Good Practice that works: Exploring the evidence base for promoting emotional well being in schools

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Good Practice that worksExploring the evidence
base for promoting emotional well being in schools

• Dr Miranda Wolpert
• CAMH Fellow for NIMHE
• YoungMinds

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Plan of Talk

• The context
• Sources, defintions, difficulties and
  determinants
• What is an evidence based approach
• Challenge for research in this area
• The evidence
• whole school approaches
• Targeted Promotion/prevention programmes within
  school
• Targeted interventions for those identified with
  problems/at risk in school
• Conclusions
• Summary of what is indicated by the evidence base
• Future challenges

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Key Sources

• Edwards, L. (Dec 2003)
• Promoting young peoples wellbeing A review of
  research on emotional health
• http//www.scre.ac.uk
• Evans, J, Harden,A., Thomas, J , Benefield, P
  (2003)
• Interventions for pupils with emotional and
  behavioural problems in primary schools
  http//www.nfer.ac.uk/research
• Topping, K Flynn, B (2003)
• Intervening with disturbed adolescents the
  research evidence http//www.dundee.ac.uk/psycholo
  gy/ida
• Weare, K and Gray, G (2003)
• What works in developing childrens emotional and
  social competence and wellbeing? (Dfes Research
  Report 456) http//www.dfes.gov.uk/research

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Unpublished sources

• Fonagy, P and Target, M
• The psychological treatment of child and
  adolescent psychiatric disorders (forthcoming
  chapter in What works for whom, Roth and Fonagy
  (Guilford Press) revised edition)
• Kurtz, Z
• The evidence of best practice in early
  intervention for child and adolescent mental
  health- talk given at a conference on best
  practice in early intervention in Norwich 14th
  November 2003

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Mental Health/Emotional Wellbeing

• Able to develop psychologically, emotionally
  creatively intellectually and spiritually
• Initiate and sustain satisfying personal
  relationships
• Use and enjoy solitude
• Aware of others and able to emphasise
• Play and learn
• Sense of right and wrong
• Problem solve and learn from set back

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Exploring definitions Adapted from Atkinson and
Hornby, 2002
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The need ?

• In a secondary school of 1000 pupils across a
  year
• 50 clinically depressed
• 10 emotional problems including self harm
• 100 significant behavioural disturbance
• 100 with anxiety states/phobias
• 10 eating disorder
• up to 10 attempt suicide
• 7-11 experiencing abuse
• In a class of 20 2 with MH problems

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The danger ?

• There is a danger of pathologising the every
  day problems that children experience, by
  identifying them and treating them through the
  mental health services (OHanlon 2000 quoted in
  Gott 2003)

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Risk factors for reduced emotional well being

• Poverty
• Poor environment
• Family problems
• Temperament
• Learning disability
• Being an asylum seeker
• Living with only one natural parent, either in a
  step-family or with a lone Parent
• Parental unemployment
• Being looked after
• Large family size (5)
• Living in families where the main breadwinner was
  unemployed
• Enduring physical ill health
• Experienced physical or sexual abuse/ witnessed
  domestic violence
• A parent with mental health problems.

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Factors that promote emotional well being

• High self esteem
• Good relationships
• Good housing
• Stable relationships
• Temperament adaptability
• High IQ
• Fairness and stability in relationships

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Barriers to feeling good (13-14 year olds self
report)

• boredom
• monotony
• stress of too much work
• teachers attitudes to them
• being put down
• difficulties with peers
• being blamed
• not doing well in sport
• physical appearance
• the weather
• lack of money

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Reasons for self harm (13-14 year old self report)

• Abuse
• Family break up
• Bereavement
• Concerns about sexuality

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Facilitators of feeling good (13-14 year old self
report)

• Respect from fiends
• Congratulations
• Compliments
• Being good looking
• Doing well in school
• Being good in sport
• Feeling accepted

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Young peoples strategies (13-14 year old self
report)

• Long baths
• Physical activity
• Eating chocolate
• Sleeping
• Talking with friends (more true of young women
  than young men)

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Evidence based Practice (EBP)

• Using the best available external evidence
  from systematic research in order to reach
  decisions for ones own specific circumstances.
• Limitations
• Lack of research
• Methodological challenges
• Strengths
• Offsets biases in decision making
• Crucial to developing appropriate practice

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Categories of Evidence

• Ia Evidence from meta-analysis of randomised
  controlled trials
• Ib Evidence from at least one randomised
  controlled trial
• IIa Evidence from at least one controlled study
  without randomisation
• IIb Evidence from at least one other type of
  quasi-experimental study
• III Evidence from descriptive studies such as
  comparative studies, correlation studies and
  case-control studies
• IV Evidence from expert committee reports or
  opinions, or from clinical experience of a
  respected authority, or both.

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Challenges

• Gaps
• Most research in USA
• Poor design
• Very little replication
• Grey literature
• Different language/approaches

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Some evaluated Whole School approaches

• Seattle programme
• PeaceBuilders (praise, avoid put downs, seek wise
  friends, correct hurts , right wrongs)
• Southampton- Emotional literacy interest group
  (SELIG)

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Some Evaluated Prevention/Promotion Programmes

• Primary school
• The Child Development Project
• Resolving Conflict Creatively Project
• PATHS
• Circle Time
• Secondary school
• School Transition Environmental Project (STEP)
• Gang Resistance Education Training (GREAT)
• Suicide prevention
• Depression preventions projects

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Some evaluated Programmes for children identified
with problems/at risk

• Primary school
• Classroom management strategies
• CBT Group work
• Coping Power
• Peer Coping Skills (PCS)
• Secondary school
• Peer education programmes
• CBT group work
• PTSD intervention

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good practice that worksoverview of common
factors

• Consistency and persistence
• inclusion of parents teachers and peers
• multiple modalities,
• integration into core curriculum
• start early and take developmental approach
• skills based
• school environment vital foster warm
  relationships, encourage participation, develop
  pupil and teacher autonomy, foster clarity about
  boundaries, rules and expectations.
• Teachers must have their own needs met

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Key future challenges

• There is some evidence that school based
  interventions are effective but there is more
  innovation than research currently
• Adopt and evidence based approach
• Include evaluation in all new projects
• Highlight and disseminate what does not work
• Need to find way of intergrating research using
  different language/viewpoints
• Need to look at wider range of needs
• Need to compare different interventions