Helen Butler

The Gatehouse Project: can a multilevel school intervention affect emotional wellbeing and health risk behaviours?

Study objective: The aim of this study was to determine the effect of a multilevel school based intervention on adolescents’ emotional wellbeing and health risk behaviours. Design: School based cluster randomised controlled trial. Students were surveyed using laptop computers, twice in the first year of intervention and annually thereafter for a further two years. Setting: Secondary schools. Participants: 2678 year 8 students (74%) participated in the first wave of data collection. Attrition across the waves was less than 3%, 8%, and 10% respectively with no differential response rate between intervention and control groups at the subsequent waves (98% v 96%; 92% v 92%, and 90% v 89% respectively). Main results: A comparatively consistent 3% to 5% risk difference was found between intervention and control students for any drinking, any and regular smoking, and friends’ alcohol and tobacco use across the three waves of follow up. The largest effect was a reduction in the reporting of regular smoking by those in the intervention group (OR 0.57, 0.62, and 0.72 at waves 2, 3, and 4 respectively). There was no significant effect of the intervention on depressive symptoms, and social and school relationships. Conclusions: While further research is required to determine fully the processes of change, this study shows that a focus on general cognitive skills and positive changes to the social environment of the school can have a substantial impact on important health risk behaviours.

Promoting Social Inclusion in Schools: A Group-Randomized Trial of Effects on Student Health Risk Behavior and Well-Being

OBJECTIVES We sought to test the efficacy of an intervention that was designed to promote social inclusion and commitment to education, in reducing among students health risk behaviors and improving emotional well-being. METHODS The design was a cluster-randomized trial in 25 secondary schools in Victoria, Australia. The subjects were 8th-grade students (aged 13 to 14 y) in 1997 (n=2545) and subsequent 8th-grade students in 1999 (n=2586) and 2001 (n=2463). The main outcomes were recent substance use, antisocial behavior, initiation of sexual intercourse, and depressive symptoms. RESULTS At 4-year follow-up, the prevalence of marked health risk behaviors was approximately 20% in schools in the comparison group and 15% in schools in the intervention group, an overall reduction of 25%. In ordinal logistic regression models a protective effect of intervention was found for a composite measure of health risk behaviors in unadjusted models (odds ratio [OR]= 0.69; 95% confidence interval [CI]= 0.50, 0.95) and adjusted models (OR= 0.71; CI =0.52, 0.97) for potential confounders. There was no evidence of a reduction in depressive symptoms. CONCLUSION The study provides support for prevention strategies in schools that move beyond health education to promoting positive social environments.

The Gatehouse Project: a systematic approach to mental health promotion in secondary schools

Objective: The objective of this paper is to outline the conceptual background and strategy of intervention for a systematic and sustainable approach to mental health promotion in secondary schools. Method: The conceptual origins of the Gatehouse Project are described in terms of the epidemiology of adolescent mental health problems, attachment theory, education reform research and health promotional theory and practice. The elements of health promotional work are described in terms of structural change and priority setting; implementation at multiple levels within the participating schools is described. Results: The conceptual framework of the Gatehouse Project emphasises healthy attachments with peers and teachers through the promotion of a sense of security and trust, effective communication and a sense of positive self-regard based on participation in varied aspects of school and community life. A school social climate profile is derived from a questionnaire survey of students. An adolescent health team uses this information to set priorities for change within the school. Interventions may focus on the promotion of a positive social climate of the whole school or in the classroom. Curriculum-based health education is also used and based on materials that are relevant to the normal developmental experiences of teenagers. These are integrated into the mainstream curriculum and incorporate a strong component of teacher professional development. Lastly, the intervention promotes linkage between the school and broader community with a particular emphasis on the needs of young people at high risk of school drop-out. Conclusions: Educational environments are complex systems undergoing continuous and simultaneous changes. The Gatehouse Project will provide unique information on the relationship between the social environment and the emotional wellbeing of young people. More importantly it outlines a sustainable process for building the capacity of schools to promote the social and emotional development of young people.

Building Capacity for System-Level Change in Schools: Lessons from the Gatehouse Project

The Gatehouse Project is an innovative, comprehensive approach to mental health promotion in secondary schools. It sets out to promote student engagement and school connectedness as the way to improve emotional well-being and learning outcomes. The key elements of the whole-school intervention are the establishment and support of a school-based adolescent health team; the identification of risk and protective factors in each school’s social and leaning environment from student surveys; and, through the use of these data, the identification and implementation of effective strategies to address these issues. The project evaluation used a cluster-randomized controlled trial design involving 26 schools with initial results demonstrating considerable success in reducing smoking rates among Year 8 children. This article describes and accounts for how system-level changes have been made in schools through a process of capacity building. This encourages teachers, parents, and students to view the core business of education differently.

