A Knowledge/ Research Agenda in SMHThis is a featured page



Introduction

The following knowledge development and research agenda is a list of important topics in school-based and school-linked mental health promotion that need further development through analyses of and more targeted research, compilations and analyses of administrative and survey data and structured consultations, qualitative studies and narrative reviews with experienced practitioners, officials and policy-makers.

This three-pronged approach (evidence, data, experience) to the development of a deeper understanding about mental health in schools is a departure from traditional research agendas developed by experts in regards to particular aspects of an issue. It is even further away from the traditional model of research funding where researchers submit specific proposals based on their own inquiries to a generally defined area or set of topics.

This knowledge/research agenda has been modelled after an ecological/systems-based framework developed for school health promotion (McCall & Doherty, 2005) through a research grant awarded to Rootman et al by the Canadian Institutes for Health Research. This framework has led to the development of a synthesis of several approaches to school health promotion, safety and social development (International School Health Network, 2009) which has been used to define certain categories in the table below.

Much of the general comments made in the table below are derived from these sources:
  • A regular monitoring of over 145 health, education, welfare, criminology, youth and other journals (23 of which are focused on mental health) as well as over 40 media outlets, over 50 social media sources and numerous national and international web sites which is posting over 50 new citations and over 25 new planning/ educational resources per month in a Twitter-based news feed on school mental health.
Participants in this process to develop a knowledge development/research agenda will likely also be interested in the work being done experts/experienced practitioners in the call for presenters, editors, writers and contributors on several SMH topics being developed within the World School Health Encyclopedia. These web-based resources will include online summaries (glossary terms, encyclopedia entries, handbook sections and extensive bibliographies) as well as recorded webinars, slide presentations, video presentations and other tools on over 30 different aspects of school-based and school-linked health promotion. The list of topics in that encyclopedia reflects the similar list of topics and issues noted herein.

This knowledge development and research development agenda has been developed by the Canadian Association for School Health for its national Community of Practice on School Mental Health. It has been posted for comments and editing on its web site. However, comments and edits are welcome from around the world. Go to this web page to add your thoughts:

List of topics needing further development in School Mental Health Promotion

The International School Health Network and our partners are calling for editors, writers, contributors, reviewers and sponsors to develop a series of summaries that define and describe several topics relating to mental health and schools. The summaries on topics could eventually form part of an e-book on School Mental Health that will be prepared from materials in this knowledge exchange program. The development of this series of topics is being guided by Dr Stan Kutcher, Chair, Sun Life Financial Chair in Adolescent Mental Health, IWK Health Centre, Dalhousie University, Canada which is recognized by the World Health Organization (WHO) and the United Nations Education, Science and Cultural Organization (UNESCO) as a global collaborating centre of excellence. The topics being used for that international call have also been used as an outline of topics for this knowledge development and research agenda.

Topics Sub Topics What we know What we need to know
School Mental Health Promotion Overview
  • There are several international and Canadian models of school-based health promotion, education and social development that include a concern or important aspects related to mental health. These include social and emotional learning, effective behavioural support, inclusive schools, safe & caring schools, child-friendly schools and others.
  1. Can we, should we develop a model of school-based and school-linked development that focuses on the psychological (rather than the social, human rights or special needs of children? If yes, what are the elements and how can they be emphasized in an aligned way with other similar approaches?
A. Prevalence, Nature & Theories on Mental Health & Schools
A-1 Prevalence, Nature of the MH of Children & Adolescents Overview
  • There are a number of studies and surveys in Canada and internationally that provide a partial statistical picture of the MH of children and youth. Most of these studies report on mental illnesses (usually less than 5% of the population) rather than MH problems affecting larger numbers of people, on positive aspects of MH or on the relationships between MH and other health/social problems. Many studies note that the onset of several mental disorders occurs in adolescence.
  • There are a number of sources that explain that MH status is a product of complex interactions between the individual traits of children, the nature of the social and physical environments in which they live, learn and play and the life incidents/processes that shape the interactions between them.
  • A minimum level of MH is often described as the ability to adapt and function (to appropriate developmental levels). An optimal level of MH is often described as leading to greater levels of self-fulfilment and productivity.
  1. What is the prevalence of MH strengths (positive), MH problems, interactions with other problems and mental disorders in Canada? In the world? In countries similar to Canada?
  2. Is that prevalence increasing or decreasing?
  3. How can we monitoring that prevalence in an ongoing way? What are the indicators (behavioural as well as conditions and factors) that should be used?
A-2 Specific Aspects of MH, Strengths, Risks, Behaviours & Conditions Overview
  • Much of the research about broad health issues like MH indicate that is more effective to focus interventions on specific behaviours, conditions or factors rather than attempting to influence all aspects simultaneously
  • Like many other health issues, much of the research in MH is focused on the problems (specifically mental disorders) and often the research seeks to find ways of identifying children at higher risk earlier and then apply a specific intervention. This approach is often problematic for schools, who are primarily concerned with the needs of all children and therefore are more apt at implementing “universal” rather than “targeted” or “indicated” programs that reply of specialized services being delivered by other agencies and professionals.
  1. What does the research say about the effectiveness of approaches and interventions affecting the specific aspects of MH listed in this sub-section?
  2. Has the attention on MH been overly focused on MH disorders?
  3. Does this dilemma about universal vs targeted or indicated school-based and school-linked programs apply to MH? Are there good examples of balanced and comprehensive approaches?





