Health and wellbeing programs in primary schools

The programme focuses on strengthening classroom management strategies using evidence-based practices. The Toolkits comprise of a combination of NEPS-developed materials and information collated from other acknowledged sources.

They promote natural resilience for all and recovery for those with additional educational needs. The Toolkits include information on psychological theories and models to guide the interaction with children and young people.

They also include references to additional resources which will support this work. In Australia, there have been national [ 36 ], state [ 37 ], and local examples [ 23 ] of programs designed to improve mental health support in primary schools. However, initiatives have either relied on untrained, time-poor school-based staff to take on additional tasks such as acting as a wellbeing officer, or clinicians from outside the school system to deliver services, often for only the most complex or severe cases [ 38 , 39 ].

Neither of these approaches addresses the capacity and service access barriers cited by educators. Where there has been effort across the sector to evaluate programs, often this is done retrospectively or using cross sectional designs which fail to capture change over longer periods of time [ 41 ].

This has resulted in an incomplete evidence base regarding the sustainability of implementation and program outcomes. Further, the lack of a control comparison in many evaluations means it is not possible to conclude if the program has produced benefit over and above what is already occurring in the school.

To achieve successful, long-term sustainability of mental health initiatives in a complex multi-level system, it is important that key implementation principles be embedded within the design. The primary school age period presents a unique opportunity to intervene early and modify the trajectory of many mental health issues and prevent progression to more chronic conditions.

The intervention in this study has been designed to leverage this developmental window and address the gaps in the school-based child mental health system by introducing the concept of a Mental Health and Wellbeing Coordinator MHWC role in primary schools. The MHWC is an experienced qualified educator who will be an additional resource for the schools and will take up their role alongside participation in a comprehensive training program designed within an implementation science framework.

The MHWC will be trained to identify mental health issues, establish clear referral pathways, work proactively with other professionals, and implement whole-school approaches to mental health and wellbeing. This will equip schools and classroom teachers with an additional resource for supporting student mental health and wellbeing.

In addition, the MHWC will act as the liaison between the school and community-based health and other community-based services.

The study is a quasi-experimental cluster study involving 16 intervention and 16 control Business and Usual [BAU] schools Fig. Flow chart estimating the progress of schools and participants through trial.

Schools will be recruited by DET based on mental health need through consultation with regional stakeholders and Incident Reporting Information System IRIS data , readiness ensuring schools have the capacity and willingness to participate and context diversity including metropolitan, regional and rural contexts, and those impacted to different degrees by COVID A comparison group of schools matched for socio-economic status SES , location metropolitan, regional, rural, remote and number of student enrolments will be recruited by the research team and will act as controls Business as Usual [BAU] schools.

Secondary schools ages 12—20 , specialist schools i. All participating schools will complete a formal consent process; details of what is required for schools to participate in the study will be outlined by the research team to the school Principal in a school plain language statement.

An online consent form with the school plain language statement will be completed by the Principal or Assistant Principal prior to participant recruitment. Across both intervention and BAU schools, classroom teachers, school leaders principals, assistant principals, leading teachers wellbeing staff and education support staff i.

Staff within these roles will receive an email from their principal inviting them to complete an online survey. The email at T1 will include a link to complete a web-based consent form, including the relevant plain language statement, before completing the survey. Data will be obtained from referral activities log, job analysis, focus groups and surveys.

Classroom teachers from years 2 and 4 will subsequently receive an email from the principal T3 inviting them to complete the Strengths and Difficulties Questionnaire [ 52 ] on each child in their class for whom parental or carer consent has been obtained see Fig. See further details under Sample Size Calculation. Once recruited the MHWC will:. Receive evidence-based training around supporting the mental health needs of primary school students;. Support the referral pathway for students identified as requiring further assessment and intervention within the school or to external community-based services the MHWC role will not involve providing counselling support to students ;.

