Helen Cahill

MindMatters, a Whole-School Approach Promoting Mental Health and Wellbeing:

Objective: MindMatters is an innovative, national mental health promotion program which provides a framework for mental health promotion in Australian schools. Its objectives are to facilitate exemplary practice in the promotion of whole-school approaches to mental health promotion; develop mental health education resources, curriculum and professional development programs which are appropriate to a wide range of schools, students and learning areas; trial guidelines on mental health and suicide prevention and to encourage the development of partnerships between schools, parents, and community support agencies to promote the mental wellbeing of young people. Method: A team of academics and health education professionals, supported by a reference group of mental health experts, developed MindMatters. The program was piloted in 24 secondary schools, drawn from all educational systems and each State and Territory in Australia. The pilot program was amended and prepared for dissemination nationally. Results: The program provides a framework for mental health promotion in widely differing school settings. The teacher professional development dimension of the program is central to enhancing the role of schools in broad population mental health promotion. Conclusions: Promoting the mental health and wellbeing of all young people is a vital part of the core business of teachers by creating a supportive school environment that is conducive to learning. Teachers need to be comfortable and confident in promoting and teaching for mental health. Specific, targeted interventions, provided within a whole-school framework, address the needs of the minority of students who require additional support.

Challenges in adopting evidence‐based school drug education programmes

ISSUES The paper discusses the school-based challenges that may moderate the implementation of evidence-based drug education in schools. APPROACH Knowledge about what constitutes an effective evidence-based drug education programme is discussed in relation to the challenge of delivery in the school setting. Research demonstrates that drug education should be engaging, incorporate interactive learning strategies, stimulate higher-order thinking, promote learning and be transferable to real life circumstances. This may difficult to accomplish in practice, as a range of contextual challenges and ideological assumptions may moderate the teachers capacity to deliver a programme of this nature. KEY FINDINGS Collaborative learning strategies are not the norm in schools and therefore teachers may find interactive drug education programmes difficult to adopt. Conflicting ideological assumptions about effective epistemological approaches to drug education may also direct the way in which teachers modify programmes in the local context. IMPLICATIONS Teachers need professional training and support if they are to adopt successfully evidence-based school drug education programmes. This support may be enhanced if it includes whole school approaches to effective pedagogy and the development of pro-social classroom environments. CONCLUSION Drug education research should take account of the complexities of implementation in the school setting and investigate further the professional and organisational support that teachers require in order to maintain high-quality provision in the school context.

Drug education in victorian schools (DEVS): the study protocol for a harm reduction focused school drug education trial

BackgroundThis study seeks to extend earlier Australian school drug education research by developing and measuring the effectiveness of a comprehensive, evidence-based, harm reduction focused school drug education program for junior secondary students aged 13 to 15 years. The intervention draws on the recent literature as to the common elements in effective school curriculum. It seeks to incorporate the social influence of parents through home activities. It also emphasises the use of appropriate pedagogy in the delivery of classroom lessons.Methods/DesignA cluster randomised school drug education trial will be conducted with 1746 junior high school students in 21 Victorian secondary schools over a period of three years. Both the schools and students have actively consented to participate in the study. The education program comprises ten lessons in year eight (13-14 year olds) and eight in year nine (14-15 year olds) that address issues around the use of alcohol, tobacco, cannabis and other illicit drugs. Control students will receive the drug education normally provided in their schools. Students will be tested at baseline, at the end of each intervention year and also at the end of year ten. A self completion questionnaire will be used to collect information on knowledge, patterns and context of use, attitudes and harms experienced in relation to alcohol, tobacco, cannabis and other illicit drug use. Multi-level modelling will be the method of analysis because it can best accommodate hierarchically structured data. All analyses will be conducted on an Intent-to-Treat basis. In addition, focus groups will be conducted with teachers and students in five of the 14 intervention schools, subsequent to delivery of the year eight and nine programs. This will provide qualitative data about the effectiveness of the lessons and the relevance of the materials.DiscussionThe benefits of this drug education study derive both from the knowledge gained by trialling an optimum combination of innovative, harm reduction approaches with a large, student sample, and the resultant product. The research will provide better understanding of what benefits can be achieved by harm reduction education. It will also produce an intervention, dealing with both licit and illicit drug use that has been thoroughly evaluated in terms of its efficacy, and informed by teacher and student feedback. This makes available to schools a comprehensive drug education package with prevention characteristics and useability that are well understood.Trial registrationAustralia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12612000079842

Alcohol prevention: What can be expected of a harm reduction focused school drug education programme?

