Creating Shared Mental Models for Evidence-Based Mental Health Promotion in Schools

In postulating the need for a more inclusive conceptualisation of knowledge that improves the practice of prevention science in mental health programs, Rowling (2008) makes a case for acknowledging the validity of the disparate research and practice cultures from both health and education. A review of literature using narrative synthesis was undertaken to explore the differing research and practice cultures. Three recurring themes were identified at the interface of these differing traditions: individual versus group orientation, school leadership and change in schools. These are perceived differently due to the mental models being used by program developers and education professionals. These alternative views consistently emerge in relevant evaluation reports. It is proposed that the identified problems of sustainable implementation in schools are not restricted to health-related programs, but are consistent across interventions. Building on this analysis, several actions are suggested that will increase the capacity to develop, implement and sustain universal and evidence-based promotion and prevention activities in Australian schools.     

Identifying Evidence-Based Work on Mental Health Promotion in Schools in Europe: An Interim Report on the DataPrev Project

This paper is an interim report on the Schools element of the DataPrev project, one element of a wider project funded by the European Union which aims to increase the understanding and knowledge across Europe of evidence-based mental health promotion policy and practice by creating a database of mental health promotion and mental disorder prevention programmes, and producing policy and practice guidelines. The Schools element of the project involves a search for both universal and targeted school-based programmes in Europe which can be shown by robust criteria to have the likelihood of promoting mental health in schools, and attempts to identify the principles that support effective programmes. It includes a systematic search for existing reviews, using over 80 search terms to reflect the range of terminology used in the field across disciplinary and geographical boundaries. To date (about halfway through the process) over 40 recent good systematic reviews have been identified, from which 16 successful evidence-based school mental health interventions have been identified. Most of these originate in the United States (US), some come from Australia and some from Europe itself. The key features of effective programmes so far identified include operating on several fronts at once (‘whole school’), developing skills in students and staff, involving learners, balancing universal and targeted approaches, and consistent implementation over a long period of time.     

National Survey on Expanded School Mental Health Services

In the 20072008 academic year, the Center for School Mental Health broadly disseminated an electronic survey to Expanded School Mental Health (ESMH) stakeholders in order to better understand ESMH programs in the United States. The survey asked respondents to share data about their ESMH programs across several domains including staffing, funding, service modalities, evidence-based practises and programs, and partnerships. Respondents reported on 156 ESMH programs. This paper highlights the results of the ESMH survey. Findings from the ESMH survey add to the limited literature on what may be typical and not typical in ESMH services and programming in the United States. Implications related to research, practise and workforce development are discussed.     

School Mental Health and Foster Care: A Logical Partnership

School mental health is increasingly recognized as an effective framework of care for enhancing access to high quality mental health services for school age youth. This article discusses the potential role that school mental health can play in helping to address the mental health needs of children and adolescents in foster care, a group with elevated risk for mental health and educational problems when compared to other children and adolescents living in high risk environments. A full continuum of school mental health services, from prevention to intervention, offers opportunities to reach these youth before academic and emotional-behavioral problems escalate. Benefits and challenges to providing services to youth in foster care through school mental health are discussed and next steps toward developing a training curriculum that addresses core competencies needed for effective school-mental health-foster care integration are addressed.     

Readiness and School Improvement: Strategies for Enhancing Dissemination and Implementation of Expanded School Mental Health Practices

The primary purpose of this paper is to describe efforts to promote effective dissemination and adoption of an evidence-based school improvement model that incorporates expanded school mental health practices. A systematic readiness and capacity assessment process was used to identify and select pilot schools and school districts for participation in the Ohio Community Collaboration Model for School Improvement (OCCMSI: Anderson-Butcher et al, 2004, in press). In this paper we describe efforts used to incorporate assessment of readiness into selection, training, and implementation of OCCMSI, an evidence-based school improvement initiative. Assessments were used to ensure that pilot sites were ‘ready’ for adoption of the initiative and to promote attention to readiness and capacity as an integral part of the aims of the intervention. Assessments were based on the A-VICTORY model (Davis & Salasin, 1975; Robbins et al, 2003). Results from each readiness assessment were used to inform delivery of training and technical assistance in support of the implementation of the school improvement model. Our experience suggests that ongoing collection of information related to organizational readiness assists in adoption and implementation of effective practices and initiatives.     

