Transcript Mental Health Promotion in Schools: Evidence of Effectiveness

Why Mental Health Matters in Schools: Evidence and
principles of effective implementation
Professor Margaret Barry
WHO Collaborating Centre for Health Promotion Research
National University of Ireland Galway
Ollscoil na hÉireann, Gaillimh
The importance of mental health
‘there is no health without mental health’
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Mental health is fundamental to good
health and quality of life
» a resource for everyday life which enables us
to manage our lives successfully
» contributes to the functioning of individuals,
families, communities and society
» importance of promoting positive mental
health in its own right
M. Barry, Dublin 2012
Current definitions of mental health
‘more than the absence of mental illness’
Mental health may be defined as;
“a state of emotional and social well-being in which the
individual realises his or her own abilities, can manage the
normal stresses of life, can work effectively, and is able to
play a role in his or her community” (WHO, 1999)
“ Mental health is the emotional and spiritual resilience
which enables us to enjoy life and to survive pain, suffering
and disappointment. It is a positive sense of well-being and
an underlying belief in our own and others’ dignity and
worth”(HEA, 1997)
M. Barry, Dublin 2012
Mental Health and Young People
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Childhood – opportunity to lay the foundations
for good mental health across the life cycle
Around 25% of children and adolescents
experience mental health problems, of which 10%
are mental disorders warranting treatment
Mental health problems co-occur with social
problems such as school failure or delinquency as
well as health problems like substance misuse
Poor adjustment in childhood is linked with
negative psychosocial outcomes in adulthood
M. Barry, Dublin 2012
Mental Health Promotion in Schools
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Schools are one of the most important settings for
promoting the mental health of young people
(WHO, 2001)
Schools provide a socialising context that has a
significant influence on:
 positive youth development
 sense of connectedness with family, community and
broader society
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School as a setting – a systems approach
M. Barry, Dublin 2012
Mental Health Promotion in Schools
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Building academic success on social and
emotional learning
• promote academic, emotional and social competence
• reducing school drop-out rates
• reducing a range of negative health and social outcomes
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Teaching and learning of skills, attitudes and
resources that are valuable for life
- communicate effectively, work as a team member, resilience in the
face of difficulties, problem-solving, coping strategies, sense of
control/efficacy
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Role of education in addressing social and health
inequity
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Social and Emotional Wellbeing
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Increasing focus on social and emotional
wellbeing
» Emotional intelligence (Salovey and Mayer, 1990;
Goleman, 2005) - skills of understanding our emotions
» Emotional literacy (Steiner and Perry, 1990) - ability to
identify, manage and communicate how we feel;
Weare (2004) “..and respond to the emotions of
others in ways that are helpful”
» Focus on teaching and learning of personal and social
skills for young people (Institute for Public Policy
Research, Margo et al., 2006)
» Social and emotional learning (CASEL, 2004, 2010)
M. Barry, Dublin 2012
Collaborative for Academic, Social
and Emotional Learning (CASEL)
Essential skills for social and emotional learning:
• Self-awareness - know yourself and others - identify
feelings, be responsible, recognize strengths
• Self-management - manage emotions, understand
situations, set goals and plans, solve problems creatively
• Social awareness - care for others - show empathy,
appreciate diversity
• Relationships skills - communicate effectively, build
relationships, negotiate fairly, refuse provocations, seek
help
• Responsible decision making - act ethically, appropriate
social norms, respect others
M. Barry, Dublin 2012
Positive Mental Health
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Focus on promoting positive mental health
Conceptualisations of positive mental health
(Keyes, 2002; Huppert, 2005; Ryff et al., 2006)
- Hedonic - subjective well-being and life satisfaction
- Eudaimonic - positive functioning, engagement,
fulfilment and social well-being
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Keyes’ concept of optimal mental health or
‘flourishing’
Abilities to develop psychologically, emotionally,
intellectually, socially and spiritually
M. Barry, Dublin 2012
Promoting Mental Health
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Mental health promotion
» focus on positive mental health and quality of
life across populations
» building strengths, competencies and resources
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Prevention of mental disorders
» concern with specific disorders - reducing
incidence, prevalence or seriousness of a
targeted problem
» mortality, morbidity and risk behaviours
M. Barry, Dublin 2012
Strategies for
promoting
well-being &
quality of life
Barry, M.M. (2001) International Journal of Mental Health Promotion, 3(1) 25-34.
