Evaluation of Mentally Healthy Schools Rapid Pilot

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Sep 14, 2018 - Place2Be School Leaders Mental Health Champion Training . ...... discussion about their answers with the evaluation team. A further electronic copy was emailed ..... When we went on our bellies on the skateboard and raced.
Evaluation of Mentally Healthy Schools Rapid Pilot Final Report 14th September 2018

EVALUATION TEAM Professor Alison Yung Director, Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust and Professor of Psychiatry, University of Manchester. [email protected] Dr Heather Law Manager, Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust. [email protected] Dr Rebekah Carney Research Associate, Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust. [email protected]

Contents Abbreviations ................................................................................................................................................. 5 Figures ............................................................................................................................................................ 5 Tables ............................................................................................................................................................. 6 Boxes .............................................................................................................................................................. 6 Images............................................................................................................................................................ 6 EXECUTIVE SUMMARY ..................................................................................................................................... 7 INTRODUCTION ....................................................................................................................................................... 7 SUMMARY ............................................................................................................................................................. 7 DELIVERY OF PROGRAMME AND KEY FINDINGS ............................................................................................................. 7 RECOMMENDATIONS ............................................................................................................................................... 9 SECTION 1: INTRODUCTION ........................................................................................................................... 10 SUMMARY OF PROGRAMME .................................................................................................................................... 10 BRIEF (AS PROVIDED BY YST) ................................................................................................................................... 11 DELIVERY ............................................................................................................................................................. 11 SECTION 2: METHODOLOGY AND MEASURES ................................................................................................ 12 MEASURES........................................................................................................................................................... 12 Mental Health First Aid ................................................................................................................................ 12 Nurture Groups and Primary Workshops ..................................................................................................... 12 Secondary Students ................................................................................................................................................... 12 Primary Students ....................................................................................................................................................... 13 Student Experience ................................................................................................................................................... 13

Case Studies ................................................................................................................................................. 14 MHC Training ............................................................................................................................................... 16 Young Health Ambassadors ......................................................................................................................... 16 Training ..................................................................................................................................................................... 16 YHA Celebratory Event and Evaluation ..................................................................................................................... 17

Experience of Athlete Mentors, Trainers and Facilitators ............................................................................ 18 Whole School Ethos...................................................................................................................................... 18 Teacher Questionnaire .............................................................................................................................................. 18 Welfare Services ........................................................................................................................................................ 19 Additional Evaluations ............................................................................................................................................... 19

SAMPLE............................................................................................................................................................... 19 Nurture Groups ............................................................................................................................................ 19 Primary Schools ......................................................................................................................................................... 19 Secondary Schools ..................................................................................................................................................... 20

Focus Groups ................................................................................................................................................ 20 Young Health Ambassadors ......................................................................................................................... 20 MHFA Attendees .......................................................................................................................................... 21 Teachers ....................................................................................................................................................... 21 Trainers and Facilitators .............................................................................................................................. 21 Welfare Staff ................................................................................................................................................ 21 ANALYSIS ............................................................................................................................................................. 21 Quantitative Analysis ................................................................................................................................... 21 Qualitative Analysis ..................................................................................................................................... 21 Case Studies ................................................................................................................................................. 22 SECTION 3: RESULTS ...................................................................................................................................... 23 PROCESS EVALUATION............................................................................................................................................ 23 Place2Be School Leaders Mental Health Champion Training ...................................................................... 23

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Dose & Reach ............................................................................................................................................................ 23 Feedback on process so far ....................................................................................................................................... 23

Mental Health First Aid Training .................................................................................................................. 23 Dose and Reach ......................................................................................................................................................... 23 Fidelity and Context .................................................................................................................................................. 23 MHFA Youth Training Evaluation............................................................................................................................... 24

Mental Health First Aid Lite Training ........................................................................................................... 25 Dose and Reach ......................................................................................................................................................... 25 Fidelity and Context .................................................................................................................................................. 25 MHFA Lite Evaluation ................................................................................................................................................ 25

YST/P2B/42nd Street workshops.................................................................................................................. 26 Dose & Reach ............................................................................................................................................................ 26 Fidelity and Context .................................................................................................................................................. 27 Mechanisms of Impact – Student Evaluation Forms ................................................................................................. 27 Focus Groups ............................................................................................................................................................. 32 Observations ............................................................................................................................................................. 45 Case Studies .............................................................................................................................................................. 47

YHA............................................................................................................................................................... 52 Dose & Reach ............................................................................................................................................................ 52 YHA Questionnaire .................................................................................................................................................... 52