Minding the Mind: The Effects and Potential of a School-Based Meditation Programme for Mental Health Promotion

A meditation programme was introduced into 31 Catholic schools in one diocese in Queensland, Australia in 2006 which engaged more than 10,000 students between the ages of 5 and 18 years. The objective of the study was to conduct an initial evaluation of this meditation programme which might serve as preparation for a larger prospective study. Semi-structured individual and group interviews with 54 students, 19 teachers and seven parents were carried out in three of these schools, each at the elementary level. Feedback from students, teachers and parents on the perceived effects of this programme indicated favourable impressions of programme benefits. Effects consistently cited included increased relaxation and feelings of calm, reduced stress, reduced anger and improved concentration. Many participants also reported that the experience of meditation at school had prompted them to meditate outside school, particularly at times of stress. A whole-school approach appeared to facilitate more regular practice. This preliminary evaluation suggests that school-based meditation may represent an effective mental health promotion intervention worthy of further study.     

Beginning Steps in School Mental Health in India: A Teacher Workshop

As emphasised by this journal, school mental health (SMH) programmes and services, when done well, lead to valued outcomes for students and systems focused on children and adolescents. However, SMH is nearly non-existent in India. Acute scarcity of trained manpower is the main stumbling block. It is therefore imperative to facilitate the process of SMH with some alternative measures, and one way is to enable the primary stakeholders. Towards this end, at the Central Institute of Psychiatry, Ranchi, India a workshop for teachers was conducted which focused on various aspects of SMH. The effectiveness of the workshop was assessed with the help of pre-post and five-month follow-up assessments which showed increased understanding by teachers of psychological problems in children from participation in the workshop. Admittedly, this is a very early step, but we hope that our experiences will be helpful in moving SMH forward in developing nations.     

Technology in Child and Adolescent and School Mental Health: A Look at Today and Tomorrow

Technological applications are increasingly being used in mental health promotion and intervention with children, adolescents and adults. This article describes various forms of technology and their application to school mental health promotion, either as the primary method of counseling or as a supplement to traditional mental health counseling. Technology applications are reviewed for their role in promotion/intervention with autism spectrum disorders, depression, anxiety and other behavioral or emotional disabilities. The article culminates in a discussion of considerations and issues for practitioners involving the use of technology in child and adolescent and school mental health promotion.     

Mental Health Promotion in Irish Schools: A Selective Review

School-based mental health promotion work continues to attract considerable attention in the general health promotion literature. Schools certainly represent one important element in any integrated system of health promotion, with both guaranteed availability of large target groups of pupils and the expertise of experienced teachers. Given high rates of identified youth psychopathology and the recognised inadequacy of youth mental health services, Irish schools are increasingly seen as important locations for preventative mental health promotion work. Some general issues in effective health promotion are outlined. The review then describes the application of a representative selection of mental health promotion resources in Irish schools, and identifies some emerging common elements. Optimising the delivery and selection of resources is then discussed, and one resource is examined. The review concludes with discussion of likely future developments in Irish school-based mental health promotion.     

Towards School Mental Health in Nigeria: Baseline Knowledge and Attitudes of Elementary School Teachers

There is a shortage of child and adolescent mental health (CAMH) professionals all over the world, and this shortage is especially critical in most parts of the developing world. Schools have been identified as ideal settings to reach needy children in the community, and training teachers in CAMH issues can help improve early identification and appropriate referrals of children with mental health problems. As part of a needs assessment for developing a training programme, selected Nigerian elementary school teachers were asked to complete confidential questionnaires to determine their perceptions of mental health problems in school children. Teachers indicated that they had no previous CAMH training. Baseline assessments revealed that teachers' knowledge of CAMH was deficient, and attitudes to children with mental health problems revealed intolerance. Incorporation of CAMH care into teacher education curricula is a critical next step towards integrating school teachers as mental health collaborators in school mental health programmes in Nigeria.     

Critical Factors and Strategies for Advancing Statewide School Mental Health Policy and Practice

The authors sought to identify factors and strategies critical to statewide advancement of school mental health (SMH) efforts from the perspective of states that have demonstrated innovation, achievement and investment in SMH practice and policy. The School Mental Health-Capacity Building Partnership (SMHCBP) 1 conducted three in-depth focus group discussions in each of four states with representatives from diverse stakeholders. Participants reported successes and challenges in developing and advancing local and state SMH policies, programs, and services. Qualitative analyses led to identification of ten critical factors to advancing SMH at state level. They included developing a vision and shared agenda for SMH, identifying feasible and sustainable funding models, and establishing effective accountability and outcomes monitoring of SMH efforts. Strategies to implement each factor were also identified by discussion group participants and SMH-CBP Steering Committee members. States and districts can employ the factors and strategies laid out in this paper as part of a planning and continuous quality improvement process to assess and advance school mental health.     

