ArticlePDF Available

Evaluating the Peer Education Project in secondary schools

Authors:
Article

Evaluating the Peer Education Project in secondary schools

Abstract

Purpose The purpose of this paper is to determine the efficacy of the Peer Education Project (PEP), a school-based, peer-led intervention designed to support secondary school students to develop the skills and knowledge they need to safeguard their mental health and that of their peers. Design/methodology/approach Six schools from across England and the Channel Islands took part in an evaluation of the PEP across the 2016/2017 academic year. In total, 45 trained peer educators from the sixth form and 455 Year 7 students completed pre- and post-questionnaires assessing their emotional and behavioural difficulties, perceived school climate, and knowledge, skills and confidence related to mental health. Findings Results indicate that participation in the PEP is associated with significant improvement in key skills among both peer educators and student trainees, and in understanding of key terms and readiness to support others among trainees. Most students would recommend participation in the programme to other students. Originality/value While peer education has been found to be effective in some areas of health promotion, research on the effectiveness of peer-led mental health education programmes in schools is limited. This study contributes evidence around the efficacy of a new peer education programme that can be implemented in secondary schools.
Journal of Public Mental Health
Evaluating the Peer Education Project in Secondary Schools
Journal:
Journal of Public Mental Health
Manuscript ID
JPMH-07-2018-0048.R1
Manuscript Type:
Original Research Paper
Keywords:
Peer education, Peer support, Mental health, Intervention, Secondary
school, Health promotion
Journal of Public Mental Health
Journal of Public Mental Health
1
Title: Evaluating the Peer Education Project in Secondary Schools
Page 1 of 17 Journal of Public Mental Health
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
Journal of Public Mental Health
2
Abstract:
Purpose: This study aims to determine the efficacy of the Peer Education Project (PEP), a
school-based, peer-led intervention designed to support secondary school students to develop
the skills and knowledge they need to safeguard their mental health and that of their peers.
Methodology: Six schools from across England and the Channel Islands took part in an
evaluation of the PEP across the 2016/2017 academic year. 45 trained peer educators from the
sixth form and 455 year 7 students completed pre- and post-questionnaires assessing their
emotional and behavioural difficulties, perceived school climate, and knowledge, skills and
confidence related to mental health. Findings: Results indicate that participation in the PEP is
associated with significant improvement in key skills among both peer educators and student
trainees, and in understanding of key terms and readiness to support others among trainees.
Most students would recommend participation in the programme to other students.
Originality/value: While peer education has been found to be effective in some areas of health
promotion, research on the effectiveness of peer-led mental health education programmes in
schools is limited. This study contributes evidence around the efficacy of a new peer education
programme that can be implemented in secondary schools.
Keywords:
Peer education
Peer support
Mental health
Intervention
Secondary school
Health promotion
Page 2 of 17Journal of Public Mental Health
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
Journal of Public Mental Health
3
Introduction
Schools are increasingly recognised as key to addressing the high prevalence of mental health
difficulties among young people (Department of Health & Department for Education, 2017),
particularly through whole-school, preventative approaches that aim to build resiliency and
promote wellbeing among all students (Department of Health & NHS England, 2015; Kelly,
Jorm & Wright, 2007). Mental health education programmes have been trialled in schools to
improve mental health awareness and literacy and reduce stigma (e.g. Patalay et al., 2017;
Chisholm et al. 2016; Milin et al., 2016). These programmes are mostly led by teachers or
professionals, but research suggests that peer-led programmes may better engage young people
and improve outcomes (Patalay et al., 2017).
Peer-led health education can be defined as “the teaching or sharing of health information,
values, and behaviours by members of similar age or status” (Sciacca, 1987, cited in Milburn,
1995, p. 407). Research has shown it to be effective for young people in other areas of health
promotion (Abdi & Simbar, 2013; Stephenson et al. 2008; Harden, Oakley, & Weston, 1999),
though some evidence questions its effectiveness (Tolli, 2012). Studies across programmes and
populations tend to show positive outcomes such as increased self-efficacy, self-management,
quality of life and well-being in addition to improved access to services and cost-saving
benefits (Cupples et al., 2011; Webel et al., 2010). Evidence suggests being a peer educator
(the individual delivering education to their peers) may increase self-esteem and improve social
skills (Webel et al., 2010). However, there is limited research on peer-led initiatives around
mental health in schools (Patalay et al., 2017). This evaluation was designed to test the
effectiveness of peer education for universal, preventative mental health information through
the Peer Education Project (PEP).
Page 3 of 17 Journal of Public Mental Health
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
Journal of Public Mental Health
4
PEP is a school-based, peer-led programme developed by the Mental Health Foundation
(MHF) aimed at supporting young people develop the skills and knowledge needed to
safeguard their mental health, and that of their peers (Mental Health Foundation, 2017).
Overview of the Peer Education Project
PEP was developed in coproduction sessions with students from target years (Years 7 and 12)
and based on a literature review of mental health education for school aged children to form a
five-session PEP syllabus, covering Mental Health Awareness; Myths, Facts and Stigma;
Staying Well; Getting Help; Helping Others. The syllabus was tested in a mixed methods
feasibility study and qualitative feedback was used to refine the syllabus.
PEP first trains peer educators to deliver the syllabus. Peer educators were selected based on
project specified suitability criteria from the school’s sixth form. Their training was delivered
over two days by the PEP staff team drawn from the Mental Health Foundation and partner
organisations. Peer educators delivered the education sessions in pairs and received a handbook
outlining the key content of the project, information about how to deliver an effective lesson,
and lesson plans for the five sessions. The first part of the training was trainer-led, introducing
students to the key concepts of the project; and the second part of the training was student led,
as trainee peer educators prepared for and delivered practice lessons from the syllabus to fellow
trainees. Working in pairs, the peer educators were then supported by school staff to deliver
the five sessions to Year 7.
In the five 40-minute lessons, the Year 7 students received workbooks to accompany the project
with structured worksheets to support lesson plans, as well as additional information about
mental health.
Aim
Page 4 of 17Journal of Public Mental Health
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
Journal of Public Mental Health
5
The aim of the evaluation was to assess the impact of PEP on peer educators and student
trainees on: student emotional and behavioural difficulties; perception of school climate;
confidence to talk about mental health; knowledge of available information and resources;
readiness to support others; knowledge of key terms related to mental health; and confidence
in key skills related to management of mental health.
The study also aimed to assess students’ experiences of the programme: its relevance,
usefulness, and acceptability.
Methods
The evaluation used a pre-post design. Students completed pre-questionnaires prior to
participating in PEP: for peer educators, before they received training from MHF; for student
trainees, before the first peer-led session. All completed post-questionnaires following the final
session delivered. The majority of students completed paper questionnaires; Ppeer educators
from two schools (n=25) completed questionnaires online; all remaining students completed
paper questionnaires..
Ethics
The evaluation was approved by the UCL research ethics board (Project 6087/004). Informed
consent was obtained from all participants aged 16 or over, and from parents or guardians for
all individual participants under 16.