OUTCOME EVALUATION ......................................................................................................................................... 59 Place2Be School Leaders Mental Health Champions Training ..................................................................... 59 Whole School Ethos...................................................................................................................................... 59 Mental Health First Aid and Mental Health First Aid Lite ............................................................................ 60 Pre-Post Referrals ........................................................................................................................................ 62 Welfare Service Questionnaires ................................................................................................................... 62 Whole School Staff Survey: referrals to school welfare services .................................................................. 65 YST/P2B/42nd Street workshops.................................................................................................................. 66 Workshop Evaluation ................................................................................................................................................ 66

Absenteeism, Truancy and Behavioural Issues ............................................................................................ 76 YHA............................................................................................................................................................... 77 Place2Be Assessments and YHA Characteristics ........................................................................................................ 77 Observations from Conference ................................................................................................................................. 80

Running of the Whole Programme .............................................................................................................. 81 Long-term Outcomes – Teacher Feedback ................................................................................................... 84 SECTION 4: DISCUSSION ................................................................................................................................. 85 SUMMARY OF RESULTS........................................................................................................................................... 85 GOOD PRACTICE & CHALLENGES .............................................................................................................................. 86 Examples of good practice ........................................................................................................................... 86 Delivery of Programme ............................................................................................................................................. 86 Training of Staff ......................................................................................................................................................... 86 Programme Content .................................................................................................................................................. 87 Expertise and Qualities of Facilitators ....................................................................................................................... 88 Engagement with Programme ................................................................................................................................... 88 Feedback from Trainers and School Teaching Staff................................................................................................... 89

Examples of Challenges................................................................................................................................ 89 Delivery Across Schools ............................................................................................................................................. 90 Collaboration Between Organisations ....................................................................................................................... 90 CAMHS Involvement and Other Schemes ................................................................................................................. 91 Feedback on the Young Health Ambassador role ..................................................................................................... 91 School Involvement ................................................................................................................................................... 93 Timeframes ............................................................................................................................................................... 94 Selection of Students for the Nurture Workshops .................................................................................................... 95

LIMITATIONS OF THE EVALUATION ............................................................................................................................ 96 Meeting the primary outcomes of the brief .............................................................................................................. 96

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Limited Sample .......................................................................................................................................................... 97 Validity of Data .......................................................................................................................................................... 98 Lack of long term outcomes and evaluation ............................................................................................................. 98 Lack of opportunity for teacher and trainer/facilitator feedback ............................................................................. 98

RECOMMENDATIONS ............................................................................................................................................. 99 Key recommendations for future roll out of the programme....................................................................... 99 Additional learning points to be considered ................................................................................................ 99 FUTURE IMPACT .................................................................................................................................................. 100 CONCLUSIONS .................................................................................................................................................... 101 REFERENCES ....................................................................................................................................................... 101 SECTION 5: APPENDIX .................................................................................................................................. 102 A. B. C. D. E. F. G. H. I. J. K. L. M. N. O. P. Q. R. S. T. U. V. W. X. Y. Z.

MENTAL HEALTH FIRST AID YOUTH EVALUATION FORMS ................................................................................... 102 MENTAL HEALTH FIRST AID LITE EVALUATION FORMS ....................................................................................... 104 MENTAL HEALTH FIRST AID UPDATED EVALUATION FORMS (GDPR) ................................................................... 106 SECONDARY STUDENTS PRE-EVALUATION QUESTIONNAIRE ................................................................................. 108 SECONDARY STUDENTS POST-EVALUATION QUESTIONNAIRE ............................................................................... 114 PRE-EVALUATION GUIDANCE NOTES .............................................................................................................. 120 PRIMARY STUDENTS PRE-EVALUATION QUESTIONNAIRE ..................................................................................... 121 PRIMARY STUDENTS POST-EVALUATION QUESTIONNAIRE ................................................................................... 125 POST-EVALUATION GUIDANCE NOTES............................................................................................................. 129 STUDENT EVALUATION FORMS ...................................................................................................................... 131 INTRODUCTORY LETTER TO SCHOOLS (TEMPLATE) .............................................................................................. 132 OBSERVATIONAL DATA ................................................................................................................................ 133 FOCUS GROUP INTERVIEW SCHEDULES ....................................................................................................... 137 PLACE2BE INITIAL YHA ASSESSMENT ............................................................................................................. 140 PLACE2BE EVALUATION FORMS YHA – MENTAL HEALTH CHAMPION SLT ............................................................ 142 YOUNG HEALTH AMBASSADOR EVALUATION FORM .......................................................................................... 143 TRAINER AND ATHLETE MENTOR QUESTIONNAIRE ............................................................................................ 146 TEACHER QUESTIONNAIRE ............................................................................................................................ 148 WELFARE SERVICES QUESTIONNAIRE .............................................................................................................. 153 PLACE2BE SCHOOL LEADERS MENTAL HEALTH CHAMPION TRAINING - FEEDBACK .................................................. 154 MHFA QUALITATIVE FEEDBACK .................................................................................................................... 158 DEMOGRAPHICS AND RESPONSE RATES – WORKSHOP EVALUATIONS ..................................................................... 161 TABLE OF RESPONSES – FAVOURITE V LEAST FAVOURITE ................................................................................. 162 DEMOGRAPHICS OF RESPONSE RATES – YHA CONFERENCE ................................................................................. 173 DEMOGRAPHICS OF TEACHER RESPONSES........................................................................................................ 174 DEMOGRAPHICS OF PRE-POST WORKSHOP EVALUATION QUESTIONNAIRE ............................................................ 175

