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Using an implementation science framework to support community practice

Teachers can sometimes help to identify mental health problems in their students and refer them to appropriate sources of external support. There is some evidence however, to suggest that teachers are not always ideally placed to help pick up problems e. Of course teachers are primarily there to teach and to generate academic success among their students, but given the right support, training and sufficient time they can work alongside mental health specialists to support mental health and well-being in their students Fazel et al, Prevention and mental health promotion programmes and activities can be effectively implemented by teachers and can have a significant impact on psychosocial and academic performance.

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The current pressure on schools and poor recruitment of teachers has resulted in many schools not having the dedicated time, training and ongoing support to carry out this work. School based interventions are well established and effective treatments for improving the mental health of children and young people Paulus et al, However, it can be difficult to transfer interventions from the research clinic into the real world and the school environment, because following a programme manual may not meet the individual needs of either students or teachers Paulus et al, In the clinic, deviating from the manual is associated with poorer outcomes, but this is often driven by the assumption that the manual is not quite right.

Adaptation with fidelity is an important issue that needs further study. The characteristics of the most effective interventions include:.


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There are academic benefits of mental health promotion in schools. Schools with social and emotional learning programmes show an increase in scores in standardised tests, compared with scores from non-intervention schools Durlak et al, Mastering social and emotional skills supports children to achieve positive life outcomes, including good health and social wellbeing, educational attainment and employment Clarke et al, It also helps to reduce or avoid behavioural and social difficulties Clarke et al, This includes strategies to develop skills and positive personal attributes, as well as those that aim to reduce behavioural and emotional difficulties Banerjee et al, NICE recommends that for primary aged children, there should be a comprehensive programme in place in schools to help them develop social and emotional skills and wellbeing.

This should include NICE, :. NICE also recommends that children in primary education aged 4—11 years , who are showing early signs of emotional and social difficulties, should be considered for the following interventions NICE, :. Several studies have shown that anxiety prevention programmes, provided as universal or indicated interventions, can be effective in the short term, when compared to no intervention groups Stallard et al, School-based prevention programmes have a small beneficial effect on depressive symptoms, and with preventative work, even small effect sizes can be associated with meaningful improvements at a population level Werner-Seidler et al, However, many school-based trials often do not include diagnostic outcomes, so understanding the full impact of these programmes can be challenging.

Improving the implementation of school-based policies and practices to improve student health

Indeed, there is evidence that some young people at risk of common mental health disorders do worse as a result of prevention programmes Stallard, Targeted programmes, such as cognitive behavioural therapy CBT , undertaken with those students already showing signs of depression, may be most effective in reducing depressive symptoms Kavanagh et al, Non-directive supportive therapy is a NICE-recommended intervention for mild depression. There is also emerging evidence to suggest that school-based humanistic counselling is effective at reducing psychological distress and helping young people achieve their personal goals Cooper School-based counselling is seen by service users and school staff as having a positive impact and as an effective means of bringing about improvements in mental health and emotional wellbeing Cooper Overall it is imperative that those with clear mental health conditions are not delayed in reaching evidence-based interventions, which adds further weight to the argument that training and support is essential for frontline staff, so that young people can be referred as appropriate.

The evidence for whether school interventions improve ADHD symptoms or academic outcomes is mixed Richardson et al, This includes approaches such as contingency management, cognitive-behavioural self-regulation, academic and study skills training, social and emotional skills training. Interventions should be tailored to individual children, classrooms and schools Richardson et al, Generally speaking, there are many positive effects of school based interventions.

However, there is also a large variation in the efficacy and efficiency of different programmes, depending on the quality of the intervention and its implementation Paulus et al, Studies show that evidence-based treatments can be delivered in school settings, group models tend to be effective, and that engagement and participation rates tend to be high Fazel et al, However, few rigorous assessments have been done of school-based interventions for students with disabilities or for specific disorders, including eating disorders or complex neurodevelopmental disorders McMillan and Jarvis, Children and young people may present to services such as counselling with a wide range of problems, including family difficulties.

There is very little evidence about how these kinds of issues, which clearly impact on mental health and well-being, should be approached Cooper Further research is needed in this area, alongside better outcomes data captured by practitioners. Evidence of the long-term impact of counselling is also sparse Cooper There are already many online mental health intervention programmes, some supported by and delivered in schools. The evidence base for these approaches is mixed.

