Health In Educational Settings - CLAHRC Community e-newsletter Issue 84

Published Date: 28 Jun 2019

Welcome to the community e-newsletter for the NIHR CLAHRCs, bringing you news from across the thirteen collaborations and the health services research community.


East of England: Register now Cross-CLAHRC Care Homes event on 23rd July, for researchers and key stakeholders to explore research, priorities and collaborations PenCLAHRC: Systematic review identifies evidence of benefits of CBT for children and young people with inflammatory bowel disease, chronic pain and epilepsy.

CLAHRC East Midlands
The Daily Mile project 
The Daily Mile (TDM) challenges primary schools to support pupils to run for 15 minutes daily. Over 4,500 schools in England have adopted TDM. There are two ongoing studies on the effectiveness of TDM for improving health, but no research on factors that influence delivery in schools in England, or ethnically diverse populations. In addition, Leicester City Council identified a TDM evaluation as important to inform local physical activity provision as Leicester City School Sport and Physical Activity Network (SSPAN) have worked to sign-up schools across the city. In response, a study supported by CLAHRC East Midlands, is generating new evidence on how TDM is implemented in a diverse and multi-ethnic city. The evaluation, which started in March 2019, will determine in Leicester city schools a) the reach and adoption of TDM; b) the level of implementation, implementation processes and drivers of TDM; and c) the maintenance and maintenance processes of TDM.
Contact Dr Ash Routen 

CLAHRC East of England
Taking care of our Future Doctors: A Service Evaluation of a Clinical Student Mental Health Service (CSMHS)
There is growing awareness of an increase in mental health difficulties amongst higher education students, particularly medical students. In this context the School of Clinical Medicine, University of Cambridge and Cambridge and Peterborough NHS Foundation Trust (CPFT) jointly established the CSMHS to support clinical students. This CLAHRC EoE project evaluates clinical and academic outcomes, and students’ feedback.
Students are initially assessed by a psychiatrist, who develops a joint management plan with the student and team clinical psychologist who offers a variety of therapies. These include cognitive-behavioural therapy, interpersonal therapy and cognitive analytic therapy. Pre and post treatment rating scales provide objective measures of levels of improvement. Initial results are encouraging with students becoming significantly less distressed, anxious or depressed after treatment. Feedback, particularly regarding swift access to specialist care, has been extremely positive. All students completed the course suggesting prompt interventions improve both clinical outcomes and career trajectory. The research team hope the CSMHS might serve as an example to others developing similar services.
Contact Tsz-yan Li or Dr Rebecca Jacob

CLAHRC North Thames
Helping school pupils manage their emotional wellbeing
ReZone is an app designed to be used in mainstream primary, and alternative provision/SEN primary and secondary schools with 10-15 year olds. It contains a series of tools designed to improve concentration and re-focus, relieve stress and help students to reflect and think through problems logically. A randomised control trial has been carried out across the U.K in mainstream and alternative provision schools with 409 pupils (aged 10-15) (publication under review). 
The CLAHRC North Thames funded study provided important data on implementation of digital interventions and non-adoption, highlighting considerations including tailored characteristics of the intervention to the requirements of the intended user group, the technology itself, and the organisation in which it is being implemented. Based on consultations with young people, mental health professionals, parents and teachers, work continues with ReZone concepts and an interactive element to increase engagement and effectiveness. 

CLAHRC North West Coast
Drama-based workshops in secondary schools raise awareness of the dangers of gambling
The CLAHRC NWC Neighbourhood Resilience Programme is a systems-resilience initiative taking place in 10 Neighbourhoods for Learning. Neighbourhoods were identified by local authority partners, as ward size areas experiencing relatively poorer health and social disadvantage. In one neighbourhood, local authority partners, residents, Community and Voluntary Organisation (CVS), Citizens Advice, Beacon Counselling Trust, Altru Drama and university partners, collaborated to provide drama-based workshops (delivered by Altru drama) and leaflet resources to young people in two secondary schools. The purpose of the workshops was to raise awareness and develop greater understanding of the risks of gambling, the dangers of loan sharks and where to seek support/money management advice. Workshops included a monologue delivered by an actor describing their journey into gambling and interactive sessions where young people explored consequences of gambling, potential solutions and how to seek help/advice.