Measures
Emotional and behavioural difficulties
Emotional and behavioural difficulties were assessed using the Me & My School Questionnaire
(M&MS; Deighton et al., 2013). The measure has good content and construct validity and
internal reliability, is consistent with other commonly used child-reported mental health
Page 5 of 17 Journal of Public Mental Health
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
Journal of Public Mental Health
6
measures and can differentiate clinical and community samples (Patalay et al., 2014; Deighton
et al., 2013). 16 items are rated on a three-point scale from 0 (never) to 2 (always) and totalled
into behavioural and emotional difficulties subscales. Scores of 6 points and above indicate
problems on the emotional difficulties subscale; scores of 10 points and above indicate
problems on the behavioural difficulties subscale
School climate
The School Climate Survey (SCS) assesses the perceived quality of relationships and support
within schools. Seven items are rated on a three-point scale from 0 (never) to 2 (always). The
measure has strong internal consistency (Wolpert et al., 2011).
Bespoke items
Questionnaires included 17 additional items from a previous evaluation of a mental health pilot
in schools (Mental Health Foundation, 2018). Items were grouped to create total scores for five
subscales based on their content: key skills; key terms; confidence to talk about mental health;
knowledge of information and resources; readiness to support others.
Items related to key terms and key skills were rated 0 (no) or 1 (yes), or ‘Don’t Know’. Total
scores were the sum of ‘yes’ answers for each subscale, ranging from 0 to 4 for key terms and
key skills respectively.
The remaining items were rated on a five-point scale from 4 (strongly agree) to 0 (strongly
disagree), or ‘Don’t Know’ (recoded to missing). Total possible scores for confidence to talk
about mental health ranged from 0-8; for knowledge of information and resources, from 0-12;
and for readiness to support others, from 0 to 16.
Average inter-item correlations were calculated to assess reliability, and ranged from 0.23 to
0.42, within the acceptable range of 0.20 to 0.40 (Briggs & Cheek, 1986).
Page 6 of 17Journal of Public Mental Health
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
Journal of Public Mental Health
7
For consistency across measures, there was no pro-rating for missing items.
Measures containing three point scales were used where their use was either supported by
published data (M&MS and SCS) or where they were seen as appropriate to capture knowledge
and skills in the bespoke items.
Feedback
In post-questionnaires, peer educators and student trainees were asked about the relevance of
topics covered in sessions, and whether they would recommend them to other students. Student
trainees were also asked if they would use their learning and if they found it helpful to be taught
by peer educators.
Analytic Strategy
Student responses on pre- and post-questionnaires were matched based on the month of their
birthday, and the first three letters of their mother’s first name. Only those students who
returned questionnaires at both time points were included in analyses (‘paired cases’).
To assess change in subscale scores from pre to post intervention, we used non-parametric
Wilcoxon Signed Rank tests, as data showed a high degree of skewness. A Bonferroni adjusted
p-value of p < 0.006 was applied to all pre-post significance tests. To assess the practical
implications of observed differences, a variation on Cohen’s d effect size was calculated for
pre-post difference in average scores (Becker, 1988). Interpretations of these effect sizes
followed the general rule of thumb for Cohen’s d (Cohen, 1988).
Further subgroup analysis was conducted on the M&MS measure (the only measure for which
clinical thresholds are available) for those young people scoring above threshold for emotional
or behavioural difficulties pre-intervention, to assess the proportion who reported scores below
threshold post-intervention, reflecting “recovery” or “clinically meaningful change” as
Page 7 of 17 Journal of Public Mental Health
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
Journal of Public Mental Health
8
assessed in similar analysis of routinely collected child mental health data (Wolpert et al.,
2016). Due to small sample sizes, peer educator and student trainee data was combined for this
analysis.
Sample
Seven schools implementing PEP in the 2016/2017 academic year agreed to take part in the
evaluation. Six schools were based in London and South-East England and one in the Channel
Islands. Four of the participating schools were single-gender (one all-male, three all-female).
950 students (84 peer educators, 866 student trainees) returned a questionnaire at either pre- or
post-intervention (including 11 peer educators and 143 student trainees from one school that
only completed post- questionnaires). 54% (n = 45) of peer educators and 53% (n = 455) of
student trainees returning questionnaires returned both pre- and post-questionnaires (‘paired
cases’).
Of students with paired data, 42% (192/455) of student trainees and 13% (6/45) of peer
educators were of black and minority ethnic origins, compared to 29% of students in state-
funded secondary schools in England (Department for Education, 2017a).
Compared to national statistics, the paired sample contained a smaller proportion of students
with special educational needs (SEN) (5%, 24/500 of peer educators and student trainers
reported a learning difficulty, compared to 14% with SEN nationally; Department for
Education, 2017b). The paired and unpaired samples did not vary significantly in terms of
learning difficulties.
Results
Online responses were not discernibly different from pen and paper responses.
Pre-post analysis
Page 8 of 17Journal of Public Mental Health
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
Journal of Public Mental Health
9
Results of pre-post significance testing are presented in Table 1. When comparing mean pre-
and post-scores for each subscale, peer educators reported significant improvements of a
medium effect size on the ‘key skills’ scale (p < 0.001, d = 0.55). There was no significant
difference in peer educators’ scores at the two time points on any other scale.
Trainees reported significant improvements of a moderate to large effect size on ‘key terms’ (p
< 0.001, d = 0.79), and significant improvements of a small effect size on ‘key skills’ (p <
0.001, d = 0.30) and ‘readiness to support others’ (p < 0.001, d = 0.23). Significant
improvements on the emotional difficulties subscale of the M&MS were also reported,
however, the effect size was negligible (p = 0.005, d = 0.09). A significant worsening of school
climate, with a small effect size, was also reported (p < 0.001, d = 0.21). There were no
significant differences reported by student trainees on any other scale.
[TABLE 1 HERE]
Subgroup analysis
Table 2 shows results of subgroup analyses. Of those students with complete M&MS emotional
or behavioural difficulties subscales pre- and post- intervention, at the first time point 18%
(77/426) were above threshold for emotional difficulties, and 9% (40/443) were above
threshold for behavioural difficulties (peer educator and student trainee data was combined
here due to small sample sizes).
Among students who were above threshold pre-intervention, 38% (29/77) of those with
emotional difficulties, and 40% (16/40) of those with behavioural difficulties were scoring in
the “normal” range post-intervention.
[TABLE 2 HERE]
Feedback
Page 9 of 17 Journal of Public Mental Health
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
Journal of Public Mental Health
10
Table 3 shows students’ responses to feedback questions. 27% of peer educators in the paired
sample felt the training content was ‘very relevant’ and 56% felt it was ‘somewhat relevant’.
18% of student trainees felt the Peer Education lessons were ‘very relevant’ and 61% felt they
were ‘somewhat relevant’.
Of students in the paired sample 69% of peer educators and 46% of student trainees would
‘definitely’ the programme to peers. 27% of peer educators and 42% of student trainees would
‘maybe’ recommend peers participate. Only 2% of peer educators and 9% of student trainees
would not recommend this.
When asked if they would use what they learned in the next 3 months, 22% of student trainees
responded ‘yes, definitely’ and 62% responded ‘maybe/yes a bit’. 14% did not think they would
use what they learned.
