School-based Mental Health Interventions Research Articles

Sustaining mental health and wellbeing programmes in schools: recommendations from an online roundtable

Despite recent investments in school-based mental health and wellbeing promotion in England, the sustainability of mental health interventions remains a substantial challenge. This article brings together potential solutions to sustaining interventions in schools, drawing on insights from an online roundtable discussion held in July 2022. Facilitated by researchers and informed by recent research on barriers and facilitators to sustaining school-based mental health interventions, 16 participants came together to discuss challenges and solutions. Participants included school staff, policy makers, educational psychologists, researchers and mental health intervention developers. The discussion explored the need for accountability at all levels (e.g., from school leaders to policy makers and Ofsted) and the potential value of engaging schools more consistently with academic evidence. Participants also discussed the importance of creating a healthy and sustainable ecosystem for interventions (underscoring the significance of staff wellbeing, adequate resourcing, and longer-term funding commitments), and moving beyond separate, isolated interventions. The findings offer a range of recommendations for school decision makers, mental health researchers, intervention developers, and those working in the wider system around schools.

School-Based Mental Health Interventions: Recommendations for Selecting and Reporting Implementation Strategies.

School-Based Mental Health Interventions: Recommendations for Selecting and Reporting Implementation Strategies.

Research recommendations for assessing potential harm from universal school-based mental health interventions

Research recommendations for assessing potential harm from universal school-based mental health interventions

Streaking and self-care planning: the influence of integrating a well-being initiative in one teacher education program

ABSTRACT Concerns about teacher burnout, compassion fatigue, and retaining early career professionals have prompted teacher education programs to seek out ways to promote mental and emotional health during pre-service teacher training. This two-year, educational design study explored pre-service teachers’ experiences with the implementation of two school-based mental health interventions: the intentional introduction of self-care planning during field experience practicums, and the promotion of ‘streaking’, a health promotion event, to encourage pre-service teachers to implement a daily individual mental health intervention. Data were collected at several different points over a two-year period through surveys and individual interviews. The data analysis indicated that this two-tiered approach holds promise as a health promotion activity, however other intentional and educational actions were needed to ensure that pre-service teachers had the resources and tools required to support their mental and emotional health during their practicum courses. A further finding suggested that the term ‘self-care’ was widely misunderstood by study participants and work is needed to help pre-service teachers understand the importance of self-care during their practicum as a prevention strategy for well-being once they begin their teaching career.

Examining the Classroom Impact of the Bounce Back Trauma Intervention: Implications for Selecting Progress Monitoring Tools

Limited research has examined the impact of Bounce Back (BB), a trauma-focused intervention for elementary-age students, on student academic engagement and daily classroom behavior. This study utilized both ongoing direct and indirect measures of student functioning to evaluate student progress and inform the implementation of BB. Participants were six U.S. students (four male and two female). We employed an AB single-subject design across cases with follow-up, and we collected data via the Direct Behavior Rating–Single Item Scale (DBR-SIS). We also employed a quasi-experimental pretest–posttest design using the Strengths and Difficulties Questionnaire (SDQ), Social, Academic, and Emotional Behavior Risk Screener (SAEBRS), and mySAEBRS across raters before/after intervention implementation. We found either direct or indirect assessment could be used to monitor intervention effectiveness for youth who presented with some internalizing and externalizing problems, whereas indirect measures (i.e., rating scales) showed the primary effect for youth with solely internalizing problems, and direct assessment (i.e., DBR-SIS) showed the primary effect for youth with predominantly externalizing behaviors. Selecting progress-monitoring tools based on presenting concerns is important to adequately monitor the effectiveness of school-based mental health interventions. Implications for practice are discussed.