Health Promotion
action areas
Systems
Build healthy public policy
Policies
Create supportive environments
environment
Reorient health services
organisation
Strengthen community action
community
Develop personal skill
person
Evaluation
Planning
Assessment
Systems
scale
Health Promotion
Socio-ecological Model
(Ottawa Charter, WHO,
1986)
The process of enabling
people to increase control
over their health and the
determinants of health
Implementation
combined into Health
Promotion strategies
micro - macro
Health Promotion Principles (participation, empowerment, equity, social justice)
Determinants of Mental Health
(HEA, 1997; VicHealth, 1999)
Key determinants of mental health:
• Societal level - healthy structures
» economic, social and cultural framework
• Community level - citizenship
» social support, sense of connectedness and
inclusion, social participation
• Individual level - emotional resilience
» self-esteem, coping, life skills, sense of control
M. Barry, Dublin 2012
Settings Approach
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Where is mental health created ?
- in the settings where people live their lives
School ecology as a focus of intervention
• Health Promoting Schools Initiative (WHO, 1997)
“ a school constantly strengthening its capacity as a
healthy setting for living, learning and working”
•curriculum approaches
•improving the school ethos and environment
•involving families and the local community
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M. Barry, Dublin 2012
Teaching and learning
Holistic Health Education
Group support
Communication
mental health
drug and sexuality education
Seeking help / safety
Emotions & feelings
Influences and decisions
Physical health
Partnerships
Whole School
School /parent links
Community health services
Adolescent mental health services
Police
Local / national support groups
Local Government
Local GPs
Learning support services
Ethos and environment
Individual difference
Belonging
Supports
Confidentiality
Anti-bullying policy
Critical incident policy
Students at risk policy
Peer supports
Equity
Counselling
HPS
Mental Health Promotion
in Schools
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Classroom curriculum-based approach generic life skills training
Whole school approach - the school setting
including the school ethos and environment,
and involving the parents and the local
community
Targeted interventions - students at higher
risk e.g. of depression and suicide
M. Barry, Dublin 2012
M. Barry, Dublin 2012
Sample Programmes
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Curriculum-based programmes
- Botvin’s Life Skills Training programme
- Cognitive skills training - problem-solving
- Greenberg et al’s Promoting Alternative
Thinking Strategies (PATHS)
- Kellam’s Good Behavior Game
M. Barry, Dublin 2012
Sample Programmes
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Whole School Approach
- Australian MindMatters (Wynn et al., 2000) and Kidsmatter
programmes (Kidsmatter, 2009)
- Olweus Bullying Prevention programme
- UK Social and Emotional Aspects of Learning (SEAL)
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Targeted Programmes
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Clarke’s Coping with Stress Course – depression
Gillham et al. Penn Resiliency programme
Resourceful Adolescent programme (Shochet et al, 2001)
Incredible Years Programme (Webster-Stratton et al., 2001)
M. Barry, Dublin 2012
Systematic Reviews of School-based
Mental Health Promotion Programmes
• Lister-Sharp et al. (1999)
• Wells, Barlow and Stewart-Brown (2001, 2003)
HSRU, University of Oxford
• Harden et al. (2001) EPPI- Centre
• Greenberg, Domitrovich & Bumbarger (2001)
• CASEL (2003)
• US Mental Health and Substance Abuse
(SAMHSA - www.samhsa.gov)
• Implementing Mental Health Promotion Actions
Database (IMPHA & Dataprev)
• Tennant et al. ( 2007); Adi et al. (2007), NICE
(2007); Payton et al. (2008); Durlak et al. (2011)
M. Barry, Dublin 2012
Conclusions from Effectiveness
Studies (Barry et al., 2009)
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Mental health promotion in schools, when
implemented effectively, can produce long-term
benefits for young people, including emotional
and social functioning and improved academic
performance
Traditional topic based health education
approaches are of limited value (knowledge only
programmes have minimal effects on behaviour)
Programmes adopting a whole school approach