WORD COUNT: 48,338

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Abbreviations AFL Alliance for Learning CAMHS Child and Adolescent Mental Health Services CofE Church of England GDPR General Data Protection Regulation GM Greater Manchester GMCA Greater Manchester Combined Authority MHC Mental Health Champion MHFA Mental Health First Aid NHS National Health Service P2B Place2Be PRU Pupil Referral Unit RC Roman Catholic SDQ Strengths & Difficulties Questionnaire SEN Special Educational Needs STL Senior Team Leader WHO-WI World Health Organisation Wellbeing Index YHA Young Health Ambassador YST Youth Sport Trust

Figures FIGURE 1: MHFA YOUTH FEEDBACK ............................................................................................................................. 24 FIGURE 2: MHFA YOUTH FEEDBACK - TRAINING MATERIALS AND PRACTICAL ISSUES ............................................................. 24 FIGURE 3: MHFA LITE FEEDBACK ................................................................................................................................. 25 FIGURE 4: MHFA LITE FEEDBACK - TRAINING MATERIALS AND PRACTICAL ISSUES ................................................................. 26 FIGURE 5: STUDENT FEEDBACK ON THE WORKSHOPS ....................................................................................................... 27 FIGURE 6: STUDENT FEEDBACK ON THE WORKSHOPS - PRIMARY ........................................................................................ 28 FIGURE 7: POSITIVE FEEDBACK ON THE WORKSHOPS (PRIMARY) ........................................................................................ 28 FIGURE 8: NEGATIVE FEEDBACK ON THE WORKSHOPS (PRIMARY) ....................................................................................... 29 FIGURE 9: STUDENT FEEDBACK ON THE WORKSHOPS (SECONDARY) .................................................................................... 30 FIGURE 10: POSITIVE AND NEGATIVE FEEDBACK ON THE WORKSHOPS (SECONDARY).............................................................. 31 FIGURE 11: EXPERIENCE OF BEING YHA ......................................................................................................................... 52 FIGURE 12: PRIMARY YHA EXPERIENCE ......................................................................................................................... 53 FIGURE 13: PRIMARY YHA CHALLENGES ........................................................................................................................ 53 FIGURE 14: PRIMARY YHA FEELINGS ............................................................................................................................ 54 FIGURE 15: SECONDARY EXPERIENCE OF YHA ................................................................................................................. 56 FIGURE 16: SECONDARY YHA CHALLENGES .................................................................................................................... 57 FIGURE 17: SECONDARY YHA FEELINGS ........................................................................................................................ 57 FIGURE 18: TEACHER FEEDBACK ON WHOLE SCHOOL ETHOS ............................................................................................. 59 FIGURE 19: IMPACT OF PROGRAMME ON TEACHER KNOWLEDGE, UNDERSTANDING AND ATTITUDES ........................................ 60 FIGURE 20: CHANGE IN CONFIDENCE (MHFA LITE) ......................................................................................................... 60 FIGURE 21: CHANGE IN CONFIDENCE (MHFA YOUTH) ..................................................................................................... 61 FIGURE 22: CHANGE IN KNOWLEDGE (MHFA LITE) ......................................................................................................... 61 FIGURE 23: CHANGE IN KNOWLEDGE (MHFA YOUTH) ..................................................................................................... 61 FIGURE 24: CHANGE IN REFERRALS TO COUNSELLING SERVICE ........................................................................................... 65 FIGURE 25: ACTIVITY LEVELS (PRIMARY) ........................................................................................................................ 66 FIGURE 26: CHANGE IN MINUTES OF ACTIVITY (PRIMARY) ................................................................................................ 67 FIGURE 27: BELIEFS ABOUT EXERCISE (PRIMARY) ............................................................................................................ 67 FIGURE 28: CHANGE IN WHO WELLBEING INDEX (PRIMARY) ............................................................................................ 68 FIGURE 29: KNOWLEDGE AND AWARENESS OF MENTAL HEALTH AND SUPPORT (PRIMARY)..................................................... 69

