Evidence and principles of the effective implementation of school-based programmes promoting the social and emotional wellbeing of young people by Professor Margaret Barry The conference Developing Strength and Resilience in Children 1-2 Nov. 2010 in Oslo

1. Health Promotion Research Centre
National University of Ireland Galway
Ollscoil na hÉireann, Gaillimh
Implementing Mental Health Promotion in Schools:
Evidence and principles of effective implementation
Professor Margaret Barry

2. M. Barry, Oslo 2010
Overview
• Promoting mental health in the school setting
• Evidence of the effectiveness of mental health
promotion in schools
• Impact of social and emotional learning
• Focus on implementation
• Opportunities and Challenges

3. M. Barry, Oslo 2010
Mental Health Promotion in Schools
• Schools are one of the most important settings for
promoting the mental health of young people
(WHO, 2001)
• Schools provide a socialising context that has a
significant influence on:
positive youth development
 sense of connectedness with family, community and
broader society

4. M. Barry, Oslo 2010
Mental Health Promotion in Schools
• Building academic success on emotional and
social learning
• promote academic, emotional and social competence
• reducing school drop-out rates
• reducing a range of negative health and social outcomes
• Teaching and learning of skills and attitudes that
are valuable for life, employment
- communicate effectively, work as a team member, resilience in the
face of difficulties, problem-solving, coping strategies
• Role of education in addressing social and health
inequity

5. M. Barry, Oslo 2010
Social and Emotional Wellbeing
• Increasing focus on social and emotional
wellbeing
» Emotional intelligence (Salovey and Mayer, 1990;
Goleman, 2005) - skills of understanding our emotions
» Emotional literacy (Steiner and Perry, 1990) - ability to
identify, manage and communicate how we feel;
Weare (2004) “..and respond to the emotions of others
in ways that are helpful”
» Focus on teaching and learning of personal and social
skills for young people (Institute for Public Policy
Research, Margo et al., 2006)
» Social and emotional learning (CASEL, 2004)

6. M. Barry, Oslo 2010
Positive Mental Health
• Focus on promoting positive mental health
• Conceptualisations of positive mental health
(Keyes, 2002; Huppert, 2005; Ryff et al., 2006)
- Hedonic - subjective well-being and life satisfaction
- Eudaimonic - positive functioning, engagement,
fulfilment and social well-being
• Keyes‟ concept of optimal mental health or
„flourishing‟
• Abilities to develop psychologically, emotionally,
intellectually, socially and spiritually

7. M. Barry, Oslo 2010
Prevalence of Mental Health
problems in young people
• 15-22% of children and adolescents experience
mental health problems - warrant treatment
• Mental health problems co-occur with social
problems such as school failure or delinquency as
well as health problems like substance misuse
• Poor adjustment in childhood is linked with
negative psychosocial outcomes in adulthood

8. M. Barry, Oslo 2010
Promoting Mental Health
• Mental health promotion
» focus on positive mental health and quality of
life across populations
» building strengths, competencies and resources
• Prevention of mental disorders
» concern with specific disorders - reducing
incidence, prevalence or seriousness of a
targeted problem
» mortality, morbidity and risk behaviours

9. Strategies for
promoting
well-being &
quality of life
Barry, M.M. (2001) International Journal of Mental Health Promotion, 3(1) 25-34.

10. Health Promotion
action areas
Build healthy public policy
Create supportive environments
Reorient health services
Strengthen community action
Develop personal skill
combined into Health
Promotion strategies
Systems
Policies
environment
organisation
community
person
Systems
scale
Health Promotion Principles (participation, empowerment, equity)
Assessment
Planning
Implementation
Evaluation
micro - macro
Health Promotion
Socio-ecological Model
(Ottawa Charter, WHO,
1986)
The process of enabling
people to increase control
over their health and the
determinants of health

11. M. Barry, Oslo 2010
Determinants of Mental Health
(HEA, 1997; VicHealth (1999)
Key determinants of mental health:
• Societal level - healthy structures
» economic, social and cultural framework
• Community level - citizenship
» social support, sense of connectedness and
inclusion, social participation
• Individual level - emotional resilience
» self-esteem, coping, life skills, sense of control

12. M. Barry, Oslo 2010
Settings-based Approach
• Mental health is created in the settings where
people live their lives
• Health Promoting Schools Initiative (WHO, 1997)
“ a school constantly strengthening its capacity as a
healthy setting for living, learning and working”
• curriculum approaches
• improving the school ethos and environment
• involving families and the local community