For example, computerised cognitive behavioural therapy for depression and anxiety in young people has been shown to be beneficial Hollis et al, However, what is certain is that with the rise in the popularity of the Internet and social media these kinds of programme will continue to grow and develop. The National Institute of Mental Health in the US predicts that in future, mobile technology will be used for managing a wider range of disorders, and will begin to incorporate face-to-face contact or remote counselling NIMH, There has been huge interest in the practice of mindfulness and how it might be adopted by schools to help improve psychological wellbeing and attention among children and young people.

Currently evidence for its impact is limited. It will take five years and involve 76 schools and nearly six thousand students aged 11 to As always, we must remember not to rush into implementing new approaches when we do not yet have sufficient evidence of their efficacy and safety. Doing something is not necessarily better than doing nothing, as many interventions that are effective for some young people, may actually be harmful to others.


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  • Evidence for Impact A database of programmes available in the UK, including details on their effectiveness and cost, produced by The Institute for Effective Education. Youthinmind For stressed teenagers and those who care for them. Fazel, M.

    Evidence-Based Educational Practice

    Mental health interventions in schools 1: Mental health interventions in schools in high-income countries. The Lancet. Psychiatry, 1 5 , — Stallard, P. Evidence-Based Mental Health, 16 3. Patalay, P. Mental health provision in schools: approaches and interventions in 10 European countries. Global Mental Health, 4, e Banerjee, R.

    Evidence-Based Educational Practice - Oxford Research Encyclopedia of Education

    Public Policy Institute for Wales. Cooper, M. University of Strathclyde. Das, J. Weare K, Nind M. Health Promot Int. Paulus, F. J Child Psychol Psychiatr, — Methods and public health burden. Trzesniewski K.


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    • Low self-esteem during adolescence predicts poor health, criminal behavior, and limited economic prospects during adulthood. Dev Psychol. Working together to safeguard children: a guide to inter-agency working to safeguard and promote the welfare of children. Copeland, W. Faculty of Public Health. Through the module participants will increase their understanding of the necessary considerations for developing a professional development plan, increase awareness of available professional development tools, and draft a professional development plan.

      The module reviews the research on effective practices for providing literacy instruction to English language learners ELL and how these practices can be applied within the RTI framework.

      Data Mining

      Using the latest research from implementation science, the Implementing RTI training module illustrates how using effective implementation strategies are critical for successful RTI outcomes and provides guidance for districts and schools at any stage of implementation. The module provides advice on how to avoid common implementation pitfalls, highlights the importance of implementing with fidelity, using data to inform decision making at each implementation stage, and evaluating your RTI framework.

      This training module was developed for teams implementing a response to intervention RTI framework at the middle school level. This module shares information about RTI implementation, essential components, practices, and considerations at the middle school level.

      Through this module participants will become familiar with the essential components of an RTI framework with a particular focus on universal screening and data-based decision making using screening data. The module covers 1 basic information on screening, 2 assessments used within an RTI framework, and 3 skills needed to use screening data to identify students at risk, to conduct basic data analysis using screening data, and to establish a screening process. The module covers basic information on progress monitoring and a multi-step process for selecting progress monitoring tools.

      Implementing Trauma Informed Strategies in a School Setting

      Data-based decision making is embedded throughout the module with content focused on using progress monitoring data to evaluate and make decisions about instruction, to set goals, and to establish an effective progress monitoring system. Through this module participants will become familiar with the essential components of an RTI framework with a particular focus on the multi-level prevention system. The module covers the three levels of a multi-level prevention system primary, secondary, and tertiary , selecting evidence-based practices, and making decisions about student movement between levels of the prevention system.

      This training module was developed for teams implementing a response to intervention RTI framework and planning to evaluate their RTI model. This module provides a rationale for conducting an RTI evaluation, information on measuring fidelity of implementation, activities for applying new knowledge, discussion questions for team planning time, and gives examples of tools and data that can be used to measure indicators of RTI success. It provides a brief description of the RTI framework and the essential components of RTI, illustrates how the essential components of RTI are implemented at eight high schools, and highlights contextual factors unique to high schools as well as how these factors can affect school-level implementation of tiered interventions.

      The training module includes a template to facilitate discussions about high school tiered interventions with school staff. TOT facilitators should have knowledge of the materials provided here, the Implementer Series training module materials e. The guide describes the structure of Center training modules and offers suggestions for delivery. This training module describes the difference between RTI and traditional assessment for learning disabilities, the basics of RTI using a three-tier model, and instructional interventions within each tier.

      The module also discusses progress monitoring, the basics of curriculum based measurement CBM , and using progress monitoring data to make decisions within an RTI framework. This training module was developed for teams implementing a response to intervention RTI framework.