60% of student trainees felt it was helpful to learn from peer educators instead of their usual
teacher and 30% felt it did not make a difference. 6% felt it was not helpful.
[TABLE 3 HERE]
Discussion
This paper reports on an independent evaluation of a novel mental health promotion
intervention, delivered by students in a school setting. Most students reported positive feedback
on the training and would recommend it to. Most student trainees found it useful to learn from
a peer educator compared to a normal teacher and found the programme content relevant to
some extent.
Results showed significant changes in student-reported key skills for both peer educators and
student trainees, and in understanding of key terms and readiness to support others for student
Page 10 of 17Journal of Public Mental Health
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
Journal of Public Mental Health
11
trainees. This suggests the programme content may be meeting a learning need in these areas,
perhaps reflecting its focus on increasing awareness around mental health and wellbeing and
promoting protective behaviours. The high initial proportion of students with scores indicating
a strong level of confidence to talk about mental health and knowledge of information and
resources may have contributed to the lack of significant change over time in these areas.
In terms of emotional and behavioural difficulties, the evidence did not suggest significant and
practically meaningful change. This is not surprising: PEP is not intended to be a therapeutic
intervention, and the school sample had low initial difficulties. More tentatively, the
intervention might also lead to an increase in reporting, potentially ‘cancelling out’ reduced
difficulties among some students. Of the small proportion of students who were above clinical
threshold pre-intervention, around 40% reported clinically meaningful improvement (moved
below threshold; Wolpert et al., 2016), consistent with a recent systematic review of mental
health promotion interventions (O’Connor et al., 2017).
The programme produced some of its highest knowledge benefits on the topics of stigma and
discrimination. This is a promising finding, contributing to the emerging evidence base
suggesting that mental health literacy and universal promotion and awareness programmes in
schools seem to be more effective than anti-stigma education (Mental Health Foundation,
2018). Normalising mental health and increasing general literacy might make a bigger
difference than targeting stigma.
Limitations
The main limitation of our research is that it is not possible to make inferences of causality due
to the non-randomised pre-post study design. Only around half of students who participated in
the evaluation completed questionnaires before and after participating in the project, meaning
reported differences may not be representative of all students who took part in the programme
Page 11 of 17 Journal of Public Mental Health
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
Journal of Public Mental Health
12
or the evaluation. Implementation of the Pprogramme implementation varied across schools –
this was deemed essential to enable the feasibility, given variable schedules and limited
capacity of the schools. Students reported low levels of emotional and behavioural difficulties,
and endorsed high levels of knowledge, confidence, and skills in several areas prior to
participating in project sessions, so ceiling and floor effects may have limited the amount of
change detected.
Implications
The findings of this evaluation suggest that PEP is a promising intervention. A more extensive
roll-out and evaluation of the project, with a more demographically diverse group of
participating schools, would improve the evidence of effectiveness. This is supported by
previous research on universal school mental health promotion programmes which showed that
they can be effective, especially when they are not brief and are implemented continuously for
more than a year (Wells J et al., 2003).
This evaluation adds to the evidence that peer-delivery may be an effective vehicle for public
mental health messages. The findings also suggest that introductory lessons on mental health
and wellbeing improve knowledge and attitudes amongst Year 7 pupils and contribute to
reducing stigma among pre-adolescents. Mental health education, whether peer-delivered or
not, could therefore form a useful component of a preventative approach to mental health in
schools.
Page 12 of 17Journal of Public Mental Health
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
Journal of Public Mental Health
13
References
Abdi, F., & Simbar, M. (2013). The peer education approach in adolescents – narrative
review article. Iranian Journal of Public Health, 42(1), pp. 1200-1206.
Becker, B.J. (1988). Synthesizing standardized mean-change measures. British Journal of
Mathematical and Statistical Psychology, 41(1), p. 257-278
Briggs, S.R., & Cheek, J.M. (1986). The role of factor analysis in the evaluation of
personality scales. Journal of Personality, 54, pp. 106-148.
Chisholm, K., Patterson, P., Torgerson, C., Turner, E., Jenkinson, D., & Birchwood, M.
(2016). Impact of contact on adolescents’ mental health literacy and stigma: The
SchoolSpace cluster randomised controlled trial. British Medical Journal Open, 6(2).
Cohen, J. (1988). Statistical Power Analysis for the Behavioural Sciences, 2nd ed. Hillsdale,
N.J.: Lawrence Erlbaum.
Cupples, M.E., Stewart, M.C., Percy, A., Hepper, P., Murphy, C., & Halliday, H.L. (2011). A
RCT of peer-mentoring for first-time mothers in socially disadvantaged areas (The
MOMENTS Study). Archives of Disease in Childhood, 96(3), pp. 252-258.
Deighton, J., Tymms, P., Vostanis, P., Belsky, J., Fonagy, P., Brown, A., Martin, M., Patalay,
P., & Wolpert, M. (2013). The development of a school-based measure of child
mental health. Journal of Psychoeducational Assessment, 31(3), pp. 247-257.
Department for Education, (2017a). Schools, pupils and their characteristics: January 2017.
SFR 28/2017. London, England.
Department for Education (2017b). Special educational needs in England: January 2017.
SFR 37/2017. London, England.
Department of Health and Department for Education (2017). Transforming Children and
Young People’s Mental Health Provision: a Green Paper: December 2017. CM 9523.
London, England.
Department of Health and NHS England (2015). Future in Mind: promoting, protecting and
improving our children and young people’s mental health and wellbeing. NHS
England Publication Gateway Ref No 02939. London, England.
Harden, A., Oakley, A., & Weston, R. (1999). A review of the effectiveness and
appropriateness of peer-delivered health promotion for young people. EPPI-Centre,
Social Science Research Unit, Institute of Education, University of London.
Available: http://eppi.ioe.ac.uk/cms/LinkClick.aspx?fileticket=bCmFZQRwu-
o%3d&tabid=255&mid=1071 [Accessed 12th February 2018].
Kelly, C., Jorm, A., & Wright, A. (2007). Improving mental health literacy as a strategy to
facilitate early intervention for mental disorders. The Medical Journal of Australia,
187(7 Suppl), pp. 26-30.
Mental Health Foundation. (2017) Peer Education Project (PEP). Available:
https://www.mentalhealth.org.uk/projects/peer-education-project-pep [Accessed 12th
February 2018].
Page 13 of 17 Journal of Public Mental Health
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
Journal of Public Mental Health
14
Mental Health Foundation. (2018) See Me: Evaluation of process and impact (Phase 2 – year
1). Glasgow.
Milburn, K. (1995). A critical review of peer education with young people with special
reference to sexual health. Health Education Research, 10(4), pp. 407-420.
Milin, R., Kutcher, S., Lewis, S.P., Walker, S., Wei, Y., Ferrill, N., Armstrong, M. (2016).
Impact of a Mental Health Curriculum on Knowledge and Stigma Among High
School Students: A Randomized Controlled Trial. Journal of the American Academy
of Child & Adolescent Psychiatry, 55(5), pp. 383-391.
NVivo qualitative data analysis Software. (2012). Version 10. QSR International Pty Ltd.