13. Teaching and learning
Holistic Health Education
Group support
Communication
mental health
drug and sexuality education
Seeking help / safety
Emotions & feelings
Influences and decisions
Physical health Ethos and environment
Individual difference
Belonging
Supports
Confidentiality
Anti-bullying policy
Critical incident policy
Students at risk policy
Peer supports
Equity
Counselling
HPS
Partnerships
School /parent links
Community health services
Adolescent mental health services
Police
Local / national support groups
Local Government
Local GPs
Learning support services
Whole School

14. M. Barry, Oslo 2010
Mental Health Promotion
in Schools
• Classroom curriculum-based approach -
generic life skills training
• Whole school approach - the school setting
including the school ethos and environment,
and involving the parents and the local
community
• Targeted interventions - students at higher
risk e.g. of depression and suicide

15. M. Barry, Oslo 2010
Systematic Reviews of School-based
Mental Health Promotion Programmes
• Lister-Sharp et al. (1999)
• Wells, Barlow and Stewart-Brown (2001, 2003)
HSRU, University of Oxford
• Harden et al. (2001) EPPI- Centre
• Greenberg, Domitrovich & Bumbarger (2001)
• CASEL (2003)
• US Mental Health and Substance Abuse
(SAMHSA - www.samhsa.gov)
• Implementing Mental Health Promotion Actions
Database (IMPHA)
• Tennant et al. ( 2007); Adi et al. (2007)

16. M. Barry, Oslo 2010
Evidence Reviews
• Durlak & Wells (1997) - meta-analytic review
American Journal of Community Psychology
25(2),115-152
• Tilford et al. (1997) Effectiveness of Mental Health
Promotion Interventions: A Review. HEA (UK)
• IUHPE Report (1999) The Evidence of Health Promotion
Effectiveness, Chapter 3
• Friedli (2003) Making it Effective: A guide to evidence
based mental health promotion. Mentality, UK
• Jané-Llopis, Barry, Hosman & Patel (2005) Mental health
promotion works: A review. Promotion & Education suppl
2. IUHPE Special Issue

17. M. Barry, Oslo 2010
Conclusions from Effectiveness
Studies
• Mental health promotion in schools, when
implemented effectively, can produce long-term
benefits for young people, including emotional
and social functioning and improved academic
performance
• Traditional topic based health education
approaches are of limited value (knowledge only
programmes have minimal effects on behaviour)
• Programmes adopting a whole school approach
are more successful and the most promising

18. M. Barry, Oslo 2010
IUHPE Special Issue, 2005
“there is sufficient knowledge to move evidence into practice”
Jané-Llopis, E., Barry, M.M., Hosman, C. and Patel,
V. (Eds.) (2005) The Evidence of Mental Health
Promotion Effectiveness
Comprehensive programmes that target
multiple health outcomes in the context of a
co-ordinated whole school approach are the
most consistently effective strategy

20. M. Barry, Oslo 2010
Characteristics of Effective Programmes
(Green et al., 2005)
• Aimed at the promotion of mental health rather
than the prevention of mental health problems
(Wells et al., 2001)
• Implemented continuously and long-term in nature
i.e. more than one year (Wells et al., 2001)
• Include changes to the school climate rather than
brief class-based prevention programmes (Wells et
al., 2001)
• Extend beyond the classroom and provide
opportunities for applying the learned skills
(CASEL, 2003)

21. M. Barry, Oslo 2010
Characteristics of Effective Programmes
(Green et al., 2005)
• Adopt a health-promoting schools approach
focusing on aspects of the social and physical
environment of the school, family and community
links with the school, the school curriculum and
pupils‟ knowledge (Lister-Sharp et al., 1999)
• Focus on enhancing generic social competences -
coping skills, good peer relationships, self-
efficacy
• Interactive teaching methodologies - active
learning, activity-based, student participation

22. M. Barry, Oslo 2010
Sample Programmes
• Curriculum-based programmes
- Botvin‟s Life Skills Training programme
- Cognitive skills training - problem-solving
- Greenberg et al‟s promoting alternative
thinking strategies (PATHS)
- Kellam‟s Good Behaviour Game

23. Zippy’s Friends
Emotional Wellbeing Programme for young children
which aims to encourage children to:
learn skills to deal with everyday problems
develop a wide range of coping strategies
identify and label feelings
focus on positive strengths and abilities
think for themselves
work cooperatively as a class group
International evaluations of Zippy’s Friends
Lithuania and Denmark (Mishara & Ystgaard, 2006)
England, Southampton, (Holmes & Faupel, 2003, 2004)
Norway (Ystgaard, M. et al.)
Canada (Mishara, B.L. et al.)

