08. Health and Wellbeing Education
Paper
Breaking Barriers to School Attendance: A Trauma-informed Approach
Catriona O'Toole1, Tara Ciric2
1Maynooth University; 2Maynooth University
Presenting Author: O'Toole, Catriona
An increasing number of young people are experiencing School Attendance Problems (Määttä et al., 2020). The term School Attendance Problems (SAPs) is used internationally to refer to difficulties labelled as school refusal, and more recently termed school avoidance or emotionally-based school avoidance; as well as other types of school absenteeism, such as truancy, school withdrawal or school exclusion (Heyne, Gren-Landell, Melvin & Gentle-Genitty, 2019). The reasons for SAPs are complex and multifaceted and they have been made more challenging by the Covid-19 pandemic.
To help address these challenges many governments have launched national school attendance campaigns. However, some attendance campaigns have been heavily criticised by parents and disability/social justice advocates. For instance, the campaign in the United Kingdom has been slated as being ‘tone deaf’, essentially blaming families and children for their problems (BBC News, 2024), rather than addressing root causes of SAPs, which are centred around systemic issues of disability, illness, neurodiversity, poverty, current and intergenerational adversity, mental distress, bullying, and discrimination (Devenney & O’Toole, 2021). There is also concern regarding how students’ school experiences may be trauma-inducing (O’Toole, 2021) and negatively impacting their wellbeing (Lombardi, et al., 2019)
Within the field of school attendance, there is recognition that the world is changing, schooling is different, students’ needs are more diverse, and our approach to school attendance and each student’s relationship with education must be different too (Heyne, et al., 2024). Consequently, there is a need to take seriously the lived experience of students who experience SAPs (and their families) and respond in compassionate and trauma informed ways.
The purpose of this study was firstly to explore the views and experiences of SAPs from multiple perspectives, including those of students, parents, school staff and other professionals from health, social care, and justice sectors; and secondly, to harness the insights from these groups to develop guidance to help address SAPs. The project was funded by the Children and Young Peoples Services Committee in County Limerick, Ireland.
The study was informed by trauma-informed values and principles (i.e., collaboration, empowerment, trustworthiness, safety, respect for diversity; Fallot & Harris, 2001) and was concerned with people’s lived experience, including their experience of themselves, of their interactions and relationships, and of the complex patterns that co-arise between individuals and the larger systemic context (Goleman and Senge, 2014). We were interested in understanding ‘what it is like to be’ a professional, parent, or young person impacted by SAPs. Thus, the methodology was designed to inquire into the affective, cognitive, and bodily/somatic experiences of key actors within the education and social system (Fuchs, 2017; Herrman, Nielsen & Aguilar-Raab, 2021).
Methodology, Methods, Research Instruments or Sources UsedFour cohorts of participants were purposively sampled: 1) school staff (n=16, including principals, guidance counsellors, teachers, alternative education teachers), 2) allied professionals (n=13 including psychologists, social workers, community and family support workers), 3) parents (n=2, both mothers), and 4) young people (n=11, aged 14-18 years). Online focus groups were conducted with the professional groups. In-person interviews were carried out with parents. The young people participated in either individual interviews or focus group interviews; and arts-based methods, including self-portraiture and body mapping were used to facilitate thoughtful, embodied communication in a safe and supportive space (Bagnoli, 2009; Orchard, 2017). Ethical approval was obtained from Maynooth University Social Research Ethics Subcommittee. All data was recorded and transcribed. Transcripts were anonymized and then analysed using Braun and Clarke’s (2021) reflective thematic analysis (RTA) approach. Data from the professionals was analysed separately to the data from parents and young people.
Conclusions, Expected Outcomes or FindingsFive themes were identified from the professionals’ data. These were 1) A perfect storm: the conditions impacting school attendance problems, 2) The rigidity of the education system, 3) Over-worked and under-resourced, 4) Lessons learned around what works, and 5) Looking to the future: what’s needed next?
Four themes were identified following analysis of focus groups and interviews with young people and parents; as follows 1) You’re not welcome here, but you’re also not allowed leave, 2) Fighting for your life – disability and mental health difficulty, 3) Nothing left in my arsenal: The stress of parenting a young person with school attendance difficulties, 4) Envisaging a better education system - blue sky thinking.
