A community is a cohesive group of persons possessing shared interests and residing in a certain geographical location. Mental health intervention refers to the act of urging someone to seek additional assistance before the deterioration of their mental well-being and the exacerbation of their symptoms (Biddle & Asare, 2011). School-based mental health interventions are crucial for addressing depression and anxiety among learners, as they provide an optimal environment for implementing preventive measures and identifying those at risk. These initiatives reach large populations, offer accessibility, and foster stronger social interactions. They help identify learners at heightened risk for anxiety and depression, reducing the difficulty of recognising or diagnosing depression and ultimately promoting recovery and overall well-being (Breitenstein et al., 2010, p. 173). This paper critically examines previous reviews of school-based interventions such as Cognitive Behavioural Therapy (CBT), positive psychology, the FRIENDs and the Adolescent Depression Awareness Programme (ADAP), and their effectiveness in addressing anxiety and depression have also been shown. The next section examines the proposed campaigns and their implementation to help address the issues of depression and anxiety at various schools. The last section has identified measures such as pre-test, which are aimed at evaluating the effectiveness of the implemented campaigns. The paper ends with a logical summary of the findings.
Various mental health treatments have been tested in schools as part of research studies. This incorporates interventions rooted in Cognitive Behavioural Therapy, positive psychology, mindfulness, mental health education and interpersonal therapy, among many others. The intervention studies and their findings have been evaluated, and their effectiveness has been shown.
An example of a CBT intervention called Stressbusters was carried out at three primary schools in South London, resulting in promising outcomes. Within the intervention trial, a total of 112 adolescents aged 12 to 16 who exhibited mild to medium symptoms of depression were divided into two groups. One group participated in an eight-week computerised Cognitive Behavioral Therapy program, while the other group was assigned to a waiting control group (Durlak et al., 2011). Throughout each intervention meeting, students autonomously engaged in an online course that included animations, collaborative tasks and videos. The intervention consisted of many elements, including psycho-education on depression and its treatment, behavioural activation, identification and modification of negative automatic thinking, enhancement of problem-solving and social abilities, and relapse prevention. Following the session, the students who took part showed a notable decrease in their depression and anxiety scores contrasted to the control group that was on the waiting list. This symptom decrease was clinically substantial compared to their scores before the intervention (Fazel et al., 2014).
Another intervention, which showcased advantageous outcomes, was conducted in 41 senior schools in Southwest England as a research component, including 1262 learners aged 9 to 10 years old. The intervention, known as FRIENDS, included nine lessons administered to all learners in the engaged classrooms. These sessions were conducted either by certified health facilitators or by personnel of the teaching staff. Adhering to the concepts of CBT, the courses addressed anxiety’s cognitive, sentimental, and behavioural components (Kieling et al., 2011, p. 1515). The goal was to assist youngsters in developing emotional awareness and control skills, identifying and replacing anxiety-inducing beliefs, and enhancing their problem-solving abilities. After 12 months, it was discovered that learners in the health-led interventions group saw a noteworthy reduction in anxiety, deemed clinically substantial, compared to the control group. Nevertheless, it is essential to acknowledge that this impact was not seen in the group where the institution directed the intervention.
A further CBT intervention, which had positive results, was carried out in nine primary schools located in central Scotland. This exercise was conducted as part of research involving a total of 317 pupils aged 9 to 10 years old. According to a prescribed publication, the intervention included ten lessons therapists or instructors gave the whole class (Lee, 2020, p. 421). The objective was to educate children in acquiring innovative talents, allowing them to engage in practice and introspection on how to apply these skills to challenges in their daily existence. The classes were specifically developed to assist students in identifying their own emotional symptoms, reducing the use of avoidance coping mechanisms, and promoting proactive problem-solving and seeking assistance. In addition, the program included techniques such as controlled breathing, muscular relaxation, and visualisation exercises. The intervention groups led by psychologists and teachers exhibited substantially reduced anxiety levels, decreased reliance on avoidance strategies, and improved problem-solving abilities compared to the control group (Merikangas et al., 2022). These positive effects were seen immediately after the intervention 15 and continued for six months.
