Implementing mental health promotion in schools


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Evidence and principles of the effective implementation of school-based programmes promoting the social and emotional wellbeing of young people by Professor Margaret Barry
The conference Developing Strength and Resilience in Children 1-2 Nov. 2010 in Oslo

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Implementing mental health promotion in schools

  1. 1. Health Promotion Research Centre National University of Ireland Galway Ollscoil na hÉireann, Gaillimh Implementing Mental Health Promotion in Schools: Evidence and principles of effective implementation Professor Margaret Barry
  2. 2. M. Barry, Oslo 2010 Overview • Promoting mental health in the school setting • Evidence of the effectiveness of mental health promotion in schools • Impact of social and emotional learning • Focus on implementation • Opportunities and Challenges
  3. 3. M. Barry, Oslo 2010 Mental Health Promotion in Schools • 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
  4. 4. M. Barry, Oslo 2010 Mental Health Promotion in Schools • Building academic success on emotional and social learning • promote academic, emotional and social competence • reducing school drop-out rates • reducing a range of negative health and social outcomes • Teaching and learning of skills and attitudes that are valuable for life, employment - communicate effectively, work as a team member, resilience in the face of difficulties, problem-solving, coping strategies • Role of education in addressing social and health inequity
  5. 5. M. Barry, Oslo 2010 Social and Emotional Wellbeing • 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)
  6. 6. M. Barry, Oslo 2010 Positive Mental Health • 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 • Keyes‟ concept of optimal mental health or „flourishing‟ • Abilities to develop psychologically, emotionally, intellectually, socially and spiritually
  7. 7. M. Barry, Oslo 2010 Prevalence of Mental Health problems in young people • 15-22% of children and adolescents experience mental health problems - warrant 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
  8. 8. M. Barry, Oslo 2010 Promoting Mental Health • Mental health promotion » focus on positive mental health and quality of life across populations » building strengths, competencies and resources • Prevention of mental disorders » concern with specific disorders - reducing incidence, prevalence or seriousness of a targeted problem » mortality, morbidity and risk behaviours
  9. 9. Strategies for promoting well-being & quality of life Barry, M.M. (2001) International Journal of Mental Health Promotion, 3(1) 25-34.
  10. 10. Health Promotion action areas Build healthy public policy Create supportive environments Reorient health services Strengthen community action Develop personal skill combined into Health Promotion strategies Systems Policies environment organisation community person Systems scale Health Promotion Principles (participation, empowerment, equity) Assessment Planning Implementation Evaluation micro - macro 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
  11. 11. M. Barry, Oslo 2010 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
  12. 12. M. Barry, Oslo 2010 Settings-based Approach • Mental health is created in the settings where people live their lives • 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
  13. 13. 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 Ethos and environment Individual difference Belonging Supports Confidentiality Anti-bullying policy Critical incident policy Students at risk policy Peer supports Equity Counselling HPS Partnerships School /parent links Community health services Adolescent mental health services Police Local / national support groups Local Government Local GPs Learning support services Whole School
  14. 14. M. Barry, Oslo 2010 Mental Health Promotion in Schools • 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
  15. 15. M. Barry, Oslo 2010 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 - • Implementing Mental Health Promotion Actions Database (IMPHA) • Tennant et al. ( 2007); Adi et al. (2007)
  16. 16. M. Barry, Oslo 2010 Evidence Reviews • Durlak & Wells (1997) - meta-analytic review American Journal of Community Psychology 25(2),115-152 • Tilford et al. (1997) Effectiveness of Mental Health Promotion Interventions: A Review. HEA (UK) • IUHPE Report (1999) The Evidence of Health Promotion Effectiveness, Chapter 3 • Friedli (2003) Making it Effective: A guide to evidence based mental health promotion. Mentality, UK • Jané-Llopis, Barry, Hosman & Patel (2005) Mental health promotion works: A review. Promotion & Education suppl 2. IUHPE Special Issue
  17. 17. M. Barry, Oslo 2010 Conclusions from Effectiveness Studies • 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
  18. 18. M. Barry, Oslo 2010 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
  19. 19. M. Barry, Oslo 2010 Characteristics of Effective Programmes (Green et al., 2005) • 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)
  20. 20. M. Barry, Oslo 2010 Characteristics of Effective Programmes (Green et al., 2005) • 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) • Focus on enhancing generic social competences - coping skills, good peer relationships, self- efficacy • Interactive teaching methodologies - active learning, activity-based, student participation
  21. 21. M. Barry, Oslo 2010 Sample Programmes • 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 Behaviour Game
  22. 22. Zippy’s Friends Emotional Wellbeing Programme for young children which aims to encourage children to: learn skills to deal with everyday problems develop a wide range of coping strategies identify and label feelings focus on positive strengths and abilities think for themselves work cooperatively as a class group International evaluations of Zippy’s Friends Lithuania and Denmark (Mishara & Ystgaard, 2006) England, Southampton, (Holmes & Faupel, 2003, 2004) Norway (Ystgaard, M. et al.) Canada (Mishara, B.L. et al.)
  23. 23. 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