Overall the findings point to the need to embrace change, reconceptualise school attendance, and consider new ways of working that are relationship-centred and grounded in a strong sense of purpose. By working together in partnership it is possible to transform educational practices, shaping a future where all students feel a sense of belonging in school and are enabled to thrive in harmony with our evolving world.
ReferencesBagnoli, A. (2009). Beyond the standard interview: The use of graphic elicitation and arts-based methods. Qualitative research, 9(5), 547-570.
BBC News 2024 (January 18th). Government school attendance campaign criticised by parents. Available at: Government school attendance campaign criticised by parents (yahoo.com)
Braun, V & Clarke, V. (2021). Thematic analysis: A practical guide. Sage.
Devenney, R., & O'Toole, C. (2021). 'What kind of education system are we offering’: The views of education professionals on school refusal. International Journal of Educational Psychology: IJEP, 10(1), 27-47.
Harris, M. E., & Fallot, R. D. (2001). Using trauma theory to design service systems. Jossey-Bass/Wiley.
Heyne, D., Gren-Landell, M., Melvin, G., & Gentle-Genitty, C. (2019). Differentiation between school attendance problems: Why and how?. Cognitive and behavioral practice, 26(1), 8-34.
Heyne D, Gentle-Genitty C, Melvin GA, Keppens G, O’Toole C and McKay-Brown L (2024) Embracing change: from recalibration to radical overhaul for the field of school attendance. Front. Educ. 8:1251223. doi: 10.3389/feduc.2023.1251223
Lombardi E, Traficante D, Bettoni R, Offredi I, Giorgetti M and Vernice M (2019) The Impact of School Climate on Well-Being Experience and School Engagement: A Study With High-School Students. Front. Psychol. 10:2482. doi: 10.3389/fpsyg.2019.02482
Orchard, T. (2017). Remembering the body: Ethical issues in body mapping research. New York, NY: Springer International Publishing.
O'Toole, C. (2022). When trauma comes to school: Toward a socially just trauma-informed praxis. International Journal of School Social Work, 6(2), 4.
08. Health and Wellbeing Education
Paper
Branching Out: Mobilising Community Assets to Support the Mental Health and Wellbeing of Children in Schools
Nicola Walshe1, Hilary Bungay2, Anna Dadswell2, Faye Acton2
1UCL; 2Anglia Ruskin University
Presenting Author: Walshe, Nicola
Children's mental health is a pressing public health concern that has only been exacerbated in recent years by the COVID-19 pandemic, the rising cost of living, and the impact of global events. In England in 2022, 18% of children aged 7-16 years had a probable mental health disorder (Newlove-Delgado et al., 2022). Furthermore, research has shown persistent inequalities in children’s mental health, and it has been suggested that the mental health gap between advantaged and disadvantaged children is growing (Collishaw et al., 2019). Poor mental health has long-term impacts on academic performance, social relationships, and overall quality of life, yet fewer than two-thirds of young people with mental health problems and their families access any professional help (NHS Digital, 2022) with high demand, limited provision, and long waiting lists for specialist mental health services (Moore and Gammie, 2018).
One approach to supporting children’s mental health and wellbeing in community and school settings is through arts-in-nature practice (Moula et al., 2022). The Creative Health Review (APPG on Arts, Health and Wellbeing and the National Centre for Creative Health, 2023) outlined how creativity, including creative activities in nature, is fundamental to supporting healthier, happier, and economically flourishing communities and creative health should be integrated into a whole-system approach to health and social care.