Aim: This pilot study investigated what alcohol prevention benefits could be achieved by a harm reduction focused school drug education intervention that addressed all drug use, both licit and illicit. Method: The study population comprised a cohort of 225 students in three intervention secondary schools and 93 students in a matched control school in Victoria, Australia. A classroom drug education programme, derived from evidence of effective practice and designed to reduce alcohol and other drug harm, was provided to the intervention students during years eight (13–14 year olds) and nine (14–15 year olds) by teachers trained in its delivery. The control students received the drug education programme normally provided by their school. Findings: The students, who received the intervention, were more knowledgeable about drug use issues, communicated more with their parents about alcohol, drank less, got drunk less, and experienced fewer alcohol related harms. They also remembered receiving more alcohol lessons. They were, however, no less likely to have tried alcohol. Conclusions: The findings are consistent with other studies that have demonstrated school alcohol education that focuses on harm reduction can be effective in reducing consumption, risk and harm. In this study, this was achieved even though the students were not persuaded against taking up drinking, and the intervention did not focus solely on alcohol. These findings have implications for both the goals and coverage of future school drug education programmes.

Responding to Young People's Health Risks in Primary Care: A Cluster Randomised Trial of Training Clinicians in Screening and Motivational Interviewing

Objective To evaluate the effectiveness of a complex intervention implementing best practice guidelines recommending clinicians screen and counsel young people across multiple psychosocial risk factors, on clinicians’ detection of health risks and patients’ risk taking behaviour, compared to a didactic seminar on young people’s health. Design Pragmatic cluster randomised trial where volunteer general practices were stratified by postcode advantage or disadvantage score and billing type (private, free national health, community health centre), then randomised into either intervention or comparison arms using a computer generated random sequence. Three months post-intervention, patients were recruited from all practices post-consultation for a Computer Assisted Telephone Interview and followed up three and 12 months later. Researchers recruiting, consenting and interviewing patients and patients themselves were masked to allocation status; clinicians were not. Setting General practices in metropolitan and rural Victoria, Australia Participants General practices with at least one interested clinician (general practitioner or nurse) and their 14–24 year old patients. Intervention This complex intervention was designed using evidence based practice in learning and change in clinician behaviour and general practice systems, and included best practice approaches to motivating change in adolescent risk taking behaviours. The intervention involved training clinicians (nine hours) in health risk screening, use of a screening tool and motivational interviewing; training all practice staff (receptionists and clinicians) in engaging youth; provision of feedback to clinicians of patients’ risk data; and two practice visits to support new screening and referral resources. Comparison clinicians received one didactic educational seminar (three hours) on engaging youth and health risk screening. Outcome Measures Primary outcomes were patient report of (1) clinician detection of at least one of six health risk behaviours (tobacco, alcohol and illicit drug use, risks for sexually transmitted infection, STI, unplanned pregnancy, and road risks); and (2) change in one or more of the six health risk behaviours, at three months or at 12 months. Secondary outcomes were likelihood of future visits, trust in the clinician after exit interview, clinician detection of emotional distress and fear and abuse in relationships, and emotional distress at three and 12 months. Patient acceptability of the screening tool was also described for the intervention arm. Analyses were adjusted for practice location and billing type, patients’ sex, age, and recruitment method, and past health risks, where appropriate. An intention to treat analysis approach was used, which included multilevel multiple imputation for missing outcome data. Results 42 practices were randomly allocated to intervention or comparison arms. Two intervention practices withdrew post allocation, prior to training, leaving 19 intervention (53 clinicians, 377 patients) and 21 comparison (79 clinicians, 524 patients) practices. 69% of patients in both intervention (260) and comparison (360) arms completed the 12 month follow-up. Intervention clinicians discussed more health risks per patient (59.7%) than comparison clinicians (52.7%) and thus were more likely to detect a higher proportion of young people with at least one of the six health risk behaviours (38.4% vs 26.7%, risk difference [RD] 11.6%, Confidence Interval [CI] 2.93% to 20.3%; adjusted odds ratio [OR] 1.7, CI 1.1 to 2.5). Patients reported less illicit drug use (RD -6.0, CI -11 to -1.2; OR 0·52, CI 0·28 to 0·96), and less risk for STI (RD -5.4, CI -11 to 0.2; OR 0·66, CI 0·46 to 0·96) at three months in the intervention relative to the comparison arm, and for unplanned pregnancy at 12 months (RD -4.4; CI -8.7 to -0.1; OR 0·40, CI 0·20 to 0·80). No differences were detected between arms on other health risks. There were no differences on secondary outcomes, apart from a greater detection of abuse (OR 13.8, CI 1.71 to 111). There were no reports of harmful events and intervention arm youth had high acceptance of the screening tool. Conclusions A complex intervention, compared to a simple educational seminar for practices, improved detection of health risk behaviours in young people. Impact on health outcomes was inconclusive. Technology enabling more efficient, systematic health-risk screening may allow providers to target counselling toward higher risk individuals. Further trials require more power to confirm health benefits. Trial Registration ISRCTN.com ISRCTN16059206.

