scholarly journals Training teachers in classroom management to improve mental health in primary school children: the STARS cluster RCT

2019 ◽  
Vol 7 (6) ◽  
pp. 1-150 ◽  
Author(s):  
Tamsin Ford ◽  
Rachel Hayes ◽  
Sarah Byford ◽  
Vanessa Edwards ◽  
Malcolm Fletcher ◽  
...  
Keyword(s):  
Mental Health ◽  
Classroom Management ◽  
Health Research ◽  
Cost Effective ◽  
Public Health Research ◽  
Poor Mental Health ◽  
Primary School Children ◽  
Short Term ◽  
South West

BackgroundPoor mental health in childhood is common, persistent and associated with a range of adverse outcomes that include persistent psychopathology, as well as risk-taking behaviour, criminality and educational failure, all of which may also compromise health. There is a growing policy focus on children’s mental health and the role of schools in particular in addressing this.ObjectivesTo evaluate whether or not the Incredible Years®(IY) Teacher Classroom Management (TCM) training improved children’s mental health, behaviour, educational attainment and enjoyment of school, improved teachers’ mental health and relationship with work, and was cost-effective in relation to potential improvements.DesignA two-arm, pragmatic, parallel-group, superiority, cluster randomised controlled trial.SettingA total of 80 UK schools (clusters) were recruited in three distinct cohorts between 2012 and 2014 and randomised to TCM (intervention) or teaching as usual [(TAU) control] with follow-ups at 9, 18 and 30 months. Schools and teachers were not masked to allocation.ParticipantsEighty schools (n = 2075 children) were randomised: 40 (n = 1037 children) to TCM and 40 (n = 1038 children) to TAU.InterventionsTCM was delivered to teachers in six whole-day sessions, spread over 6 months. The explicit goals of TCM are to enhance classroom management skills and improve teacher–student relationships.Main outcome measuresThe primary planned outcome was the teacher-reported Strengths and Difficulties Questionnaire Total Difficulties (SDQ-TD) score. Random-effects linear regression and marginal logistic regression models using generalized estimating equations were used to analyse outcomes.ResultsThe intervention reduced the SDQ-TD score at 9 months [adjusted mean difference (AMD) –1.0, 95% confidence interval (CI) –1.9 to –0.1;p = 0.03] but there was little evidence of effects at 18 months (AMD –0.1, 95% CI –1.5 to 1.2;p = 0.85) and 30 months (AMD –0.7, 95% CI –1.9 to 0.4;p = 0.23). Planned subgroup analyses suggested that TCM is more effective than TAU for children with poor mental health. Cost-effectiveness analysis using the SDQ-TD suggested that the probability of TCM being cost-effective compared with TAU was associated with some uncertainty (range of 40% to 80% depending on the willingness to pay for a unit improvement in SDQ-TD score). In terms of quality-adjusted life-years (QALYs), there was evidence to suggest that TCM was cost-effective compared with TAU at the National Institute for Health and Care Excellence thresholds of £20,000–30,000 per QALY at 9- and 18-month follow-up, but not at 30-month follow-up. There was evidence of reduced disruptive behaviour (p = 0.04) and reductions in inattention and overactivity (p = 0.02) at the 30-month follow-up. Despite no main effect on educational attainment, subgroup analysis indicated that the intervention’s effect differed between those who did and those who did not have poor mental health for both literacy (interactionp = 0.04) and numeracy (interactionp = 0.03). Independent blind observations and qualitative feedback from teachers suggested that teachers’ behaviour in the classroom changed as a result of attending TCM training.LimitationsTeachers were not masked to allocation and attrition was marked for parent-reported data.ConclusionsOur findings provide tentative evidence that TCM may be an effective universal child mental health intervention in the short term, particularly for primary school children who are identified as struggling, and it may be a cost-effective intervention in the short term.Future workFurther research should explore TCM as a whole-school approach by training all school staff and should evaluate the impact of TCM on academic progress in a more thorough and systematic manner.Trial registrationCurrent Controlled Trials ISRCTN84130388.FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 7, No. 6. See the NIHR Journals Library website for further project information. Funding was also provided by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula (NIHR CLAHRC South West Peninsula).

scholarly journals Mental health support and training to improve secondary school teachers’ well-being: the WISE cluster RCT

2021 ◽  
Vol 9 (12) ◽  
pp. 1-138
Author(s):  
Judi Kidger ◽  
Rhiannon Evans ◽  
Sarah Bell ◽  
Harriet Fisher ◽  
Nicholas Turner ◽  
...  
Keyword(s):  
Public Health ◽  
Mental Health ◽  
Peer Support ◽  
Health Research ◽  
Well Being ◽  
Public Health Research ◽  
Support Service ◽  
Mental Health Difficulties ◽  
Peer Support Service