Mobilising existing creative, cultural and community assets is central to asset-based approaches that are gaining credence in UK public health policy making, and schools have been identified as key institutional community assets that can promote wellbeing (Forrester et al., 2020). The importance of schools is also recognised in the Healthy Child Programme (HCP, DoH/DSCF, 2009), the national prevention and early intervention public health framework for children, young people, and their families in the UK. Such policies position schools as a community asset for children’s mental health and wellbeing; however, it is the individuals within the school community that are often the driving force, and schools with strong social links and support from parents/carers are more likely to be motivated to develop and maintain such interventions (Herlitz et al., 2020). As such, one way of building capacity for schools to implement and sustain public health interventions including arts-in-nature practice would be to mobilise community assets such as parents/carers and other community members as local volunteers. Despite the nature of volunteering changing in recent times due to factors such as increased use of technology, austerity, and the COVID-19 pandemic (e.g. Mak et al., 2022), volunteers are an essential human resource, supporting local cultural and community arts projects and sustaining the wider cultural sector.
Within this context, the ‘Branching Out’ project set out to investigate how an established arts-in-nature programme ‘Eco-Capabilities’ could be scaled up from time-limited projects involving small numbers of children, to a sustainable public health intervention involving whole-school communities. The Eco-Capabilities programme was originally developed to explore the impact of the arts-in-nature practice called ‘Artscaping’ on children’s mental health and wellbeing. Eco-Capabilities found that Artscaping contributed to enhancing the mental and emotional wellbeing of children (Walshe et al., 2022). However, extending its reach to more children and ensuring its sustainability beyond projects that are restricted by funding, time, and resources remains a challenge. Accordingly, the Branching Out model was developed with the intention of extending the reach of Artscaping by mobilising community assets, including school staff and volunteers, as ‘Community Artscapers’ to support its delivery and promote the mental health and wellbeing of children in primary schools.
Methodology, Methods, Research Instruments or Sources UsedThe Branching Out research methodology drew on Creswell and Plano Clark’s (2011) exploratory multi-level mixed methods approach to investigate how partners could adapt their Artscaping practice for a model using Community Artscapers to reach more. The first phase of the research was concerned with developing the Branching Out model, involving interviews with artists and school staff involved in the Eco-Capabilities programme; a national online survey of arts organisations delivering arts and nature activities in schools; an e-Delphi Study with primary school staff with responsibility for children’s mental health and wellbeing; and stakeholder workshops including representatives from the health sector, local authority, education, and voluntary organisations (Bungay et al., 2023). The second phase of the research reported in this paper focused on the implementation of the Branching Out model across six pilot sites. Ethical approval for the research was granted by the UCL Research Ethics Panel. All participants were fully informed about the research using the appropriate participant information sheet and signed a consent form before data collection.
The Branching Out model was piloted in six primary schools geographically dispersed across Cambridgeshire in areas of high disadvantage and ensuring a mix of both rural and urban settings. Delivery was led by project partners CCI and CAP with support from Fullscope. The initial intention was for all schools to recruit local volunteers to be Community Artscapers supported by school staff, but some schools found volunteer recruitment challenging and/or felt that including staff would lead to greater sustainability. All adults involved in facilitating Artscaping were considered Community Artscapers. The process of selecting children to participate was different in each school, but usually involved consultation between the senior leadership and teachers through pupil progress meetings and discussions with SENCOs and pastoral leads. Artscaping was seen as an opportunity to support those on the cusp of requiring external mental health support. In the Branching Out pilot, Community Artscapers delivered 1.5 hour Artscaping sessions with children outdoors for eight weeks in Autumn 2022.
Researchers attended one session in each of the schools to inform subsequent online semi-structured interviews at the end of the pilots. A total number of 12 participants were interviewed including school staff (head teachers or inclusion leads, teachers, and teaching assistants involved in delivering Artscaping) and community volunteers to reflect on the experience of implementing the Branching Out model and facilitating Artscaping. Interviews were audio recorded and professionally transcribed. Transcriptions were subject to thematic analysis.
Conclusions, Expected Outcomes or FindingsFindings were explored in relation to mobilising community assets, the impact of the pilot on the children, and the impact on Community Artscapers.
One of the first steps in mobilising community assets as Community Artscapers was to develop the opportunity in a way that would engage individuals; the Community Artscaper role was framed as an opportunity for school staff and volunteers to engage with children in a novel way, outside of the classroom, fostering a connection with nature using the arts. Schools recruited volunteers through newsletters, emails, social media, noticeboards, and word-of-mouth communication. A pivotal component of the pilot was the training day which offered the opportunity for Community Artscapers to experience the activities for themselves, enabling a better sense of the potential impact on children's mental health and wellbeing.