O’Connor, C.A., Dyson, J., Cowdell, F., & Watson, R. (2017). Do universal schoolbased
mental health promotion programmes improve the mental health and emotional
wellbeing of young people? A literature review. Journal of Clinical Nursing, 27(3-4),
pp. e412-426.
Patalay, P., Annis, J., Sharpe, H., Newman, R., Main, D., Ragunathan, T., Parkes, M. and
Clarke, K. (2017). A Pre-Post Evaluation of OpenMinds: a Sustainable, Peer-Led
Mental Health Literacy Programme in Universities and Secondary Schools.
Prevention Science, 18(8), pp.995-1005.
Patalay, P., Deighton, J., Fonagy, P., Vostanis, P., & Wolpert, M. (2014). Clinical validity of
the Me and My School questionnaire: A self-report measure for children and
adolescents. Child and Adolescent Psychiatry and Mental Health, 8(1), pp. 1-7.
Sciacca, J.P. (1987). Student peer health education: a powerful yet inexpensive helping
strategy. The Peer Facilitator Quarterly, 5, pp. 4–6.
Stephenson, J., Strange, V., Allen, E., Copas, A., Johnson, A., Bonell, C., Babiker, A.,
Oakley, A., the RIPPLE Study Team. (2008). The long-term effects of a peer-led sex
education programme (RIPPLE): A cluster randomised trial in schools in England.
PLoS Med 5(11), e224.
Tolli, M.V. (2012). Effectiveness of peer education interventions for HIV prevention,
adolescent pregnancy prevention and sexual health promotion for young people: a
systematic review of European studies. Health Education Research, 27(5), pp. 904-
913.
Webel, A.R., Okonsky, J., Trompeta, J., & Holzemer, W. (2010). A systematic review of the
effectiveness of peer-based interventions on health-related behaviours in adults.
American Journal of Public Health, 100(2), pp. 247-253.
Wells, J., Barlow, J., & Stewart-Brown, S. (2003). A systematic review of universal
approaches to mental health promotion in schools. Health Education, 103(4), pp. 197-
220.
Wolpert, M., Deighton, J., Patalay, P., Martin, A., Fitzgerald-Yau, N., Demir, E. &
Frederikson, N. (2011). Me and My School: Findings from the National Evaluation of
Targeted Mental Health in Schools 2008-2011. Nottingham: Department for
Education.
Page 14 of 17Journal of Public Mental Health
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
Journal of Public Mental Health
15
Wolpert, M., Jacob, J., Napoleone, E., Whale, A., Calderon, A., & Edbrooke-Childs, J.
(2016). Child-and parent- reported outcomes and experience from child and young
people’s mental health services 2011-2015. London: Child Outcomes Research
Consortium.
Page 15 of 17 Journal of Public Mental Health
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
Journal of Public Mental Health
Table
1
.
Comparison of mean pre and post scores for peer educators and student trainees
Peer educators Student trainees
Pre
Mean
(SD)
Post
Mean
(SD)
P Effect
Size
Pre
Mean
(SD)
Post
Mean
(SD)
P Effect
Size
Key Terms 3.6 3.8 0.04 0.35 2.4 3.2 <0.001*
0.79
Key Skills 3.1 3.7 <0.001*
0.55 2.7 3.1 <0.001*
0.30
Confidence to Talk about
Mental Health
6.3 6.7 0.08 0.26 5.7 6.0 0.03 0.11
Knowledge of Information
and Resources
9.2 10.1 0.02 0.41 9.6 10.0 0.07 0.13
Readiness to Help Others 13.5 13.4 0.80 0.05 12.9 13.5 <0.001*
0.23
Emotional Difficulties
6.3
6
0.24
0.07
6
5.7
0.005*
0.09
Behavioural Difficulties 1.8 2 0.65 0.17 2.7 2.6 0.10 0.05
School Climate 9.3 9.1 0.50 0.08 9.3 8.8 <0.001*
0.21
*indicates significance at Bonferroni adjusted level of p < .006
Table 2. Proportion of students scoring above threshold on Emotional and Behavioural difficulties
subscales (Me & My School Questionnaire) pre-intervention and distribution post-intervention
Valid N N above
threshold pre-
intervention (%
of total)
N Remained
above threshold
post-
intervention
(% of students
above threshold
pre-
intervention)
N Moved
below threshold
post-
intervention (%
of students
above threshold
pre-
intervention)
Emotional difficulties 426 77 (18%) 48 (62%) 29 (38%)
Behavioural difficulties 443 40 (8%) 24 (60%) 16 (40%)
Page 16 of 17Journal of Public Mental Health
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
Journal of Public Mental Health
Table 3
.
Feedback on the programme
peer educator and student trainee responses
N %
(1) Yes, very
relevant
(2,3) Yes,
definitely
(4) Yes, very
helpful
%
(1) Yes, a bit
relevant /
somewhat
relevant
(2) Maybe
(3) Maybe/Yes
a bit
(4) It did not
make a
difference
%
(1) No, not
relevant at
all
(2,3) No
(4) No, not
helpful
Peer educators
1 Did you find the topics covered by
the training relevant to you?
44 27% 56% 16%
2 Would you recommend that other
Year 12 students take part in
the Peer
Education project in the future?
44 69% 27% 2%
Student trainees
1
Did you find the topics covered in
the Peer Education lessons relevant
to you?
441
18
%
61
%
18
%
2 Would you recommend that other
Year 7 students take part in the Peer
Education lessons in the future?
442 46% 42% 9%
3
Do you think you will use what you
have learned in this training in the
next 3 months?
444
22
%
62
%
14
%
4 Was it helpful to learn from peer
educators instead of your usual
teacher?
436 60% 30% 6%
Page 17 of 17 Journal of Public Mental Health
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
... Despite the extensive literature on peer support programs for individuals with serious mental illness, few studies have investigated peer support programs for mental health promotion in colleges and vocational schools. Most studies on school-based mental health peer support were conducted in secondary or high schools [1,13,15,20,21,38,41] and one was conducted in a veterinary school [40]. Out of the four studies found that were conducted among college students, two had small sample sizes of 20 to 30 peer supporters [2,4], one collected only qualitative data [4], and two did not collect any primary data [22,42]. ...
... Peer support training also had positive impacts on general communication skills [40,41] and specific empathetic and reflection skills [2,9,28]. Peer supporters had also reported self-development [40], increased confidence in supporting peers [15,20], decreased nervousness and increased self-awareness [1]. A longitudinal study on secondary school peer supporters' pre-and post-peer program participation found significant improvement in peer support skills and understanding [15], which corroborates the results from our study. ...
... Peer supporters had also reported self-development [40], increased confidence in supporting peers [15,20], decreased nervousness and increased self-awareness [1]. A longitudinal study on secondary school peer supporters' pre-and post-peer program participation found significant improvement in peer support skills and understanding [15], which corroborates the results from our study. These findings suggest that school-based programs that involve young adults in mental health training and supporting their peers could be an effective way to increase young adults' perceived mental health literacy and skills to cope with their own and their peers' mental health issues. ...