are more successful and the most promising
M. Barry, Dublin 2012
IUHPE Special Issue, 2005
“there is sufficient knowledge to move evidence into practice”
Jané-Llopis, E., Barry, M.M., Hosman, C. and Patel,
V. (Eds.) (2005) The Evidence of Mental Health
Promotion Effectiveness
Comprehensive programmes that target
multiple health outcomes in the context of a
co-ordinated whole school approach are the
most consistently effective strategy
M. Barry, Dublin 2012
Reviews of Evidence
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Weare & Nind (2011) – review for the EU Dataprev project
Health Promotion International, Special Issue Vol 26
Review of 52 systematic reviews and meta-analyses of
mental health interventions in schools (46 universal
interventions)
Positive effects on social, emotional and educational
outcomes
• few examples of adverse effects
• higher risk children benefit more
• family and community involvement
• high quality implementation - clarity, intensity and
fidelity
M. Barry, Dublin 2012
Effectiveness of programmes
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Weare (2004) “ programmes that teach social and
emotional competence can result in gains that are
absolutely central to the goals of all schools.
Gains include improved school atmospheres, more
effective learning, better behaviour, higher school
attendance, higher motivation, higher morale of
students and teachers, and better results for
students and schools” (p13)
M. Barry, Dublin 2012
CASEL - evidence based support for
social and emotional learning (SEL)
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Improved attitudes toward school, better sense of
community (Schaps et al., 2004) and higher academic
motivation (Johnson and Johnson 2004)
Positive school behaviours - more prosocial interactions
(Johnson and Johnson, 2004), fewer absences and
suspensions (Christenson and Havsy, 2004) and reductions
in aggression, disruptions and interpersonal violence
(Greenberg et al., 2004)
Enhanced school performance in terms of improved
maths, language, arts and social studies (Brown et al.,
2004) and better problem solving and planning (Greenberg
et al., 2004).
M. Barry, Dublin 2012
CASEL Technical Report on the impact of social
and emotional learning (Payton et al., 2008)
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Three scientific reviews - 317 studies involving
324,303 school children aged 5-13 years
Strong and consistent support for sustained
positive impact of SEL programmes
Students scored 11 percentile points higher on
standardized achievement tests relative to peers
not receiving the programme
Only when delivered by school staff did students’
academic performance improve significantly
M. Barry, Dublin 2012
CASEL 2008 Technical report on the
impact of social and emotional learning
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Improvement in multiple areas :
• Social and emotional skills
• Attitudes towards self, school and others
• Positive social and classroom behaviours
• Conduct problems - misbehaviour and
aggression
• Emotional distress - stress and depression
• Academic performance - test scores and school
grades
M. Barry, Dublin 2012
CASEL 2008 Technical report on the
impact of social and emotional learning
Interventions using four recommended evidence-based
practices for skill training were more effective than those
that did not;
• Sequenced - skills are developed sequentially in a step-bystep fashion
• Active - active learning -role plays and behavioural
rehearsal with feedback
• Focused - time given exclusively to developing social and
emotional skills
• Explicit - programme targets specific social and emotional
skills
M. Barry, Dublin 2012
Characteristics of Effective Programmes
(Green et al., 2005; Weare & Nind, 2011)
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Aimed at the promotion of mental health rather
than the prevention of mental health problems
(Wells et al., 2001)
Implemented continuously and long-term in nature
i.e. more than one year (Wells et al., 2001)
Include changes to the school climate rather than
brief class-based prevention programmes (Wells et
al., 2001)
Extend beyond the classroom and provide
opportunities for applying the learned skills
(CASEL, 2003)
M. Barry, Dublin 2012
Characteristics of Effective Programmes
(Green et al., 2005; Weare & Nind, 2011)
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Adopt a health-promoting schools approach
focusing on aspects of the social and physical