Impacts for children included: improved mental health; freedom in creativity and being outside; personal development, particularly increased confidence in terms of participating, speaking and taking ownership of what they were doing; emotional impacts as the sessions instilled a sense of calm; and social connection as children had new opportunities to connect with adults. The impact on children meant that Artscaping delivered by Community Artscapers could serve as another “wave” of support for emerging mental health concerns before the point of being eligible for other provisions.
Impacts for Community Artscapers included sub-themes of: developing confidence in Artscaping as practice which makes a difference to children; supporting their own emotional wellbeing; providing personal and professional development for both volunteers and school staff; and providing opportunities for intergenerational connection and community.
In summary, the Branching Out model represents an innovative way of extending the reach of Artscaping by mobilising community assets and thus demonstrates potential as a public health intervention to support the mental health and wellbeing of children in primary schools.
ReferencesBungay, H., Walshe, N. & Dadswell, A. (2023) Mobilising volunteers to deliver a school-based arts-in-nature practice to support children’s mental health and wellbeing: A modified e-Delphi study with primary school staff. Cogent Education.
Collishaw, S., Furzer, E., Thapar, A.K. and Sellers, R. (2019). Brief report: a comparison of child mental health inequalities in three UK population cohorts. European Child & Adolescent Psychiatry, 28, pp.1547-1549.
Creswell, J.W. and Plano-Clark, V.P. (2011) Designing and Constructing Mixed Methods Research. Sage: London, UK.
Forrester, G., Kurth, J., Vincent, P. and Oliver, M., (2020). Schools as community assets: an exploration of the merits of an Asset-Based Community Development (ABCD) approach. Educational Review, 72(4), pp.443-458.
Newlove-Delgado T, Marcheselli F, Williams T, Mandalia D, Davis J, McManus S, Savic M, Treloar W, Ford T. (2022) Mental Health of Children and Young People in England, 2022. NHS Digital, Leeds.
Mak, H.W., Coulter, R. and Fancourt, D. (2022). Relationships between Volunteering, Neighbourhood Deprivation and Mental Wellbeing across Four British Birth Cohorts: Evidence from 10 Years of the UK Household Longitudinal Study. International Journal of Environmental Research and Public Health, 19(3), p.1531.
Moore, A. and Gammie, J. (2018). Revealed: hundreds of children wait more than a year for specialist help. Available at: https://www.hsj.co.uk/quality-and-performance/revealed-hundreds-of-children-wait-more-than-a-year-for-specialist-help/7023232.article. (Accessed: 31 March 2023)
Moula, Z., Palmer, K. & Walshe, N. (2022) A Systematic Review of Arts-Based Interventions Delivered to Children and Young People in Nature or Outdoor Spaces: Impact on Nature Connectedness, Health and Wellbeing. Frontiers in Psychology – Health Psychology. https://doi.org/10.3389/fpsyg.2022.858781
National Health Service Digital. (2022) Mental Health of Children and Young People in England 2022—Wave 3 Follow Up to the 2017 Survey. Available at: Mental Health of Children and Young People in England 2022 - wave 3 follow up to the 2017 survey - NDRS (digital.nhs.uk) (Accessed: 31 March 2023).
Walshe, N., Moula, Z. & Lee, E. (2022) Eco-Capabilities as a Pathway to Wellbeing and Sustainability. Sustainability, 14(6), 3582. https://www.mdpi.com/2071-1050/14/6/3582
08. Health and Wellbeing Education
Paper
Exploring Adolescent Resilience and Mental Health: Methodologies and Outcomes of the me_HeLi-D Project's Participatory Workshops in Poland
Katarzyna Borzucka-Sitkiewicz, Marcin Gierczyk, Katarzyna Kowalczewska-Grabowska
University of Silesia, Poland
Presenting Author: Borzucka-Sitkiewicz, Katarzyna;
Kowalczewska-Grabowska, Katarzyna
Recent research indicates that the mental health of adolescents is alarming and requires urgent remedial action. WHO data shows that worldwide, 1 in 7 (14%) people aged 10-19 experience disorders in psychosocial functioning. Attention is drawn to the significant underestimation of the problem - many cases remain undiagnosed and untreated (WHO, 2021). The international HBSC study (Cosma et al., 2023), conducted in the 11-15 age group, showed, based on the analysis of many indicators, that the mental health of adolescents deteriorates with age, with 15-year-olds generally having the worst mental condition. This was reflected primarily in the deterioration of mental well-being and the severity of problems related to their cognitive/psychosocial functioning. The difficulties mentioned above were deepened by the COVID-19 pandemic, during which interpersonal contacts and opportunities to engage in attractive activities were significantly limited.