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FIGURE 30: SATISFACTION WITH SCHOOL (PRIMARY) ....................................................................................................... 69 FIGURE 31: SDQ (PRIMARY) ....................................................................................................................................... 70 FIGURE 32: ETHNICITY (SECONDARY) ............................................................................................................................ 71 FIGURE 33: ACTIVITY LEVELS (SECONDARY) .................................................................................................................... 71 FIGURE 34: CHANGE IN MINS OF ACTIVITY (SECONDARY).................................................................................................. 72 FIGURE 35: BELIEFS ABOUT EXERCISE (SECONDARY) ........................................................................................................ 72 FIGURE 36: BODY IMAGE (SECONDARY) ........................................................................................................................ 73 FIGURE 37: CHANGE IN WHO WELLBEING INDEX (SECONDARY) ........................................................................................ 73 FIGURE 38: KNOWLEDGE AND AWARENESS OF MENTAL HEALTH (SECONDARY) .................................................................... 74 FIGURE 39: SATISFACTION WITH SCHOOL LIFE (SECONDARY) ............................................................................................. 75 FIGURE 40: SDQ (SECONDARY) ................................................................................................................................... 76 FIGURE 41: ABSENTEEISM AND TRUANCY ....................................................................................................................... 76 FIGURE 42: CONFIDENCE LEVELS PRE-POST YHA TRAINING .............................................................................................. 77 FIGURE 43: YHA SKILLS RATING................................................................................................................................... 77 FIGURE 44: USEFULNESS OF YHA TRAINING ................................................................................................................... 80 FIGURE 45: TRAINER SATISFACTION OF PROGRAMME ....................................................................................................... 81 FIGURE 46: TRAINER EXPERIENCE OF TRAINING PROCESS .................................................................................................. 81 FIGURE 47: TRAINER FEEDBACK ................................................................................................................................... 82 FIGURE 48: LONG-TERM IMPACT ON SCHOOLS ................................................................................................................ 84

Tables TABLE 1: SCHOOLS FOR IN-DEPTH EVALUATION ............................................................................................................... 14 TABLE 2: SCHOOLS THAT TOOK PART IN FOCUS GROUPS ..................................................................................................... 20 TABLE 3: PLACE2BE OBSERVATIONS OF YHA SKILLS ......................................................................................................... 78

Boxes BOX 1: MHFA FEEDBACK ........................................................................................................................................... 26 BOX 2: PRIMARY STUDENT FEEDBACK - WHAT DID YOU ENJOY MOST? ................................................................................. 29 BOX 3: PRIMARY STUDENT FEEDBACK - WHAT DID YOU ENJOY LEAST? ................................................................................. 30 BOX 4: SECONDARY STUDENT FEEDBACK - WHAT DID YOU ENJOY THE MOST? ....................................................................... 31 BOX 5: SECONDARY STUDENT FEEDBACK - WHAT DID YOU ENJOY THE LEAST? ....................................................................... 32 BOX 6: PRIMARY FOCUS GROUPS - FAVOURITE PARTS ...................................................................................................... 33 BOX 7: PRIMARY FOCUS GROUPS - KNOWLEDGE LEARNED ................................................................................................ 35 BOX 8: PRIMARY FOCUS GROUPS - DESCRIPTION OF YHA ................................................................................................. 36 BOX 9: SECONDARY FOCUS GROUPS - FAVOURITE PART ................................................................................................... 39 BOX 10: SECONDARY FOCUS GROUPS - LEAST FAVOURITE PARTS ....................................................................................... 40 BOX 11: SECONDARY FOCUS GROUPS - KNOWLEDGE LEARNED .......................................................................................... 40 BOX 12: SECONDARY FOCUS GROUPS - BARRIERS TO SEEKING MENTAL HEALTH SUPPORT ...................................................... 42 BOX 13: SECONDARY FOCUS GROUPS - IMPROVING MENTAL HEALTH SUPPORT IN SCHOOLS ................................................... 42 BOX 14: SECONDARY FOCUS GROUPS - CHARACTERISTICS OF TRAINERS ............................................................................... 43 BOX 15: DESCRIPTIONS OF YHA (PRIMARY) ................................................................................................................... 55 BOX 16: ACHIEVEMENTS AS YHA (PRIMARY).................................................................................................................. 55 BOX 17: SUPPORT FOR THE YHA (PRIMARY) .................................................................................................................. 55 BOX 18: DESCRIPTION OF YHA (SECONDARY)................................................................................................................. 58 BOX 19: FLEXIBILITY OF PROGRAMME ........................................................................................................................... 87 BOX 20: FACILITATOR FEEDBACK ON PREPARATION.......................................................................................................... 94

Images IMAGE 1 EMOJIS AND CARDS USED IN THE PRIMARY FOCUS GROUP ...................................................................................... 16 IMAGE 2: BUNTING MADE AT THE YHA CELEBRATORY EVENT ............................................................................................ 81

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Executive Summary Introduction The Mentally Healthy Schools Pilot is delivered by a consortium of 4 partners; Place2Be, Alliance for Learning, 42nd Street and Youth Sport Trust. The pilot aims to offer a complete package of support to 31 schools across Greater Manchester considering a whole school, workforce, peer mentor and young people approach whilst considering both their physical and emotional wellbeing as outlined in Future in Mind.