Teaching for Community: Empowerment through Drama

Building Community in the Classroom I am keenly interested in the impact of the group dynamic on learning and on the use of drama strategies to enhance enquiry, engagement and empowerment. Much of my work has entailed an exploration of how to educate in such a way as to enhance resilience, agency and integrity. In this article I draw on research examining how the drama educator can teach for community and at the same time pursue skills and understandings in the art form. I examined these interests in a term-long research study with a Year 11 drama class. The project entailed taking a reflective practitioner perspective on a series of drama workshops in which the students explored the theme of Coping with Change and Challenge. They used anti-naturalistic techniques to examine power, choice and the internal and external influences on behaviour and relationships. They developed and performed short dramas designed to reveal an important issue to an adult audience. The dramas examined instances of powerlessness, shame and help-seeking and were interlaced with parodies of common fantasies of escape and rescue. In addition, the students worked as an ensemble in forum-style improvised theatre. In the forums, the actors and a range of audience members improvised together, exploring predicaments requested by the audience. Data was collected from each of the twenty students in the form of interviews and written feedback and from audience members

Re-thinking the fiction–reality boundary: investigating the use of drama in HIV prevention projects in Vietnam

Drama is often used as a tool to investigate experience and to assist people to rehearse for change. Dramatic portrayals, however, can reinforce rather than challenge limiting stereotypes, and there is the potential for a positivist approach to research through drama to contribute to a pathologising of the subject and to limit the possibility of change. Assumptions are commonly made about the protective nature of the divide offered by the drama, but within the naturalistic tradition, a certain rule-play may confine the role-play, with actors replicating social norms and dominant storylines in order to create a level of believability or verisimilitude. For change to occur one must rupture the assumed and re-imagine what is possible. The paper discusses the way in which poststructuralist approaches to drama can be used to enable participants to grapple with the limiting positions and categories provided in the dominant discourses and to re-imagine their futures. Examples are drawn from a HIV prevention project with the Womens Union in Vietnam. The project aims to equip women and girls to talk openly about sex within a culture in which this is not the norm. Theory is developed which identifies that the selection of genre influences the knowledge that can be represented through the drama, and consequently the possibilities for change that can be fashioned. Multifarious and poly-vocal accounts of the self are needed to re-fashion the shared and gendered identity absorbed as part of culture and to create new storylines within which to enact change.