Effects of a school-based, post-pandemic recovery intervention on Canadian educators

Although copious research has documented elevated stress and burnout in teachers worldwide during the COVID-19 pandemic, few studies have provided empirical evidence of effective interventions to support post-pandemic educator recovery and resilience. Attention to educator well-being is essential not only to healthy schools, but also to preventing teacher shortages. In the current study, Canadian educators (n = 621) who participated in a school-based mental health intervention program offered by a national mental health organization demonstrated significantly higher levels of well-being and recovery post-intervention than pre-intervention. Moreover, when compared with a control group (n = 86), the intervention group demonstrated significantly higher levels of connectedness, recovery, well-being, and resilience, although no differences in organizational commitment were demonstrated. Implications on teacher attrition and shortages are discussed.

33.3 Improv Training as a School-Based Mental Health Intervention

33.3 Improv Training as a School-Based Mental Health Intervention

Depressed, disconnected, and distraught: School-based mental health intervention for rural youth.

Depressed, disconnected, and distraught: School-based mental health intervention for rural youth.

Effectiveness of Adolescent School-Based Digital Mental Health Interventions: A Systematic Review

Purpose: This review aimed to investigate the effectiveness of digital school-based mental health interventions for adolescents in Sub-Saharan Africa. Method: The authors conducted a comprehensive search of digital school-based mental health interventions to identify studies conducted in Sub-Saharan Africa targeting adolescents between the ages of (10–19) years. Peer-reviewed studies published in English between 2009 and May 2023 were obtained through electronic bibliographic databases. Result: Only one study met the full inclusion criteria for this review. The included study tested a digital mental health intervention (“Shamiri Digital”) for treating depression, anxiety, and well-being in adolescents. The “Shamiri Digital” intervention demonstrated positive outcomes on depressive symptoms within the full sample. Discussion: The dearth of studies investigating digital mental health solutions for adolescents in low-income countries demonstrates a critical gap in intervention and research for adolescent mental health in resource constrictive settings

Health Services Use Among Children With Prenatal Substance Exposure or Neonatal Abstinence Syndrome.

Infants with prenatal substance exposure or neonatal abstinence syndrome (NAS) use health services more often than other children; however, little is known about their use of mental health services and psychotropic medication. The sample (N=1,004,085) consisted of infants born in 2016 in 38 states who were followed through the fifth year of life and enrolled each year in Medicaid or the Children's Health Insurance Program. Infants with prenatal substance exposure or NAS were identified with ICD-10 diagnosis codes; procedure and revenue codes documented their service use. Rates of any mental health visit and of psychotropic medication use were higher among infants with prenatal substance exposure or NAS compared with infants without either condition; these patterns persisted during most years of the 5-year study. Infants' elevated mental health services use through their first 5 years of life highlights the importance of early screening and subsequent engagement in school-based mental health interventions.

Co-Creation of a School-Based Motor Competence and Mental Health Intervention: Move Well, Feel Good.

Low motor competence (MC) and inhibited psychosocial development are associated with mental health difficulties. Improving children's MC through school-based physical activity interventions emphasising psychosocial development may therefore be a mechanism for promoting positive mental health. This study describes and provides reflective insights into the co-creation of 'Move Well Feel Good', a primary school physical activity intervention to improve children's MC and mental health. Class teachers, school leaders, physical activity specialists, and children (aged 8-9 years) participated in a series of co-creation workshops. Stakeholders' knowledge and experiences were integrated with existing research evidence using creative methods (e.g., post-it note tasks, worksheets, and drawings) to facilitate discussion. The co-creation process culminated in stakeholder consensus voting for one of three proposed intervention ideas. Children cited physical and mental health benefits, enjoyment with friends, and high perceived competence as motives for being physically active. Opportunities to develop MC across the different segments of the school day were identified by adult stakeholders, who perceived children's lack of resilience, an overloaded curriculum, and poor parental support for physical activity as barriers to intervention implementation. The chosen intervention idea received six out of a possible twelve votes. Co-creation projects are specific to the contexts in which they are implemented. This study reinforces the complex nature of school-based intervention development and highlights the value of engaging with stakeholders in co-creation processes.