Summary The independent evaluation has been conducted by: Professor Alison Yung, Director, Youth Mental Health Research Unit Greater Manchester Mental Health NHS Foundation Trust and Professor of Psychiatry, University of Manchester. Dr Heather Law, Manager, Youth Mental Health Research Unit Greater Manchester Mental Health NHS Foundation Trust. Dr Rebekah Carney, Research Associate, Youth Mental Health Research Unit Greater Manchester Mental Health NHS Foundation Trust and Honorary Research Associate, University of Manchester.

The evaluation design has included both qualitative and quantitative methods including surveys with attendees from the different strands of training, focus groups and surveys with young people involved in the programme, ethnographic study and case study visits. A process and outcome evaluation of the pilot has been conducted and recommendations made for any future programmes and evaluation.

Delivery of Programme and Key Findings The programme was delivered to 31 schools across Greater Manchester. 62 senior leaders in schools received Mental Health Champion training over four sessions. This aimed to positively change the whole school ethos and ensure that a designated person at each school was responsible for supporting mental wellbeing in students and staff, and knowing how to and when to refer students to welfare and specialised mental health services. School leaders reported increased confidence in dealing with students with mental health problems, improved knowledge about how to refer students to specialised services, and increased awareness about the importance of staff health and wellbeing. 53 school middle leaders received MHFA training. This aimed to train two middle leaders from each of the schools to improve their confidence, competence, knowledge and motivation in supporting young people with mental health issues. Middle school leaders reported enjoying the training and improved attitudes towards mental health.

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60 school staff received MHFA Lite training. This aimed to train two support staff from each school to become wellbeing champions to support students with their mental health needs. Middle school leaders reported enjoying the training and that they had improved knowledge about mental health. They also wanted to engage with the full 2day training course. Year 5 primary school students at all 14 schools received co-designed and cofacilitated YST/P2B workshops. Workshops were well received with students reporting enjoying the active games, social nature of the workshops, meeting the athlete and trying their sports and learning about mental health. Students reported improved confidence and knowledge of mental and physical health. The written and more sedentary tasks were reported as being less enjoyable and less helpful than the active tasks. Some students were also confused by the workshops and did not understand why they were taking place. Outcomes of physical activity levels, beliefs about activity, wellbeing, school satisfaction and emotional wellbeing and behavioural conduct were unchanged following the workshops. Secondary school students at 17 schools received co-designed and co-facilitated YST/42nd Street workshops. Workshops were well received with students reporting enjoying learning about mental and physical health, the discussions on stress management and meeting the athlete mentors. Tasks such as drawing support networks and worries in the form of a bus, talking about stress and feelings in front of the class and trying out breathing techniques were reported as less enjoyable and less helpful than the more active tasks. Outcomes of wellbeing, emotional stress and knowledge of mental health support improved following the workshops. Students reported feeling more confident and discussed many skills which they had learned from the workshops. Outcomes of physical activity levels, beliefs about activity, body image, and understanding of metal health, school satisfaction, emotional wellbeing and behavioural conduct were unchanged following the workshops. 67 primary students received training to become Youth Health Ambassadors. Primary students reported enjoying the training and described feeling proud and confident about being chosen. However, understanding of the role varied, with some believing it involved helping others with their mental health and being a source of support for their peers and others not realising they would also learn to look after their own mental health. School leaders reported feeling positive about the YHA programme, and optimistic that it would be useful addition to schools. Both students and school leaders thought that ongoing support, such as further training and confidence building, was important for YHA. 90 secondary students received training to become Youth Health Ambassadors. They reported feeling proud and happy about being chosen and enjoyed the training. Understanding of the role was generally good, they felt empowered, and optimistic they could make a difference in their schools. School leaders reported feeling positive about the YHA programme, but felt that it was important for staff to receive support to encourage the YHA to fulfill their role. Both students and school leaders thought that ongoing support, such as help organising assemblies and events, and continued emotional support and encouragement was important for YHA.

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Feedback from people providing the training across all 4 organisations was generally positive and supportive of the programme. However most trainers described feeling that they did not have adequate preparation time and that the schools were often not ready to receive the training. Most trainers reported having to adapt their training across different schools, often at last minute.