Background Health and Safety Executive data show that teachers are at heightened risk of mental health difficulties, yet few studies have attempted to address this. Poor teacher mental health may impact on the quality of support provided to young people, who also report increased mental health difficulties themselves. Objective To test the effectiveness of an intervention aiming to improve secondary school teachers’ well-being through mental health support and training. Design A cluster randomised controlled trial with embedded process and economic evaluations. Setting Twenty-five mainstream, non-fee-paying secondary schools in the south-west of England and South Wales, stratified by geographical area and free school meal entitlement, randomly allocated to intervention or control groups following collection of baseline measures (n = 12, intervention; n = 13, control) between May and July 2016. Participants All teachers in the study schools at any data collection. All students in year 8 (baseline) and year 10 (final follow-up). Intervention Each intervention school received three elements: (1) a 1-day mental health first aid for schools and colleges training session delivered to 8% of all teachers; (2) a 1-hour mental health session delivered to all teachers; and (3) 8% of staff trained in the 2-day standard mental health first aid training course set up a confidential peer support service for colleagues. Control schools continued with usual practice. Main outcome measures The primary outcome was teacher well-being (using the Warwick–Edinburgh Mental Wellbeing Scale). Secondary outcomes were teacher depression, absence and presenteeism, and student well-being, mental health difficulties, attendance and attainment. Follow-up was at 12 and 24 months. Data were analysed using intention-to-treat mixed-effects repeated-measures models. Economic evaluation A cost–consequence analysis to compare the incremental cost of the intervention against the outcomes measured in the main analysis. Process evaluation A mixed-methods study (i.e. qualitative focus groups and interviews, quantitative surveys, checklists and logs) to examine intervention implementation, activation of the mechanisms of change outlined in the logic model, intervention acceptability and the wider context. Results All 25 schools remained in the study. A total of 1722 teachers were included in the primary analysis. We found no difference in mean teacher well-being between study arms over the course of follow-up (adjusted mean difference –0.90, 95% confidence interval –2.07 to 0.27). There was also no difference in any of the secondary outcomes (p-values 0.203–0.964 in the fully adjusted models). The average cost of the intervention was £9103 (range £5378.97–12,026.73) per intervention school, with the average cost to Welsh schools being higher because of a different delivery model. The training components were delivered with high fidelity, although target dosage was sometimes missed. The peer support service was delivered with variable fidelity, and reported usage by teachers was low (5.9–6.1%). The intervention had high acceptability, but participants reported low support from senior leadership, and minimal impact on school culture. Limitations Participants and the study team were unblinded, self-report for the main outcome measures and inaccurate measurement of peer support service usage. Conclusions The Wellbeing in Secondary Education (WISE) intervention was not effective at improving teacher or student well-being, or reducing mental health difficulties, possibly because of contextual barriers preventing it becoming embedded in school life. Future work Identification of ways in which to achieve system-level change and sustained support from senior leaders is important for future school-based mental health interventions. Trial registration Current Controlled Trials ISRCTN95909211. Funding This project was funded by the National Institute for Health Research Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 12. See the NIHR Journals Library website for further project information. Intervention costs were met by Public Health Wales, Public Health England and Bristol City Council.

scholarly journals Cluster randomised controlled trial and economic and process evaluation to determine the effectiveness and cost-effectiveness of a novel intervention [Healthy Lifestyles Programme (HeLP)] to prevent obesity in school children

2018 ◽  
Vol 6 (1) ◽  
pp. 1-204 ◽  
Author(s):  
Katrina Wyatt ◽  
Jenny Lloyd ◽  
Siobhan Creanor ◽  
Colin Green ◽  
Sarah G Dean ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Process Evaluation ◽  
Health Research ◽  
Controlled Trial ◽  
Cost Effective ◽  
Cluster Randomised Controlled Trial ◽  
Public Health Research ◽  
Healthy Lifestyles ◽  
Percentage Body Fat

