School-based wellbeing interventions: What does the research evidence say?
There’s a lot of research about how best to support young people who have been affected by potentially traumatic experiences. But how much of it is truly of practical use to schools? Not as much as you’d think – but cognitive behavioural therapy (CBT) techniques and involving parents or caregivers are promising components of impactful interventions.
Why are school-based wellbeing interventions important?
Many young people are currently struggling with their mental health. This is particularly the case for young people who have experienced Adverse Childhood Experiences (ACEs) such as domestic violence or parental incarceration. Without support, ACEs can have a negative impact on mental and physical health across the lifespan. As such, schools are increasingly expected to provide mental health support. However, resources are stretched and demand for specialist help – from EPs and other professionals – vastly outstrips supply.
One way in which schools could address the issue of limited access to specialists is to provide support in-house, through teacher or teaching assistant-led supportive interventions. However, I found in a systematic review of published literature that there is a limited research-evidence base for interventions which are suitable for school staff to deliver (Avery et al., 2024).
A surprising lack of evidence
Beginning this project, I thought I had a pretty good idea of what the results would be. Having worked as a teacher and Assistant EP, I was already familiar with ELSA, Thrive, and a range of other programmes I had come across in schools. However, I didn’t find any published articles addressing whether these well-known programmes delivered a positive impact for young people affected by trauma.
Of those which were supported by research evidence, most types of intervention which were included only had one or two studies suggesting they would be helpful. That doesn’t mean none of these interventions are good, or that no part of them is any good, it just means that there’s not much reliable research-evidence either way.
The most promising interventions included CBT, a caregiver component, or both
Interventions which were based on CBT, and those which involved parents or caregivers in the intervention, seemed most promising. Existing research evidence strongly suggests that trauma-focused CBT is an effective form of psychological therapy (Mavranezouli et al., 2020). I found through this review that it is feasible to adapt CBT to be delivered by a non-clinician and still achieve impact. This is an important finding for EPs, school staff, and anyone supporting these professions in considering how to allocate limited resources to supporting young people.
Involving caregivers in interventions is likely to be a more surprising finding as it relates to the UK school context. I have never worked in a school where this has been done (although I have heard of it happening).
There are likely to be practical challenges associated with engaging caregivers with an intervention, such as finding a convenient time or day, juggling other commitments, and sensitively managing stigma. This may be particularly the case for secondary schools, as there are fewer opportunities for regular contact with caregivers compared with primary schools.
Whole school approaches to wellbeing often have a family-focused additional offer, such as Family Thrive for schools using Thrive, or Advanced Practitioner training for Trauma Informed Schools. The research evidence suggests that such ideas could be worth exploring as an impactful way to support young people who have experienced ACEs.
Early Adolescent Skills for Emotions as an example
One such group utilising elements of CBT alongside a caregiver component is EASE (Early Adolescent Skills for Emotions), authored by the World Health Organisation. This intervention was specifically designed for non-clinicians working in low-resourced areas. Bryant et al. (2022) conducted a randomised control trial of EASE with adolescent Syrian refugees and found a significant reduction in symptoms of internalising distress.
EASE involves a weekly group for 8-12 participants which meets for 90 minutes for seven weeks and covers mindfulness and behaviour activation strategies. Caregivers also attend three separate 90 minute groups concurrently. EASE could be an effective way for school staff to support young people with ACEs.
Next steps: Trialling EASE with an EP service
For the final part of my PhD, I will be partnering with the Caerphilly Educational Psychology Service to run a pilot trial of EASE and to see if this intervention can be optimised for the Welsh context. This is much needed research to improve the efficacy of support currently on offer at school to young people affected by ACEs.
More broadly, educational professionals should look out for school-based interventions which are CBT-based or include a caregiver element, to ensure resources are allocated as efficiently as possible.
Read the full systematic review – A systematic review of non-clinician trauma-based interventions for school-age youth
References
Avery, F., Kennedy, N., James, M., Jones, H., Amos, R., Bellis, M., … & Brophy, S. (2024). A systematic review of non-clinician trauma-based interventions for school-age youth. PloS one, 19(9), e0293248
Bryant, R. A., Malik, A., Aqel, I. S., Ghatasheh, M., Habashneh, R., Dawson, K. S., … & Akhtar, A. (2022). Effectiveness of a brief group behavioural intervention on psychological distress in young adolescent Syrian refugees: A randomised controlled trial. PLoS Medicine, 19(8), e1004046.
Mavranezouli, I., Megnin‐Viggars, O., Daly, C., Dias, S., Stockton, S., Meiser‐Stedman, R., … & Pilling, S. (2020). Research Review: Psychological and psychosocial treatments for children and young people with post‐traumatic stress disorder: a network meta‐analysis. Journal of child psychology and psychiatry, 61(1), 18-29.
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