Learning together to promote mental health and well-being in English secondary schools: LTMH study refinement and feasibility evaluation, a comprehensive synopsis.

内容摘要

Young people's mental health worsened during and since the coronavirus disease discovered in 2019 pandemic. School environments play a key role in young people's mental health. Learning Together for Mental Health is a whole-school intervention aiming to promote mental health in secondary schools, adapted from the previous Learning Together intervention which was found effective in reducing bullying and promoting mental health. To adapt Learning Together to increase focus on mental health so producing the Learning Together for Mental Health intervention and evaluate the appropriateness of conducting a Phase III trial of the Learning Together for Mental Health intervention regarding pre-defined progression criteria relating to the intervention and trial methods, and assessing intervention feasibility, reach and acceptability, feasibility of trial measures and procedures, potential mechanisms and possible harms. We conducted a feasibility study with baseline and follow-up surveys, process evaluation and economic-evaluation feasibility-testing. One school participated in intervention adaptation. Our feasibility study included four state, mixed-sex secondary schools in southern England (one of which dropped out after baselines and was replaced with another). We recruited 640 year-7 (age 11-12) students at baseline survey and 566 year-10 (age 14-15) students at 12-month follow-up. Baseline and follow-up participants were different groups, as the focus was assessing feasibility for the age groups to be surveyed at baseline and follow-up in a Phase III randomised controlled trial. Twenty staff, 27 year-8 (age 12-13) students and 22 year-10 students participated in qualitative research as did two trainers and one external facilitator. As part of our feasibility study, all schools received the Learning Together for Mental Health intervention for one academic school year. Pre-defined criteria for progression to a Phase III trial. The intervention was successfully adapted from the previous intervention using public involvement. The trial met all criteria for progression to Phase III. The all-staff and in-depth restorative practice training were implemented with fidelity in all schools and all schools had at least two staff trained in-depth in restorative practice. Curriculum training was delivered with fidelity in three of four schools. The response rate to the baseline (needs) survey across the three participating schools was 79%. Progression required at least two schools to have delivered the curriculum with at least 50% fidelity, which was achieved; one of the two schools which delivered the curriculum reported over 80% fidelity and the other school reported over 75% fidelity. All students and staff across all four schools who completed the action group survey and 93% of senior leadership team members who completed the senior leadership team survey reported that Learning Together for mental health was a good way to promote student Mental Health. Potential mechanisms of action involve promoting student sense of school belonging and practical reasoning and skills. No harms were reported. Trial measures and procedures were feasible and acceptable to implement. Intervention and trial refinement are suggested. Our study involved a small, purposive sample of schools and students which are not representative of those in England. With some minor amendments, Learning Together for Mental Health should be subject to a future Phase III trial of effectiveness. The intervention should be refined by making the curriculum optional and improving materials. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR131594. Mental health disorders are common among young people, but there are few effective interventions provided in schools to address this that go beyond teaching about mental health in lessons. Some that do are called ‘whole-school’ interventions. They offer a practical and sustainable way of promoting mental health. We previously evaluated an intervention called ‘Learning Together’. Learning Together provided a report for schools on bullying and school experiences of students. Also, it enabled schools to form ‘action groups’, comprising students and staff who worked together to review this report and plan how the school should respond. Teachers were trained to use restorative practice to address bullying, misbehaviour or conflict. Restorative practice responds to incidents by staff facilitating meetings between those affected, identifying harms, ensuring perpetrators take responsibility and improving the relationship of those involved. Moreover, schools delivered lessons aiming to promote students’ social and emotional skills. We found that Learning Together reduced bullying and improved students’ mental health. In the present study, we adapted Learning Together to develop Learning Together Mental Health. This new intervention included a ‘menu’ of evidence-based actions for action groups to choose from to address student mental health needs. It also featured an improved social and emotional learning curriculum. This paper reports on whether the intervention and evaluation methods proved feasible and acceptable in a small study involving four secondary schools in southern England. The intervention was successfully adapted from the previous intervention. Staff training was well delivered. We had good response rates when we surveyed students before and after the intervention. Schools delivered the intervention well enough to meet the targets we set ourselves. Students and staff who were involved in intervention activities thought that it was a good way to promote mental health. With some refinements, Learning Together for Mental Health is ready to be evaluated in a larger study to assess its effectiveness.