Recommendations Based on this independent evaluation, the following key recommendations are made for future programmes: 1. Allow more time for trainers across different organisations to work together and plan activities for the sessions. 2. The training and workshops should be adapted for different schools and environments depending on the needs of the school (e.g. SEN schools, PRU). 3. Within schools, a designated contact person should be put in place and engaged early in the delivery of the programme to ensure the programme runs smoothly and all organisations have a point of contact. Clear timetables, schedules and preparations should be made for trainers and facilitators. Reminders should be provided on a regular basis. 4. Consider running the programme earlier in the school year and over a longer period of time to enable schools to fully implement what has been learnt and make changes in their schools. 5. The evaluation team should be engaged early, before the beginning of the programme. Clear procedures for assessing the delivery and impact of each component of the programme need to be in place and communicated with the training organisations, trainers and schools before the start of the programme.

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Section 1: Introduction Summary of Programme The Mentally Healthy Schools Rapid Pilot comprises of several inter-related interventions that together aimed to develop a whole school approach to improve student and staff wellbeing, develop resilience and life-readiness and identify and support students with mental health issues.

The interventions were: 1. Mental Health Champions (MHC) training for school leaders. This aimed to provide training to two school leaders from each of the 31 schools. The training consisted of four workshops and two consultation meetings and aimed to positively change whole school ethos towards mental health. Such training is identified in the Green Paper as an important component in developing a school system that can support students with mental health issues and refer them as necessary to school welfare staff and/or NHS services. 2. Mental Health First Aid (MHFA) Youth training for two middle leaders from each of the 31 schools, consisting of a 2-day course. The aim was to improve their confidence, competence, knowledge and motivation in supporting young people with mental health issues. In addition, Mental Health First Aid Lite training consisting of a half day course for two support staff from each of the 31 schools to become wellbeing champions to support students with their mental health needs. 3. Workshops for secondary students identified by school staff as experiencing anxiety, stress or other mental health issues, or students identified as vulnerable to these issues (“nurture groups”). These were co-designed and co-facilitated by Youth Sport Trust (YST) athlete mentors and 42nd Street service and aimed to improve confidence and wellbeing and increase awareness of the importance of health. 4. Workshops for a whole class of Year 5 primary students co-designed and co-facilitated by Youth Sport Trust (YST) athlete mentors and by Place2Be (P2B), and aimed to improve confidence and wellbeing and increase awareness of the importance of health. 5. Follow-up workshops by YST and 42nd Street to discuss coping strategies, and to consult young people about the Mentally Healthy Schools programme 6. Training of Young Health Ambassadors (YHA)1 to act as peer mentors for their classmates. This involved conducting a social action project of their choice within the schools. Secondary school students were trained by YST athlete mentors and 42nd Street and primary school students are trained by both the athlete mentor and Place2Be. 1

When the pilot was commissioned the original brief referred to training Young Health Ambassadors in each of the schools. Halfway through the programme the name was changed to Young Mental Health Champions, and thus the term was used interchangeably by teachers, trainers and students. However, for continuity and to avoid confusion with the MHC STL role, the students will be referred to as YHA throughout this evaluation.

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Brief (as provided by YST) The Greater Manchester pilot will engage and support 31 schools to develop their school, workforce and their young people to improve the culture around mental health and develop lasting skills and strategies to prevent mental health issues in the future. Each partner (YST, AFL, P2B, 42nd Street) will deliver the content and support that they have expertise in delivering and the evaluation will consider how effectively each one of these elements has been delivered as a package of support to maximise the resource available and the impact they have together. The programme will be evaluated by examining whether the approach is effective in its primary outcomes, as provided by YST:       

Reduction in/or increase in referrals to wellbeing support within or beyond the school (4 weeks) and how welfare staff are coping with this Reduction in absenteeism/behavioural incidents in designated groups Increase in staff competence and confidence to support and refer Changes in self-reported attitudinal data relating to school life Increased reported happiness/wellbeing/readiness Return on investment Impact on wellbeing of designated staff themselves

Delivery The programme began on 8th March 2018 and the interventions were completed by July 2018. Further interventions and consultations will be conducted in September 2018.

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Section 2: Methodology and Measures An independent evaluation has been conducted for the four interventions described above. The interventions have been analysed individually, and the combined to assess the impact of the whole programme on the whole school ethos. The evaluation team have worked with each of the organizations involved to ensure as much information is captured regarding the pilot scheme, and to inform future intervention development and evaluation. All data for the evaluations was received by July 2018.

Measures The measures used to conduct this evaluation were specifically designed in accordance with the original brief. The evaluation team collected a combination of qualitative and quantitative data using the following measures.