The prevention access and risk taking in young people (PARTY) project protocol: A cluster randomised controlled trial of health risk screening and motivational interviewing for young people presenting to general practice

BackgroundThere are growing worldwide concerns about the ability of primary health care systems to manage the major burden of illness in young people. Over two thirds of premature adult deaths result from risks that manifest in adolescence, including injury, neuropsychiatric problems and consequences of risky behaviours. One policy response is to better reorientate primary health services towards prevention and early intervention. Currently, however, there is insufficient evidence to support this recommendation for young people. This paper describes the design and implementation of a trial testing an intervention to promote psychosocial risk screening of all young people attending general practice and to respond to identified risks using motivational interviewing. Main outcomes: clinicians’ detection of risk-taking and emotional distress, young people’s intention to change and reduction of risk taking. Secondary outcomes: pathways to care, trust in the clinician and likelihood of returning for future visits. The design of the economic and process evaluation are not detailed in this protocol.MethodsPARTY is a cluster randomised trial recruiting 42 general practices in Victoria, Australia. Baseline measures include: youth friendly practice characteristics; practice staff’s self-perceived competency in young people’s care and clinicians’ detection and response to risk taking behaviours and emotional distress in 14–24 year olds, attending the practice. Practices are then stratified by a social disadvantage index and billing methods and randomised. Intervention practices receive: nine hours of training and tools; feedback of their baseline data and two practice visits over six weeks. Comparison practices receive a three hour seminar in youth friendly practice only. Six weeks post-intervention, 30 consecutive young people are interviewed post-consultation from each practice and followed-up for self-reported risk taking behaviour and emotional distress three and 12 months post consultation.DiscussionThe PARTY trial is the first to examine the effectiveness and efficiency of a psychosocial risk screening and counselling intervention for young people attending primary care. It will provide important data on health risk profiles of young people attending general practice and on the effects of the intervention on engagement with primary care and health outcomes over 12 months.Trial registrationISRCTN16059206

Using simulated patients to develop doctors' skills in facilitating behaviour change: addressing childhood obesity

Medical Education 2010: 44: 706–715

Handbook of children and youth studies

In this chapter, we explore the idea of the “critical moment” as a tool for understanding young people’s narratives of transition. The chapter draws on the 15-year UK-based empirical study “Inventing Adulthoods” which employed longitudinal qualitative methods to explore the process of growing into adulthood in five contrasting locations of the UK. The prospective design of the research enabled the researchers to capture change over time and the identity work involved in the reworking of narratives. The idea of the “critical moment” arose early in the study as a way of capturing the biographical significance of particular moments and their consequences. Drawing on a late modern theoretical model provided by Giddens’ idea of the “fateful moments” within the “reflexive project of self,” we show how we operationalized “critical moments” as a tool for identifying, mapping, and comparing narratives. This approach enabled us to capture the importance of timing in life events and their consequences. As time passed and narratives accrued, we progressively gained insight into the relationship between critical moments as a narrative device in individual interviews and the slower deeper processes at play in shaping biographies and life chances. In this chapter, we revisit analyses of critical moments with the benefit of hindsight, drawing some conclusions regarding the relationship between the life that is lived and the life that is told, suggesting the value of a biographical approach within the interdisciplinary field of youth studies.Indigenous women and girls in Australia remain highly disadvantaged econom- ically, culturally, and politically. The ways in which schools can better address this disadvantage are the focus of this chapter. The chapter builds on existing research in the area of Indigenous schooling and social justice to add important theoretical and practical insight into supporting Indigenous girls – an equity group whose marginalization (while highly salient) tends to be lost amid broader concerns about Indigeneity. With reference to “Emma’s” story as exemplifying some of the key constraints to the educational attainment of Indigenous girls, the chapter explores how schools might begin to remedy this disadvantage through their engagement with a politics of (1) economic redistribution, (2) cultural recognition, and (3) political representation.