Harnessing Complexity: Taking Advantage of Context and Relationships in Dissemination of School-Based Interventions:

Schools and school systems are increasingly asked to use evidence-based strategies to promote the health and well-being of students. The dissemination of school-based health promotion research, however, offers particular challenges to conventional approaches to dissemination. Schools and education systems are multifaceted organizations that sit within constantly shifting broader contexts. This article argues that health promotion dissemination needs to be rethought for school communities as complex systems and that this requires understanding and harnessing the dynamic ecology of the sociopolitical context. In developing this argument, the authors draw on their experience of the dissemination process of a multilevel school-based intervention in a complex educational context. Building on this experience, they argue for the need to move beyond conventional dissemination strategies to a focus on active partnerships between developers and users of school-based intervention research and offer a conceptual tool for planning dissemination.

Implementing multi-level programmes and approaches that address student well-being and connectedness: Factoring in the needs of the schools

Implementation of effective school-level mental health promotion initiatives is challenging. This paper presents findings from the beyondblue schools research initiative, a cluster randomised trial which aimed to promote student mental health. It sought to implement emotional skills through curriculum, greater community linkages and whole-school environment change in 25 schools in three states of Australia. Using qualitative process evaluation data collected during the three years of the project, we describe key features of the intervention that, according to the project facilitators, influenced its implementation. Project design flexibility to meet individual school needs and provision of sufficient resources appeared to be crucial for successful implementation.

Friends or Foes? Relational Dissonance and Adolescent Psychological Wellbeing

The interaction of positive and negative relationships (i.e. I like you, but you dislike me – referred to as relational dissonance) is an underexplored phenomenon. Further, it is often only poor (or negative) mental health that is examined in relation to social networks, with little regard for positive psychological wellbeing. Finally, these issues are compounded by methodological constraints. This study explores a new concept of relational dissonance alongside mutual antipathies and friendships and their association with mental health using multivariate exponential random graph models with an Australian sample of secondary school students. Results show male students with relationally dissonant ties have lower positive mental health measures. Girls with relationally dissonant ties have lower depressed mood, but those girls being targeted by negative ties are more likely to have depressed mood. These findings have implications for the development of interventions focused on promoting adolescent wellbeing and consideration of the appropriate measurement of wellbeing and mental illness.

The Gatehouse Project: a multi-level integrated approach to promoting well-being in schools

It addresses not only how to locate and utilize scientific evidence, but also how to implement and evaluate interventions in a way that generates new evidence. Practical topics covered in this light include:conducting community assessmentdeveloping an initial statement of issue (and quantifying it)using scientific literature and systematic reviewscreating an action plan and implementing interventionsevaluating programs and policiesFeatures:Synthesizes techniques and theory epidemiology, healthcare economics, and behavioral science in a format that is easy to comprehend and applyEquips students and practitioners with the most reliable and up-to-date research methodologies and sources of evidenceStrikes an ideal balance of conceptual issues in program implementation and evaluation and practical, real-life examplesDetails a proven multi-stage framework for evidence-based practice in public healthEssential reading for individuals at every career stage from undergraduate student to seasoned professionalNew to this edition:A fully revised and updated edition of the classic textbookIncludes new chapter on building capacity in evidence-based decision-makingIncorporates insights from the most up-to-date literature in public health economics, epidemiology, and public healthNew case examples to illustrate the core principles of evidence-based decision-making

Advancing Partnership Research: A Spatial Analysis of a Jointly-Planned Teacher Education Partnership

This chapter addresses the critical and often divisive international issue of how to create high quality teacher education. It does this through an investigation of a teacher education partnership designed to meet the goals of the university and school partners as well as sector leadership. Basing its analysis on a view of teacher education as taking place in the boundary zone where teacher educators, teachers and pre-service teachers (PSTs) can jointly construct professional knowledge, the study explores the partnership in terms of its vision (conceived space), its particular program and approach (perceived space) and the experience of participants (lived space). Using a case study methodology to explore a partnership that aimed to develop teachers well-qualified to work in a particular context, the study finds that the creation of successful teacher education partnerships is a process in which participants must demonstrate an ability to respond to others, their needs, standpoints and understandings in order to develop PST capacity.

A Systems Approach to Enhancing the Capacity of Teachers and Leaders in Catholic School Communities to Link Learning, Student Wellbeing, Values and Social Justice

Good practice in learning, community strengthening and social justice in faith-based school communities needs to be underpinned by good practice in system partnerships and professional learning for teachers and leaders. This chapter describes how a Catholic education system and a Catholic university worked in partnership to develop and implement a postgraduate learning programme to support and enhance the work of teachers and leaders in Catholic school communities in the Archdiocese of Melbourne in Victoria, Australia. The coherence and alignment between the development of this accredited professional learning and the goals of: Australian education; Catholic Education in Victoria; and individual school communities are highlighted. The particular learning and teaching approach is explored through one unit of the course that focuses on a whole school approach to social justice. The chapter concludes with some reflections on how this approach can enable critical reflection to take place on practice for teachers and leaders in faith-based school communities.