Mental Health First Aid Alliance for Learning facilitated training in Mental Health First Aid (MHFA). MHFA Lite sessions took place between 20th April 2018 and 3rd May 2018; MHFA Youth sessions took place between 22nd March 2018 and 20th June 2018. Attendees at the MHFA Lite completed an evaluation form on the day of the course. Attendees at the MHFA Youth completed a feedback form after day 2 of their course. The forms were designed by Alliance for Learning and were the standard forms used across the training. Due to changes in legislation on GDPR the first half of the attendees completed a slightly different evaluation form to the second half. The first evaluation form (Appendix A/B) asked attendees specifically about the course materials such as presentation slides. The updated form (Appendix C) used in the workshops that took place after 10th May 2018, omitted questions about course materials and instead covered course content. However, the main feedback and evaluation questions remained the same. The completed forms were anonymised and sent electronically to the evaluation team. They aimed to evaluate the outcomes of confidence, competence, knowledge and motivation in supporting young people with mental health issues

Nurture Groups and Primary Workshops YST and P2B co-facilitated workshops in primary schools and YST and 42nd Street delivered individual workshops, along with consultations for secondary schools. The aim of the workshops was to improve confidence and wellbeing and increase awareness of the importance of health for young people. The original proposal specified that although the content varied, both primary and secondary workshops would be evaluated as one package. However, due to the observed differences in delivery, measures and content of the workshops, primary and secondary workshops were evaluated separately.

Secondary students Pre-workshop assessment Knowledge of mental health, participation in physical activity, motivation for physical activity participation, perceived stress, knowledge and awareness of mental health, wellbeing, school satisfaction, body image and confidence were assessed using a bespoke questionnaire based on the YST 2020 survey and 42nd Street evaluation questionnaires (see Appendix D).

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Emotional wellbeing and behaviour was assessed using the Strengths and Difficulties Questionnaire (SDQ), a well-validated brief behavioural screening questionnaire suitable for 3-16 year olds. It contains 25 questions that map onto 5 subscales: emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems and prosocial behavior (Goodman, 2001; Law & Wolpert, 2014). Normative values are available for the SDQ to enable comparison with British norms (Meltzer et al., 2000). Wellbeing was assessed with the World Health Organisation Wellbeing Index (WHO-WI), a well-validated measurement tool suitable for children 9 years and over. It consists of 5 statements that relate to emotions and life satisfaction (Topp et al., 2015; WHO, 1998). Normative values are available for the WHO-WI to enable comparison with British norms. Ethnicity and gender were assessed using routine questions in a demographic questionnaire.

Post-workshop assessment Post-workshop questionnaires for secondary school students included the same instruments as the above baseline assessments and also contained a shortened life readiness questionnaire at the request of YST (Appendix E). Life-Readiness refers to the aim of the Greater Manchester Combined Authority (GMCA) to make Greater Manchester (GM) an area where all young people have access to good quality careers advice and are ‘ready for life’ once they finish education. The questionnaire assessed how secondary school pupils feel about their future and what they understand by the term ‘life-ready’. Questionnaires were reviewed by YST prior to being administered in the schools. Prequestionnaires were delivered to schools via YST and 42nd Street. Post-questionnaires were posted out to schools and were completed after the second workshop, prior to the end of term. The forms were sent back to the evaluation team using stamped addressed envelopes or collected by P2B. Guidance notes were provided to teachers to accompany the measures and ensure the forms were completed correctly (Appendix I).

Primary students Pre-workshop assessment The above instruments were adapted for use in primary schools by simplifying language, including visual aids and allowing more space for answers. Questions on body image and school life were omitted (Appendix G).

Post-workshop assessment These were the same as the primary school pre-workshop assessments (Appendix H).

Student Experience Student experience of the workshops was collected using one page feedback forms that were developed by the evaluation team. Students were asked what they did and did not like about the workshops and if they enjoyed taking part (Appendix J). The evaluation forms were given to the schools alongside the bespoke questionnaire and students were told to complete them on the day of the workshops. The same form was given to all 31 schools and was administered twice to collect feedback on both workshop 1 and 2. Data were anonymised and sent back to the evaluation team. The aim of this was to capture the opinions of the students and to

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determine which components they enjoyed or did not enjoy, which they thought worked well or not well, in order to inform future programmes.

Case studies The evaluation team were allocated 10 schools from the pilot to conduct a more in-depth evaluation and develop a series of case studies, (see below).

