Theoretical and practical development of a prototype school based Mental Health Screening Programme to be delivered in primary schools.
(Alternative title:The ‘DEAL’ study – Developing Early identification and Access in Learning Environments)
Type of research
Applied health research
Background and rationale for new research
Poor mental health amongst children and young people has sparked a national conversation1. At odds with the fact that common mental health (MH) disorders are treatable, they often go undetected and so untreated. Schools have an important role to play in the early detection and response to MH problems. Several preventative and early intervention initiatives are being piloted in the East of England to test innovative models of integrating MH care into the school setting.
School-based MH screening may be an efficient strategy for detecting children experiencing early symptoms who could benefit from these services, provided that services have capacity to see children identified with difficulties.
Well-designed screening programmes, show promise for improving detection and referral to intervention, and may improve the MH outcomes of evidence-based intervention. However, the evidence base is still relatively underdeveloped with few UK studies. Further, evidence of cost effectiveness is limited, as is the generalisability of bespoke programmes to routine practice. In recognition of this a recent Lancet review of school- based MH provision identified school based screening as a priority area for research and service development.
Primary schools may be particularly well placed to undertake screening given that most mental disorders begin in childhood and adolescence and the already accepted practice of school led physical health checks for 4-5 and 10-11 year olds. Recent non-statutory guidance issued by the Department for Education advocates a targeted approach to screening in primary schools,however this advice is issued without any guidance on implementation, or any forecast of cost or impact on local services.
These are critical issues to address alongside effectiveness to determine whether this is an appropriate strategy to enhance the identification of children’s MH problems in the UK.
The study was a formative evaluation to address the feasibility and acceptability of primary school based MH screening with the aim of fulfilling preclinical and first phase of the MRC framework on developing and evaluating complex interventions.
Study aims and hypothesis
To develop a prototype school-based MH screening programme for primary schools to identify children likely to be experiencing MH difficulties. The study will address six research questions informed by key criteria set out by the UK national screening committee (NSC) criteria as well as the Medical Research Council (MRC) frameworks on developing and evaluating complex interventions.
- Effectiveness: Is school based MH screening effective and is there evidence that one approach to screening is relatively more effective? (NSC criterion 11; MRC development phase)
- Key characteristics: What are the key features of effective screening and referral programmes? (MRC development phase)
- Mechanisms: What are the causal mechanisms through which a screening and referral intervention improves outcomes for children? (MRC development phase)
Potential harms: What are the harms associated with school based MH screening? (NSC criterion 13; MRC development phase)
- Acceptability: Is school based MH screening acceptable to parents and children, school staff and commissioners, and is one model preferable to the other (targeted vs universal)? (NSC criteria 12 and 19; MRC feasibility phase)
- Value for money: What is the projected impact of implemented school based MH services on school resources and local services? (NSC criteria 14 and 18; MRC feasibility phase)
- WP1: Qualitative analysis of child parent and professional views regarding the role of schools
- WP2: Systematic review of screening programmes for primary schools.
- WP3: Mixed methods analysis of data from completed Cambridgeshire study
- WP4: Qualitative interviews with stakeholders from four pilot sites
- WP5: Prototype programme development
- WP6:Estimating the resource and cost implication of programme implementation
Expected Output of Research / Impact and added value:
The primary output from this study will be a prototype screening programme that can be tested in a subsequent trial programme involving our regional stakeholders. We will produce at least 2 papers for publication in open access peer reviewed journals. We will present study findings at one international and one national conference. Given the recent focus on the role of schools as a setting for and provider of MH interventions, the findings, themselves, have real potential to inform educational policy and practice. This will be optimised by the expertise of the study steering group who will help translate findings into relevant messages for policy makers and practitioners. In addition, this study has the potential to make a major contribution to both the national and international evidence base on school based MH screening.
Key findings and outputs
The study results suggest that most parents within the socio-demographic context of the study will accept mental health difficulty (MHD) screening within primary schools, and that school-based screening is viable from the perspective of parents. Comments provided about potential harms as well as suggestions for programme delivery can inform the development and evaluation of acceptable and sustainable school-based identification models. Implementation and scale-up of such programmes will require further understanding of the perspectives of mental health professionals, school staff, and the general public as well as further evaluation against the established standards for identification programmes.
- Soneson E, Child-Fegredo J, Anderson JK, Stochal J, Fazel M, Ford T, Humphrey A, Jones PB, Howarth E. Acceptability of screening Acceptability of screening for mental health difficulties in primary schools: a survey of UK parents. BMC Public Health. 2018 Dec; 18(1):1404. doi.org/10.1186/s12889-018-6279-7 (link)
Parent Advisory Groups
Patient and public involvement (PPI) was achieved in the study by having two parent advisory groups (PAGs), in Cambridge and Norfolk. Parents with children who had a mental health challenges were invited to join the advisory, which were set up adn managed by a partnership between the study team and Healthwatch (for both Cambridge and Norfolk).
This poster outlines the vital role of the PAGs in the study: ‘Parents Made All the Difference‘
For further information on the project, contact Dr Emma Howarth, Senior Research Associate. Email: firstname.lastname@example.org
Child and Young People Mental Health Services – For information about the CLAHRC EoE Research group, please click here.