Article
Full-text available
Background A nation-wide mental health peer support initiative was established in college and vocational schools in Singapore. The purpose of this cross-sectional study was to develop and validate a 20-item self-report instrument, the Mental Health Peer Support Questionnaire (MHPSQ), to assess young adults’ perceived knowledge and skills in mental health peer support. Methods We administered the questionnaire to 102 students who were trained as peer supporters, and 306 students who were not trained as peer supporters (denoted as non-peer supporters ), in five college and vocational schools. Exploratory factor analysis and descriptive statistics were conducted. Cronbach’s α was used to assess reliability, and independent sample t-tests to assess criterion validity. Results Exploratory factor analysis indicated a three-factor structure with adequate internal reliability (discerning stigma [α = .76], personal mastery [α = .77], skills in handling challenging interpersonal situations [α = .74]; overall scale [α = .74]). Consistent with establishing criterion validity, peer supporters rated themselves as significantly more knowledgeable and skilled than non-peer supporters on all items except two: (1) letting peer support recipients make their own mental health decisions, and (2) young adults’ self-awareness of feeling overwhelmed. Peer supporters who had served the role for a longer period of time had significantly higher perceived awareness of stigma affecting mental health help-seeking. Peer supporters who had reached out to more peer support recipients reported significantly higher perceived skills in handling challenging interpersonal situations, particularly in encouraging professional help-seeking and identifying warning signs of suicide. Conclusions The MHPSQ may be a useful tool for obtaining a baseline assessment of young adults’ perceived knowledge and skills in mental health peer support, prior to them being trained as peer supporters. This could facilitate tailoring of training programs based on young adults’ initial understanding of mental health peer support. Subsequent to young adults’ training and application of skills, the MHPSQ could also be applied to evaluate the effectiveness of peer programs and mental health training.
... Contact with experts as part of the scoping review process to identify studies missed by search strategy and to identify grey literature, and discussions with experts during interviews and coproduction workshops (see Section 4) identified 62 grey literature resources. In total, 7 completed studies [28][29][30][31][32][33][34] undertaken in the UK between 2015 and June 2020 fulfilled the review criteria. ...
... One in process study was identified from contact with experts [39]. A summary of the 7 completed peer-reviewed studies [28][29][30][31][32][33][34] and the 5 in process studies [35][36][37][38][39] are presented in Tables 1 and 2 respectively. Due to the small number of completed studies identified by the scoping review and heterogeneity in their designs and delivery methods, the planned assessment of active ingredients (e.g. ...
... Uncontrolled before and after studies were undertaken to evaluate OpenMinds [30], Peer ...
Technical Report
Full-text available
We conducted a scoping literature review and in-depth qualitative work with Trailblazer Programme and Public Health England staff, school staff (Special Educational Needs Co-ordinators and student support/pastoral teams working in a range of school settings) and charitable organisations with expertise and lived experience of involvement in anti-stigma campaigns/mental health awareness activities across the North East and North Cumbria. This work underpinned the development of an evidence-based framework to inform the development/enhancement and evaluation of WSAs to mental health awareness raising and anti-stigma campaigns.
... Contact with experts as part of the scoping review process to identify studies missed by search strategy and to identify grey literature, and discussions with experts during interviews and coproduction workshops (see Section 4) identified 62 grey literature resources. In total, 7 completed studies [28][29][30][31][32][33][34] undertaken in the UK between 2015 and June 2020 fulfilled the review criteria. ...
... One in process study was identified from contact with experts [39]. A summary of the 7 completed peer-reviewed studies [28][29][30][31][32][33][34] and the 5 in process studies [35][36][37][38][39] are presented in Tables 1 and 2 respectively. Due to the small number of completed studies identified by the scoping review and heterogeneity in their designs and delivery methods, the planned assessment of active ingredients (e.g. ...
... Uncontrolled before and after studies were undertaken to evaluate OpenMinds [30], Peer ...
Preprint
EXECUTIVE SUMMARY In England, it is estimated that 1 in 8 young people (13%) aged between 5 and 19 years are living with a diagnosable mental health disorder, which typically persists into adulthood. The Green Paper (2017) on Transforming Children and Young People’s Mental Health Provision focused on piloting early intervention and prevention approaches in the context of schools and colleges. A key aspect of this preventative approach is the rollout of the ‘Trailblazer’ programme which, by taking a ‘whole school approach’ (WSA) to mental health, embeds clinicians into schools and colleges to improve mental health awareness and treatment of mild to moderate mental health disorders, including providing help to school staff, signposting and delivery of focused evidence-based interventions. Supported by the NHS England’s Northern England Clinical Networks (NECN), there are currently five Trailblazer sites funded across the North East and North Cumbria, with successive annual waves expected. To support the North East Trailblazer sites, NECN commissioned this research to produce an accessible resource for localities to develop and/or enhance and evaluate their mental health awareness raising and anti-stigma campaigns. To achieve this aim, we engaged staff from localities and the clinical networks in a co-production process with the following objectives: • Conduct a scoping literature review to identify components of effective mental health awareness raising and anti-stigma campaigns in schools, including methods that localities can use to evaluate their campaigns • Informed by the findings of the scoping review, to co-produce (using one-to-one interviews, co-production meetings and interactive group workshops) the mode, form and information content of an accessible resource informed by the lived experience and expertise of staff from localities and NECN The scoping review identified seven completed and five in-process studies of UK-based schoolwide interventions targeting children and young people published from 2015 to June 2020. Mental health literacy interventions utilising a range of structured educational interventions demonstrated positive results. Empathy-based approaches and interventions capitalising on peer support also appear to have promise. Interventions primarily focused on children and omitted other members of the staff school community, including parents/guardians and stakeholders from the wider community. Critically, the scoping review identified a lack of studies evaluating the impact on behaviour (at the school level) and school culture. The findings of the scoping review informed in-depth qualitative work that engaged 27 people in semi-structured interviews or interactive group workshops, with representation from all three localities (Newcastle and Gateshead; South Tyneside; and Northumberland). Guided by the analytical heuristic of micro, meso and macrosystem levels of analysis, qualitative data demonstrated a pressing need for top-down guidance, support and incentives from the Government to embed mental health and well-being as a core business activity of compulsory and further education. Mental health provision was often viewed as a ‘luxury’ with traditional academic attainment prioritised in schools. Bottom-up learning to inform campaigns where lived experiences of teachers, parents and children/young people need to be heard and valued was also identified as a core theme. The ‘recovery curriculum’ (in response to the COVID-19 pandemic) was considered to be an opportunity for the Government to learn about what schools have been doing to address mental health and well-being as part of the core business of schools. A WSA embedded with an over-arching whole community approach (WCA) was proposed by participants, where everyday mental health and well-being practices are embedded into communities and schools as the business of all stakeholders such as schools, public and private organisations, including voluntary services, parents/guardians and children/young people. This would necessitate buy-in and involvement from all community stakeholders, with everyone adopting the same practices and talking the same “language” about mental health and well-being, and critically taking responsibility for funding, implementation, monitoring and evaluation of a WCA. Further, the concept of a trauma-informed approach, use of the restorative related practice, and shifting practices to an empathy-based approach were considered optimal for addressing existing and preventing trauma-related conditions and adverse childhood experience in both children and staff. Finally, participants emphasised that a positive mental health and well-being culture in a WSA could in part be achieved by introducing relatively simple environmental changes at a little financial cost, for example, a “buddy bus stop” system in the schoolyard at breaktimes. Scoping review and qualitative findings, along with expert recommendations on resources and evaluation strategies informed the development of an accessible resource, broken down into four parts to inform campaign design and evaluation. Part 1 of the resource describes its structure and content, including how this resource is complimentary, and distinctive, from existing guides on WSAs to mental health and well-being. Part 2 focuses on the rationale for, and components of, a WSA as described by our participants, focusing primarily on the value of adopting a trauma-informed approach. Part 3 focuses on the organisation, mode, form and content of campaigns. The value and principles of co-production and the need for diversity and involvement of all stakeholders in this activity (learning from the bottom-up) are extolled to inform the selection and design of the campaign activities and content, with support from senior management to implement their recommendations. Part 4 focuses on planning and implementing a robust mixed-methods evaluation of campaigns.
