Bonell Chris, Hope Steven, Sundaram Neisha, Lloyd-Houldey Oliver, Michalopoulou Semina, Scott Stephen, Nicholls Dasha, Viner Russell
London School of Hygiene & Tropical Medicine, Department of Public Health, Environments and Society, London, UK.
Population Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK.
Public Health Res (Southampt). 2024 Dec 4:1-22. doi: 10.3310/JWGT4863.
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).
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.
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.
Southern England.
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.
None.
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.
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.
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.
A feasibility study to optimise the intervention and assess whether progression to a full trial is justified.
This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR131594.
尽管青少年心理健康问题发生率很高，但几乎没有有效的校本干预措施来解决这一问题。全校性干预措施为促进心理健康提供了一种可行且可持续的方法，但迄今为止几乎没有得到评估。此前，我们对“共同学习”干预措施进行了试验，该措施包括当地需求评估、学生和教职员工参与决策、恢复性实践以及社会和情感技能课程。这不仅在预防欺凌方面有效（主要结果），而且在促进心理健康和心理功能方面也有效（次要结果）。
我们旨在对“共同学习”进行调整，开发出“心理健康共同学习”，重点是促进心理健康。本文报告了我们如何完善和细化干预材料，以产生“心理健康共同学习”干预措施，包括通过患者和公众的参与。
我们审查了相关证据，为课程组成部分的选择和需求评估调查的内容提供参考。我们让学校工作人员和学生，以及来自国家儿童局的儿童和年轻人参与进来，以调整干预措施。我们还对综述进行了系统回顾，以制定一份基于证据的行动清单，但这将另行报告。
英格兰南部。
与一所中学的四名工作人员和五名学生、来自不同学校的两名学校高级领导团队成员，以及约八名国家儿童局青年成员进行了患者和公众参与。
无。
我们完善并细化了最初的“心理健康共同学习”计划，以生成一个有完整材料、培训和外部指导支持的干预措施。我们将需求评估的重点放在心理健康上，增加了一份基于证据的全校心理健康行动清单，并改用了不同的社会和情感技能课程。我们保留了恢复性实践以及工作人员/学生参与决策的机制。干预措施的变革理论或总体方法没有进一步完善。患者和公众参与是有用的，但并非所有建议都得到了采纳，要么是因为一些参与者建议放弃预先确定的要素（如需求调查），要么是因为建议（如包括芳香疗法）缺乏有效性证据。
我们与患者和公众参与利益相关者的所有接触并非都能长期持续。我们的患者和公众参与工作受到其在新冠疫情恢复期开展的影响，当时学校比平时压力更大。我们原计划参与患者和公众参与的学校在学生享受免费学校餐资格方面高于平均水平，但最初招募的学校在最后一刻退出了。其替代学校的免费学校餐资格率低于平均水平。
本文报告了调整过程，并反思了参与和证据审查在这一过程中的各种作用方式。我们发现，通过利用证据审查以及患者和公众参与的过程，可以完善和细化干预措施，以提供完整的材料和支持。事实证明，后者对于确保“心理健康共同学习”在可行性、可接受性和包容性方面的完善具有重要价值。然而，在我们看来，并非所有患者和公众参与的建议都能够或应该被采纳，特别是当它们与证据基础不一致时。
进行一项可行性研究，以优化干预措施，并评估是否有理由推进到全面试验阶段。
本文介绍了由国家卫生与保健研究机构（NIHR）公共卫生研究项目资助的独立研究，资助编号为NIHR131594。