24. Evaluation of the Zippy’s Friends programme in
Ireland (Clarke & Barry, 2010)
• Programme was introduced into designated disadvantaged
Irish primary schools on a pilot basis in 2008
• Health Service Executive and Department of Education &
Science
• 24 week programme – six modules, structured materials
• Teachers trained in its delivery
• Evaluation of process and outcomes

25. Methodology
Study Design: Randomised Controlled Design
Data Collection
T1: Baseline
(Feb ’08)
T2: Interim I
(June ’08)
T3: Interim II
(Oct ’08)
T4: End of Prog
(Apr ’09)
T5: 1 Year Follow Up
(Apr ’10)
DEIS Schools (n=42)
(n= 730)
Intervention
(n= 523)
Control
(n=207)
Intervention
Type I
(n=270)
Intervention
Type II
(n=253)

26. Evaluation of the Zippy’s Friends programme in
Ireland (Clarke & Barry, 2010)
• Measures: structured scales, child participatory workshops, Draw-and-
Write technique
• Teachers’ weekly reports on implementation, review sessions
• School Context – case studies
Summary of main findings
• Successful programme adaptation to Irish designated disadvantaged
primary schools
• Significant positive effects on children’s emotional literacy, coping
skills, hyperactivity and teachers’ relationships with the children
• 12 months post-intervention follow-up

27. A copy of the full report
is available to download
at:
http://www.nuigalway.ie/
hprc

28. M. Barry, Oslo 2010
Sample Programmes
• Whole School Approach
- Australian MindMatters programme (adapted as MindOut
programme in Ireland- Byrne, Barry and Sheridan, 2004)
- Olweus Bullying Prevention programme
- UK Social and Emotional Aspects of Learning (SEAL)
• Targeted Programmes
- Clarke‟s Coping with Stress Course – depression
- Gillham et al. Penn Resiliency programme
- Resourceful Adolescent programme (Shochet et al, 2001)
- Incredible Years Programme (Webster-Stratton et al., 2001)

29. M. Barry, Oslo 2010
Effectiveness of programmes
• Weare (2004) “ programmes that teach social and
emotional competence can result in gains that are
absolutely central to the goals of all schools.
Gains include improved school atmospheres, more
effective learning, better behaviour, higher school
attendance, higher motivation, higher morale of
students and teachers, and better results for
students and schools” (p13)

30. M. Barry, Oslo 2010
Collaborative for Academic, Social
and Emotional Learning (CASEL)
Essential skills for social and emotional learning:
• Self-awareness - know yourself and others - identify
feelings, be responsible, recognize strengths
• Self-management - manage emotions, understand
situations, set goals and plans, solve problems creatively
• Social awareness - care for others - show empathy,
appreciate diversity
• Relationships skills - communicate effectively, build
relationships, negotiate fairly, refuse provocations, seek
help
• Responsible decision making - act ethically, appropriate
social norms, respect others

31. M. Barry, Oslo 2010
CASEL - evidence based support for
social and emotional learning (SEL)
• Improved attitudes toward school, better sense of
community (Schaps et al., 2004) and higher academic
motivation (Johnson and Johnson 2004)
• Positive school behaviours - more prosocial interactions
(Johnson and Johnson, 2004), fewer absences and
suspensions (Christenson and Havsy, 2004) and reductions
in aggression, disruptions and interpersonal violence
(Greenberg et al., 2004)
• Enhanced school performance in terms of improved
maths, language, arts and social studies (Brown et al.,
2004) and better problem solving and planning (Greenberg
et al., 2004).

32. M. Barry, Oslo 2010
CASEL Technical Report on the impact of social
and emotional learning (Payton et al., 2008)
• Three scientific reviews - 317 studies involving
324,303 school children aged 5-13 years
• Strong and consistent support for the value of SEL
programmes implemented by school staff
• Effective in both the school and after-school
setting and for students with and without
presenting problems, rural/urban, racially and
ethnically diverse groups
• The effects remained over time

33. M. Barry, Oslo 2010
CASEL 2008 Technical report on the
impact of social and emotional learning
• Improvement in multiple areas :
• Social and emotional skills
• Attitudes towards self, school and others
• Positive social and classroom behaviours
• Conduct problems - misbehaviour and
aggression
• Emotional distress - stress and depression
• Academic performance - test scores and school
grades

34. M. Barry, Oslo 2010
CASEL 2008 Technical report on the
impact of social and emotional learning
• Across the studies evaluating academic outcomes
students scored 11 percentile points higher on
standardized achievement tests relative to peers
not receiving the programme
• Only when delivered by school staff did students‟
academic performance improve significantly
• Programme implementation had a strong influence
on outcomes
• Review paper - Durlak & DuPre (2008)
Implementation Matters. American Journal
Community Psychology, 41, 327-350;

