Public Health Research (Dec 2024)
Public engagement to refine a whole-school intervention to promote adolescent mental health
Abstract
Background Despite high rates of adolescent mental health problems, there are few effective school-based interventions to address this. Whole-school interventions offer a feasible and sustainable means of promoting mental health, but few have to date been evaluated. Previously we trialled the Learning Together intervention comprising local needs assessment, student and staff participation in decision-making, restorative practice, and a social and emotional skills curriculum. This was effective not only in preventing bullying (primary outcome), but also in promoting mental well-being and psychological functioning (secondary outcomes). Objective We aimed to adapt Learning Together to develop Learning Together for Mental Health, focused on promoting mental health. This paper reports on how we refined and elaborated intervention materials to produce the Learning Together for Mental Health intervention including through patient and public involvement and engagement. Design We reviewed evidence to inform choice of the curriculum component and the contents of our needs assessment survey. We conducted patient and public involvement and engagement with school staff and students, and children and young people from the National Children’s Bureau to adapt the intervention. We also conducted a systematic review of reviews to inform a menu of evidence-based actions, but this is reported separately. Setting Southern England. Participants Patient and public involvement and engagement was conducted with four staff and five students from one secondary school, and a group of two school senior leadership team members from different schools, and about eight children and young people who were members of the Young National Children’s Bureau. Interventions None. Results We refined and elaborated our initial plans for Learning Together for Mental Health to generate an intervention supported by full materials, training and external facilitation. We focused needs assessment on mental health, added a menu of evidence-based whole-school mental health actions, and switched to a different social and emotional skills curriculum. We retained restorative practice and staff/student involvement in decisions. No further refinements were made to the intervention theory of change or overall approach. Patient and public involvement and engagement was useful, but not all suggestions were acted on either because some participants suggested dropping pre-determined elements (e.g. needs survey) or because suggestions (e.g. to include aromatherapy) lacked evidence of effectiveness. Limitations Not all of our engagements with patient and public involvement and engagement stakeholders were sustained over time. Our patient and public involvement and engagement work was affected by its having occurred within the recovery period from COVID-19 when schools were more stressed than normal. We had planned for the school involved in patient and public involvement and engagement to be above average in student free-school-meals eligibility, but the school initially recruited dropped out at the last minute. Its replacement had a lower-than-average rate of free-school-meal entitlement. Conclusions This paper reports on the process of adaptation and reflects on the various ways in which engagement and evidence review were useful in this process. We found that it is possible to refine interventions and elaborate them to provide full materials and support via processes drawing on evidence review and patient and public involvement and engagement. The latter proved valuable in informing refinement of Learning Together for Mental Health in terms of ensuring its feasibility, acceptability, and inclusiveness. However, in our opinion, not all suggestions from patient and public involvement and engagement can or should be acted on, especially when they do not align with the evidence base. Future work A feasibility study to optimise the intervention and assess whether progression to a full trial is justified. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR131594. Plain language summary Many teenagers in the UK suffer from mental health problems. Schools can help in responding to and preventing these problems. Schools can prevent these problems by implementing multiple activities that all aim to change how the school runs and relationships within the school. We previously evaluated an intervention called Learning Together, which used this approach to prevent bullying in English secondary schools. It asked students about their needs. It involved students and staff in decision-making. It trained teachers so they could address bullying and conflict by focusing on repairing relationships and not just punishing perpetrators. It taught students social and emotional skills. As well as being effective in preventing bullying, it also improved students’ mental health. In the present study, we adapted Learning Together to increase its focus on mental health, calling the new intervention Learning Together for Mental Health. To refine the components of Learning Together for Learning Together for Mental Health we did several things. We reviewed existing research to identify the best ways to promote mental health. We also worked with the staff and students from one secondary school, senior leaders from various schools, and members from a group for children and young people in England. We did this to inform how we developed Learning Together for Mental Health so that it would be possible to implement in schools and acceptable to staff and students. Advice from teachers, students, children and young people helped make the intervention more practical, acceptable, and inclusive, but not all suggestions could be taken on board. We look forward next to trying out this intervention in schools to check whether it is feasible and see how it can be further improved.
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