Positive Mental Health


Mental Health Literacy
  • Health literacy is defined as the degree to which people can obtain, process and understand basic health information and services they need to make acceptable health decisions. Mental health literacy may be understood similarly as knowledge, beliefs and abilities that enable the recognition, management or prevention of mental health problems. Enhanced mental health literacy is thought to confer a range of benefits: prevention, early recognition and intervention, and reduction of stigma associated with mental illness.Developing strategies to improve mental health literacy is a relatively new approach to mental health promotion, particularly in Canada. Some countries, such as Australia, have been doing a great deal of work assessing the degree of mental health literacy in the population and applying social marketing approaches to enhance it. (Canadian Alliance on Mental Health & Mental Illness, 2007)
  1. Does the promotion of mental health literacy only involve social marketing and education of individuals or does it include other health promoting strategies such as reorienting health services towards prevention, increased social support through community development, addressing the determinants of health etc?
  2. How does an understanding of MH literacy improve our efforts to promote MH? What is the difference between promoting MH literacy and promoting MH?
  3. Is the promotion of MH literacy concerned primarily with only or primarily "basic" MH literacy (implying a focus on equity and social determinants) or is it concerned with all levels of MH literacy and therefore the MH literacy of all people?

Emotional Intelligence & Development

Brain Development

Mindfulness/ Self Knowledge
  1. How should curricula and school practices be modified to encourage greater mindfulness of self-knowledge?

Critical Thinking/ Self Control

Spirituality

Social Skills

Social Attachment

Physical Activity and Diet

Mental Health Problems


Resilience
  1. What is unique about resilience theory that is distinct from other health promotion, prevention and asset-building approaches? ie what does it teach us about response mechanisms and bouncing back from adversity)

Vulnerability in Transitions

Children Living with a Parent with Mental illness

Bereavement

Stress/Distress

Social Isolation/ Loneliness/Social Exclusion

Divorce/Family Breakdown

Homelessness/ Transience

Trauma from Violence, War, Disasters

Intersection with Other Health & Social Problems


Intellectual, Physical & Learning Disabilities

Child Abuse/Neglect and Family Violence

Child Sexual Abuse

Pregnancy

Bullying/Aggression & Bystander Trauma

Addictions

Homophobia/ Gender Ambiguity/ Sexual Orientation
  1. What are the most effective ways to prevent homophobic taunting, bullying in and through schools?

Chronic Diseases

Obesity/ Overweight
  1. Is the connection between MH and overweight more significant than the connection between physical activity and diet?

Eating Disorders/ Disordered Eating/ Body Image

Economic, social or geographical disadvantage

Cultural Isolation

Cultural Oppression/ Colonization

Mental Illnesses & Disorders


Stigma/ Help Seeking

Compulsive/ Obsessive Behaviours

Anxiety

ADHD

FASD

Behaviour Disorders/ Delinquency/ Criminal Behaviours

Depression

Violence/ Aggression

Self-harm

Suicide
A-3 Behaviour Theories that Explain MH problems or approaches Overview
  • Most of the effective approaches and interventions on health and other problems are based on well-developed behavioural theories. In the case of MH, the theories that have been used more often include social-emotional intelligence, social attachment, social learning, cognitive-behavioural theory and self-determination, with resilience emerging as an area of interest.
  1. Has the use of these theories truly guided program and policy development?
  2. Are there surveys and studies documenting how many programs are based on these theories and evidence?
  3. Are there studies documenting if those evidence-based programs are being used in the schools?