... Contact with experts as part of the scoping review process to identify studies missed by search strategy and to identify grey literature, and discussions with experts during interviews and coproduction workshops (see Section 4) identified 62 grey literature resources. In total, 7 completed studies [28][29][30][31][32][33][34] undertaken in the UK between 2015 and June 2020 fulfilled the review criteria. ...
... One in process study was identified from contact with experts [39]. A summary of the 7 completed peer-reviewed studies [28][29][30][31][32][33][34] and the 5 in process studies [35][36][37][38][39] are presented in Tables 1 and 2 respectively. Due to the small number of completed studies identified by the scoping review and heterogeneity in their designs and delivery methods, the planned assessment of active ingredients (e.g. ...
... Uncontrolled before and after studies were undertaken to evaluate OpenMinds [30], Peer ...
Technical Report
Full-text available
We conducted a scoping literature review and in-depth qualitative work with Trailblazer Programme and Public Health England staff, school staff (Special Educational Needs Co-ordinators and student support/pastoral teams working in a range of school settings) and charitable organisations with expertise and lived experience of involvement in anti-stigma campaigns/mental health awareness activities across the North East and North Cumbria [accessible via the following link: https://cutt.ly/Yx632vl]. This work underpinned the development of an evidence-based framework to inform the development/enhancement and evaluation of WSAs to mental health awareness raising and anti-stigma campaigns. The framework consists of four parts: Part 1 describes how the framework is complementary to existing guides on WSAs to mental health and wellbeing. Part 2 focuses on the rationale for, and components of a WSA, focusing on a trauma-informed approach. Part 3 focuses on the organisation, mode, form, and information content of campaigns, with reference to co-production and the need for diversity and involvement of all stakeholders in this activity. Part 4 focuses on planning a robust mixed methods evaluation of campaigns.
... The Mental Health Foundation's Peer Education Project (PEP) aims to improve the mental health literacy of young people and decrease stigmatising attitudes towards mental health. Its focus is on behaviours that promote good mental health, and on risk and protective factors for mental health and help-seeking [20]. This study will contribute in-depth qualitative findings regarding the mechanisms by which the intervention may have an impact, providing perspectives from schools who have delivered the intervention for a number of years, as well as those who are new to the project. ...
... In a previous evaluation of the programme [20], we have seen encouraging findings suggesting that PEP improved self-reported knowledge of mental health and confidence to discuss it. However, these evaluations have been limited by their lack of control groups, and the intervention content has been modified since this initial study. ...
Article
Full-text available
Background Emotional disorders in young people are increasing but studies have found that this age group do not always recognise the signs and symptoms of mental health problems in themselves or others. The Mental Health Foundation’s school-based Peer Education Project (PEP) has the potential to improve young people’s understanding of their own mental health at a critical developmental stage (early adolescence) using a peer teaching method. This study is a process evaluation to understand: the mechanisms through which PEP might improve young people’s mental health literacy, any challenges with delivery, how the project can be embedded within wider school life and how it can be improved to be of most benefit to the widest number of young people. We will also validate a bespoke mental health literacy questionnaire, and test the feasibility of using it to measure outcomes in preparation for a future study evaluating effectiveness. Methods All schools recruited to the study will receive the PEP intervention. The process evaluation will be informed by realist evaluation approaches to build understanding regarding key mechanisms of change and the impact of different school contexts. The evaluation will test and revise an existing intervention logic model which has been developed in partnership with the Mental Health Foundation. Process evaluation data will be collected from newly recruited schools (n = 4) as well as current PEP user schools (n = 2) including training and lesson delivery observations, staff interviews and student focus groups. Baseline and follow-up data will be collected in all newly recruited intervention schools (n = 4) from all students in Year 7/8 (who receive the PEP) and recruited peer educators in Year 12 via a self-report survey. Discussion This study will enable us to refine the logic model underpinning the peer education project and identify areas of the intervention that can be improved. Findings will also inform the design of a future effectiveness study which will test out the extent to which PEP improves mental health literacy.
... A majority of studies (n = 22) did not publish a protocol paper or register the study on a trial registry, making it difficult to assess reporting bias. The 27 school-based MHL interventions reviewed included The Guide Mcluckie et al., 2014;Nguyen et al., 2020), Peer Education Project (Eisenstein et al., 2019), Breaking the Silence (Lanfredi et al., 2019;Wahl et al., 2011), Youth Education and Support (Riebschleger et al., 2019), Finding Space for Mental Health (Campos et al., 2018), How to get up and go when you're feeling low and I gotta feeling , Eliminating the Stigma of Differences (Painter et al., 2017), OpenMinds , Adolescent Depression Awareness Program (Ruble et al., 2013;Swartz et al., 2017), SchoolSpace (Chisholm et al., 2016), The Curriculum Guide (Milin et al., 2016), The Little Prince is Depressed (Lai et al., 2016), Definizione di obiettivi e soluzione di problemi (establishing goals and problem solving; Gigantesco et al., 2015), HeadStrong (Perry et al., 2014), Paul down in the dumps and Understanding depression in adolescents (Schiller et al., 2014), S.P.E.A.K (Bulanda et al., 2014), Mental Health for Everyone (Skre et al., 2013), and In Our Own Voice (Pinto-Foltz et al., 2011). Five interventions did not have a specific name (Bella-Awusah et al., Greenwood et al., 2016;Katz et al., 2020;Ojio et al., 2015Ojio et al., , 2019. ...
Article
Mental health literacy (MHL) encompasses understanding mental health and learning how to obtain and maintain good mental health. Increasing MHL may increase help-seeking behaviors and positive mental health. This study aimed to identify school-based MHL interventions for children/youth using a scoping review methodology following the Johanna Briggs Model. The interventions were assessed for quality of evidence using the National Institutes of Health Study Quality Assessment Tools. Six databases were searched: Scopus, APA PsycInfo, Cochrane Library, ERIC, PubMed, and ProQuest Psychology. Search terms included “mental health literacy,” “intervention,” and “children.” The search yielded 27 studies after applying inclusion criteria. Eight of these studies were assessed as “poor” quality, twelve as “fair” quality, and seven as “good” quality. The results highlight the need for more research to implement and evaluate interventions to sustainably and feasibly incorporate school-based MHL interventions for children and youth into practice. Impact Statement Mental health literacy interventions are needed to improve knowledge of mental health, promote help-seeking for mental illness, and reduce stigma and negative attitudes toward mental illness. This review identifies that more good quality research is required of school-based mental health literacy interventions. New research is urgently needed to evaluate the feasibility and sustainability of interventions that reduce the prevalence of mental illness for children and youth. Supplemental data for this article is available online at http://dx.doi.org/10.1080/2372966X.2021.2018918.
