Review: Delivering mental health support within schools and colleges - a thematic synthesis of barriers and facilitators to implementation of indicated psychological interventions for adolescents

TY - JOUR

T1 - Review: Delivering mental health support within schools and colleges - a thematic synthesis of barriers and facilitators to implementation of indicated psychological interventions for adolescents

AU - Gee, Brioney

AU - Wilson, Jon

AU - Clarke, Tim

AU - Farthing, Sophie

AU - Ben Carroll, null

AU - Jackson, Christopher

AU - King, Kahfee

AU - Murdoch, Jamie

AU - Fonagy, Peter

AU - Notley, Caitlin

N1 - Funding Information: This study was funded by the National Institute for Health Research (NIHR) Health Services & Delivery Research programme (Ref 17/09/31). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. B.G., J.W., T.C., J.M., P.F. and C.N. contributed to the conception and design of the study. B.G., J.W., T.C., S.F., B.C., C.J., K.K. and C.N. carried out study selection and data extraction. B.G., S.F., B.C., C.J. and K.K. contributed to data analysis, overseen by C.N. B.G., J.W., T.C., J.M. and C.N. interpreted the findings. B.G. wrote the first draft of the manuscript. All authors contributed to and agreed the final version of the manuscript. The authors would like to thank all authors who kindly responded to requests for copies of their work or recommended potentially eligible studies, and Helen Nicholls and Juan Herran-Alonso for their assistance with data extraction. The authors are grateful to NSFT Frank Curtis Library and University of East Anglia Library for assistance refining the search strategy and accessing full-text articles and theses. The authors would also like to acknowledge the support of the wider BEST study team. The authors have declared that they have no competing or potential conflicts of interest. Funding Information: This study was funded by the National Institute for Health Research (NIHR) Health Services & Delivery Research programme (Ref 17/09/31). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. B.G., J.W., T.C., J.M., P.F. and C.N. contributed to the conception and design of the study. B.G., J.W., T.C., S.F., B.C., C.J., K.K. and C.N. carried out study selection and data extraction. B.G., S.F., B.C., C.J. and K.K. contributed to data analysis, overseen by C.N. B.G., J.W., T.C., J.M. and C.N. interpreted the findings. B.G. wrote the first draft of the manuscript. All authors contributed to and agreed the final version of the manuscript. The authors would like to thank all authors who kindly responded to requests for copies of their work or recommended potentially eligible studies, and Helen Nicholls and Juan Herran‐Alonso for their assistance with data extraction. The authors are grateful to NSFT Frank Curtis Library and University of East Anglia Library for assistance refining the search strategy and accessing full‐text articles and theses. The authors would also like to acknowledge the support of the wider BEST study team. The authors have declared that they have no competing or potential conflicts of interest. Publisher Copyright: © 2020 The Authors. Child and Adolescent Mental Health published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/2

Y1 - 2021/2

N2 - Background: Increasing the role of schools and colleges in the provision of mental health services for young people has the potential to improve early intervention and access to treatment. We aimed to understand what factors influence the successful implementation of indicated psychological interventions within schools and colleges to help guide increased provision of mental health support within education settings. Methods: Systematic search for studies that have reported barriers or facilitators to the implementation of indicated interventions for adolescent emotional disorders delivered within schools and further education/sixth form colleges (CRD42018102830). Databases searched were EMBASE, MEDLINE, PsycINFO, CINAHL, British Nursing Index, ASSIA, ERIC and British Education Index. A thematic synthesis of factors reported to impact implementation was conducted. Results: Two thousand five hundred and sixty-nine records and 177 full texts were screened. Fifty studies were identified for inclusion, all of which were of school-based interventions. Eleven analytic themes were developed encompassing intervention characteristics, organisational capacity, training and technical assistance, provider characteristics and community-level factors. Findings indicate the need to select appropriate interventions, consider logistical challenges of the school context and provide training and supervision to enable staff to deliver interventions with fidelity. However, structural and environmental support is required for these facilitators to have the greatest impact on successful implementation. Conclusions: Implementing indicated school-based mental health interventions is challenging. Those involved in planning school-based mental health initiatives must be alert to the impact of factors on multiple interacting levels. There is a lack of research on implementing mental health support within further education and sixth form colleges. Key Practitioner Message: Increased utilisation of schools and colleges as a setting for early intervention has been proposed as a means of improving access to mental health treatment, but successful implementation of mental health interventions within educational settings is challenging. Based on a synthesis of current evidence, we recommend that young people and education professionals should be involved in the selection of school-based interventions to ensure they are acceptable and practical to deliver within the logistical constraints of the school environment. Those delivering interventions within schools, as well as staff involved in identifying young people who might benefit from these interventions, must receive high-quality ongoing training and support. Senior school leaders play an important role in championing mental health interventions and developing a school culture that prioritises mental well-being. Health and education policy should be designed to promote a cross-sector focus on the emotional health of young people. There is a lack of evidence on the implementation of indicated psychological interventions within sixth form and further education colleges.

AB - Background: Increasing the role of schools and colleges in the provision of mental health services for young people has the potential to improve early intervention and access to treatment. We aimed to understand what factors influence the successful implementation of indicated psychological interventions within schools and colleges to help guide increased provision of mental health support within education settings. Methods: Systematic search for studies that have reported barriers or facilitators to the implementation of indicated interventions for adolescent emotional disorders delivered within schools and further education/sixth form colleges (CRD42018102830). Databases searched were EMBASE, MEDLINE, PsycINFO, CINAHL, British Nursing Index, ASSIA, ERIC and British Education Index. A thematic synthesis of factors reported to impact implementation was conducted. Results: Two thousand five hundred and sixty-nine records and 177 full texts were screened. Fifty studies were identified for inclusion, all of which were of school-based interventions. Eleven analytic themes were developed encompassing intervention characteristics, organisational capacity, training and technical assistance, provider characteristics and community-level factors. Findings indicate the need to select appropriate interventions, consider logistical challenges of the school context and provide training and supervision to enable staff to deliver interventions with fidelity. However, structural and environmental support is required for these facilitators to have the greatest impact on successful implementation. Conclusions: Implementing indicated school-based mental health interventions is challenging. Those involved in planning school-based mental health initiatives must be alert to the impact of factors on multiple interacting levels. There is a lack of research on implementing mental health support within further education and sixth form colleges. Key Practitioner Message: Increased utilisation of schools and colleges as a setting for early intervention has been proposed as a means of improving access to mental health treatment, but successful implementation of mental health interventions within educational settings is challenging. Based on a synthesis of current evidence, we recommend that young people and education professionals should be involved in the selection of school-based interventions to ensure they are acceptable and practical to deliver within the logistical constraints of the school environment. Those delivering interventions within schools, as well as staff involved in identifying young people who might benefit from these interventions, must receive high-quality ongoing training and support. Senior school leaders play an important role in championing mental health interventions and developing a school culture that prioritises mental well-being. Health and education policy should be designed to promote a cross-sector focus on the emotional health of young people. There is a lack of evidence on the implementation of indicated psychological interventions within sixth form and further education colleges.

KW - Mental health

KW - adolescent

KW - school

KW - school-based

KW - implementation

UR - http://www.scopus.com/inward/record.url?scp=85083087685&partnerID=8YFLogxK

U2 - 10.1111/camh.12381

DO - 10.1111/camh.12381

M3 - Review article

SN - 1475-357X

VL - 26

SP - 34

EP - 46

JO - Child and Adolescent Mental Health

JF - Child and Adolescent Mental Health

IS - 1

ER -