35. M. Barry, Oslo 2010
Importance of Implementation
• “How well a proposed programme or intervention
is put into practice” (Durlak, 1998)
• Assessing both the quantity and quality of
implementation
» how much of the programme was delivered
» how well each part was conducted
• Conditions necessary for successful
implementation in the local context
• Generic processes that underpin effective
programme planning and delivery

36. M. Barry, Oslo 2010
Importance of Implementation
• Finding the right mix of programme fidelity
and adaptation
• The process of planning, implementation
and training systems
• Implementation support system - facilitatory
and inhibitory factors in the local setting or
context
• Sources: Barry & Jenkins, 2007; Barry,
Domitrovich and Lara, 2005

37. M. Barry, Oslo 2010
CASEL 2008 Technical report on the
impact of social and emotional learning
Interventions using four recommended evidence-based
practices for skill training were more effective than those
that did not;
• Sequenced - skills are developed sequentially in a step-by-
step fashion
• Active - active learning -role plays and behavioural
rehearsal with feedback
• Focused - time given exclusively to developing social and
emotional skills
• Explicit - programme targets specific social and emotional
skills

38. M. Barry, Oslo 2010
Context Matters in Programme Implementation
Clarke, Barry & O’Sullivan (2010)
Health Education, Vol 110, No. 4
Impacts on programme implementation:
• Complex interaction of factors operating at the classroom,
school and wider community level
• School culture, environment and whole school practices
• readiness for change (Bumbarger & Perkins, 2008)
• Contextual factors in the local community (Wanders et al.,
2007)
• teacher-parent relationship
• impact of economic and social factors on parental involvement
• Understanding the organisational and cultural contexts
of schools is critical for implementation and
sustainability (Rowling, 2008)

39. M. Barry, Oslo 2010
Generic Principles of Effective
Mental Health Promotion in Schools
• Adopt a whole school approach - bring
about change at the level of the individual,
the classroom and the school
• Adopt a social competence approach -
promotion of resourcefulness and generic
coping and competence skills. Also includes
peer-led approaches and mentoring
programmes as potentially useful

40. M. Barry, Oslo 2010
Generic Principles of Effective
Mental Health Promotion in Schools
• Theory-based interventions - grounded on theories
of child development and learning
• Sustained interventions over multiple years - once-
off or short-term interventions are not likely to
produce long-term effects
• High quality programme delivery - supportive
implementation system
- engagement of school management, teachers, parents
and students
- teacher training, resources, organizational support

41. M. Barry, Oslo 2010
Generic Principles of Effective
Mental Health Promotion in Schools
• Evaluation - systematic evaluation methods
(process, impact and outcome) contribute to
ongoing improvement and sustainability of
programmes
• Sustainability - organizational and system-
level practices and policies that will ensure
the long-term impact of high quality
programmes

42. M. Barry, Oslo 2010
Challenges
• Integrating efforts to promote social and emotional
learning of young people with the school‟s
educational mission of academic learning
• Over-crowded curriculum
• Adopting a whole school approach in practice
• Leadership
• Training and support - both pre- and in-service
• Content and methodologies
• Evaluation framework - focus on programme
implementation and its relationship to impact and
to outcomes

43. M. Barry, Oslo 2010
Useful Sources
• Barry, M. and Jenkins, R. (2007) Implementing Mental
Health Promotion. Elsevier, Oxford
• Jané-Llopis E, Barry M M, Hosman C, Patel V (2005)
Mental health promotion works: a review. Promotion and
Education suppl 2:9-25
• Rowling, L., Martin, G., & Walker L (2002) Mental health
promotion and young people: concepts and practice.
McGraw Hill, Sydney
• Weare, K. (2000) Promoting mental, emotional and social
health: a whole school approach. Routledge, London
• Payton et al. (2008) The positive impact of social and
emotional learning for kindergarten to eight-grade
students: Findings from three scientific reviews. CASEL
www.casel.org or www.lpfch.org/sel

44. M. Barry, Oslo 2010
Useful Sources
• Weare, K. and Gray, G. (2003) What Works in Developing
Children’s Emotional and Social Competence and
Wellbeing? [online]. Available:
http://www.dfes.gov.uk/research/data/uploadfiles/RR456.pdf
• Weare, K. (2004) Developing the Emotionally Literate
School. London: Paul Chapman Publishing
• Hallam, S., Rhamie, J., and Shaw, J. (2006). Evaluation of
the Primary Behaviour and Attendance Pilot (DfES
Research Report 717). London: DfES. [online]. Available:
http://www.dfes.gov.uk/research/data/uploadfiles/RR717.pdf
• Zins, J. E. et al. (2004) Building Academic Success on
Social and Emotional Learning. Teachers College Press,
Columbia University.