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Measuring progress on preventing serious mental health conditions in children

Reos Partners
March, 2015


Discover how this initiatives seeks to increase a child’s capacity for resilience and create a more supportive “social ecology”.

Through the HeadStart Programme, Big Lottery Fund (BLF) is providing £75 million for 12 local government-led and charity-led partnerships to pilot interventions aimed at preventing serious mental health conditions in young people in the UK. The goal is to build children’s resilience – that is, their positive development despite adversity – by providing support at home, at school, in the community, and through digital media.

With a multi-stakeholder team, each partnership has designed as many as 15 interventions that target entire schools or specific at-risk children. Some of these interventions are discrete, and others are linked together. Some projects draw on tested approaches such as peer mentoring and Emotional First Aid in Schools. Others are testing and learning from innovative approaches with new target populations in order to contribute to an emerging evidence base. Reos has been involved in facilitating the establishment of the multi-stakeholder partnerships, co-designing the process with young people, and designing project plans.

As of yet, there is not a substantial evidence base to support large-scale preventative interventions in children ages 10-14. HeadStart is unique in that it is piloting a national program on building resilience that enables local government to shape interventions to be specific to their local contexts and co-designed with young people. By impacting the young person’s social, institutional, and cultural and community contexts, the initiatives seek not just to increase a child’s capacity for resilience, but also to create a more supportive “social ecology”.

A Critical Time

The age span of 10-14 is a critical time in young people’s lives. As children have to contend with the transition to secondary school, biologically, they are going through hormonal changes and become adolescents. They stop playing with toys and become deeply influenced by peers. Young people today live in worlds that are different from those inhabited by adults. They are “digital natives”, meaning they are fluent with digital technology and social media plays a bigger role in their lives than it did in previous generations. Through apps like Whatsapp, Facebook, and SnapChat, a whole school may learn about a playground incident in a matter of minutes. Yet children and young people receive little guidance on how to use social media safely, how to avoid cyber bullying and how to protect their own data and pictures from misuse.

Many are also growing up in a context of financial austerity and amidst the rise of serious mental health issues amongst both their peers and adults. The causes of this increase in serious mental health conditions in children are not well understood. One thing we know is that context has a significant role to play in determining outcomes for children. We also know that it is difficult to evaluate children with the most complex needs to be able to understand their levels of resilience.

Evaluation of Outcomes

To conduct a national evaluation of the HeadStart Programme, Big Lottery Fund has initiated a collaboration involving the Evidence Based Practice Unit of the Anna Freud Centre, University College London, University of Manchester, Common Room, and myself from Reos. The evaluation will look into the extent that local projects meet three HeadStart outcomes:

  • Enabling young people to cope with difficult experiences and do well in life
  • Reducing the onset of serious mental health conditions through resilience building
  • Learning from approaches to contribute to an evidence base for service redesign and investment in prevention

Sometimes in addressing complex problems, teams of dedicated professionals co-create interventions without a clear theory of change. Other times a social innovation is described in general terms without a description of how, when, how often, and why it will benefit the target population—what we might call a “logic model”. A logic model is like a recipe to bake bread. It describes what goes into the intervention (inputs), what contextual factors and processes are relevant, what the mechanism of change is (the yeast that causes the dough to rise), and what the outcomes are (outputs). The value of the kind of evaluation being organised by BLF is that the “logic model” for how change happens, either within children or within a school, will be under the microscope. Through understanding a range of logic models of different interventions, we can begin to understand what is effective in changes in children’s levels of mental health and well-being. Why is this important? Because if we are serious about changing lives through interventions, having the recipe or the conceptual understanding of how we expect it to occur as compared with changes observed is essential to verify if interventions make a difference to young people’s lives.

Attention to Context

The 12 HeadStart localities are in areas of the UK with pockets of extreme deprivation. They vary in terms of urban/rural, north/south, large city/small city, high levels of deprivation/pockets of deprivation, and differing levels of racial, cultural, and religious diversity.

The BLF evaluation has quantitative and qualitative components, both of which aim to pick up differences between schools, regions, and programs. The quantitative part is informed by a set of surveys that children will take in school. These surveys are carefully designed to scientifically measure four different domains: a general well-being measure (Child Outcome Research Survey), a Student Resilience Survey, a mental health survey (Me and My School), and a Quality-Adjusted Life Year Survey that shows the economic impact of programs on physical and emotional health (the name of this survey is EQ4DY). Over two years and two survey collection points with the same group of children, the surveys will show change over time for this range of measures. Upon successful completion over 30000 children will have sat in computer rooms and filled out the surveys. We are also collecting qualitative data through interviews and focus groups. The evaluation team aims to describe what partnerships are doing and what contexts they are operating in as well as evaluate in-depth one of the interventions from each area. They will conduct interviews with a range of stakeholders and listen to young people’s views who are both co-designers and beneficiaries of the interventions. Our “fieldforce” is a team of workers trained in qualitative methods who will visit each of the twelve areas five times over the year to collect qualitative data and observe interventions.

In addition, the team will collect data on children not-in-school to understand any changes they have experienced from the HeadStart programmes on them. We are also collaborating with the local partnerships so that they provide us with the evidence they are collecting in their local evaluations through an “evidence pipeline”. In this study we will not be using randomised control trials and so technically we will not be able to scientifically prove impact. What we will be able to see from the data is associations between the packages of interventions and changes in children and young people’s mental health, and differences across populations. The final report will be ready by June 2016.

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