  24. 24. Methodology Study Design: Randomised Controlled Design Data Collection T1: Baseline (Feb ’08) T2: Interim I (June ’08) T3: Interim II (Oct ’08) T4: End of Prog (Apr ’09) T5: 1 Year Follow Up (Apr ’10) DEIS Schools (n=42) (n= 730) Intervention (n= 523) Control (n=207) Intervention Type I (n=270) Intervention Type II (n=253)
  25. 25. Evaluation of the Zippy’s Friends programme in Ireland (Clarke & Barry, 2010) • Measures: structured scales, child participatory workshops, Draw-and- Write technique • Teachers’ weekly reports on implementation, 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
  26. 26. A copy of the full report is available to download at: hprc
  27. 27. M. Barry, Oslo 2010 Sample Programmes • Whole School Approach - Australian MindMatters programme (adapted as MindOut programme in Ireland- Byrne, Barry and Sheridan, 2004) - Olweus Bullying Prevention programme - UK Social and Emotional Aspects of Learning (SEAL) • Targeted Programmes - 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)
  28. 28. M. Barry, Oslo 2010 Effectiveness of programmes • 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)
  29. 29. M. Barry, Oslo 2010 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
  30. 30. M. Barry, Oslo 2010 CASEL - evidence based support for social and emotional learning (SEL) • 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).
  31. 31. M. Barry, Oslo 2010 CASEL Technical Report on the impact of social and emotional learning (Payton et al., 2008) • Three scientific reviews - 317 studies involving 324,303 school children aged 5-13 years • Strong and consistent support for the value of SEL programmes implemented by school staff • Effective in both the school and after-school setting and for students with and without presenting problems, rural/urban, racially and ethnically diverse groups • The effects remained over time
  32. 32. M. Barry, Oslo 2010 CASEL 2008 Technical report on the impact of social and emotional learning • 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
  33. 33. M. Barry, Oslo 2010 CASEL 2008 Technical report on the impact of social and emotional learning • Across the studies evaluating academic outcomes 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 • Programme implementation had a strong influence on outcomes • Review paper - Durlak & DuPre (2008) Implementation Matters. American Journal Community Psychology, 41, 327-350;
  34. 34. M. Barry, Oslo 2010 Importance of Implementation • “How well a proposed programme or intervention is put into practice” (Durlak, 1998) • Assessing both the quantity and quality of implementation » how much of the programme was delivered » how well each part was conducted • Conditions necessary for successful implementation in the local context • Generic processes that underpin effective programme planning and delivery
  35. 35. M. Barry, Oslo 2010 Importance of Implementation • Finding the right mix of programme fidelity and adaptation • The process of planning, implementation and training systems • Implementation support system - facilitatory and inhibitory factors in the local setting or context • Sources: Barry & Jenkins, 2007; Barry, Domitrovich and Lara, 2005
  36. 36. M. Barry, Oslo 2010 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-by- step 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
  37. 37. M. Barry, Oslo 2010 Context Matters in Programme Implementation Clarke, Barry & O’Sullivan (2010) Health Education, Vol 110, No. 4 Impacts on programme implementation: • 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) • Contextual factors in the local community (Wanders et al., 2007) • teacher-parent relationship • impact of economic and social factors on parental involvement • Understanding the organisational and cultural contexts of schools is critical for implementation and sustainability (Rowling, 2008)
  38. 38. M. Barry, Oslo 2010 Generic Principles of Effective Mental Health Promotion in Schools • Adopt a whole school approach - bring about change at the level of the individual, the classroom and the school • Adopt a social competence approach - promotion of resourcefulness and generic coping and competence skills. Also includes peer-led approaches and mentoring programmes as potentially useful
  39. 39. M. Barry, Oslo 2010 Generic Principles of Effective Mental Health Promotion in Schools • Theory-based interventions - grounded on theories of child development and learning • Sustained interventions over multiple years - once- off or short-term interventions are not likely to produce long-term effects • High quality programme delivery - supportive implementation system - engagement of school management, teachers, parents and students - teacher training, resources, organizational support
  40. 40. M. Barry, Oslo 2010 Generic Principles of Effective Mental Health Promotion in Schools • Evaluation - systematic evaluation methods (process, impact and outcome) contribute to ongoing improvement and sustainability of programmes • Sustainability - organizational and system- level practices and policies that will ensure the long-term impact of high quality programmes
  41. 41. M. Barry, Oslo 2010 Challenges • 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 • Leadership • Training and support - both pre- and in-service • Content and methodologies • Evaluation framework - focus on programme implementation and its relationship to impact and to outcomes
  42. 42. M. Barry, Oslo 2010 Useful Sources • 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 or
  43. 43. M. Barry, Oslo 2010 Useful Sources • Weare, K. and Gray, G. (2003) What Works in Developing Children’s Emotional and Social Competence and Wellbeing? [online]. Available: • Weare, K. (2004) Developing the Emotionally Literate School. London: Paul Chapman Publishing • Hallam, S., Rhamie, J., and Shaw, J. (2006). Evaluation of the Primary Behaviour and Attendance Pilot (DfES Research Report 717). London: DfES. [online]. Available: • Zins, J. E. et al. (2004) Building Academic Success on Social and Emotional Learning. Teachers College Press, Columbia University.