Work proactively with regional staff i. Connect wellbeing initiatives across the school and be responsible for implementing whole school approaches to mental health and wellbeing, including the social and emotional learning curriculum.

An additional loading will be provided for MHWCs working in regional and rural schools. The MHWC will participate in a purpose designed training program, delivered by the research team, to increase their knowledge, skills, and attitudes to effectively focus on building the capacity of the whole school, working with individual teachers and the whole staff cohort.

To promote whole school upskilling, encourage staff buy-in, and maximise the chance of sustainably embedding the MHWC model in the broader school setting, leaders at each intervention school will nominate three additional staff members to attend components of the MHWC training training participants.

All MHWCs will receive an explanation of the research component at the induction session by the training delivery lead and complete a plain language statement. Nominated training participants must be members of school leadership i. Administrative staff will be excluded from the MHWC or training participant groups.

The content of the core modules will focus on the following broad areas:. Mental health and wellbeing as a continuum, including behavioural, social emotional and learning indicators;.

Engaging parents and carers and supporting school staff in conversations with parents and carers about student mental health and wellbeing;. Evidence-based prevention and promotion approaches and programs and evaluating their effectiveness and fit for purpose in the school context.

MHWCs and other school participants will practice applying their knowledge through case studies, role-plays, and case studies and examples from their school context. Induction and the three core modules will be delivered over an intensive 3-day training program via a synchronous online environment, using teleconference technology to facilitate the building of professional networks and communities of practice between schools.

In addition, asynchronous learning will include, videos, content-based activities, pre-reading, skills and knowledge checks, completion of online modules from other providers as pre-requisites to cover basic concepts and engage with potential resources for staff professional development and reviewing previously covered material to consolidate learning.

To evaluate the impact of the MHWC model on perceived levels of support for student mental health, study designed questions will be developed to capture a how much support staff expect in managing student mental health and wellbeing from within their school and DET, and b how supported staff have felt in the past month from within their school and DET.

To evaluate the perceived level of knowledge and confidence in identifying child mental health and wellbeing issues, study designed items will be developed and rated on a 6-point Likert scale from strongly agree to strongly disagree.

Study devised multiple choice items requiring respondents to choose the correct answer will also be developed to capture knowledge about internalising and externalising mental health issues in students. The skills assessment will comprise case study vignettes covering a range of potential scenarios school staff may be presented with, and respondents will be asked about key behavioural issues, contributing factors, strategies and further support required, as well as confidence in supporting the child described in the vignette.

The Child Health Poll includes items that address parent confidence in recognising and managing child mental health issues measured on a 3-point Likert scale: confident, somewhat confident, not confident and items that address knowledge about child mental health measured on a 6-point Likert scale: strongly agree to strongly disagree. Each item is rated on a 6-point Likert response scale that ranges from 1 strongly disagree to 6 strongly agree.

The SDQ has good concurrent and predictive validity, and satisfactory internal consistency [ 47 ]. To evaluate the level of prioritisation of child mental health and wellbeing, school leaders will answer questions exploring the level of priority given to wellbeing and mental health provision for students, whether wellbeing and mental health provision for students is part of the school strategic plan or annual implementation plan, or if the school has a policy related to child mental health and wellbeing.

School staff engagement with school-based and external child mental health services will be measured using study designed questions to capture the perceived level of engagement required, the actual level of engagement and the types of child mental health support and services provided to staff.

Student engagement with mental health support and perceived availability of mental health and wellbeing support will be measured using subscales from the Attitudes to School Survey AToSS years 4—6 version [ 48 ]. The survey items use a five-point Likert scale from 1 strongly disagree to 5 strongly agree. Parent engagement with school-based and external child mental health and wellbeing support will be measured using study designed items and items from the DET Parent Opinion Survey POS [ 49 ].

The items use a five-point Likert scale from 1 strongly disagree to 5 strongly agree. To effectively evaluate the implementation of the MHWC model we will also seek to understand individual and contextual characteristics across all participant groups that are present prior to implementation which may also influence program outcomes.