An additional strategy involved implementing comprehensive mental health and anti-stigma programmes that focused on providing purely educational interventions to improve depression literacy in high schools. These interventions were intended to alter the mood or feelings of learners. An example of such a programme is the Adolescent Depression Awareness Programme developed by Johns Hopkins University. ADAP was a scientifically validated curriculum used in schools, aiming to enhance depression literacy among high school teenagers. The initiative’s objective was to increase understanding of depression and reduce negative attitudes associated with the condition (Palinkas et al., 2011, p. 51). The ADAP programme consisted of a three-hour curriculum delivered by healthcare experts during health class. It has been shown to enhance understanding based on findings from the studies.
Additionally, one of these research showed that it also enhances the ability to recognise and acknowledge depression. These results have not been duplicated, and no effects on the stigma surrounding depression have been shown. According to the ADAP programme, Health education campaigns can be enhanced by incorporating key features of successful prevention programmes, such as facilitating meaningful connections with adults and peers to foster solid interactions and encourage positive results, customising the programme to align with the community and cultural norms of the respondents and involving the target group in the planning and executions of the programmes (Pedrelli et al., 2015, p. 503).
Implementation
The psychological health services in schools will be delivered by staff who have received training or are employed within the education or healthcare systems. These staff members will have a background in education, which will help them navigate the intricate school culture. Moreover, it will be important for school-employed staffs to prioritise educational goals. Their specialised training in school-based programmes makes them better than non-school employed peers to meet learner’s psychological health needs (Powell et al., 2017). However, school staff will be limited by schools in the future, so policies will be enacted to tackle the limitations on the range of treatments that school psychologists may provide. These measures will strive to enhance their capacity to address individual requirements and cater to specific learners. Modifying financing and special education standards will enable school psychologists to prioritise their consulting and intervention abilities above routine mental health testing and eligibility evaluations.
Furthermore, in several regions, educational staff will get training in intricate psychiatric manifestations to enhance their ability to support children dealing with mental stress and anxiety challenges. The BRIDGE research, which integrates both universal and customised therapies, will serve as a paradigm for enhancing mental wellness and education in metropolitan schools. The efficacy of this intervention will be evaluated via controlled trials, with the anticipation of seeing enhanced results at both the classroom and individual levels (Proctor et al., 2011, p. 65). The project will use empirically generated tactics that will be evaluated in challenging metropolitan secondary school settings. The campaign will enhance the rapport between educators and learners, foster students’ intellectual self-perception, and mitigate instances of mental distress issues.
School and community mental health specialists will be engaged in several disciplines, including counselling, psychology, psychiatry, social work and occupational therapy. There will be three prevalent approaches to integration: the engagement of external agency experts who will be hired to work inside schools, the establishment of mental wellness clinics within schools staffed by experts offering services, and the creation of health facilities in schools with a focus on mental health as a specialisation (Reinke et al., 2011). Therapists and social workers will deliver mental health interventions in schools, with psychologists and psychiatrists playing a secondary role. Certain schools will collaborate with psychologists and psychiatrists to seek advice and provide assistance to individual children facing mental depressions. However, this approach may be challenging due to the limited availability of adolescent psychiatrists worldwide (Breitenstein et al., 2010). Telemedicine will be used to augment the capability of psychological health services in schools. However, effective approaches will include on-site school mental health specialists offering assistance and ongoing interventions. In addition, highly skilled nurse physicians will be hired to oversee the needs of the learners.
Furthermore, the mental health industry will increasingly include natural supports, such as specialised staff workers and school nurses, alongside conventional practitioners. The emphasis will be on enhancing the training and assistance provided to school workers to recognise and tackle mental health issues in learners successfully. This paradigm is seen as feasible and enduring, considering the resources at hand and the increasing proof of its efficacy (Reiss, 2013). Teachers will have a vital role as guardians and sources of referral for mental health treatment. Implementing mental health awareness and preventive initiatives by teachers will significantly influence learners’ psychosocial well-being and academic performance. Nevertheless, it will be crucial to guarantee that instructors have sufficient experience and time to fulfil these obligations, considering the additional demands they currently face in supporting academic achievement (Sklad et al., 2012). Subsequent models will strive to include mental health awareness into the inherent teaching environment and provide guidance to enhance instructors’ self-efficacy.
