Implementing school-based interventions for mental health: a research portfolio

Abstract

Background: Difficulties with anxiety among children and young people are common and can impact upon their developmental trajectory leading to adverse outcomes in later life. There is, therefore, a need to increase access to early intervention services. Existing research has indicated that school-based cognitive behavioural interventions are effective for children and young people experiencing difficulties with anxiety, yet there remains a proportion of the population for whom they are not effective. In addition, there is a lack of research on how these may be implemented in real world settings as opposed to a research trial. The present research focuses on the provision of cognitive behavioural school-based interventions in two parts: a systematic review of psychological, interpersonal and social variables as predictors, mediators and moderators of mental health outcomes following a school-based intervention and an empirical mixed methods evaluation of the facilitators and barriers to the implementation of a school-based intervention. Method: A systematic search of electronic databases for studies examining interpersonal, psychological and social predictors, moderators and mediators of mental health outcome following school-based cognitive behavioural interventions was conducted. Effect sizes for these analyses were calculated and the quality of eligible studies was assessed using a standardised rating tool. Within the empirical project, the implementation of a school-based cognitive behavioural intervention was evaluated through a mixed methods approach. Semi-structured interviews with stakeholders in the intervention were analysed using grounded theory integrated with framework analysis. Quantitative data on the reach of the intervention, practitioner evaluation of training and coaching as well as routine outcome measures from children and young people receiving the intervention was collected. Results: Within the systematic review, twenty-two studies (N=22) met the predefined eligibility criteria. There was heterogeneity in the variables explored, effect size of these on treatment outcome and the quality of the literature within the included studies. Cognitive style was found to mediate treatment outcome, but there was limited evidence for other predictors, mediators and moderators of treatment outcome within the review. Quantitative results of the empirical project indicated that the model of the intervention was acceptable to both practitioners and children and young people, and preliminary data indicated a significant improvement in mental health outcomes. Facilitators that emerged from qualitative data included an enabling context, therapeutic engagement, motivation and congruence, self-efficacy and containment and encouragement. The exclusivity of the intervention, a lack of systemic understanding and transparency as well as demands and pressure on resources were barriers to implementation. Conclusions: Although preliminary evidence for potential predictors, mediators and moderators is presented, further research with improvements in the design and reporting of explanatory variables on treatment outcome is required prior to informing clinical decision-making. The successful implementation of school-based interventions requires multi-agency integration and collaboration as well as on-going support in managing systemic pressures and skill development.