Objectives

This paper presents findings from the Minds@Play cluster randomized controlled trial. We aimed to determine whether:

1. Compared to controls, children who receive a mindfulness intervention within the first years of primary school have better outcomes in the areas of attention, executive functioning, social-emotional well-being, emotional regulation and behavior;
2. There are sustained changes in teacher practice and classroom interactions; and
3.  The implementation predicts the efficacy of the intervention and the cost effectiveness relative to outcomes.

 Theoretical Framework

The importance of the early years of primary school: It is well established that the first three years of school are a critical period for later school success.(Cohen & Syme, 2013) The skills learned during these years include both traditional academic skills (e.g., reading) and cognitive and non-cognitive life skills (e.g., attentional control, self-regulation and social-emotional competence; Gutman & Schoon, 2013) Although these skills begin to emerge during the preschool years, these skills are further developed, reinforced and established during the primary school years.(Cohen & Syme, 2013; Duncan et al., 2007)

 Impact of social isolation related to distance learning during COVID-19: Internationally, many jurisdictions introduced remote learning periods in response to the COVID-19 pandemic. This dramatically limited the number of social interactions these children could have with their peers, at a period which is critical for their development not only academically, but also socially. Recent international reports have highlighted the substantial negative impacts on children’s mental well-being due to the COVID-19 pandemic. (Liu et al., 2020; Wang et al., 2020) Therefore, research needs to focus on the outcomes of these students once they recommence physically attending school. Focus is needed on both immediate and long-term outcomes.

 Mindfulness as an approach for life skill development: Mindfulness is broadly defined as the ability to pay purposeful attention to a present moment focus, non-judgmentally, with acceptance or curiosity, bringing attention back if distracted.(Kabat‐Zinn, 2003) Numerous programs have been developed for both children and adults to build sustained attention, self-monitoring, self-regulation, switching attention, and selective attention(Lutz et al., 2008) as well as mental flexibility, engagement, openness, and creativity.(Pirson et al., 2012) Such programs propose that individuals can become more ‘mindful’ (characterized by improved attention, self-regulation and executive functioning) by learning and practicing these skills. It is possible that providing children with a mindfulness intervention that directly targets the skills required to make a successful transition back to physical schooling may have significant immediate and long-term outcomes.

 Evidence and limitations for mindfulness-based interventions in primary school children: The rapidly growing interest in mindfulness-based interventions has been matched with a growing number of studies, reviews, and meta-analyses (Hwang et al., 2017; Maynard et al., 2017; Sedlmeier et al., 2012; Vøllestad et al., 2012).  A systematic review by Dunning et al. (2019) found that across 35 studies, mindfulness interventions had positive effects on cognitive (effect size = 0.25), socio-emotional (effect size = 0.22), behavioral (effect size = 0.14) and academic (effect = 0.27) outcomes (Maynard et al., 2017). However, similar to other reviews, the review raised concerns about the quality of current studies on which existing evidence is based (Maynard et al., 2017). Control groups are often weak or non-existent, selective samples are used, measures are limited and rely on self-report, and methods are inconsistent. In addition, few studies have examined the use of mindfulness in young students during the primary school years. The lack of robust research can expose individuals to unintended and adverse consequences which may result from poorly or incorrectly implemented interventions focused on mindfulness.(Van Dam et al., 2018) There is a clear gap between interest and investment in mindfulness-based interventions in schools in early childhood. 

Design: This is a cluster RCT with an embedded implementation and economic evaluation. This enables findings to inform the benefits of the intervention compared to current practice, identify for whom and under what conditions the intervention is beneficial, and indication of the intervention's cost-benefits. Participants: 19 primary schools from disadvantaged areas were recruited due to the higher prevalence of social-emotional difficulties reported for students in these areas. All school entry students (age 6-7 years) were approached to participate, with a final sample of 706 children. Consent was explicitly forcused on participation in the data collection, with the intervention provided to all students in the classes. Randomization: After baseline data collection, schools, stratified by school sector, were randomized to control or intervention by a researcher independent of the study team, and group allocation was concealed from research team members involved in data collection. Mindfulness Intervention: Children were exposed to the intervention across two consecutive academic school years in 2021 and 2022. In the schools randomized to intervention, teachers in each year received professional learning delivered via a self-directed online module, as well as a two-hour virtual workshop. The professional learning focused on the theoretical and practical foundations of the program and instructions for implementing the program. The teachers were asked to embed the 12-week intervention into their classrooms, using the manual to help them to learn, practice, incorporate, and reflect on the activities and strategies. The mindfulness program involved three core practice components, (i) mindful games/activities; (ii) mindful routines/transitions/moments; and (iii) use of props/books/music/art, which can be used within the classroom and integrated with normal teaching activities. Outcome data: Outcome data was collected after the first (October 2021) and second year of the intervention (October 2022). On each occasion, data collection was conducted by research assistants blinded to the school’s group allocation. Measures: Student, teacher and parent-reported measures were chosen to measure proximal and distal outcomes that align with our intervention’s theory of change (Dawson et al., 2019; Dunning et al., 2018; Maynard et al., 2017). Constructs included student social-emotional, executive functioning, attention and self-regulation, as well as teacher and parent mindfulness practice and well-being. Statistical Analysis: Statistical analysis will follow standard methods for cluster randomized trials and the primary analysis will be by intention to treat. Multiple imputation will be conducted separately in the two groups using chained equations applied to all outcomes simultaneously, including baseline measures as auxiliary variables.

The final outcome data is currently being analysed and will be presented at the ECER annual meeting. This project is significant and innovative in that it: • Trains teachers, providing a theoretical and practical foundation to the program, enabling the program to be integrated directly into classroom practices • Tests the efficacy of a teacher-led mindfulness program. • Targets at risk communities, local government areas which have a high proportion of children starting school with teacher-reported emotional and social difficulties that impact on their learning, providing early intervention and support for those at risk for poor academic and social outcomes. • Uses a cluster randomized control design, addressing calls for more robust studies. • Is provided across two years, providing a sustainable approach to developing attention, self-regulation and executive functioning skills. • Considers the implementation, identifying for whom and under what conditions the intervention may be beneficial. • Includes a cost-effectiveness analysis, providing the first economic evaluation of mindfulness interventions in primary schools. Mindfulness has been proposed as one potential approach to meet these needs. Yet even as the use of mindfulness interventions appears to be beneficial in adults and growing in popularity, there are limited robust studies during the primary years. If our cluster RCT concludes that the intervention is effective, we expect the following outcomes: • The best evidence yet that teacher-led mindfulness practices can be delivered in a whole-class approach to improve early school functioning and adjustment. • A ready-to-use intervention that focuses on building teacher practice in primary school settings.

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