious of scripted programmes.
Too much prescription – lack of ownership, engagement, depowerment.
Too much tailoring – dilution, confusion, hard to evaluate
Age, stage, lengthEarly interventions seem more effectiveBooster sessions usefulOne offs never found to work Short term can help with conduct disorders
and anxietyConduct disorders seem to need longer
interventionsFew programmes for 11+ age. Mostly
conduct disorder. Evidence base weak. No clarity about length of intervention.
Targeting Balance/ mutual support:UniversalTargetedIndicated
More impact on boys that girls
More impact on high risk than low (ceiling effect?)
Physical environment
CommunityParentsOutside agencies
ManagementLeadershipPoliciesStaff
School climate and ethos
Skill developmentCurriculum andMethodsPupil supportPupil involvement
Whole school approach: using
Who should deliver?Hard to be definitive as few
direct comparisons, Psychologists effective,
especially for short term and complex interventions
Teachers often used, long term input, sustainable, integrated. Need training, can be effective, although unreliable judges of students
Essential to involve parents as part of the team – parenting education effective
Peer learning/ mediation effective
Best when agencies work together
Appropriate targeting
Whole school approach- features that seem influential
ParentsPeersInvolved and trained
Staff development
Climate, ethos, values, attitudes
Curriculum andMethods- CBT and social skills-integrated
Curriculum Usually a key part of effective interventions
Whatever the issue, CBT/ social skills mix seems to help
For long term impact, needs integrating with wider curriculum and processes
Specific mental health issuesSelf esteem and depression harder to
influence than anxiety and conduct disorder
Conduct disorder – reasonably good evidence, long term approach needed, training teachers to be less negative and work with parents more effectively helps
Bullying/ conflict resolution – peer training essential
Universal suicide prevention unwise
Specific mental health issuesSelf esteem – tough to influence. Best
if focused onDepression – also tough. Associated
problems make it complicated. Long term, CBT/Social Skills indicated.
Anxiety, stress, coping – easier to influence with medium term interventions using mixed methods e.g. relaxation, CBT, meditation, body work
ADHD – no effective interventions found so far