What kinds of mental health activities (5-18) should be the focus for funders’ grant-making and what should they be

aiming to learn?Dr Miranda Wolpert

Reader in Evidence Based Practice and Research UCL

Director of Evidence Based Practice Unit

Director of Child Outcomes Research Consortium

30th September 2015

Educational Endowment Foundation

Policy context

• Future in mind : emphasis on better integrated working and early intervention

• Advice on school counselling • “Grit” and “character”• Centrality of academic attainment• Ofsted framework Sept 2015

Delivery context

• Increased diversity in education• Cuts in Mental Health provision: 25- 50%• Historic lack of collaboration• Increasing problems especially in girls 13- 15 • Increases in self harm and body image issues• Some plateau of improvement for behavioural

problems especially for boys• No linked data but increasing possibilities

What is the problem: In a class of 30:Around 3 with “mental health problems”

In a secondary school of 1000 pupils across a year:– 50 clinically depressed– 10 emotional problems including self harm– 100 significant behavioural disturbance– 100 with anxiety states/phobias– 10 eating disorder– up to 10 attempt suicide – 7-11% experiencing abuse

The THRIVE ModelAttempts at drawing a clearer distinction than before between:• treatment and support• self-management and intervention

We are aware there are a number of initiatives across the country who use “Thrive” in their title. We use the term to reflect our core commitment to young people “thriving” and to represent our commitment to provision that is Timely,

Helpful, Respectful, Innovative, Values-based and Efficient.

Risk factors for reduced emotional well being

• Poverty• Poor environment• Family problems• Temperament• Learning disability• Being an asylum seeker • Living with only one natural parent, either in a step-family or with a lone

Parent• Parental unemployment• Being looked after• Large family size (5+)• Living in families where the main breadwinner was unemployed• Enduring physical ill health• Experienced physical or sexual abuse/ witnessed domestic violence• A parent with mental health problems.

Factors that promote emotional well being

• High self esteem• Good relationships• Good housing• Stable relationships • Temperament adaptability• High IQ• Fairness and stability in relationships

Islington Mental Health and Resilience in Schools framework

Young peoples strategies (13-14 year old self report)

• Long baths• Physical activity • Eating chocolate• Sleeping• Talking with friends (more true of young

women than young men)

What do we know helps: interventions

• Lots of research in US• Specific interventions eg PATHS, Penn Resilience• PHSE eg re suicide

Possibilities• Mindfulness• Reslience programmes• Headstart

Provocations• Do not assume humanistic counselling only way forward• Do not assume that training teachers necessarily helps

What do we know helps: Prevention/Promotion Programmes in

secondary schools

• Seattle programme• School Transition Environmental Project

(STEP)• Gang Resistance Education Training

(GREAT) • Suicide prevention• Depression preventions projects

What do we know works: programmes for those with

problems/at risk

• Peer education/mentoring programmes• CBT group work e.g. FRIENDS• PTSD intervention• Social skills training for antisocial youth

What do we know helps: common factors

• Consistency and persistence • inclusion of parents teachers and peers• multiple modalities• integration into core curriculum • start early and take developmental approach • skills based• school environment: foster warm relationships,

encourage participation, develop pupil and teacher autonomy, foster clarity about boundaries, rules and expectations.

• Teachers must have their own needs met

What do we know helps: Implementation context characteristics

• Owned by senior teachers, governing bodies and senior staff from any external body who may be supporting the programme.

• Linked to and embedded in the relevant aspects of the curriculum• Skills based, that is focused on the teaching and development of skills

by students• Underpinned by effective training and supervision for all staff involved in

the delivery of the programme • Informed by routine monitoring and feedback on key process and

outcome measures to staff providing and managing the delivery of the programme

Limitations of the evidence based

• Paucity of research• Most research currently from US• Few RCTs (or indeed CTs)• Few intention to treat designs• Few control groups included• Less on secondary than primary• Lack of research on recovery or reintegration

What else do we know

• Difficulties of implementation• Unintended consequences eg re suicide• Time it takes to embed• Complexity of school systems• Lack of RCTS• Schools liking local ownership

Gaps

• Different forms of work in UK• Targeted vs whole school• Impact on attendance• Impact on attainment• Young people and families own strategies

Learning from experience of research and evaluation in this area

• People want to measure everything• People want to measure long term• Everyone has their favourite measure• Everyone can pick apart others’ measures• Hard to capture what is done in such a

way as to aid replicability

What are schools doing?

INTERVENTION

CHANGE MECHANISMS OUTCOMES

MODERATORS

TARGET

Who is the intervention for?

What is the intervention?

Why does the intervention

work?

What difference will it make?

Will it affect everyone the same?

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Tidier framework1.Brief name: provide the name or phrase that describes your intervention

2.Why: describe any rationale, theory, or goal of the elements essential to the intervention

3.What (materials): describe any physical or informational materials used in the intervention, including those provided to participants, used in intervention delivery, and/or training of intervention providers

4.What (procedures): Describe each of the procedures, activities and/or processes used in the intervention, including any enabling or support activities

5.Who provides: For each intervention provider (e.g. teacher, psychologist, youth worker), describe their expertise, background and any specific training given)

6.Who receives: Provide a description of the target population for the intervention

7.How: Describe the mode(s) of delivery (e.g. face to face) of the intervention and whether it is provided individually or in a group

8.Where: Describe the type(s) of location(s) where the intervention occurs, including any necessary infrastructure or relevant features

9.When and how much: Describe the number of times the intervention is to be delivered and over what period of time including (if applicable) the number of sessions, their schedule, and their duration, intensity or dose

10.Tailoring: If the intervention is planned to be personalised or adapted, then describe what, why, when and how

Me and My school

Friends (Kidscreen)

School and Learning (Kidscreen)

School Climate

• At this school we care about each other• At this school we like each other• We can talk to teacher about our problems• Teachers try hard to help us• We feel safe in school• Our teachers are fair• There is an adult in my school who understands

how I feel

Opportunities

Funders could:• Mandate a common set of metrics • Mandate use of logic models• Mandate use of Tidier frameworks• Encourage links across datasets• Encourage consideration context, mechanism and

outcome• Encourage focus on consider implementation science• Support focus on elements of the approach

How to evaluate funded work

• Consider logic diagrams• Consider RCTS• Consider detailed qualitative studies• Consider cohort studies• Don’t just do pre and post• Towards common set of metrics

INTERVENTION

CHANGE MECHANISMS OUTCOMES

MODERATORS

TARGET

Who is the intervention for?

What is the intervention?

Why does the intervention

work?

What difference will it make?

Will it affect everyone the same?

UN

DER

STA

ND

ING

YO

UR

MO

DEL