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

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

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

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

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)

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

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�

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

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

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

Pla

nn

ing

Implementation

Ev

alu

ati

on

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

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

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

Teaching and learningHolistic Health Education

Group support

Communication

mental health

drug and sexuality education

Seeking help / safety

Emotions & feelings

Influences and decisions

Physical health Ethos and environmentIndividual difference

Belonging

Supports

Confidentiality

Anti-bullying policy

Critical incident policy

Students at risk policy

Peer supports

Equity

Counselling

HPS

PartnershipsSchool /parent links

Community health services

Adolescent mental health services

Police

Local / national support groups

Local Government

Local GPs

Learning support services

Whole School

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

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 - www.samhsa.gov)• Implementing Mental Health Promotion Actions

Database (IMPHA)• Tennant et al. ( 2007); Adi et al. (2007)

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

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

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

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)

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

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

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.)

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

MethodologyStudy 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)

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

A copy of the full report

is available to download

at:

http://www.nuigalway.ie/

hprc

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)

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)

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

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).

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

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

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;

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

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

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

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)

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

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

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

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

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 www.casel.org or www.lpfch.org/sel

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: http://www.dfes.gov.uk/research/data/uploadfiles/RR456.pdf

• 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: http://www.dfes.gov.uk/research/data/uploadfiles/RR717.pdf

• Zins, J. E. et al. (2004) Building Academic Success on Social and Emotional Learning. Teachers College Press, Columbia University.