Acceptability and Feasibility of Early Identification of Mental Health Difficulties in Primary Schools: A Qualitative Exploration of UK School Staff and Parents’ Perceptions

Abstract

One in eight children aged 5–19 years in the UK suffer from a psychiatric disorder, while fewer than 35% are identified and only 25% of children access mental health services. Whilst government policy states that primary schools are well-placed to spot the early warning signs of mental health issues in children, the implementation of early identification methods in schools remains under-researched. This study aims to increase understanding of the acceptability and feasibility of different early identification methods in this setting. Four primary schools in the East of England in the UK participated in a qualitative exploration of views about different methods that might enhance the early identification of mental health difficulties (MHDs). Twenty-seven staff and 20 parents took part in semi-structured interviews to explore current and future strategies for identifying pupils at risk of experiencing MHDs. We presented participants with four examples of identification methods selected from a systematic review of the literature: a curriculum-based approach delivered to pupils, staff training, universal screening, and selective screening. We used NVivo to thematically code and analyse the data, examining which models were perceived as acceptable and feasible as well as participants’ explanations for their beliefs. Three main themes were identified; benefits and facilitators; barriers and harms, and the need for a tailored approach to implementation. Parents and staff perceived staff training as the most acceptable and feasible approach to systematic identification, followed by a curriculum-based approach. Universal and selective screening garnered mixed responses. Findings suggest that a systematic and tailored approach to early identification would be most acceptable and feasible, taking into consideration school context. Teacher training should be a core component in all schools.

Determining stakeholder priorities and core components for school-based identification of mental health difficulties: A Delphi study

“…Evidence for effectiveness came from our systematic review of effectiveness and cost-effectiveness of school-based identification methods ( Anderson et al, 2018 ). Evidence for feasibility came from our systematic review of feasibility of school-based identification methods ( Soneson et al, 2020 ) and interviews with parents and school staff ( Childs-Fegredo et al, 2020 ). Evidence for acceptability came from the systematic review of feasibility ( Soneson et al, 2020 ), interviews with parents and school staff ( Childs-Fegredo et al, 2020 ), and survey of primary school parents ( Soneson et al, 2018 ).…”

“…Evidence for feasibility came from our systematic review of feasibility of school-based identification methods ( Soneson et al, 2020 ) and interviews with parents and school staff ( Childs-Fegredo et al, 2020 ). Evidence for acceptability came from the systematic review of feasibility ( Soneson et al, 2020 ), interviews with parents and school staff ( Childs-Fegredo et al, 2020 ), and survey of primary school parents ( Soneson et al, 2018 ). We identified components that were relevant across all identification models (e.g., program aims, conditions identified, consent/assent, program delivery, feedback provision), as well as components relevant to individual identification models (e.g., frequency of screening, curriculum content).…”

“…To inform program development, we synthesized existing evidence on the effectiveness, cost-effectiveness, and feasibility of school-based identification programs through two systematic reviews ( Anderson et al, 2018 ; Soneson et al, 2020 ). We further conducted a survey ( Soneson et al, 2018 ) and interviews ( Childs-Fegredo et al, 2020 ) with parents and school staff members to understand their perspectives on the characteristics of an ideal school-based identification program. At the conclusion of these studies, uncertainty remained as to the best way to identify mental health difficulties in schools.…”

Teacher-pupil Relations and Subject Preference

“…Pupils will face their subject preference when they start having classes in school. Apeh et al pointed out that psychologists are interested in personal difference because it links to an individual's personality, learning and personal motivation, which means choices of individuals are related to the diversity of human beings [15]. By analyzing the scores of different types of pupils, they drew out a conclusion that diverse personalities cause the existence of subject preference.…”

Preventing Emotional Dysregulation: Acceptability and Preliminary Effectiveness of a DBT Skills Training Program for Adolescents in the Spanish School System

“…A review of school-based mental health interventions has highlighted the need for more research to identify mental health disorders in children as a priority to maximize the effectiveness of school-based interventions [ 11 ]. Including mental health services into the school system was reported as a key factor in this direction, whereby integrative strategies would increase access to mental health support when required [ 12 ]. Despite all these benefits, using schools as the center for mental health services may have some limitations, as there is typically limited access to trained mental health professionals [ 10 ].…”