Social-Emotional Intelligence
  • There is a popular and well-evaluated whole school model based on social-emotional intelligence (SEL).

Social Attachment Theory
  1. How does social attachment theory explain the connection between child and parents, among close friends and peer groups, between student and schools?

Resilience

Stages of Change/ Trans-theoretical Model

Self-Determination Theory

Cognitive Behaviour Theory

Health Belief Model

Risk Reduction/Harm Reduction Theory


Social Learning





Planned Behaviour Theory

Problem Behaviour Theory
B Influence of the School Environment on MH
B-1 Influence of the School Social Environment & Regular School Practices Overview
  • Several studies have shown that the social environment in the school will have an impact on the mental health and well-being of children.

  1. How can we deconstruct simplistic ideas about school "connectedness" so that people understand that it is far more than teachers being nice to their students and that generalized attempts to improve the school climate often go unnoticed by students, especially those who are experiencing difficulties.
B-2 Influence of the School Physical Environment
B-3 Influence of School Organization & Practices

Student Evaluation/ Retention/ Recognition Practices
  • Some studies show that a disconnect between students and school can start in the early primary grades with student who experience difficulties adjusting or achieving at school.
  1. Do alternative academic pathways through schooling have an impact on MH as well as keep kids in school? (Vocational programs, IEP's, alternative schools, magnet schools in music, art, technology, etc)
  2. Do modifications to school rituals such as graduation ceremonies, awards nights, student yearbooks etc have an impact on MH, school retention?
  3. Does student MH fluctuate with the rigidity and type of academic standards established in schools?

Use of homerooms, teacher-student advisers in secondary schools

Age/groupings for middle & high schools
B-4 Influence of School-related Transitions

Transition from another school

Pre-School to school transition

Transition between primary & secondary school

Transition between sec school and post-sec education

Transition between school and first job
C. Comprehensive Approaches, Coordinated Agency-School Programs, Whole School Strategies to SMH
C-1 SMH Statements, Models & Frameworks
  • There are several well developed statements, models and frameworks for promoting different aspects of mental health, personal and social development through schools
C-2 Effectiveness of Comprehensive Approaches (Multi-issue, not only MH, multi-level, multi-agency)
  • Research in MH and on several other issues shows that the effect on behaviours, conditions and educational outomes is greater if multiple interventions are delivered in comprehensive approaches, coordinated agency school programs and whole school strategies. However, these multi-intervention approaches are more difficult to start, support and maintain.
  1. 1. Where are the evaluated and experience-tested comprehensive models? Where do they start - in the MH agencies, within school systems, by ministry directive?
  2. When combining MH with other health and social issues, are their better variations (eg safe & caring schools, physical health (healthy living) and MH, academic and social learning etc)
  3. What are the best examples of inter-ministry cooperation in different types of jurisdictions?
C-3 Effectiveness of Coordinated Agency-School Programs on MH only
  1. What the best examples of inter-agency cooperation in different types of communities
C-4 Effectiveness of Whole School (Educator only) Strategies on MH
C-5 Effectiveness of MH programs on learning, educational achievement
D. Use of Evidence-based Individual Interventions in SMH
D-1 Ministry, Agency, School Policy Interventions Overview

Whole of Government Policies

Health Ministries, Health Authorities & MH Agencies Policies/ Professional Guidelines re working with schools

Education Ministries, School Boards and Ed. Professional Guidelines re MH

Law Ministries, Police Service policies re MH and schools

Social Service/ Child Protection Ministry & Agency Policies & Professional Guidelines re MH and working with schools
D-2 Curriculum & Instruction in Mental Health Overview

Curriculum Design/ Learning Objectives/ MH Literacy

Instructional Programs

Teaching Learning Methods/ Classroom Management

Teacher Education & Development

Student Assessment & Evaluation re MH

Web-based MH Learning

Parent Involvement in MH Instruction

Peer-based Instruction

Awareness & Information Classroom Programs using Celebrities, Survivors or Community or PH Personnel
D-3 Mental Health Services delivered in or linked with schools Overview

Early Identification, Screening & Referral Services

Brief Counselling Services

Student Assistance Programs

Case Management & Coordination

School Support during Treatment, Incarceration, incl. cooperation with family-based programs