BackgroundApproximately one-third of children in England leave primary school overweight or obese. There is little evidence of effective obesity prevention programmes for children in this age group.ObjectiveTo determine the effectiveness and cost-effectiveness of a school-based healthy lifestyles programme in preventing obesity in children aged 9–10 years.DesignA cluster randomised controlled trial with an economic and process evaluation.SettingThirty-two primary schools in south-west England.ParticipantsChildren in Year 5 (aged 9–10 years) at recruitment and in Year 7 (aged 11–12 years) at 24 months’ post-baseline follow-up.InterventionThe Healthy Lifestyles Programme (HeLP) ran during the spring and summer terms of Year 5 into the autumn term of Year 6 and included four phases: (1) building a receptive environment, (2) a drama-based healthy lifestyles week, (3) one-to-one goal setting and (4) reinforcement activities.Main outcome measuresThe primary outcome measure was body mass index (BMI) standard deviation score (SDS) at 24 months post baseline measures (12 months post intervention). The secondary outcomes comprised waist circumference SDS, percentage body fat SDS, proportion of children overweight and obese at 18 and 24 months, accelerometer-assessed physical activity and food intake at 18 months, and cost-effectiveness.ResultsWe recruited 32 schools and 1324 children. We had a rate of 94% follow-up for the primary outcome. No difference in BMI SDS was found at 24 months [mean difference –0.02, 95% confidence interval (CI) –0.09 to 0.05] or at 18 months (mean difference –0.02, 95% CI –0.08 to 0.05) between children in the intervention schools and children in the control schools. No difference was found between the intervention and control groups in waist circumference SDS, percentage body fat SDS or physical activity levels. Self-reported dietary behaviours showed that, at 18 months, children in the intervention schools consumed fewer energy-dense snacks and had fewer negative food markers than children in the control schools. The intervention effect on negative food markers was fully mediated by ‘knowledge’ and three composite variables: ‘confidence and motivation’, ‘family approval/behaviours and child attitudes’ and ‘behaviours and strategies’. The intervention effect on energy-dense snacks was partially mediated by ‘knowledge’ and the same composite variables apart from ‘behaviours and strategies’. The cost of implementing the intervention was approximately £210 per child. The intervention was not cost-effective compared with control. The programme was delivered with high fidelity, and it engaged children, schools and families across the socioeconomic spectrum.LimitationsThe rate of response to the parent questionnaire in the process evaluation was low. Although the schools in the HeLP study included a range of levels of socioeconomic deprivation, class sizes and rural and urban settings, the number of children for whom English was an additional language was considerably lower than the national average.ConclusionsHeLP is not effective or cost-effective in preventing overweight or obesity in children aged 9–10 years.Future workOur very high levels of follow-up and fidelity of intervention delivery lead us to conclude that it is unlikely that school-based programmes targeting a single age group can ever be sufficiently intense to affect weight status. New approaches are needed that affect the school, the family and the wider environment to prevent childhood obesity.Trial registrationCurrent Controlled Trials ISRCTN15811706.FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 6, No. 1. See the NIHR Journals Library website for further project information.

scholarly journals An online family-based self-monitoring and goal-setting intervention to improve children’s physical activity: the FRESH feasibility trial and three-arm pilot RCT

2021 ◽  
Vol 9 (9) ◽  
pp. 1-116
Author(s):  
Esther MF van Sluijs ◽  
Helen E Brown ◽  
Emma Coombes ◽  
Claire Hughes ◽  
Andrew P Jones ◽  
...  
Keyword(s):  
Public Health ◽  
Physical Activity ◽  
Health Research ◽  
Delphi Study ◽  
Family Members ◽  
Public Health Research ◽  
Feasibility Trial ◽  
Recruitment Strategies ◽  
Family Based

