Jay Belsky

Embedding mental health support in schools: learning from the Targeted Mental Health in Schools (TaMHS) national evaluation

The Targeted Mental Health in Schools (TaMHS) programme was a nationwide initiative that funded mental health provision in schools for pupils at risk of or already experiencing mental health problems. The implementation, impact and experience of this programme was evaluated using quantitative and qualitative methodology involving three main studies: (1) a 1-year RCT involving 8658 8–10 year olds and 6583 11–13 year olds, (2) a 3-year longitudinal study involving 3346 8–10 year olds and 2647 11–13 year olds and (3) qualitative interviews with 26 TaMHS workers, 31 school staff, 15 parents and 60 pupils. The RCT demonstrated that TaMHS led to reductions in behaviour problems but not emotional problems for 8–10 year olds. No impact was found for 11–13 year olds. The effects on behaviour problems in primary school were enhanced by the provision of evidence based self-help materials, but not by other area level support. The longitudinal study found information giving and good inter-agency working correlated with more positive outcomes for behavioural problems in secondary schools. The qualitative findings indicated that TaMHS was well received by all groups, though challenges to its implementation were noted. Overall, findings indicate the utility of targeted mental health provision in schools, particularly in primary settings. The implications for implementation are discussed.

Does early family risk and current quality of care predict indiscriminate social behavior in institutionalized Portuguese children

The current study extends research on the effects of institutionalization, most notably by evaluating the influence of proximal relationship processes over and above prenatal and pre-institutional family experiences. By focusing on current quality of institutional care and the child’s early family background, it examines the influence of variations in the institutionalization experience on displays of indiscriminate social behavior, after taking into account potentially confounding pre-admission experiences. Seventy-four Portuguese children (11–30 months) placed in 17 residential institutions and their primary caregivers participated in the study. Children’s displays of indiscriminate social behavior were assessed based on an observational measure and a semi-structured interview administered to the child’s caregiver. Data on children’s physical and mental development were also collected. Three contextual-risk composites of early family behavior – prenatal, family relational, and emotional-neglect – were created. The quality of institutional care was examined in terms of structural, relational characteristics, and, additionally, of the quality of child–caregiver relationship. Current quality of care experienced in the institution, operationalized in terms of the absence (vs. presence) of a preferred caregiver, predicted indiscriminate social behavior over and above prenatal and family risk conditions that preceded the child’s institutionalization.

Children, Research, and Public Policy An Evaluation of the Implementation and Impact of England's Mandated School-Based Mental Health Initiative in Elementary Schools

Abstract. We report on a randomized controlled trial of Targeted Mental Health in Schools (TaMHS), which is a nationally mandated school-based mental health program in England. TaMHS aimed to improve mental health for students with, or at risk of, behavioral and emotional difficulties by providing evidence-informed interventions relating to closer working relationships between health and education services. Our study involved 8,480 children (aged 8–9 years) from 266 elementary schools. Students in intervention schools with, or at risk of, behavioral difficulties reported significant reductions in behavioral difficulties compared with control school students, but no such difference was found for students with, or at risk of, emotional difficulties. Implementation of TaMHS was associated with increased school provision of a range of interventions and enhanced collaboration between schools and local specialist mental health providers. The implications of these findings are discussed, in addition to the strengths and limitations of the study.

Diverse Physical Growth Trajectories in Institutionalized Portuguese Children Below Age 3: Relation to Child, Family, and Institutional Factors

OBJECTIVEnTo identify and analyze diverse longitudinal trajectories of physical growth of institutionalized children and their relation to child, family, and institutional factors.nnnMETHODSn49 institutionalized children were studied for 9 months after admission. Weight, height, and head circumference were measured on 4 occasions, beginning at admission. Data were analyzed using latent class analysis, yielding diverse patterns of growth for each feature, and relations with child characteristics, early family risk factors, and institutional relational care were investigated.nnnRESULTSnFor each growth feature, 4 classes emerged: Persistently Low, Improving, Deteriorating, and Persistently High. Younger age at admission was a risk factor for impaired physical growth across all domains. Physical characteristics at birth were associated with trajectories across all domains. Lower prenatal risk and better institutional relational care were associated with Improving weight over time.nnnCONCLUSIONSnDiscussion highlights the role of childrens physical features at birth, prenatal risk, and caregivers cooperation with the child in explaining differential trajectories.