Multilevel Barriers and Facilitators to Sustainability of a Universal Trauma-Informed School-Based Mental Health Intervention Following an Efficacy Trial: A Qualitative Study

Arnold, K; Porter, Keshia M. Pollack; Frattaroli, Shannon; Durham, Rachel E.; Clary, Laura K.; Mendelson, Tamar

doi:10.1007/s12310-020-09402-w

Cited by 11 publications

(11 citation statements)

References 34 publications

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“…Turnover amongst individual teachers (who had received intervention training), programme coordinators, the senior leadership team of a school, and even a district created a considerable barrier to sustainability. This is consistent with the broader literature on sustaining programmes in schools, where staffing issues are noted as one of the major barriers to sustainment [ 48 , 49 , 50 ]. Similarly, commitment and prioritisation across all levels of staff was a facilitator to sustained delivery of the mental health and wellbeing programmes in this review.…”

Section: Discussionsupporting

confidence: 89%

“…However, there were some departures between the current review and those carried out previously. For instance, in both the Herlitz et al [ 19 ] review and a recent qualitative study [ 48 ], a lack of confidence in school staff to deliver health promotion was a barrier to sustainability which did not feature in the current review. In contrast, while the importance of training was noted in the current review, there was a greater emphasis on staff enjoying delivering the sessions and simply having the capacity to do so.…”

Section: Discussionmentioning

confidence: 93%

“…Similarly, commitment and prioritisation across all levels of staff was a facilitator to sustained delivery of the mental health and wellbeing programmes in this review. This maps onto findings that identify continued engagement at all stakeholder levels as crucial [ 48 , 50 , 51 ]. For interventions to be sustained in schools, maintained commitment and prioritisation are required at all levels of the school system.…”

Section: Discussionmentioning

confidence: 99%

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Barriers and Facilitators to Sustaining School-Based Mental Health and Wellbeing Interventions: A Systematic Review

Moore

Stapley

Hayes

et al. 2022

IJERPH

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Despite an increasing focus on schools to deliver support and education around mental health and wellbeing, interventions are often not sustained beyond initial funding and research. In this review, the barriers and facilitators to sustaining mental health and wellbeing interventions in schools are explored. A systematic review was conducted using keywords based on the terms: ‘sustainability’, ‘school’, ‘intervention’, ‘mental health’, and ’emotional wellbeing’. Six online databases (PsycINFO, Embase, MEDLINE, British Education Index, ERIC, and Web of Science) and relevant websites were searched resulting in 6160 unique references. After screening, 10 articles were included in the review and extracted data were qualitatively synthesized using thematic analysis. Data synthesis led to the identification of four sustainability factors at the school level (school leadership, staff engagement, intervention characteristics, and resources) and one at the wider system level (external support). These factors were separated into 15 themes and discussed as barriers and facilitators to sustainability (for example, school culture and staff turnover). Most articles included no definition of sustainability, and nearly all barriers and facilitators were discussed at the school level. The findings suggest that more longitudinal and theory-driven research is required to develop a clearer picture of the sustainability process.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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Barriers and Facilitators to Sustaining School-Based Mental Health and Wellbeing Interventions: A Systematic Review

Moore

Stapley

Hayes

et al. 2022

IJERPH

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“…Barriers to sustainability of the YAM implementation program under the existing delivery method included RRN staff turnover, logistical challenges ability to deliver the program due to the school calendar, and insu cient funding to sustain the program outside of the research context. These barriers are in line with prior research about the sustainability of school-based public health programs (Arnold et al, 2021;Herlitz et al, 2020). In fact, in a systematic review, no relationship was found between evidence of effectiveness and sustainability, while key sustainability indicators included commitment/support from senior leaders, staff observing a positive impact on students' engagement and wellbeing, and staff con dence in delivering health promotion and belief in its value (Herlitz et al, 2020).…”

Section: Discussionsupporting

confidence: 75%

Developing a School-Based Risk and Resilience Network to Implement the Youth Aware of Mental Health (YAM) Program with Texas Adolescents