Understanding interventions as social practices: How a school-based mental health intervention for migrant adolescents in Denmark interacted with context

The rise of school-based mental health interventions calls for an understanding of how such interventions interact with context as well as analytical tools for examining these interactions. This article explores how learners and teachers in two classrooms for newly-arrived migrant adolescents in Denmark (one urban, highly diverse classroom and one small-town classroom mainly serving youth who had fled armed conflict) experienced and implemented the same teacher-led, classroom-based intervention differently. Based on participant observations and interviews with three teachers and 12 learners, we draw on practice theory to disentangle how the same intervention came to life differently in the two classrooms. First, there were important differences in how teachers and learners in the two classrooms made sense of their participation in the intervention, reflecting the different life situations and psychosocial needs of the learners. Second, local ways of structuring educational practices (weekly schedules, expectations about homework, and different local educational policies) critically shaped intervention experiences and implementation. Third, the possibility of establishing a safe social space during the intervention depended on the stability of existing social relationships and conditions for teachers’ relational work in the classrooms. To aid analyses of how school-based interventions interact with classroom practices, and to help identify ways of consolidating interventions with their contexts, we propose future avenues for examining school-based mental health interventions in context from a social practice perspective.

Non-Positive Experiences Encountered by Pupils During Participation in a Mindfulness-Informed School-Based Intervention

Mindfulness-informed school-based mental health curricula show much promise in cultivating a positive school climate which supports the well-being and mental health of pupils and staff. However, non-positive pupil outcomes and experiences of school-based mental health interventions are often under-recognised and under-reported. This study sought to capture non-positive pupil experiences of a popular mindfulness-informed curriculum. Some pupils across all schools in the study described non-positive experiences, including having troubling thoughts and emotions, and not finding the programme effective. Contexts surrounding these experiences are explored and linked to existing literature, and subsequent recommendations for improvements are made, including the importance of having clear programme structure, definitions and aims, acknowledging and accommodating fidelity issues as best as possible, and better highlighting the potential for non-positive experiences and how they may be reduced.

Minding the gap: Evidence, implementation and funding gaps in mental health services delivery for school-aged children

State and local educational agencies are grappling with growing mental health needs among school-aged children that intensified during the COVID-19 pandemic. We undertake a case study of the experiences of one state, Tennessee, to examine the landscape of mental health interventions that are being deployed and to illuminate contextual factors that can support their implementation or exacerbate state and local challenges in addressing children’s fast-rising mental health needs. We begin with an examination of the knowledge base on interventions and approaches that are commonly employed in K-12 schools to address children’s mental health needs, including in Tennessee, with the aim to identify notable gaps in what we understand about their implementation and impacts on student outcomes. We find a lack of rigorous research that can inform efforts to improve the implementation and effectiveness of school-based mental health interventions. We bring this insight to our case-study analysis, which shows that this lack of guidance from research is compounded by inadequate, time-limited and fluctuating public funding that hinders local efforts to establish strong, ongoing programs that provide or connect K-12 students to essential mental health services. We call for more federal funding to support state and local implementation of proven and promising interventions for addressing children’s mental health needs and more rigorous evaluations to strengthen the evidence base on their implementation and impacts.

Missing the context: The challenge of social inequalities to school-based mental health interventions.

Given well-established links between socio-economic adversity and mental health, it is unsurprising that young people's mental health is deteriorating amidst economic crises. The World Health Organisation (WHO) recognises mental health as "crucial to personal, community, and socio-economic development" and outlines goals to reshape environments such as schools to protect mental health. Schools offer an ideal setting to promote wellbeing and prevent mental ill-health during a key developmental window. We describe how social inequalities present a challenge to designing school-based interventions for prevention and promotion for mental health and wellbeing, and suggest priorities to aid and evaluate their effectiveness.

Digital mental health interventions for school teachers - A narrative review.