Additionally, school-based psychological health services and facilities will be implemented that are partnered with the community. These services will enhance the current behavioural health supports available to learners. These programs will be provided by staff engaged in community-based organisations. Experts in mental health will be sought out for consultation in regular schools to aid in analysing cases, distinguishing between various diagnoses, and making decisions on treatment within the community (Taylor et al., 2017). Certain educational institutions may collaborate with or establish connections with community-based organisations to offer on-site individual, family, and group therapy for children who have been diagnosed with issues such as anxiety, depression, disruptive behaviour disorders, and traumatic stress. Implementing intensive therapy will often be scheduled throughout the school day, resulting in enhanced time management for both children and parents. School personnel will also augment their ability to provide specialised mental health therapy for learners (Waters, 2011). Research has shown that administering treatments, such as interpersonal therapy, inside school-based health centres is a successful approach for treating depression in adolescents.
Measures to Evaluate the Effectiveness of the Programme
Evaluating implementation results will provide vital information on how to enhance the execution of intervention programs in the future. Additionally, studying the variations in how interventions are carried out in different schools will be associated with variances in the results of these interventions. Therefore, it will be crucial to examine implementation results and the intervention outcomes to fully estimate the efficacy (Weiner et al., 2017, p. 90).
The evaluation team will measure implementation results from various angles, considering the involvement of teachers, administrators, learners, and school psychologists in school-based interventions. Assessors will analyse discrepancies across data sources using triangulation in implementation outcome evaluations to understand the implementation process better. They will also utilise mixed-methods techniques, combining qualitative and quantitative methods, to provide more thorough assessments of implementation results. For example, our group will assess the level of acceptance from the viewpoints of students, instructors, and school administrators (Werner-Seidler et al., 2017, p. 30). Relevant and feasible tests will be given to instructors, such as teachers and principals. The evaluation team and the execution team will discuss pre-test results with a group of interested parties from the schools involved as part of a formative assessment.
The assessment team will continue to ask instructors to record their instruction throughout the five-week supervision period in predefined tests. Impartial observers will also be present for two classroom sessions; of every instructor involved and will fill out fidelity observation checklists (World Health Organization, 2021). Additionally, fidelity in the instructor’s delivery of essential elements at a post-test will be assessed from the learners’ perspective. This approach of recording fidelity in connection to treatment results of school-based programs is becoming increasingly frequent. It will allow for assessing whether intervention groups that adhere more closely to the prescribed guidelines or beyond a certain standard of adherence will have superior results. This will determine the efficacy of the intervention in addressing the specific issue while it is executed according to its intended design. Furthermore, linking fidelity to intervention results will assist in refining the fundamental elements of an intervention. To achieve this objective, a correlation will be established between the fidelity measurements of each core component and the results of the intervention. The findings may prompt a reevaluation of the critical elements of the intervention, as some components may not be as crucial for achieving the intended benefits as previously anticipated (Proctor et al., 2011). Therefore, it can be inferred that certain elements can be readily adjusted without compromising the campaign’s efficacy.
Conclusion
In conclusion, school-based health interventions have played significant roles in addressing mental health issues such as anxiety and depression as indicated from the previous reviews. For instance, the CBT based interventions have made significant support towards leaners in various institutions. For instance, the CBT intervention that was conducted in nine primary schools in Scotland yielded positive results. The programme was aimed to enable leaners to learn innovative skills. The test was based in emotional intelligent and it involved muscle relaxation and controlled breathing. At the end of the exercise, learners were confirmed to reducing anxiety levels and improved problem solving abilities compared to the controlled group. The implementation campaign entails the training of teachers to gain the relevant skills, consultations from experts, building psychological facilities in schools offering the relevant services, implementing mental health facilities at various schools. To evaluate the effectiveness of the implemented strategies various measures such as pre-test exercises to teachers, learners and relevant school administrators will be exercised. This will help to identify whether the programming is effective or it needs further adjustments.