Gutiérrez

Anderson

et al. 2021

Preprint

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BackgroundDespite the school setting presenting an ideal place to address youth depression and suicide prevention, there continues to be a need for innovative and effective school-based mental health interventions. MethodsThe University of Texas Southwestern Medical Center’s Center for Depression Research and Clinical Care developed a collaborative school-based prevention effort, the Risk and Resilience Network (RRN), to develop and test approaches to aid in enhancing resiliency factors, prevention of depression and suicide, and improve early identification and care linkage for youth with depression and/or suicidality. The aims of RRN were: 1) to build collaborative partnerships with schools and youth-focused community organizations to study risk and resilience in youth, and 2) in collaboration with school partners and youth-focused community organizations, to engage school stakeholders and families in developing and testing innovative strategies for addressing depression and suicide prevention in schools. To engage schools in the RRN, a cornerstone, evidenced-based program was selected (Youth Aware of Mental Health, YAM, program) to offer to schools as part of an implementation project. This report uses the RE-AIM framework to describe the rationale, design, implementation process, and YAM program evaluation results from the initial years of a school-based network focused on depression and suicide prevention.ResultsDescriptive data are presented, using the RE-AIM framework, on the first three academic years of the RRN and YAM program partnerships (2016-2017, 2017-2018, and 2018-2019), which included 24 RRN partnerships. Eleven (73.3%) out of the 15 school systems who agreed to RRN partnerships agreed to implement the YAM program, resulting in 14,061 students who participated in YAM.ConclusionsThe RRN is a collaborative school-based prevention effort to develop and test approaches to aid in enhancing resiliency factors, preventing of depression and suicide, and improving early identification and care linkage for youth with depression and/or suicidality. Trial Registration: Not applicable

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“…Schools are ideal settings for the implementation of universal prevention programs owing to a broad audience primed for learning (Yager et al, 2013). Nevertheless, current programs are often not practical for schools, requiring multiple, lengthy sessions with a trained provider (Arnold et al, 2021). Microinterventions are a promising alternative.…”

Section: Introductionmentioning

confidence: 99%

Feasibility and acceptability of video‐based microinterventions for eating disorder prevention among adolescents in secondary schools

Kristoffersen

Johnson

Atkinson

2022

Intl J Eating Disorders

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Objective Eating disorders (EDs) often emerge in late adolescence. Schools are ideal settings for prevention programs; however, cost and time limit implementation. Microinterventions may overcome these challenges. This study adapted two microinterventions (cognitive dissonance, self‐compassion) and assessed feasibility and acceptability among mid‐adolescents to provide proof‐of‐concept for further investigation. Method Feedback from staff (n = 5) and student (n = 15) focus groups contributed iteratively to the adaptation of intervention materials. Students in Grade 10 and 11 (N = 101, Mage = 15.80, SD = 0.68) were then randomly allocated by class to a 20‐min video‐based cognitive‐dissonance or self‐compassion intervention, accessed on their school devices. ED risk and protective factors were assessed at baseline, immediate postintervention (state outcomes), and 1‐week follow‐up (trait outcomes). Acceptability items were included at both timepoints. Results Implementation was deemed feasible. Girls generally reported greater acceptability than boys. Among girls, the self‐compassion intervention demonstrated greater acceptability. Among boys, some aspects of acceptability (e.g., lesson endorsement, utilization of techniques) were rated higher in the cognitive dissonance group whereas other aspects (e.g., understanding, interest) were greater in the self‐compassion group. All groups exhibited favorable changes in most state outcomes, however trait outcome change was varied. Discussion Microinterventions provide a feasible way of implementing prevention strategies in a time‐poor educational context. Future large‐scale evaluation is warranted to determine efficacy, following modifications based on current findings. Public Significance This study shows promising feasibility and acceptability of two brief, self‐guided video‐based lessons (microinterventions) for adolescents in school classrooms, that use psychological techniques to target appearance pressures as a key risk factor for eating disorders. Such interventions are easier to implement in school settings than longer, facilitator‐led interventions, to encourage greater uptake and ongoing use. Findings support further research to evaluate effectiveness, to ultimately provide accessible and gender‐inclusive tools for busy schools.

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Multilevel Barriers and Facilitators to Sustainability of a Universal Trauma-Informed School-Based Mental Health Intervention Following an Efficacy Trial: A Qualitative Study

Cited by 11 publications

References 34 publications

Barriers and Facilitators to Sustaining School-Based Mental Health and Wellbeing Interventions: A Systematic Review

Barriers and Facilitators to Sustaining School-Based Mental Health and Wellbeing Interventions: A Systematic Review

Developing a School-Based Risk and Resilience Network to Implement the Youth Aware of Mental Health (YAM) Program with Texas Adolescents

Feasibility and acceptability of video‐based microinterventions for eating disorder prevention among adolescents in secondary schools

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