School teachers face the paradox of being in a privileged position to act in youth mental health prevention, but in a vulnerable position for not receiving adequate training and personal support. Digital interventions can provide unexpensive tools and narrow this gap in a large scale without major structural changes. We aimed to synthesize the evidence for digital mental health interventions for school teachers. Studies published from any date until August 2022 were identified through a literature search of the MEDLINE, Embase, ScIELO, and Cochrane Central databases. The studies included evaluated digital interventions targeting school teachers to deal with their own mental health or to assist them in the management of students' mental health. Studies that addressed school-based digital mental health interventions, but directly targeted students, parents, or specifically other professionals were not included. The literature search retrieved 5626 hits and several interventions were described, but only 11 studies fulfilled the inclusion criteria, none of which focused on teachers' mental health. There was some evidence that these interventions improved knowledge about general or specific topics in mental health, and most studies also reported gains in preparedness, confidence, and attitudes towards mental health. The studies identified in this review provide initial support for teacher-focused mental health digital interventions. However, we discuss limitations regarding study designs and data quality. We also discuss barriers, challenges, and the need for effective evidence-based interventions.

O is for Awesome: National Survey of New Zealand School-Based Well-being and Mental Health Interventions

Although student well-being and mental health are government-identified responsibilities for New Zealand schools, the extent to which school-based well-being and mental health interventions are currently delivered is unknown. This survey of a nationally representative sample of schools was undertaken to identify: what well-being and mental health interventions are currently used by primary (elementary) and secondary (high) schools; what gaps exist between current practice and the evidence base; what ideas staff have for improving student well-being and mental health; and what barriers staff can identify for implementing evidence-based interventions and suggestions for how these may be overcome. Forty staff from 37 (22 primary, 13 secondary and 2 composite) schools participated in semi-structured interviews. Seven key themes were identified: (1) awareness and enthusiasm about student well-being and mental health; (2) existence of specific interventions to support student well-being and mental health; (3) support for government-sponsored programmes; (4) limitations of existing programmes; (5) drivers of new interventions; (6) perceived barriers to the implementation of new interventions; and (7) suggestions for future interventions and their implementation. Currently, a wide range of primarily non-evidence based well-being and mental health interventions are delivered in a variable manner by school-based and external providers. Despite current enthusiasm by schools, there is room for improvement in the quality and equity of intervention delivery.

"When Adversity Strikes: Maintaining Student and Teacher Wellbeing During the Covid-19 Pandemic"

This one-year, three-wave longitudinal study adopted a positive prevention approach to test whether a school-based mental health intervention helped avert declines in student and teacher wellbeing at a P-12, co-educational school in Hong Kong, Special Administrative Region of the People’s Republic of China (Hong Kong SAR, China). Teachers (n = 181) and students (n = 782) rated their individual levels of wellbeing at three time points (May 2021, September 2021, May 2022) and were also asked rate the levels of collective wellbeing they saw in others at the start and end of the intervention (May 2021 - May 2022).

Do no harm: can school mental health interventions cause iatrogenic harm?

In recent years, there have been extensive efforts in secondary schools to prevent, treat and raise awareness of adolescent mental health problems. For some adolescents, these efforts are essential and will lead to a reduction in clinical symptoms. However, it is also vital to assess whether, for others, the current approach might be causing iatrogenic harm. A growing body of quantitative research indicates that some aspects of school-based mental health interventions increase distress or clinical symptoms, relative to control activities, and qualitative work indicates that this may be partly due to the interventions themselves.

Universal, School-Based Mental Health Program Implemented Among Racially and Ethnically Diverse Youth Yields Equitable Outcomes: Building Resilience for Healthy Kids

Although suicide is a leading cause of mortality among racial and ethnic minority youth, limited data exists regarding the impact of school-based mental health interventions on these populations, specifically. A single-arm pragmatic trial design was utilized to evaluate the equity of outcomes of the universal, school-based mental health coaching intervention, Building Resilience for Healthy Kids. All sixth-grade students at an urban middle school were invited to participate. Students attended six weekly sessions with a health coach discussing goal setting and other resilience strategies. 285 students (86%) participated with 252 (88%) completing both pre- and post-intervention surveys. Students were a mean age of 11.4 years with 55% identifying as girls, 69% as White, 13% as a racial minority, and 18% as Hispanic. Racial minority students exhibited greater improvements in personal and total resilience compared to White students, controlling for baseline scores.