Implementation quality of whole‐school mental health promotion and students’ academic performance

Abstract

BackgroundThis paper argues for giving explicit attention to the quality of implementation of school-wide mental health promotions and examines the impact of implementation quality on academic performance in a major Australian mental health initiative.MethodHierarchical linear modelling was used to investigate change in standardised academic performance across the 2-year implementation of a mental health initiative in 96 Australian primary (or elementary) schools that was focused on improving student social-emotional competencies.ResultsAfter controlling for differences in socioeconomic background, a significant positive relationship existed between quality of implementation and academic performance. The difference between students in high- and low-implementing schools was equivalent to a difference in academic performance of up to 6 months of schooling.Key Practitioner MessageGiven the known relationship between student academic achievement and mental health, many nations are mounting school-based mental health interventions: however, the quality of program implementation remains a concernThe Australian KidsMatter primary school mental health intervention enabled the development of an Implementation Index allowing schools to be grouped into low- to high- implementing schoolsThe quality of implementation of KidsMatter appears to be positively associated with the level of student academic achievement, equivalent to 6 months more schooling by Year 7, over and above any influence of socioeconomic background

Strategies for Integrating Mental Health into Schools via a Multitiered System of Support

“…43,44 Poor implementation has resulted in iatrogenic effects, including reactive disciplinary practices, multiple changes in programs implemented, inequitable outcomes for disadvantaged students, and consumer dissatisfaction and lack of confidence. 9,45 Given these consequences, education and mental health systems should consider using implementation science to more effectively integrate a full continuum of evidence-based mental health practices into schools. Sugai and Stephan 46 review key questions to consider when determining if and how to implement evidencebased mental health practices in schools: (1) Are need and intended outcome specified?…”

“…In fact, data are mounting that it is in the best interest of schools and districts to provide such interventions to effectively promote students' academic success. 3,9 From a mental health perspective, one could not ask for a better opportunity to support the healthy social, emotional, and behavioral development of young children, and to identify and address mental health issues before or early after their onset. All mental health and school personnel could work together to support the healthy development of all students by strengthening protective factors, reduce the exacerbation of existing risk factors, and screen for conditions that might indicate development of later emotional, social, and mental health difficulties.…”

“…In addition, by improving the capacity of educators (ie, general and special education teachers, paraprofessionals, principals), and school and community mental health professionals (ie, psychiatrists, psychologists, counselors, occupational therapists, nurses, social workers) to work together to leverage their respective knowledge, skills, and resources to implement evidence-based mental health practices, improvements in student academic achievement and social and behavioral competence may be realized. 4,9,10 HISTORICAL CONTEXT AND CHALLENGES Historically, school mental health services have not effectively spanned a full continuum of care, from mental health promotion to treatment, and several implementation and service challenges have evolved. First, school mental health service provision has largely been characterized by tertiary clinical care models, serving students with identified mental health challenges that interfere with school functioning.…”

The Survey of School Promotion of Emotional and Social Health (SSPESH): A Brief Measure of the Implementation of Whole-School Mental Health Promotion

“…Given the complexity of implementing mental health promotion school-wide, some schools do this more readily than others. For example, in Australia, significant positive relationships were found between the extent of implementation of a whole-school mental health initiative and students' differential mental health outcomes (Slee et al, 2009) and academic performance (Dix, Slee, Lawson, & Keeves, 2012). In order to assess implementation quality in the 96 schools studied, Dix, Slee, Lawson, and Keeves (2012) used latent class analysis to develop an 'implementation index'.…”

“…For example, in Australia, significant positive relationships were found between the extent of implementation of a whole-school mental health initiative and students' differential mental health outcomes (Slee et al, 2009) and academic performance (Dix, Slee, Lawson, & Keeves, 2012). In order to assess implementation quality in the 96 schools studied, Dix, Slee, Lawson, and Keeves (2012) used latent class analysis to develop an 'implementation index'. The index categorised schools as high, moderate, or low implementers of the mental health initiative based on a set of criteria (fidelity, dosage, quality of delivery) and found that high implementing schools showed greater academic gains than low implementing schools.…”