environment of the school, family and community
links with the school, the school curriculum and
pupils’ knowledge (Lister-Sharp et al., 1999)
Integrated with academic learning and the overall
goals of the school (Weare & Nind, 2011)
Balancing universal and targeted
approaches(Weare & Nind, 2011)
M. Barry, Dublin 2012
Characteristics of Effective Programmes
(Green et al., 2005; Weare & Nind, 2011)
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Need for rigorous implementation
Focus on skills and enhancing generic social
competences - coping skills, good peer
relationships, self-efficacy (Weare & Nind, 2011)
Interactive teaching methodologies - active
learning, activity-based, student participation
(Weare & Nind, 2011)
M. Barry, Dublin 2012
An evaluation of the Zippy’s Friends
emotional wellbeing programme for
primary schools in Ireland
Aleisha M. Clarke &
Margaret M. Barry
Health Promotion Research Centre
Department of Health Promotion
National University of Ireland, Galway
Funded by:
• HSE West
• HSE Population Health, Health Promotion
Directorate
• National Office for Suicide Prevention
• Irish Research Council for Humanities and
Social Sciences
Evaluation of the Zippy’s Friends programme in
Ireland (Clarke & Barry, 2010)
• Programme was introduced into designated disadvantaged
Irish primary schools on a pilot basis in 2008
• Health Service Executive and Department of Education &
Science
• 24 week programme – six modules, structured materials
• Teachers trained in its delivery
• Evaluation of process and outcomes
Methodology
Study Design: Randomised Controlled Design
Data Collection
T1: Baseline
(Feb ’08)
DEIS Schools (n=42)
(n= 730)
T2: Interim I
(June ’08)
Intervention
Control
(n= 523)
(n=207)
T3: Interim II
(Oct ’08)
T4: End of Prog
(Apr ’09)
Intervention
Type I
Intervention
Type II
(n=270)
(n=253)
T5: 1 Year Follow Up
(Apr ’10)
Evaluation of the Zippy’s Friends programme in
Ireland (Clarke & Barry, 2010)
• Measures: structured scales, child participatory workshops, Draw-andWrite technique
• Teachers’ weekly reports on implementation, class observations,
review sessions
• School Context – case studies
Summary of main findings
• Successful programme adaptation to Irish designated disadvantaged
primary schools
• Significant positive effects on children’s emotional literacy, coping
skills, hyperactivity and teachers’ relationships with the children
• 12 months post-intervention follow-up
Twelve months follow-up (Clarke, 2011 Doctoral thesis)
• Emotional Literacy (EL) improvements at 12 months follow up - total
scores and empathy and social skills sub-scales
• No significant effects for children in the “well below/below average”
range -> additional support for children with specific emotional
literacy needs
• Child participatory workshops - improved vocabulary for articulating
feelings
• Emotional & Behavioural Wellbeing - Strengths & Difficulties
Questionnaire – reduced hyperactivity scores for intervention group
Control group – significant reduction in conduct problems sub-scale
scores
• No significant effects for children in the “borderline’ and ‘abnormal’
score bands –> additional support for children with specific
behavioural needs
Twelve months follow-up (Clarke, 2011 Doctoral thesis)
• Children’s Coping Skills - Draw & Write Activity– increased use of
active coping and support seeking strategies in dealing with conflict,
rejection and loss
• All maintained at 12 months apart from conflict –> avoidance
strategies
• Schoolagers Coping Strategies Inventory – few significant findings
– intervention group more likely to ‘relax and try to stay calm’
Draw and Write Technique:
Children’s Drawings
Draw and Write Technique:
Children’s Drawings
Twelve months follow-up (Clarke, 2011 Doctoral thesis)
• Programme Fidelity – high fidelity (over 90%
implementation) positive impact on emotional literacy; low
fidelity (less than 75%) no improvements in emotional
literacy
 greater fidelity and better quality implementation leads to
better outcomes
• Positive impact on the Teachers – increased awareness of
children’s emotional wellbeing
• Limited impact on the whole School - lack of whole
school awareness
 need for whole school training and parental involvement
A copy of the full report is
available to download at:
http://www.nuigalway.ie/hprc
Or email:
[email protected]
Context Matters in Programme Implementation
Clarke, Barry & O’Sullivan (2010)
Health Education, Vol 110, No. 4