We will use the Readiness to Implement Scale [ 51 ] which looks at three key areas: feasibility, fit and staff support. Costs of delivering the intervention will be estimated to inform wider implementation. This will be based on budgets for each role, the log of activities kept by MHWCs tracking time and resources used and from records of replacement teachers filling in for classroom teachers to attend professional development and training activities run by the MHWCs.

The costs will be from the perspective of the school. To evaluate the tasks, responsibilities, time, and resources required to achieve all aspects of the MHWC role and successful implementation of the MHWC model, MHWC activity will be recorded in a study developed database.

This information will be collected for two working weeks during the academic school year Semester 2. These measures consist of 4-items each targeting perceived intervention acceptability. Items are measured on a 5-point Likert scale completely disagree-completely agree and the score is a calculated mean. To evaluate the level of engagement that school staff have with the MHWC model, questions will be developed to capture the perceived level of engagement required, the actual level of engagement and the types of support provided to staff by MHWCs.

To further explore and capture data regarding the feasibility, appropriateness, and acceptability of the model, purposive sampling will be used to recruit a subset of school and regional staff to participate in qualitative focus groups at T4 and T5, using a semi-structured interview guide.

Focus groups will consist of between 3 and 8 participants and will include MHWCs and other trainees from participating intervention schools as well as a cross-section of other school staff including leadership and education support staff, wellbeing staff, classroom teachers and regional support staff. Interviews will be facilitated by an experienced qualitative researcher, audio-recorded with permission from the participants and transcribed verbatim using an external transcription service.

Participation of 12 teachers per school with the intra-cluster intra-school correlation coefficient ICC set to 0. All analyses will be based on observed data only; i. We will make every attempt to ensure that data are not missing from surveys at the point of completion. If there are missing responses to surveys completed by school or regional staff, we will follow up via phone or email up to three times to obtain the missing responses. The details of how this will be conducted will be outlined in the statistical analysis plan.

According to the nature of the secondary outcomes to be analysed binary, continuous or ordinal the appropriate mixed effects model will be used to estimate the impact of the MHWC model on the outcome of interest compared to the BAU schools.

These models will be fitted at the participant level, including a fixed effect for arm MHWC vs. Variation in costs across participating schools will be evaluated to identify factors that may impact on the costs of delivering the intervention according to school characteristics such as number of student enrolments, location, and SES.

Based on these estimated costs, budget impact of delivering the intervention state-wide will be calculated, with associated resource implications, particularly workforce. Focus group transcripts will be deidentified and imported into the computer software package QSR Nvivo 12 [ 57 ].

Data analysis will follow the guidelines for reflexive thematic analysis [ 58 ]. An experienced qualitative researcher will independently code the data and emergent categories and themes will be cross-checked with the broader team for accuracy and to ensure the data is well represented. Study findings will be reported in line with the COREQ checklist for reporting qualitative research [ 59 ].

This study protocol introduces a quasi-experimental cluster study investigating the impact of a mental health and wellbeing coordinator MHWC model on classroom teacher confidence to support student mental health and wellbeing in an Australian primary school setting.

Previous approaches have largely focussed on developing and evaluating specific mental health and wellbeing programs delivered using existing school resources in cross-sectional study designs with limited attention paid to implementation factors [ 38 ].

This protocol describes a novel approach to building the capacity of primary schools by introducing an additional resource for schools, the MHWC, which is embedded through an implementation science framework to maximise impact on target outcomes and long-term sustainability. Despite the strengths of the proposed study, there are some practical limitations involved in conducting applied research in a school setting [ 60 ].

First, a randomised controlled trial RCT , the gold standard for assessing effectiveness of an intervention, was not feasible in the current study as intervention schools were selected by DET based on mental health need, readiness and context diversity [ 61 ].

