Determining stakeholder priorities and core components for school-based identification of mental health difficulties: A Delphi study

Anne-Marie Burn,Emma Soneson,Emma Howarth,Mina Fazel,Peter B Jones,Joanna K Anderson,Tamsin Ford,Ayla Humphrey

doi:10.1016/j.jsp.2022.01.008

Abstract

Only approximately half of children and young people (CYP) with mental health difficulties access mental health services in England, with under-identification of need as a contributing factor. Schools may be an ideal setting for identifying mental health difficulties in CYP, but uncertainty remains about the processes by which these needs can best be identified and addressed. In this study, we conducted a two-round, three-panel Delphi study with parents, school staff, mental health practitioners, and researchers to inform the development of a program to identify mental health difficulties in primary schools. We aimed to assess and build consensus regarding (a) the aims of such a program, (b) identification model preferences, (c) key features of the identification model, and (d) key features of the implementation model. A total of 54 and 42 participants completed the Round 1 and 2 questionnaires, respectively. In general, responses indicated that all three panels supported the idea of school-based identification of mental health difficulties. Overall, 53 of a possible 99 items met the criteria for inclusion as program core components. Five main priorities emerged, including that (a) the program should identify children experiencing mental health difficulties across the continuum of severity, as well as children exposed to adversity, who are at greater risk of mental health difficulties; (b) the program should train staff and educate pupils about mental health in parallel; (c) parental consent should be obtained on an opt-out basis; (d) the program must include clear mechanisms for connecting identified pupils to care and support; and (e) to maximize implementation success, the program needs to lie within a school culture that values mental health and wellbeing. In highlighting these priorities, our study provides needed stakeholder consensus to guide further development and evaluation of mental health interventions within schools.

Highlights

Journal of School Psychology 91 (2022) 209–227Mental health difficulties in children and young people (CYP) are an important public health challenge requiring urgent attention (Patel et al, 2007; Wolpert et al, 2018)
We identified United Kingdom (UK)-based practitioners and researchers who specialized in school-based mental health, CYP's mental health, and/or edu cation through (a) review of key publications in the areas of children's mental health and school-based mental health, and (b) existing networks focusing on mental health in schools
Five main priorities emerged from our findings: (a) the program should identify children experiencing mental health difficulties across the continuum of severity, as well as children exposed to adversity, who are at greater risk of mental health difficulties; (b) the program should train staff and educate pupils about mental health in parallel; (c) parental consent should be obtained on an opt-out basis; (d) the program must include clear mechanisms for connecting identified pupils to care and support; and (e) to maximize implementation success, the program needs to be grounded within a school culture that values mental health and wellbeing

Summary

Introduction

Journal of School Psychology 91 (2022) 209–227Mental health difficulties in children and young people (CYP) are an important public health challenge requiring urgent attention (Patel et al, 2007; Wolpert et al, 2018). There are several factors that contribute to this care gap, including individual- and family-level factors (e.g., knowledge about mental health difficulties and services and attitudes toward treatment; Gould et al, 2009; Radez et al, 2021; Reardon et al, 2017) as well as service-level factors (e.g., unavailability of care, inflexible services, long waiting times; Anderson et al, 2017; O'Brien et al, 2016) and broader structural-level factors (e.g., inability to pay for services and lack of culturally-competent practitioners; Anderson et al, 2017; Owens et al, 2002). These factors, which may co-exist and interact with one another, serve as barriers to ensuring that CYP with mental health difficulties can receive prompt, high-quality care and support when needed

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