The ‘Healthy Me’ project: evaluating a mental health promotion initiative in primary schools in Northern Ireland

Looked after children

Statutory guidance from the Departments of Health and Education (2015) indicates that local authorities have a duty not just to treat but also to actively promote the mental health of looked after children (The Mental Health Foundation, 2002). Research has found that many mental health initiatives that work with the general population are also likely to be effective with this group (NSPCC, 2014). Education has been shown to play a key role in preventing mental health problems among looked after children (Department for Education and Department of Health, 2015), so schools provide an ideal forum for prevention and early intervention initiatives.

Aims of the programme

To promote:

awareness of emotional well-being and positive mental health;

This universal health initiative aims to promote a positive whole-school ethos that avoids stigma and discrimination in relation to mental health and to catalyse a culture change where social and emotional difficulties are concerned. Transition from primary to secondary school is a particularly stressful time for children and it was hoped that targeting the programme at all Year 6 and Year 7 (Primary 6 and Primary 7 in NI) children would help them to cope.

Aims of the programme evaluation

To determine the feasibility of delivery, positive and negative aspects, and inform changes before a wider roll-out.

Before and after programme data on the children’s knowledge of aspects of physical and emotional health were collected using unvalidated structured and semi-structured questionnaires designed by the programme’s creators. Similarly structured questionnaires were also used to evaluate the children’s and teachers’ thoughts about it (see Appendices 1 & 2).

The participants

The programme was delivered to 267 pupils from five primary schools in the Southern Education and Library Board area with a mix of Catholic and Protestant ethos. One school had a large population of black and minority ethnic pupils with many non-English speakers; sessions in this school were punctuated by the sound of children translating in a variety of different languages for their friends. The cohort included children with learning difficulties, some requiring classroom assistant support.

A Medical Research Council decision-making tool indicated that this evaluation did not require formal research ethics council approval.

The evaluation

Evidence for mental health promotion interventions in schools indicates that one-off workshops do not constitute an effective way of influencing children’s mental health and well-being in the longer term (Weare and Nind, 2011). Post-workshop consolidation is necessary to stop the positive impact of the programme from diminishing over time. The ‘Healthy Me’ workbook and the creation of wall displays after the workshop were thus considered to be essential towards helping to consolidate children’s learning. Figure 2 provides an overview of the steps involved. OPEN IN VIEWER

Feedback from the children

Zero to 10 likert-scale questions were used to assess the children’s enjoyment of, interest in and learning from the programme. Mean fun score was 9/10, mean interest score was 8.6/10 and mean learning score was 8.8/10. Clearly a very high percentage of children found it both fun and interesting, and learned a lot. Unsurprisingly, the interactive elements of the programme were the most enjoyed, with games being the favourite aspect for 21% of children and music the most popular for 12%.

Only 26 out of the 263 children highlighted something they did not like and out of those the most frequent response was that they would have liked more games.

Positive comments included:

I loved every moment of it.

I liked everything because I thought it was very interesting.

I learned stuff, I had a great time and I understood everything.

Thanks for the good time.

I learned brilliant stuff so I am happy.

These show that the material was pitched at the right level. The comments seem to reflect what we know about children: they learn better when they are enjoying themselves.

Teacher’s evaluation

All teachers reported that the programme was useful, addressed an unmet need within their schools and increased their confidence in addressing emotional or mental health problems among pupils. As Table 1 shows, the feedback was overwhelmingly positive. The most highly rated aspects were that the content was age and ability appropriate and engaging for the pupils, thus reinforcing the children’s response.

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Table 1.

Feedback from teachers (%).

	% very good	%excellent	% non- applicable
Quality of the teachers' information session	27	45	27
Content of teachers’ information session	27	45	27
Quality of teachers' information booklet	18	55	27
Content of teachers’ information booklet	27	45	27
Quality of presentation	45	55	0
Content of presentation appropriate to age and ability of class	27	73	0
Content of presentation applicable to needs of the class	36	64	0
Ability of presenters to engage class	27	73	0
Quality of pupils workbook	45	45	9

Among the comments were:

General behavioural change – I haven’t needed to talk to the children as much about behavioural issues such as how they treat each other since.

[They’re] more chatty about things to do with mental health. As a school [we are] very mindful of these things. [The programme] reinforced everything we try to do.

The children have been coming in and talking to me about things that have happened in the playground . . . told me about someone being upset and said, ‘We tried to say to her to tell someone.’

All teachers said they would recommend the programme to other schools. It is clear from these comments that the children are reflecting on their own mental health needs and those of the class.

No negative effects were noted. Teachers said that they were glad the presentation did not mention mental illness as such but had a positive mental health message, and it was noted that the children did not perceive stigma around mental health at primary school age.

In terms of suggestions for improving the programme, comments were divided into the following themes: length of the session – aim to break it up; have a follow-up session to consolidate learning; include more activities and games; and develop the workbook. Including a parents’ session as standard could further strengthen the messages children are learning in school.