Bibliography
Biddle, S. J., & Asare, M. (2011). Physical activity and mental health in children and adolescents: a review of reviews. British journal of sports medicine, 45(11), 886–895.
Breitenstein, S. M., Gross, D., Garvey, C. A., Hill, C., Fogg, L., & Resnick, B. (2010). Implementation fidelity in community‐based interventions. Research in nursing & health, 33(2), 164-173.
Durlak, J. A., Weissberg, R. P., Dymnicki, A. B., Taylor, R. D., & Schellinger, K. B. (2011). The impact of enhancing students’ social and emotional learning: A meta‐analysis of school‐based universal interventions. Child development, 82(1), 405-432.
Fazel, M., Hoagwood, K., Stephan, S., & Ford, T. (2014). Mental health interventions in schools in high-income countries. The Lancet Psychiatry, 1(5), 377–387.
Kieling, C., Baker-Henningham, H., Belfer, M., Conti, G., Ertem, I., Omigbodun, O., … & Rahman, A. (2011). Child and adolescent mental health worldwide: evidence for action. The Lancet, 378(9801), 1515-1525.
Lee, J. (2020). Mental health effects of school closures during COVID-19. The Lancet Child & Adolescent Health, 4(6), 421.
Merikangas, K. R., Nakamura, E. F., & Kessler, R. C. (2022). Epidemiology of mental disorders in children and adolescents. Dialogues in clinical neuroscience.
Palinkas, L. A., Aarons, G. A., Horwitz, S., Chamberlain, P., Hurlburt, M., & Landsverk, J. (2011). Mixed method designs in implementation research. Administration and Policy in Mental Health and Mental Health Services Research, 38, 44-53.
Pedrelli, P., Nyer, M., Yeung, A., Zulauf, C., & Wilens, T. (2015). College students: mental health problems and treatment considerations. Academic psychiatry, 39, 503-511.
Powell, B. J., Beidas, R. S., Lewis, C. C., Aarons, G. A., McMillen, J. C., Proctor, E. K., & Mandell, D. S. (2017). Methods to improve the selection and tailoring of implementation strategies. The journal of behavioural health services & research, pp. 44, 177–194.
Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., … & Hensley, M. (2011). Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Administration and policy in mental health and mental health services research, 38, 65–76.
Reinke, W. M., Stormont, M., Herman, K. C., Puri, R., & Goel, N. (2011). Supporting children’s mental health in schools: Teacher perceptions of needs, roles, and barriers. School Psychology Quarterly, 26(1), 1.
Reiss, F. (2013). Socioeconomic inequalities and mental health problems in children and adolescents: a systematic review. Social science & medicine, pp. 90, 24–31.
Sklad, M., Diekstra, R., Ritter, M. D., Ben, J., & Gravesteijn, C. (2012). Effectiveness of school‐based universal social, emotional, and behavioural programs: Do they enhance students’ skill, behaviour, and adjustment development? Psychology in the Schools, 49(9), 892-909.
Taylor, R. D., Oberle, E., Durlak, J. A., & Weissberg, R. P. (2017). Promoting positive youth development through school‐based social and emotional learning interventions: A meta‐analysis of follow‐up effects. Child development, 88(4), 1156-1171.
Waters, L. (2011). A review of school-based positive psychology interventions. The Australian Educational and Developmental Psychologist, 28(2), 75–90.
Weiner, B. J., Lewis, C. C., Stanick, C., Powell, B. J., Dorsey, C. N., Clary, A. S., … & Halko, H. (2017). Psychometric assessment of three newly developed implementation outcome measures. Implementation Science, 12, 1–12.
Werner-Seidler, A., Perry, Y., Calear, A. L., Newby, J. M., & Christensen, H. (2017). School-based depression and anxiety prevention programs for young people: A systematic review and meta-analysis. Clinical psychology review, 51, 30-47.
World Health Organization. (2021). WHO menu of cost-effective interventions for mental health. World Health Organization.
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