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Interventions in Schools vs. Clinics – ReSET Project


Recently, there has been increasing recognition of the role of schools in mental health provision, and the prevention of mental health problems through psychosocial education. This blog will outline how we have optimized a new preventative mental health intervention: “building resilience through socio-emotional training” (ReSET), to be delivered in schools, and the benefits of school-based interventions for young people at risk of mental health problems. The ReSET project is based at University College London (UCL).


I am a Research Assistant at UCL, working on the ReSET intervention which is focused on building resilience through socio-emotional training in schools. I have a background in Developmental Neuroscience, Psychopathology and Psychology and my work on ReSET involves conducting research assessments at schools across Greater London, as well as supporting dissemination through social media and blog posts. The ReSET project is a longitudinal trial, even though we are waiting for the final results, the feedback so far has been incredibly positive from students and staff members. This blog is intended to outline more about the ReSET project, what we are doing in schools, and why integrating mental health support into education systems is so important.


Adolescent mental health and the role of schools


In the UK, emotional problems such as anxiety and depression are the most common mental health issues experienced by young people. Mental health problems typically begin in adolescence, and almost half of psychopathology emerges before the age of 18. Poorer mental health in adolescence increases the risk of experiencing other types of mental health problems both during adolescence and into adulthood.


Given the amount of time that adolescents spend within a school setting, schools are an important factor in understanding and supporting wellbeing in this age group. The school environment plays a key role in the development and maintenance of peer relationships. Inclusion in peer groups and a sense of school belonging are important predictors of mental well-being, such that positive peer relationships may act as protective factors against mental health issues. In contrast, lower-quality peer relationships in adolescence are associated with feelings of loneliness, and poor mental health outcomes such as depression and anxiety.


Integrating mental health support within schools can provide a unique opportunity to support adolescents in a setting where they are exposed to experiences that can be beneficial or detrimental to their mental health.



The potential for school-based interventions has been reflected both in the UK and internationally, by an increasing focus of government policies directed at improving mental health outcomes through school-based programmes.


School-based interventions are advantageous as they can reach young people who might otherwise be missed by mental health services. A review of child and adolescent mental health services outlined common barriers that young people face when accessing services, which include difficulties taking children out of school to attend treatment sessions, navigating complicated referral processes, and lengthy wait list times. School-based interventions can overcome these barriers and reduce the number of steps needed to access mental health support. Stigma is another barrier to accessing services, and young people may perceive accessing mental health support through schools as more acceptable and less stigmatizing than engaging in conventional mental health services.


Challenges associated with school-based mental health interventions


While delivering mental health support within schools is important, the process itself is not without challenges.


School-based interventions require a high degree of communication between mental health services, school staff, and, in the case of clinical trials, the research team


The most frequently cited challenge for school-based interventions is logistical difficulties. Practitioners and researchers must consider the timing constraints of the academic term, and school day, as well as finding a physical space suitable for the intervention.


Another challenge is engagement from teaching staff, which affects the extent to which interventions are delivered correctly and to completion. Many of these factors are related, for example, if students are not engaged in an intervention, teaching staff are less motivated to continue with delivery. Similarly, teachers may be more accepting of an intervention that cuts into teaching time if they believe it will benefit their students. Successful interventions tend to be those which include the support of senior leadership teams in schools, protect staff time to participate in supervision and training, and have an intervention manual that is clear and easy to follow with good quality support materials.

 

The ReSET project 


The ReSET project is a new 8-week school-based preventive intervention that aims to promote resilience in students through group workshops.


Our intervention focuses on two mechanisms: emotional processing and social relationships, both of which are implicated in mental health outcomes during adolescence.


The intervention aims to strengthen protective factors related to emotional processing and social relationships and promote well-being generally. Unlike most other mental health interventions for adolescents, ReSET focuses on preventing a range of mental health outcomes, rather than targeting specific diagnoses.


The intervention is aimed at young people aged 11-14 (Years 7 –9) who show elevated risk of mental health problems. This age group represents a major developmental stage of both biological and psychological change, and coincides with a changing social environment – students transition from primary school to secondary school, which comes with larger class sizes, increased academic pressure, and, crucially, increasing dependence on peers over family.


In order to students who are suitable, we conduct a short wellbeing questionnaire, which is delivered to the entire year group. Those identified as having an elevated risk of mental health problems, based on scores on the Strength and Difficulties Questionnaire, are invited to participate.


The intervention consists of 8 weekly group sessions, run by a trained mental health professional. Eligible students meet over the course of one academic term and develop skills in regulating emotions and managing relationships, in groups of 8-10 students in the same year group.



How we used process evaluation to integrate ReSET into schools


Interviews with young people and school staff have provided unique insight into how to best integrate this project within the school day and have played a crucial role in the development of ReSET. 


We received feedback that the study could be time-consuming for staff, so we implemented measures to reduce the pressure on them. School staff noted that “the fact that external staff were coming in and delivering the intervention was really helpful, due to the lack of resources that we had within the school”.


Another insight was that the language used to describe school-based intervention is important, in terms of how it is received by parents and students alike. Based on feedback from young people and their parents, when we introduce the intervention, we are careful to highlight the groups as an opportunity to learn more about social-emotional skills, rather than describing it as a form of mental health support.


In conclusion, schools are not organized in the same way as mental health services, and teaching staff are not trained mental health professionals (nor should they be). Structural challenges of integrating mental wellbeing into schools such as finding confidential spaces to meet, and lack of equipment, resources, and time, have all been identified as barriers to implementing interventions in schools. Therefore, interventions must continue to adapt and be flexible to meet the needs of schools to be as effective as possible when supporting young people experiencing mental health problems. 

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