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      A qualitative exploration of stakeholder perspectives on the implementation of a whole school approach to mental health and emotional well-being in Wales

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      , , , ,
      Health Education Research
      Oxford University Press

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          Abstract

          Early intervention to support mental health and well-being of school-aged children may be of significant benefit in preventing escalation of mental health problems in later life. While there are limitations to current understanding of the best ways for schools to support mental well-being, a whole school approach (WSA), involving all those who are part of the school system in creating and sustaining a supportive environment where health is prioritized, may be effective. This research explored stakeholder views of this approach, as part of a contract commissioned by the Welsh Government to conduct an evaluability assessment of a WSA. Semistructured focus groups and interviews were completed with stakeholders from the health and education sectors, as well as parents, to explore how a WSA may operate in a Welsh context and barriers and facilitators to potential implementation and outcomes. Findings suggest that existing pressures on schools may impact implementation of a WSA, with school staff already time poor and many staff experiencing their own mental well-being challenges. Implementation may be supported by clear guidance at local and national levels, funding for staff time and training and stakeholder involvement at all stages. Long-term monitoring and evaluation are also needed to understand system changes.

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          Clinical practice guidelines for the management of chronic musculoskeletal pain in primary healthcare: a systematic review

          Background Up-to-date, high quality, evidence-based clinical practice guidelines (CPGs) that are applicable for primary healthcare are vital to optimize services for the population with chronic musculoskeletal pain (CMSP). The study aimed to systematically identify and appraise the available evidence-based CPGs for the management of CMSP in adults presenting in primary healthcare settings. Methods A systematic review was conducted. Twelve guideline clearinghouses and six electronic databases were searched for eligible CPGs published between the years 2000 and May 2015. CPGs meeting the inclusion criteria were appraised by three reviewers using the Appraisal of Guidelines Research and Evaluation (AGREE) II. Results Of the 1082 records identified, 34 were eligible, and 12 CPGs were included based on the inclusion and exclusion criteria. The methodological rigor of CPG development was highly variable, and the median domain score was 66%. The median score for stakeholder involvement was 64%. The lowest median score was obtained for the domain applicability (48%). There was inconsistent use of frameworks to aggregate the level of evidence and the strength of the recommendation in the included CPGs. The scope and content of the included CPGs focussed on opioid prescription. Conclusion Numerous CPGs that are applicable for the primary healthcare of CMSP exists, varying in their scope and methodological quality. This study highlights specific elements to enhance the development and reporting of CPGs, which may play a role in the uptake of guidelines into clinical practice. These elements include enhanced reporting of methodological aspects, the use of frameworks to enhance decision making processes, the inclusion of patient preferences and values, and the consideration of factors influencing applicability of recommendations. Trial registration PROSPERO CRD42015022098. Electronic supplementary material The online version of this article (doi:10.1186/s13012-016-0533-0) contains supplementary material, which is available to authorized users.
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            Mental health promotion and problem prevention in schools: what does the evidence say?

            The European Union Dataprev project reviewed work on mental health in four areas, parenting, schools, the workplace and older people. The schools workpackage carried out a systematic review of reviews of work on mental health in schools from which it identified evidence-based interventions and programmes and extracted the general principles from evidence-based work. A systematic search of the literature uncovered 52 systematic reviews and meta-analyses of mental health in schools. The interventions identified by the reviews had a wide range of beneficial effects on children, families and communities and on a range of mental health, social, emotional and educational outcomes. The effect sizes associated with most interventions were generally small to moderate in statistical terms, but large in terms of real-world impacts. The effects associated with interventions were variable and their effectiveness could not always be relied on. The characteristics of more effective interventions included: teaching skills, focusing on positive mental health; balancing universal and targeted approaches; starting early with the youngest children and continuing with older ones; operating for a lengthy period of time and embedding work within a multi-modal/whole-school approach which included such features as changes to the curriculum including teaching skills and linking with academic learning, improving school ethos, teacher education, liaison with parents, parenting education, community involvement and coordinated work with outside agencies. Interventions were only effective if they were completely and accurately implemented: this applied particularly to whole-school interventions which could be ineffective if not implemented with clarity, intensity and fidelity. The implications for policy and practice around mental health in schools are discussed, including the suggestion of some rebalancing of priorities and emphases.
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              Lessons from complex interventions to improve health.

              Complexity-resulting from interactions among many component parts-is a property of both the intervention and the context (or system) into which it is placed. Complexity increases the unpredictability of effects. Complexity invites new approaches to logic modeling, definitions of integrity and means of standardization, and evaluation. New metaphors and terminology are needed to capture the recognition that knowledge generation comes from the hands of practitioners/implementers as much as it comes from those usually playing the role of intervention researcher. Failure to acknowledge this may blind us to the very mechanisms we seek to understand. Researchers in clinical settings are documenting health improvement gains made as a consequence of complex systems thinking. Improvement science in clinical settings has much to offer researchers in population health.
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                Author and article information

                Contributors
                Journal
                Health Educ Res
                Health Educ Res
                healed
                Health Education Research
                Oxford University Press (US )
                0268-1153
                1465-3648
                June 2023
                30 January 2023
                30 January 2023
                : 38
                : 3
                : 241-253
                Affiliations
                departmentDECIPHer, Cardiff University , SPARC, Maindy Road, Cardiff, Wales CF24 4HQ, UK
                departmentWolfson Centre for Young People’s Mental Health, Cardiff University , SPARC, Maindy Road, Cardiff, Wales CF24 4HQ, UK
                departmentDECIPHer, Cardiff University , SPARC, Maindy Road, Cardiff, Wales CF24 4HQ, UK
                departmentDECIPHer, Cardiff University , SPARC, Maindy Road, Cardiff, Wales CF24 4HQ, UK
                departmentDECIPHer, Cardiff University , SPARC, Maindy Road, Cardiff, Wales CF24 4HQ, UK
                departmentDECIPHer, Cardiff University , SPARC, Maindy Road, Cardiff, Wales CF24 4HQ, UK
                departmentWolfson Centre for Young People’s Mental Health, Cardiff University , SPARC, Maindy Road, Cardiff, Wales CF24 4HQ, UK
                Author notes
                *Correspondence to: R. Brown. E-mail: brownr14@ 123456cardiff.ac.uk
                Author information
                https://orcid.org/0000-0002-4475-1733
                Article
                cyad002
                10.1093/her/cyad002
                10203039
                36715722
                e4bcc692-5b02-4621-9fb0-967a786f471c
                © The Author(s) 2023. Published by Oxford University Press.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 24 August 2022
                : 06 December 2022
                : 10 January 2023
                : 04 January 2023
                : 30 January 2023
                Page count
                Pages: 13
                Funding
                Funded by: Llywodraeth Cymru, DOI 10.13039/100015846;
                Award ID: C059/2020/202
                Categories
                Original Article
                AcademicSubjects/MED00860

                Education
                Education

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