Objective

This paper presents findings from a quasi-experimental study to evaluate the Mental Health in Primary Schools program. We aimed to determine whether compared to matched comparison schools, primary schools that implemented the MHiPS intervention had:

1. Improved Teacher outcomes related to their attitudes, confidence and skills in identifying and responding to the mental health and wellbeing of their students
2. Increased school prioritisation of mental health and wellbeing
3. Improved engagement with school and community mental health support.

Theoretical framework

In recent years there has been increasing international policy attention related to child mental health. This is timely and follows reports of worrying increases in mental health concerns in schools and increased presentations of children with mental health issues to medical services. The Report on the Second Australian Child and Adolescent Survey of Mental Health and Wellbeing (Lawrence et al., 2016) [4] found that the impact of mental health disorders on children’s education includes absenteeism, impaired functioning at school, and poorer academic performance compared to peers without mental health concerns. Left unaddressed, mental health challenges in childhood are related to increased school absenteeism, poorer peer relationships and increased risk of substance abuse and unemployment (Patel et al., 2007).

Schools are one setting where children can be supported in their development of mental health competencies, especially as some children require effective mental health support to succeed at school. Their success in adjusting emotionally and socially when young is a strong predictor of their adjustment into adulthood (Vogler, 2008).  While there are effective interventions available to change this trajectory, the prevalence of childhood mental health continues to increase, with children not accessing help soon enough or for long enough (Tully, et.al., 2019).   A range of barriers exist inhibiting children from accessing mental health services, including lack of parental knowledge, cost of treatment, stigma and lack of service availability (CCCH, 2006; CCCH, 2012; Rhodes, 2017). Schools have been responding to this by increasingly focusing on prevention and intervention, with many incorporating wellbeing into their values and vision (Allen, 2017).  

The primary school period presents a unique opportunity to intervene early and modify the trajectory of many mental health issues and prevent progression to 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. 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 role and the training program combine to form the “MHWC model”, which aims to build mental health capacity within the school.  The MHWC will act as the liaison between the school and community-based health and other community-based services. The role within schools involved:

• Receive evidence-based training around supporting the mental health needs of primary school students;
•  Embed evidence-based training and professional development (Tier 1 practices & frameworks) across the school and build the capability of teaching and education support staff to better identify and support students with mental health issues;
•  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 1:1 counselling support to students);
•  Work proactively within school and community services
•  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.

Design: This paper will present findings from a quasi-experimental study involving 16 schools that participated in 2021 with 21 matched comparison schools. Participants and sample size: 16 primary schools were recruited to participate in the program 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). 21 primary schools were recruited by the research team to participate as ‘business as usual’ comparison schools matched on sociodemographic characteristics (ie. ICSEA), school size (ie. the number of enrolments) and location (ie. metropolitan/regional/rural). Parents of students in Year 2 (2-8 years old) and Year 4 (9-10 years old) were approached to participate at the start of 2021 with a final sample of 686 participants. All school staff at participating schools were approached to participate, with 821 recruited. Intervention: The training aimed 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. The training comprised three core modules: Mental Health Literacy; Supporting Needs; and Building Capacity as well as regular Communities of Practice DATA SOURCES Outcome data: Outcome data were collected across six-time points, being time 1 (2 months post allocation) and then 3, 5, 6, 10 and 17 months post allocation Measures: School staff and parent-reported measures were chosen to measure proximal and distal outcomes that align with our intervention’s theory of change. School staff and parent-reported measures were chosen to measure proximal and distal outcomes that align with our intervention’s theory of change. The primary outcome was the School Mental Health Self-Efficacy Teacher Survey (SMH-SETS), with secondary measures capturing student mental health, staff mental health literacy, service use, stigma and implementation. Focus groups with stakeholders were also conducted. Interviews/focus groups with school staff and MHWC at intervention schools. 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 arms using chained equations applied to all outcomes simultaneously, including baseline measures as auxiliary variables.

The outcome data from educators, school leadership and parents are currently being analysed and will be presented at ECER annual meeting. This project is significant and innovative in that it: • Evaluates the teacher and student outcomes of increasing school capacity to support the mental health and well-being of their students • Tests the efficacy of a system-focused, whole-school mental health approach. • Examines the sustainability of the whole school approach across two years, with data collected about teachers and students. • Considers the implementation process, identifying for whom and under what conditions the intervention may be beneficial. If our study demonstrates positive outcomes, we expect: • The best evidence yet that whole school mental health and wellbeing intervention focused on improving teacher and school capacity, can improve key early implementation outcomes. • A ready-to-use intervention that focuses on building teacher practice in primary school settings

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