Consequently, as research has shown, over two-thirds of adolescents' parents stated that due to social isolation and lack of contact with peers, they witnessed a deterioration in the emotional well-being (72%) and behavior (68%) of their children (Martinelli et al., 2020). For the above reasons, promoting mental health and resilience among young people is crucial. To create the right tools to help adolescents and support their mental health, it is essential to listen to their voices in this critical issue, and a participatory approach is used for this purpose (Martin, Buckley, 2020). Adopting participatory research methods transforms the traditional view of young people merely as research subjects to recognizing them as active contributors who can significantly influence various stages of research, including its development, design, execution, analysis, and dissemination. This approach, as Clavering and McLaughlin (2010) suggest, acknowledges adolescents as capable agents playing a pivotal role in the research process. In response to this need, the "Mental Health Literacy and Diversity. Enhancing Mental Health and Resilience through Digital Resources for Youth" (me_HeLi-D) project was created and implemented under the Erasmus+ program. Partners from Austria, Slovenia, Poland, and Bulgaria participate in the project. The me_HeLi-D project focuses on directly improving mental health, building the necessary skills in this area, and promoting diversity awareness among students. Its primary goal is to develop a research-based, publicly available digital tool for a specific target group of students (aged 12 to 15). The tool is intended to be used by students to support their resources and strengthen and spread knowledge about mental health. The main objective of the paper is to present some of the activities carried out in the project. To do this, the following research questions were formulated:
- How do adolescents aged 13-15 perceive and articulate their sources of well-being, resilience, and gratitude when engaged in participatory workshop activities?
- What are the methodological challenges and benefits of using photovoice and workshop methods with adolescents aged 13-15 to explore mental health and resources in a classroom setting?
Methodology, Methods, Research Instruments or Sources UsedA participatory approach was used in the research and implementation activities undertaken. Participation was understood as the interactivity of strategies used to strengthen the motivation of young people to engage in various types of social and educational activities and also meant sharing with them the responsibility for making decisions (Bruselius-Jensen & Nielsen, 2021). In contrast to more traditional research design strategies, researchers utilizing a participatory approach often choose research methods and tools that can be conducted democratically. The foundational premise of participatory research methods is the value placed on genuine and meaningful participation – methods that offer "the ability to speak up, to participate, to experience oneself and be experienced as a person with the right to express yourself and to have the expression valued by others" (Abma et al., 2019). The advantages of the participatory approach include: 1) supporting the development of young people's identity and competencies, 2) supporting the development of self-efficacy, agency, and empowerment, 3) contributing to achieving better educational results, 4) promoting better health. It was assumed that this approach would help build a program tailored to the needs of adolescents and thus make them more willing to engage in its implementation, increasing its effectiveness. When creating preventive programs for young people, they should be adapted to their needs to reach them. Therefore, to ensure that the realities of life of as many children and young people as possible are considered, researchers are looking for and creating opportunities for their participation in developing such programs (Wickenden et al., 2022). This participation is crucial because young people are the experts and have the best knowledge about their lives (Johnson &West, 2022).
Using a participatory approach, two workshops (PW) were organized for students aged 13-15, during which they had the opportunity to co-design the content and structure of the prepared digital program.