Background Family-based physical activity promotion presents a promising avenue for promoting whole-family physical activity, but high-quality research is lacking. Objectives To assess the feasibility, acceptability and preliminary effectiveness of FRESH (Families Reporting Every Step to Health), a child-led online family-based physical activity intervention; and to identify effective and resource-efficient family recruitment strategies. Design The project consisted of (1) a randomised feasibility trial, (2) a randomised controlled pilot trial and (3) a systematic review and Delphi study. Setting Norfolk/Suffolk counties, UK. Participants Families, recruited from schools, workplaces and community settings, were eligible to participate if one child aged 7–11 years and one adult responsible for their care provided written consent; all family members could participate. Interventions The FRESH intervention, guided by self-determination theory, targeted whole families and was delivered via an online platform. All family members received pedometers and were given website access to select family step challenges to ‘travel’ to target cities around the world, log steps, and track progress as they virtually globetrotted. Families were randomised to FRESH intervention, pedometer-only or control arm. Main outcome measures Physical (e.g. blood pressure), psychosocial (e.g. family functioning) and behavioural (e.g. device-measured family physical activity) measures were collected at baseline and at 8- and 52-week follow-up. A mixed-methods process evaluation assessed the acceptability of the intervention and evaluation. Data sources review Systematic search of four databases (Cochrane Library, PubMed, PsycINFO and SCOPUS). Review methods Articles were screened in duplicate, and data extraction was fully checked. Academic experts participated in the three-round Delphi study. Data were combined to identify effective and resource-efficient family recruitment strategies. Inclusion criteria Included generally healthy school-aged children and at least one adult; intervention attempted to change physical activity, sedentary behaviour, screen use, diet, or prevent overweight/obesity in multiple family members; presented relevant measure of effect in children and adults. Results The feasibility study (12 families, 32 participants; 100% retention at 8 weeks) demonstrated the feasibility and acceptability of FRESH, but highlighted that adaptations were required. Of 41 families recruited in the pilot study (149 participants), 98% and 88% were retained at the 8-week and 52-week follow-up, respectively. More children in the FRESH arm self-reported doing more family physical activity, and they thought that FRESH was fun. There were no notable between-group differences in children’s outcomes. Change in moderate to vigorous physical activity at 8 weeks favoured FRESH intervention adults [vs. control: 9.4 minutes/week (95% confidence interval 0.4 to 18.4) vs. pedometer only: 15.3 (95% confidence interval 6.0 to 24.5)], and was stronger in fathers, but this was not maintained. In 49 included studies, apart from recruitment settings and strategies used (reported in 84% and 73% of the studies, respectively), recruitment details were scarce. School-based recruitment was predominant. The Delphi study identified a wide range of recruitment settings and strategies. Limitations Recruitment was the main limitation of the FRESH studies; generalisability of the proposed recruitment strategies may be limited. Conclusions This study has demonstrated the feasibility and acceptability of the FRESH intervention. However, we failed to recruit the target sample size and were unable to demonstrate a signal of effectiveness. Future research should employ a multifaceted recruitment approach. Future work Further refinements to intervention delivery and recruitment methods should be investigated. Study registration Current Controlled Trials ISRCTN12789422 and PROSPERO CRD42019140042. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 9. See the NIHR Journals Library website for further project information.

scholarly journals The economics of mental health in the workplace: what do we know and where do we go?

2007 ◽  
Vol 16 (4) ◽  
pp. 294-298 ◽  
Author(s):  
David McDaid
Keyword(s):  
Mental Health ◽  
Grey Literature ◽  
Cost Effective ◽  
Evidence Base ◽  
Poor Mental Health ◽  
Health Interventions ◽  
Economic Evaluations ◽  
Policy Makers ◽  
Productivity Losses ◽  
Mental Health Interventions

AbstractTo provide an overview of the economic impact of poor mental health in the workplace and assess the extent to which economic evaluation has been used to further the case for investment in workplace based mental health programmes. Rapid scoping review of published and grey literature. The socio-economic costs of poor mental health in the workplace are substantial but conservative, as few studies have included productivity losses from work cutback, as well as absenteeism. While few economic evaluations of workplace based mental health interventions were identified, the available evidence base suggests that they have the potential to be highly cost effective. Much of this evidence may be from the US and be less applicable elsewhere; it may also have been solely published in company documents making assessment of methodological quality difficult. The potential economic case for workplace based mental health interventions appears good. More collaboration between policy makers and the private sector would help facilitate rigorous and transparent economic evaluations. A number of evaluations are planned. The challenge is to build on these initiatives, in order to address what remains a major gap in our knowledge on the economics of mental health.

Developing a reliable and cost-effective follow-up programme after a short-term head and neck reconstructive mission in Ethiopia: a pilot study

2020 ◽  
Vol 58 (10) ◽  
pp. e175
Author(s):  
Daniel Bradley ◽  
Calum Honeyman ◽  
Vinod Patel ◽  
Julian Zeolla ◽  
Lucy Lester ◽  
...  
Keyword(s):  
Pilot Study ◽  
Head And Neck ◽  
Cost Effective ◽  
Short Term

Urban environment and mental health

1997 ◽  
Vol 171 (6) ◽  
pp. 530-536 ◽  
Author(s):  
Odd Steffen Dalgard ◽  
Kristian Tambs
Keyword(s):  
Mental Health ◽  
Marked Change ◽  
Poor Mental Health ◽  
Substantial Improvement ◽  
Social Characteristics ◽  
Mental Health Information ◽  
Environment Stress ◽  
Further Development