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The specific contexts of schools participating in the study
- contextual factors impacting on local implementation
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Two schools – large urban multi-cultural school in an area
of multiple disadvantage; smaller mono-cultural rural
school on the border region with Northern Ireland
Case study - views of teachers, parents and key community
informants
•different levels of parental involvement
•socio-economic and cultural factors in the local community
•community histories and local politics
•different stages of ‘readiness’
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Unique school culture within which programme
implementation occurs
M. Barry, Dublin 2012
Context Matters in Programme Implementation
Clarke, Barry & O’Sullivan (2010)
Health Education, Vol 110, No. 4
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Complex interaction of factors operating at the classroom,
school and wider community level
School culture, environment and whole school practices
 readiness for change (Bumbarger & Perkins, 2008)
 strategies for school organizational change
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Contextual factors in the local community (Wanders et al.,
2007)
 teacher-parent relationship
 impact of economic and social factors on parental involvement
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Understanding the organisational and cultural contexts of
schools is critical for implementation and sustainability
(Rowling, 2008)
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Importance of Implementation
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High quality programme delivery - supportive
implementation system
- engagement of school management, teachers, parents
and students
- teacher training, resources, organizational support
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Finding the right mix of programme fidelity and
adaptation
The process of planning, implementation and
training systems
M. Barry, Dublin 2012
Importance of Implementation
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Sustained interventions over multiple years
- once-off or short-term interventions are
not likely to produce long-term effects
Organizational and system-level practices
and policies that will ensure the long-term
impact of high quality programmes
M. Barry, Dublin 2012
Opportunities & Challenges
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Leadership - integrating efforts to promote social
and emotional learning of young people with the
school’s educational mission of academic learning
Over-crowded curriculum
Adopting a whole school approach in practice
- wider school, parental and community engagement
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Training and support - both pre- and in-service
- content and methodologies
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Supportive policies and collaboration across the
education and health sectors
M. Barry, Dublin 2012
Useful Sources
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Barry, M. and Jenkins, R. (2007) Implementing Mental
Health Promotion. Elsevier, Oxford
Jané-Llopis E, Barry M M, Hosman C, Patel V (2005)
Mental health promotion works: a review. Promotion and
Education suppl 2:9-25
Rowling, L., Martin, G., & Walker L (2002) Mental health
promotion and young people: concepts and practice.
McGraw Hill, Sydney
Weare, K. (2000) Promoting mental, emotional and social
health: a whole school approach. Routledge, London
Payton et al. (2008) The positive impact of social and
emotional learning for kindergarten to eight-grade
students: Findings from three scientific reviews. CASEL
www.casel.org or www.lpfch.org/sel
M. Barry, Dublin 2012
Useful Sources
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Weare, K. and Gray, G. (2003) What Works in Developing
Children’s Emotional and Social Competence and
Wellbeing? [online]. Available:
http://www.dfes.gov.uk/research/data/uploadfiles/RR456.pdf
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Weare, K. (2004) Developing the Emotionally Literate
School. London: Paul Chapman Publishing
Weare, K. and Nind, M. (2011) Mental health promotion
and problem prevention in schools: What does the
evidence say? Health Promotion International, Special
Issue Vol. 26.
Zins, J. E. et al. (2004) Building Academic Success on
Social and Emotional Learning. Teachers College Press,
Columbia University.
M. Barry, Dublin 2012