Improving Children's Adaptation: New Evidence Regarding the Effectiveness of Zippy's Friends,a School Mental Health Promotion Program

This article presents the results of the first North American evaluation study of the short-term effects of the French version of Zippy's Friends, a worldwide universal school-based program that promotes mental health in young children. The intervention group consisted of 310 children from 16 first and second grade primary school classes. Prepost changes were compared with a control group of 303 children in 19 comparable classes who had not participated in Zippy's Friends. The program was successfully implemented as planned. Results showed promising findings in terms of decreased internalisation and improved cooperation, autonomy and perceived social support. Building on previous evidence, this new study confirms that Zippy's Friends is a commendable program.     

Learning from Turbulent,Real-World Practice: Insights from a Whole-School Mental Health Promotion Project

The World Health Organization predicts that depression will be the second leading cause of disease and disability by 2020. Apart from having an impact on the quality of a young person's life, depression is also a major risk factor for suicide and is associated with long-term health consequences in adulthood, including suicide, depression, anxiety, drug and alcohol use, and poor social and vocational outcomes. This paper examines the current literature on depression prevention, drawing on evidence from a variety of disciplines including education, psychology, psychiatric epidemiology and public health, and presents a school-based intervention model that was developed in Australia by beyondblue: the national depression initiative. The beyondblue schools research initiative was designed to reduce levels of depressive symptoms in young people, promote emotional well-being in adolescence and increase the capacity of schools to design and evaluate interventions relevant to prevention of depression.     

Unpacking Interdisciplinary Collaboration in Expanded School Mental Health: A Conceptual Model for Developing the Evidence Base

Despite its appeal and promise for addressing the multi-layered needs of young people, there is a lack of research documenting the extent to which interdisciplinary collaboration affects outcomes valued by schools, families, and communities. To address this gap in understanding, this review synthesizes the literature to consider the meaning, goals, processes, contextual influences, and anticipated outcomes of interdisciplinary collaboration in expanded school mental health. Based on this review, a conceptual model to help support the efforts of researchers, policy makers, and practitioners who are interested in understanding the relationship between interdisciplinary collaboration and outcomes is offered. Recommendations for developing the evidence base are also suggested.     

Implementing Multi-level Programmes and Approaches that Address Student Well-being and Connectedness: Factoring in the Needs of the Schools

Implementation of effective school-level mental health promotion initiatives is challenging. This paper presents findings from the beyondblue schools research initiative, a cluster randomised trial which aimed to promote student mental health. It sought to implement emotional skills through curriculum, greater community linkages and whole-school environment change in 25 schools in three states of Australia. Using qualitative process evaluation data collected during the three years of the project, we describe key features of the intervention that, according to the project facilitators, influenced its implementation. Project design flexibility to meet individual school needs and provision of sufficient resources appeared to be crucial for successful implementation.     

Flourishing in Life: An Empirical Test of the Dual Continua Model of Mental Health and Mental Illness among Canadian University Students

In 2008-2009 a national household mailout was undertaken across Australia by beyondblue: the national depression initiative. The aim was to raise awareness of depression and encourage people to seek more information via the beyondblue information line or website. Following the staggered dispatch of information across the country, 2051 telephone surveys were conducted to evaluate recall of the material, and calls to the beyondblue infoline and website hits were monitored. The results indicate that direct mail can be a highly effective strategy to not only promote mental health, but also encourage information and help seeking. The impact of a range of factors on recall and help-seeking behaviour is also explored. Findings reveal the impact of demographic factors whilst also highlighting the potential importance of brand recognition and perceived relevance of information when determining those most likely to recall and respond to mailouts as mental health promotion strategy.     

Lessons Learned in Implementing Evidence-Based Practices: Implications for Psychiatric Administrators

Factors related to the dissemination and implementation of evidence-based practices (EBPs) are discussed. Extensive effort is required to successfully implement and sustain EBPs that improve clinical outcomes. There is a rapid rate of discovery of new EBPs. Examples of large-scale implementations of EBPs in mental health are described with emphasis on the factors thought critical for success. The need for designing systems which can cost-effectively implement new EBPs is highlighted. Finally, the implications for psychiatric administrators are discussed.     

Contextual Features of Public Schools in the United States as Settings for Mental Health Promotion

Scanning the current policy and practice landscape of mental health promotion in the United States reveals indicators of significant progress in establishment of comprehensive school-based programs and services. At the same time, however, there remain significant challenges to advancing the SMH agenda. Using a conceptual lens, the authors elucidate fundamental political and practical dimensions of public education that must be addressed, including collaboration with stakeholders opposed to school mental health and partnering with teachers in mental health promotion. Concept mapping is introduced as a strategy to increase understanding about the role of school mental health in public education.