... Thus, some previous studies evaluating peer education activities from around the world such as England [37] and Eritrea [14] reported relatively lower scores of acceptability than that of the current study. Successful school-based programmes are often characterized by improved acceptability and feasibility of the intervention which is ultimately is used to sustain it [38,39]. ...
Article
Full-text available
Background Evidence on peer educators’ experiences of implementing the school-based educational interventions on malaria prevention would be used as inputs for malaria eliminating efforts. This study explored the acceptability of the school-based peer-learning and education approach on malaria prevention (PLEA-malaria) among peer educators in Ethiopia. Methods This process evaluation study was aimed to examine the success of the school-based PLEA-malaria that was implemented in 75 primary schools in Jimma from 2017 to 2019. A mixed research method was employed to collect post-intervention data from 404 peer educators and key stakeholders. Data were collected using a structured questionnaire and interview guide. Multivariable linear regression modelling was performed using SPSS software version 26.0. Atlas ti 7.5 for windows was used to analyse the qualitative data. The result was presented by triangulating the findings of the qualitative and quantitative methods. Results The mean score (M, range = R) of acceptability of PLEA-malaria was (M = 20.20, R = 6–30). The regression modelling showed that age; (β = 0.264, 95% CI 0.266 to 0.632), GPA; (β = 0.106, 95% CI 0.008 to 0.074), parental readiness for malaria education; (β = 0.184, 95% CI 0.711 to 2.130), frequency of peer education; (β = 0.232, 95% CI 1.087 to 2.514) and team spirit; (β = 0.141, 95% CI 0.027 to 0.177) were positively associated with the acceptability while this relationship was negative for the number of ITN in the household; (β = − 0.111, 95% CI − 1.182 to -0.13) and frequency of parent-student communication; (β = − 0.149, 95% CI − 1.201 to − 0.293). The qualitative study identified facilitators of PLEA-malaria (e.g. team formation process, outcome efficacy, presence of schools’ structures, schools priority, and support) and barriers (e.g. low commitments, threat appraisal, response efficacy, and PLEA-malaria implementation gaps). Conclusion The results suggested that the acceptability of the school-based PLEA-malaria was higher implying the strategy is promising in promoting malaria prevention in primary schools. Considering factors related to personal, access to malaria preventive services, school system, and social support in education and behaviour change interventions would be important to improve the acceptability. The relationship about how an improvement in the level of acceptability would in turn influences malaria preventive behaviours among the students should be investigated.
Article
Full-text available
Background School-based youth mental health promotion is increasingly recognised as a useful tool to improve mental health knowledge and help-seeking among adolescents. Peer-led initiatives are emerging as a potentially viable mode of delivering this material. Yet, there is limited evidence on the effectiveness of these initiatives compared to more traditional, adult-led, forms of mental health promotion. Aims This study aimed to compare improvements in students’ mental health knowledge and help-seeking after attending either a peer- or adult-led youth mental health promotion workshop. It also sought to examine differential effects by gender. Method A within- and between-group comparative design was used to examine secondary school students’ (N = 536) mental health knowledge and help-seeking intentions before and after attending a school-based mental health promotion workshop. Results Students’ mental health knowledge and help-seeking intentions significantly improved in both peer- and adult-led groups. Outcomes did not differ across modes of delivery, although the impact of adult-led workshops on mental health knowledge was moderated by gender. Conclusions Peer-led youth mental health promotion appears to be as effective as traditional adult-led delivery, and seems to be particularly beneficial for male students who respond more favourably to content communicated through their peers.
Article
Background: Research suggests that a whole-school approach to mental health promotion can be more effective than a compartmentalized approach. In particular, student-led initiatives have demonstrated a positive impact on students' mental health, though not without systemic and individual barriers. Factors that lead to successful implementation and sustaining of student-led initiatives are currently not well understood. Methods: A case study is presented to demonstrate how a student-led intervention came about, inspired changes in the school organization and members, and transformed the school's approach to mental health promotion. Analysis of in-depth interviews with student leaders and adult advisors was informed by theories of innovation diffusion and human motivation. Results: Key factors and mechanisms of change were identified for the initiation, transformation, and institutionalization stages of the student-led initiative. Changes in students' identity and adult advisors' mindset were found to be integral to the successful conversion to a whole-school approach in mental health promotion. Conclusions: This study confirms the value of mobilizing the student body as an active resource in promoting mental health in school and the importance of input from school management, advisors, and intervention expert. Recommendations on how to implement a student-led initiative and sustain the positive changes are given.
Article
Full-text available
Engaging young people in the design and delivery of mental health education could lead to more effective interventions; however, few of these interventions have been evaluated. This study aimed to gain preliminary evidence with regards to the efficacy and acceptability of OpenMinds: a peer-designed and facilitated mental health literacy programme for university and secondary school students. The programme involves a structured programme of education and training for university medical students, who then deliver workshops in secondary schools. Pre- and post-surveys were completed by 234 school students who received two workshops and 40 university medical students who completed the OpenMinds programme and delivered the workshops. The main outcomes in both groups were components of mental health literacy (non-stigmatising attitudes, knowledge, social distance and helping attitudes). Perceived teaching efficacy and interest in mental health careers (university medical students) and workshop acceptability (school students) were also examined. University and school student participation in OpenMinds was associated with significant improvements in three of four mental health literacy elements in both samples. Knowledge and attitudes improved in both samples, social distance improved only in the university sample and knowledge of helping behaviours increased in the school sample. University students’ perceived teaching efficacy improved but there was no change in their reported interest in pursuing psychiatry in their career. Acceptability was high; over 70% of the school students agreed that they enjoyed the workshops and liked being taught by a university student. This study provides preliminary evidence for the acceptability and efficacy of OpenMinds as a sustainable peer-led model of mental health education for young people. The OpenMinds programme is ready for efficacy testing in a randomised trial.
Article
Full-text available
Objective: This study evaluated the effectiveness of a school-based mental health literacy intervention for adolescents on knowledge and stigma. Method: A total of 24 high schools and 534 students in the regional area of Ottawa, Ontario, Canada participated in this randomized controlled trial. Schools were randomly assigned to either the curriculum or control condition. The curriculum was integrated into the province's grade 11 and 12 "Healthy Living" courses and was delivered by teachers. Changes in mental health knowledge and stigma were measured using pre- and posttest questionnaires. Descriptive analyses were conducted to provide sample characteristics, and multilevel modeling was used to examine study outcomes. Results: For the curriculum condition, there was a significant change in stigma scores over time (p = .001), with positive attitudes toward mental illness increasing from pre to post. There was also a significant change in knowledge scores over time (p < .001), with knowledge scores increasing from pre to post. No significant changes in knowledge or stigma were found for participants in the control condition. A meaningful relationship was found whereby increases in knowledge significantly predicted increases in positive attitudes toward mental health (p < .001). Conclusion: This is the first large randomized controlled trial to demonstrate the effectiveness in mental health literacy of an integrated, manualized mental health educational resource for high school students on knowledge and stigma. Findings also support the applicability by teachers and suggest the potential for broad-based implementation of the educational curriculum in high schools. Replication and further studies are warranted. Clinical trial registration information-Impact of a Mental Health Curriculum for High School Students on Knowledge and Stigma; http://clinicaltrials.gov/; NCT02561780.
