Mental health interventions in UK secondary schools: A systematic review and an acceptability and feasibility study of an ACT intervention delivered by school-based staff.

Thesis Preface: The aim of this research was to review studies concerning mental health interventions which have been carried out in UK secondary schools since 2010. This research also assessed the acceptability and feasibility of training school-based professionals to deliver an intervention to secondary school students, based on the therapeutic approach of Acceptance and Commitment Therapy (ACT). The systematic review aimed to understand the current evidence base for interventions that intend to support and improve adolescent mental health and are carried out as part of the school timetable. School-based interventions for young people can be categorised into those delivered to groups of young people who are experiencing difficulties or at risk of developing difficulties (targeted interventions), or those which are delivered to everyone regardless of need (universal interventions). Published articles from 2010 were searched across eight databases (PsycInfo, ASSIA, Scopus, Web of Science, ERIC, CINAHL, BEI and Medline), returning 1630 papers with fifteen meeting criteria for the review question. Results highlighted the variable interventions that have been published on improving adolescent mental health and wellbeing in the UK since 2010. Ten were universally delivered and five were targeted interventions. The results reflected those of previous reviews in the UK, in that understanding the effectiveness of interventions is limited by a lack of follow-ups, with eleven studies looking at differences immediately post-intervention or three months post-intervention only. Nearly all studies reported positive improvements. However, further detail around training for those delivering the interventions, assessment of whether the interventions are delivered as intended, longer follow-ups, and consistency across studies in the measures used to assess outcomes for young people is needed from future studies. 7 The empirical paper describes an acceptability and feasibility study assessing training for school-based staff to deliver an ACT intervention within schools, and how well this was delivered. School-based interventions can be helpful for young people’s mental health, although often studies do not report whether the intervention was delivered as planned or give minimal information. The intervention was designed to be delivered in pairs made up of one schoolteacher and one school counsellor. Facilitators attended a two-day training course and delivered the three-lesson workshop hoping to improve adolescent well-being and developing skills for psychological flexibility, based on ACT. A questionnaire assessed their satisfaction with training. Another questionnaire was developed to see whether training improved their knowledge of responding to young people in ways consistent with the principles of ACT. Changes to their own levels of psychological flexibility were measured pre-training and followed up after delivering the workshops to school students. All workshops were recorded and assessed for how many of the key intervention activities were adhered to, and whether the overall delivery was consistent with the principles of ACT. Results indicated that the training was highly acceptable to school staff and did impact on their knowledge of responding in ways consistent with ACT. However, the measure had not been validated and is interpreted with caution. School-based staff were able to deliver the workshops with high adherence to the manual (completing between 86% and 100% of key tasks). The measure of adherence to the principles of ACT was used with good effect, with high levels of agreement when comparing the scores of two raters. The content of the workshop appeared to impact some of the scores, for instance scores relating to discussion of values were highest in the final session where this was the focus of work. Scores of psychological flexibility (an overarching aim of ACT) increased for facilitators, indicating that attending training and/or delivering interventions may have additional impacts on facilitators which is an area currently unexplored. 8 Overall, the review provides an update on the state of UK school-based mental health interventions. This includes the quality of such studies and how future research can address the limitations of these or add to the strength of the evidence base. Where possible, further information and resources for replicating these interventions are given. The empirical paper addresses a gap within the literature for assessing the implementation of a school-based ACT intervention and highlights the acceptability of a two-day virtual training course. The results showed that school-based staff were able to deliver the intervention with high adherence and good fidelity to the theoretical model of ACT. The research highlights how greater use of a fidelity measure across ACT interventions and establishing norms for ‘high’ fidelity are needed. It also gives an additional element to consider for future research in the change of a facilitator’s own psychological flexibility through delivering an ACT intervention