BackgroundIn a follow-up survey from Oslo, 503 persons were re-interviewed using the same questionnaire after 10 years.MethodThe questionnaire includes questions about social support, social characteristics of the neighbourhood and mental health. Information about the neighbourhood was also gathered from key informants.ResultsOf the five types of neighbourhoods surveyed, only one showed marked change over time with respect to social characteristics. This was an initially poorly functioning neighbourhood with poor mental health among the residents, where substantial improvement took place as part of the further development of the area. Parallel with the improvement in social environment there was a significant improvement in mental health among those who continued to live in the same area, as opposed to those who continued to live in the other areas. Selective migration could not explain this finding.ConclusionsThe findings support the environment stress hypothesis, implying that the quality of a neighbourhood has an impact on mental health. The implications for psychiatric prevention are discussed.

scholarly journals Aging Workers: Work Environment as a Factor in Employee Mental Health

2015 ◽  
Vol 10 ◽  
Author(s):  
Wendy A. Coduti ◽  
Kristin Tugman ◽  
Susanne M. Bruyère ◽  
Valerie Malzer
Keyword(s):  
Mental Health ◽  
Quantitative Data ◽  
Qualitative Interviews ◽  
Cost Effective ◽  
Wellness Programs ◽  
Work Environments ◽  
Work Culture ◽  
Short Term ◽  
Seeking Help ◽  
Employee Mental Health

In 2014, the health and productivity team of the disability insurance provider, Unum, conducted a mixed methods study that included qualitative interviews with internal mental health disability claims professionals, and external interviews with employers. Quantitative data of 15 employers were analysed to identify descriptive statistics involving mental health short-term disability (STD) claims. Workplace factors were examined to understand best practices among companies, related to mental health STD, to identify work environments that may increase or decrease mental health disabilities. Quantitative data found workers aged 40 to 49 had the highest rates of mental health STD claims and workers aged 50 to 59 had the longest duration of absence. Anxiety and depression were the main reasons for mental health absences from work. Results from the qualitative interviews showed a supportive work culture (i.e., work–life balance, good benefits, successful wellness programs) may lead to higher STD claim rates, demonstrating workers in these environments may feel more comfortable disclosing and seeking help for mental health disabilities. Conclusions from this study indicate that although presenteeism rates for mental health are high and impact employers financially, having higher STD claim rates may be more cost effective than having employees with mental health conditions remain at work instead of filing STD claims, seeking treatment and returning to productive employment. Employee age can impact rate and duration of mental health STD claims, meaning employers should implement workplace practices that support overall mental health of employees.

scholarly journals Chronic pain and mental health problems among Syrian refugees: associations, predictors and use of medication over time: a prospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e046454
Author(s):  
Elisabeth Marie Strømme ◽  
Jannicke Igland ◽  
Jasmin Haj-Younes ◽  
Bernadette Nirmal Kumar ◽  
Lars T Fadnes ◽  
...  
Keyword(s):  
Mental Health ◽  
Chronic Pain ◽  
Cohort Study ◽  
Pharmacological Treatment ◽  
Prospective Cohort ◽  
Mental Health Problems ◽  
Health Problems ◽  
Poor Mental Health ◽  
Syrian Refugees

ObjectivesThis study aims to examine associations, predictors and pharmacological treatment of chronic pain and mental health problems among Syrian refugees in a longitudinal perspective.DesignProspective cohort study.SettingWe collected survey data among Syrian refugees in Lebanon granted resettlement to Norway (self-administered questionnaires) and at follow-up 1 year after arrival in Norway (structured telephone interviews).ParticipantsAdult Syrian refugees attending mandatory pretravel courses in Lebanon in 2017–2018 were invited to participate. In total, 353 individuals participated at both time points.Primary and secondary outcomesWe examined the cross-sectional associations between pain, mental health and migration-related exposures at baseline and follow-up and assessed whether associations changed significantly with time. Furthermore, we investigated the longitudinal association between mental health at baseline and pain at follow-up. We also evaluated temporal changes in use of analgesics and psychotropic drugs.ResultsWhile most refugees reported improved health from the transit phase in Lebanon to the early resettlement phase in Norway, a few had persisting and intertwined health problems. Most migration-related stressors were more closely associated with chronic pain and mental health problems after resettlement as compared with the transit phase. In parallel, poor mental health was associated with chronic pain in the follow-up (adjusted risk ratio (ARR) 1.5 (1.0, 2.2)), but not at baseline (ARR 1.1 (0.8, 1.5)). Poor mental health at baseline was a statistically significant predictor of chronic pain at follow-up among those not reporting chronic pain at baseline. At both timepoints, one in four of those with chronic pain used analgesics regularly. None with mental health problems used antidepressants daily.ConclusionsProviders of healthcare services to refugees should be attentive to the adverse effect of postmigration stressors and acknowledge the interrelations between pain and mental health. Possible gaps in pharmacological treatment of pain and mental health problems need further clarification.

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