Article
Full-text available
Objectives To investigate whether intergroup contact in addition to education is more effective than education alone in reducing stigma of mental illness in adolescents. Design A pragmatic cluster randomised controlled trial compared education alone with education plus contact. Blocking was used to randomly stratify classes within schools to condition. Random allocation was concealed, generated by a computer algorithm, and undertaken after pretest. Data was collected at pretest and 2-week follow-up. Analyses use an intention-to-treat basis. Setting Secondary schools in Birmingham, UK. Participants The parents and guardians of all students in year 8 (age 12–13 years) were approached to take part. Interventions A 1-day educational programme in each school led by mental health professional staff. Students in the ‘contact’ condition received an interactive session with a young person with lived experience of mental illness. Outcomes The primary outcome was students’ attitudinal stigma of mental illness. Secondary outcomes included knowledge-based stigma, mental health literacy, emotional well-being and resilience, and help-seeking attitudes. Results Participants were recruited between 1 May 2011 and 30 April 2012. 769 participants completed the pretest and were randomised to condition. 657 (85%) provided follow-up data. At 2-week follow-up, attitudinal stigma improved in both conditions with no significant effect of condition (95% CI −0.40 to 0.22, p=0.5, d=0.01). Significant improvements were found in the education-alone condition compared with the contact and education condition for the secondary outcomes of knowledge-based stigma, mental health literacy, emotional well-being and resilience, and help-seeking attitudes. Conclusions Contact was found to reduce the impact of the intervention for a number of outcomes. Caution is advised before employing intergroup contact with younger student age groups. The education intervention appeared to be successful in reducing stigma, promoting mental health knowledge, and increasing mental health literacy, as well as improving emotional well-being and resilience. A larger trial is needed to confirm these results. Trial registration number ISRCTN07406026; Results.
Article
Full-text available
Adolescence is an important stage of human life span, which crucial developmental processes occur. Since peers play a critical role in the psychosocial development of most adolescents, peer education is currently considered as a health promotion strategy in adolescents. Peer education is defined as a system of delivering knowledge that improves social learning and provides psychosocial support. As identifying the outcomes of different educational approaches will be beneficial in choosing the most effective programs for training adolescents, the present article reviewed the impact of the peer education approach on adolescents. In this review, databases such as PubMed, EMBASE, ISI, and Iranian databases, from 1999 to 2013, were searched using a number of keywords. Peer education is an effective tool for promoting healthy behaviors among adolescents. The development of this social process depends on the settings, context, and the values and expectations of the participants. Therefore, designing such programs requires proper preparation, training, supervision, and evaluation.
Article
Full-text available
Background The Me and My School Questionnaire (M&MS) is a self-report measure for children aged eight years and above that measures emotional difficulties and behavioural difficulties, and has been previously validated in a community sample. The present study aimed to assess its clinical sensitivity to justify its utility as a screening tool in schools. Methods Data were collected from service-users (n = 91, 8–15 years) and accompanying parent/carer in outpatient mental health services in England. A matched community sample (N = 91) were used to assess the measure’s ability to discriminate between low- and high-risk samples. Results Receiver operating curves (area under the curve, emotional difficulties = .79; behavioural difficulties = .78), mean comparisons (effect size, emotional difficulties d = 1.17, behavioural difficulties = 1.12) and proportions above clinical thresholds indicate that the measure satisfactorily discriminates between the samples. The scales have good internal reliability (emotional difficulties α = .84; behavioural difficulties α = .82) and cross-informant agreement with parent-reported symptoms is comparable to existing measures (r = .30). Conclusion The findings of this study indicate that the M&MS sufficiently discriminates between high-risk (clinic) and low-risk (community) samples, has good internal reliability, compares favourably with existing self-report measures of mental health and has comparable levels of agreement between parent-report and self-report to other measures. Alongside existing validation of the M&MS, these findings justify the measures use as a self-report screening tool for mental health problems in community settings for children aged as young as 8 years.
Article
Full-text available
Early detection of child mental health problems in schools is critical for implementing strategies for prevention and intervention. The development of an effective measure of mental health and well-being for this context must be both empirically sound and practically feasible. This study reports the initial validation of a brief self-report measure for child mental health suitable for use with children as young as 8 years old (“Me & My School” [M&MS]). After factor analysis, and studies of measurement invariance, 2 subscales emerged: emotional difficulties and behavioral difficulties. These 2 subscales were highly correlated with corresponding constructs of the Strengths and Difficulties Questionnaire (SDQ) and showed correlations with attainment, deprivation, and educational needs similar to ones obtained between these demographic measures and the SDQ. Results suggest that this school-based self-report measure is psychometrically sound, and has the potential of contributing to school mental health surveys, evaluation of interventions, and recognition of mental health problems within schools.
Article
Aim: To examine evidence-using a range of outcomes- for the effectiveness of school-based mental health and emotional well-being programmes. Background: It is estimated that 20% of young people experience mental health difficulties every year. Schools have been identified as an appropriate setting for providing mental health and emotional well-being promotion prompting the need to determine whether current school-based programmes are effective in improving the mental health and emotional well-being of young people. Methods: A systematic search was conducted using the health and education databases, which identified 29 studies that measured the effectiveness of school-based universal interventions. Prisma guidelines were used during the literature review process. Results: Thematic analysis generated three key themes: i) help seeking and coping; ii) social and emotional well-being; and iii) psycho-educational effectiveness. Conclusion: It is concluded that whilst these studies show promising results there is a need for further robust evaluative studies to guide future practice. Relevance to clinical practice: All available opportunities should be taken to provide mental health promotion interventions to young people in the school environment, with a requirement for educational professionals to be provided the necessary skills and knowledge to ensure that the school setting continues to be a beneficial environment for conducting mental health promotion. This article is protected by copyright. All rights reserved.
Article
Early detection of child mental health problems in schools is critical for implementing strategies for prevention and intervention. The development of an effective measure of mental health and well-being for this context must be both empirically sound and practically feasible. This study reports the initial validation of a brief self-report measure for child mental health suitable for use with children as young as 8 years old (“Me & My School” [M&MS]). After factor analysis, and studies of measurement invariance, 2 subscales emerged: emotional difficulties and behavioral difficulties. These 2 subscales were highly correlated with corresponding constructs of the Strengths and Difficulties Questionnaire (SDQ) and showed correlations with attainment, deprivation, and educational needs similar to ones obtained between these demographic measures and the SDQ. Results suggest that this school-based self-report measure is psychometrically sound, and has the potential of contributing to school mental health surveys, evaluation of interventions, and recognition of mental health problems within schools.