Child and adolescent mental health services
In the Oxford Early Intervention Theme we have been working together with local commissioners and schools to evaluate some changes in local child and adolescent mental health services, primarily to tackle the significant number of children who do not access services in a timely manner.
This evaluation is important and timely for two main reasons. Firstly, there is increasing dissatisfaction with the traditional ‘tiered’ CAMHS model – a system of steps that escalate in specialisation or treatment intensity and type depending on the needs of the young person. Second, the significant investment in the transformation of CAMHS services. New models of services are emerging but little is known about their effectiveness. 
Although these changes have been welcomed by user groups, there remains a need to evaluate whether outcomes have improved, and with a mixed methods approach we are doing this.
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Link found between school absence and anxiety
New Exeter Medical School research, supported by PenCLAHRC and the Wellcome Trust, has found a link between school absence and anxiety. The comprehensive, international data review investigated the relationship between anxiety and poor attendance, including excused and unexcused absence. The second publication from this research suggests that children with anxiety miss more school than their peers and identifies a difficult to delineate crossover between emotional and behavioural reasons for absence.
Lead author Katie Finning said: “Anxiety is a major issue that not only affects young people’s schooling, but can also lead to worse academic, social and economic outcomes throughout life. It’s important that we pick up the warning signs and support our young people as early as possible. Our research has identified a gap of high-quality studies in this area, and we urgently need to address this so that we best understand how to give our young people the best start in life.” 
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Assessing the effectiveness of teaching methods on well-being and learning
The first phase of the Supporting Teachers And childRen in Schools (STARS) programme, a randomised trial assessing the effectiveness of the Incredible Years Teacher Classroom Management (IY - TCM) project, has come to a close (see final report), with a new intake of schools now taking part in the second phase.
Starting in 2012, the project looked at how teaching methods impact youngsters’ behaviour and help to create a positive learning environment. Figures show that 10% of children and young people aged between 5 and 16 have a clinically diagnosed mental disorder. Disruptive behaviour in the classroom can be an indicator of poor mental health and social adjustment, affecting a child’s academic attainment and life chances. The project aims to assess whether the IY-TCM can help teachers to reduce disruptiveness and promote well-being among pupils in line with a NICE recommendation for schools to implement programmes to foster emotional and social well-being.
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Preventing childhood obesity: a realist review in the UK context
Childhood obesity has been increasing rapidly in the UK for the last 30 years. National data shows that 20 per cent of 4-5 year olds and one third of 10-11 year olds have either overweight or obesity (NHS Digital, 2017). Children spend a quarter of their waking lives in schools. We know that schools can’t improve children’s health on their own, but the school setting presents a real opportunity for intervention.
In this project, CLAHRC West are carrying out a ‘realist review’ – a novel approach to looking at evidence. A realist review will identify the key components of an obesity prevention programme which can be successfully implemented in the UK.
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CLAHRC West Midlands

Mental Health in Schools
Over half of mental health illnesses begin by the age of 14. Only about 25% of children and young people with a diagnosable condition access services. Schools are well-placed to deliver and promote positive mental health due to the amount of time young people spend in this environment. However, teachers are often expected to spot early signs and symptoms of mental health in young people with limited or no mental health training. Training and a collaborative approach are needed to generate cultural change in educational settings. Palmer and colleagues (2017) highlighted high levels of work-related stress in teachers that can have serious consequences for their mental health and impede their ability to provide effective support. A whole school strategy is needed emphasizing emotional wellbeing of young people and school staff not only to support positive mental health but also improve academic attainment.
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