School Support for Re-integration

Individual Ed Programs for students with MH problems

School Clinics in or linked with schools

Crisis Response & Follow Up Services for Students, Parents, Staff

Role of Physicians, Clinics, Hospitals re SMH

Role of School Social Worker, Social Services Agency

Role of PH Nurse, PH Programs & Health Authority in SMH

Role of School Guidance Counsellor, SB Student Services re SMH

Role of Pastoral Care Worker, Local Clergy re SMH

Role of Police Officer, Police Services re SMH

Role of School Psychologists, local psychologits re SMH

Role of School Principal in SMH

Role of Classroom Teachers in SMH

Role of Trained Peer Helpers in SMH

Role of Parent Volunteers, Adult Mentors in SMH
D-4 Social Support Interventions Overview

School Discipline/Conduct

Whole School Climate Programs

Anti-stigma programs & campaigns

Anti-harassment, bullying policies, programs & campaigns

School activities to promote MH

After school programs that promote MH

Student Friendship Programs

Student Leadership/ Advocacy Programs

Peer Helper Programs

Mentoring Programs

Inter-generational activities

Parent Information Activities

Parent Involvement & Volunteer Programs

Parent Education, Training & Support Programs

Working with Community & Self-help Organizations

Web Awareness Programs for Parents & Students

Working with Local Media

Staff Wellness & Occ. Safety/Health Programs
D-5 Physical Environment & Resources Overview

Safe Transportation to school

Adequate lighting

Student friendly places within school

Stress-reducing school grounds
E, Implementation, Capacity, Systems Change & Sustainability in SMH Overview
E-1 Evidence-based, Practical & Strategic Implementation Planning in SMH Overview

High Quality Implementation of SMH Programs: Definition, Measuring, Monitoring

Evidence-based Implementation Planning in SMH

Practical: Using mechanisms and engaging stakeholders in SMH

Strategic Local Drivers of Change or Resistance in SMH
E-2 Diffusion of Successful SMH Programs Overview

Defining Distribution, Dissemination & Diffusion

Critical Appraisal of the innovation & "fit" with schools & local context

Fidelity Issues in SMH
E-3 Capacity and Capacity Building in SMH

Evidenced-based minimums for staffing, curriculum time, access & service delivery in SMH

Inter-ministry policy & coordination in SMH

Inter-agency policy, coordination in SMH

Assigned staff to coordination in SMH

Formal & Informal mechanisms for cooperation in SMH including:
- inter-ministry agreements
- inter-agency agreements
- inter-ministry committees
joint service and budget planning

Knowledge exchange in SMH

Workforce development in SMH including:
- teacher education programs
- inter-professional ed programs
- teacher development programs
- special certificates
- police officer development
- nurse, social worker development programs

Monitoring, reporting and program evaluation in SMH including:
- school self-assessments
- school recognition programs
- Indicator development
- survey development

Explicit planning for Sustainability

Strategic Management of Issues
E-4 Sustainability

Sustainability of SMH Programs
E-5 Consideration of system characteristics and change in SMH Overview

Applications of Systems Change Models in SMH

Open Adaptive Systems & SMH

Loosely-coupled systems & SMH

Professional Bureaucratic systems & SMH

Working across multiple systems in SMH
F Consideration of Local Community Context Overview
F-1 Cultural, Linguistic & Faith Communities
F-2 Aboriginal/ Indigenous Communities
F-3 Rural Communities
F-4 Disadvantaged Communities
F-5 Affluent Communities
G. Consideration of the primary roles, professional norms and ideologies and constraints of school systems Overview
G Integrating within school system: Primary Roles, Professional Norms and Constraints of Schools re MH
G-1 Consideration of Primary Roles, Functions of Schooling Overview

Primary Role: Accreditation/Sorting & Selecting Role means many students must fail

Competition with primary academic & vocational roles
G-2 Consideration of Professional Norms & Ideologies of educators Overview

Norm: All students deserve equal time and attention

Norm: Disruptions in class cannot be tolerated
G-3 Consideration of social, economic & political constraints on schools re MH

Constraint: Parent rights and privacy must be respected
H. Major Research Issues
H-1 Knowledge & Research Agendas in SMH
H-2 Research Connecting MH & Learning
H-3 Cost-effectiveness & cost benefit studies in SMH
H-4 Use of multiple research methods in SMH
H-5 Methodological, Measurement & Technical Issues in SMH Research





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