The quasi-experimental design does have the benefit of enabling enrolment of schools to the intervention based on motivation, which reflects the real-life situation of public health interventions. The lack of randomisation, however, can introduce both selection bias and confounding.

We will aim to mitigate these biases by matching our control schools and adjusting for known confounders as well as T1 values at the analysis level. Second, standardised measures and data collection methods for some of the project outcomes were not available i.

Ideally standardised measures and data collection processes would be used to maximise the quality of the research conclusions, including comparisons with previous school-based mental health initiatives, and across intervention and BAU schools.

This lack of measures relevant to the study outcomes and standardised processes for routine data collection in schools likely reflects a historical lack of scientific rigour in evaluating school-based initiatives [ 63 ]. To mitigate the lack of appropriate measures, the research team in collaboration with an expert advisory panel, developed bespoke items to target these outcomes.

The measures developed for this project will likely be relevant for future projects and therefore measures development may form a sub-project of the broader study. To mitigate the lack of standardised, routine data collection across schools, the research team has developed data collection templates that will capture pertinent referral pathway information for students.

The Strategy also included a specific action to review personal and social education delivery, including the role of pastoral guidance in local authority schools, and services for counselling for children and young people. The commitment ensures that every secondary school has access to counselling services, while improving the ability of local primary and special schools to access counselling.

Access to counselling support through secondary schools is now in place across Scotland. The Scottish Government and local authority leaders reached a joint agreement on the distribution of funding and a set of aims and principles for the delivery of the commitment. Guidance for local authorities was also produced to assist in the design and development of the access to counsellors in secondary schools programme. The first reporting exercise for the commitment was undertaken in July and a summary of those reports is now available.

School counselling will enhance the work that schools already do to support children and young people to learn about mental wellbeing as part of health and wellbeing in Curriculum for Excellence. The Health and Wellbeing Experiences and Outcomes aim to ensure that children and young people understand the importance of mental wellbeing and that this can be fostered and strengthened through personal coping skills and positive relationships.

Children and young people will learn that it is not always possible to enjoy good mental health and that if this happens there is support available. This training provides attendees with knowledge on mental health issues and the attitudes surrounding them, equalities, listening skills, the impact of alcohol and drugs on mental health and suicide intervention.

We are taking forward a range of actions aimed at developing mutually respectful, responsible and confident relationships amongst children and young people. A short life gender based violence working group has been established to develop a national framework to prevent and respond to harmful behaviour and gender based violence in schools.

This work is expected to be completed in early As part of a 10 year mental health strategy, Scottish Ministers committed to undertaking a review of personal social education PSE. This review included consideration of pastoral care and guidance as well as school counselling. The review was completed in January Find out more: Personal social education review.

Guidance for teachers on the Conduct of relationships, sexual health and parenthood education in schools clearly states how important it is that this education addresses diversity and reflects issues relating to LGBT young people or children with LGBT parents, such as same sex marriage and hate-crime reporting.

We will update this teaching guidance during Safe and responsible use of mobile technology in schools: guidance provides advice for schools and local authorities on how to develop policies relating to mobile phones in school. We are committed to schools delivering at least two hours of PE for all pupils in primary school, and at least two periods of PE for all pupils between Secondary 1 and Secondary 4. We also support initiatives like Active Schools and the Daily Mile. As part of health promotion, schools are required to provide food which meets strict nutritional standards, given the major benefits these have for pupils' current and future health.

The standards call for a variety of dishes available so pupils learn about making healthy choices about what they eat. We also published a report on the responses we received to our consultation. The new regulations came into effect on 8 April , replacing the previous regulations which had been in place since August We have published refreshed guidance on healthy eating in schools February , to accompany the new regulations.

Children and young people will learn about a variety of substances including alcohol, medicines, drugs, tobacco and solvents as part of Curriculum for Excellence. They will explore the impact risk taking behaviour has on life choices and health. To support this we provide funding to the Choices for Life programme in partnership with the justice and health departments.