Conclusions, Expected Outcomes or FindingsThis paper provides a detailed exposition of the methodology and outcomes of participatory workshops (PWs) conducted in Poland as part of the me_HeLi-D project. The workshops, held in December 2023, explored and identified the sources of resilience, gratitude, and well-being among students, utilizing innovative and interactive methods such as Photovoice (Wang, Burris, 1997; Stephens et al., 2023). and Creation Labs. The significance of these workshops lies in their capacity to encourage self-expression and critical reflection among adolescents, enabling a deeper understanding of their mental health needs and perspectives (Maddy et al., 2020; Mooney et al., 2023). The methodology section of the paper is into the specifics of how the workshops were designed and implemented. Also, it discusses the rationale behind choosing these methods, emphasizing their suitability for engaging young people in conversations about mental health and well-being. PWs were organized in the project's partner schools in Austria, Slovenia, and Poland; however, the paper will present only the Polish findings. In the Polish context, 28 students aged 13-15 participated in these workshops. The paper presents the analysis of the data gathered from this workshop, highlighting the insights and perspectives shared by the participants. This analysis covered themes of resilience, how students articulate their sense of gratitude, and the various factors contributing to their well-being. The outcomes will be contextualized within the broader goals of the me_HeLi-D project, illustrating how these findings can inform the development of digital programs tailored to youth mental health. In summary, the paper will document not only the methodological framework and implementation of the participatory workshops in Poland but also offer a nuanced understanding of the mental health narratives of adolescents.
ReferencesAbma, T., Banks, S., Cook, T., Dias, S., Madsen, W., Springett, J., & Wright, M. T. (2019). Participatory research for health and social well-being. Springer.
Bruselius-Jensen, M., & Nielsen, A. M. W. (2021). The participation project: how projects shape young people’s participation. In M. Bruselius-Jensen, I. Pitti, & E. K. M. Tisdall (Eds.), Young People’s Participation: Revisiting Youth and Inequalities in Europe (1st ed., pp. 119–136). Bristol University Press.
Cosma A, Abdrakhmanova S, Taut D, Schrijvers K, Catunda C, Schnohr C. (2023). A focus on adolescent mental health and wellbeing in Europe, central Asia and Canada. Health Behaviour in School-aged Children international report from the 2021/2022 survey. Volume 1. Copenhagen: WHO Regional Office for Europe.
Johnson, V., West, A. (2022). Approaches and Creative Research Methods with Children and Youth. In D. Burns, J. Howard, S. M. Ospina (Eds.), The SAGE handbook of participatory research and inquiry. (Vols. 1-2), SAGE Publications.
Maconochie, H., & McNeill, F. (2010). User involvement: Children’s participation in a parent-baby group. Community Practitioner, 83(8), 17–20.
Madison Stephens, Eleanor Keiller, Maev Conneely, Paul Heritage, Mariana Steffen & Victoria Jane Bird (2023) A systematic scoping review of Photovoice within mental health research involving adolescents, Internation
Martin, S., & Buckley, L. (2020). Including children’s voices in a multiple stakeholder study on a com- munity-wide approach to improving quality in early years setting. Early Child Development and Care, 190(9), 1411–1424.
Martinelli, K., Cohen, Y., Kimball, H., & Sheldon-Dean, H. (2020). Children’s Mental Health Report: Telehealth in an increasingly virtual world. Child Mind Institute.
Mooney R, Dempsey C, Brown BJ, Keating F, Joseph D and Bhui K (2023) Using participatory action research methods to address epistemic injustice within mental health research and the mental health system. Front. Public Health 11:1075363.
Slattery, Maddy et al. “Participation in creative workshops supports mental health consumers to share their stories of recovery: A one-year qualitative follow-up study.” PloS one.
Wang, C., & Burris, M. A. (1997). Photovoice: Concept, methodology, and use for participatory needs assessment. Health Education & Behavior: The Official Publication of the Society for Public Health Education, 24(3), 369–387
WHO, (2021). Mental health of adolescents. https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health
Wickenden, M, Lopez Franco, E.(2022). Don’t Leave Us Out: Disability Inclusive Participatory Research – Why and How? In D. Burns, J. Howard, S. M. Ospina (Eds.), The SAGE handbook of participatory research and inquiry, 1-2, SAGE Publications Ltd. 321-338.
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