Table 1: Schools for In-depth evaluation

Schools for in depth evaluation St Hilda’s Primary Oasis Academy Rushbrook Primary St Wilfrid’s CofE Primary ESSA Primary Academy

Sale High School ESSA Secondary Academy Our Lady’s RC High School Trafford High School (PRU) Manor High School (SEN)

A mixture of different schools across localities were selected to maximize the spread of data. This included five primary schools, three secondary schools, one SEN school and one PRU. The schools were contacted in advance by YST and the evaluation team to arrange visits and assessments (Appendix K). Case studies were formulated using different data collection methods including:

1. Ethnographic study The team visited four schools to observe the nurture workshops and YHA training at different time points. The aim of this was to ensure the evaluation team had current knowledge of the programme content and how it was being delivered. The team also conducted ethnographic observations across each of the schools and assessed:      

The delivery and content of each of the workshops The relationship between the students and facilitators/Athlete Mentors (i.e. whether rapport was achieved and how this was done) Levels of student engagement Student participation in each component Whether any incidents occurred (e.g. disruptive behavior, conflict between pupils/staff) The general school environment and any examples of how health and wellbeing was addressed within the school

See Appendix L for the forms used to collect the observational data. The team planned on conducting a more in-depth visual ethnographic study, and photographing the school environment to provide a visual depiction of the whole school ethos. However it was not feasible to do this within the schools due to safeguarding issues. Instead, the team took photographs of the workshops and work that the students had completed at different time points to supplement the report. These images were collected with permission of the students and teachers and can be found throughout the results section.

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2. Focus Groups The aim of the focus groups was to capture more in-depth feedback from students regarding the programme, and to enable context to be added to quantitative responses. Focus groups provide rich data and allow people to speak freely about their experiences. The data was triangulated with the wider data collection from all workshop participants. Two members of the evaluation team conducted focus groups with approximately 6-8 students who took part in the programme, to explore in more detail their experiences of taking part. Interviews took place after the second workshops/consultation groups, to capture the student experience of the whole programme. Semi-structured interview schedules (Appendix M) were used to obtain information on:

       

What they had done as part of the programme Their overall experience and what they thought of each component of the workshop Favourite and least favourite parts How useful they had found it and what they had learnt The impact it had on their school Their perception of the whole school promoting wellbeing How their school supports students with mental health needs Recommendations for the future

Focus groups took place in schools in a quiet place, such as a classroom or library. In some instances, the teacher was also present but did not form part of the discussion. Groups lasted between 40-60 minutes and students completed them voluntarily. From previous experience, the evaluation team also decided to use visual aids as prompts for the primary school students to facilitate discussion and to ensure that the session was interactive. This included two sets of A4 laminated cards featuring thumbs up/thumbs down or different emoji’s (e.g. happy face, sad face) to guide the conversation. Thumbs up/down were used to indicate if the students enjoyed the programme, what they thought about the different components (e.g. How did you like the Athlete Mentor? …. The P2B counsellor? – thumb up/ in the middle/ thumb down). They were asked to explain their reasons and asked to give examples to add context to their answers. Emoji cards were presented to the students face down and the interviewer went round the table asking each student to select one at random. The students were then asked to describe part of the programme that best represented that feeling (see Image 1).

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Image 1 Emojis and cards used in the primary focus group

All students were informed that their responses were confidential and that they did not have to answer anything they did not want to. They were also informed that the evaluation team was not affiliated with the programme, to encourage them to be honest with their responses. The interviews were recorded on an encrypted Dictaphone and later transcribed to aid with data analysis.

MHC training P2B aimed to train two senior team leaders in all schools. The training consisted of four workshops and two consultation meetings (taking part in September 2018). The aim of the training was to positively change the whole school ethos towards mental health issues. A standardized evaluation form was completed prior to the start of the programme and will be administered again at the end of the consultations in September 2018. This measure captures knowledge of mental health, confidence identifying mental health needs, the school ethos and relationship with services such as CAMHS, and school awareness/attitude towards mental health. Due to the timescales of the training the evaluation team was unable to assess whether it was successful in changing the whole school ethos and achieved its aims. This is because the final consultations and data collection will be taking place in September after the evaluation team have completed the report. P2B will conduct their own evaluation of this component upon completion. P2B trainers collected feedback on the training from MHC using the following two questions: 1. What would you say to others considering this training? 2. What are your thoughts and feelings about the course?

Young Health Ambassadors Training The original brief aimed to train up to 5 Young Health Ambassadors in each school to act as peer mentors for their classmates. YHA were trained by YST and P2B (primary students) and YST/42nd Street (secondary students). The aim of the training was to increase confidence in

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influencing peers to understand the importance of health and wellbeing, influence their peers to improve attitudes to physical activity and wellbeing and establish a legacy as part of their role as a peer mentor. Potential primary school YHA were identified by teachers trained as MHC and put forward for the role. Place2Be counsellors assessed the students during the first workshops to identify whether they were suitable for the role, their confidence, whether they understood what was expected of them, identify any safeguarding concerns and recommend support they may need from the MHC. They were encouraged to work with the MHC to create a ‘legacy’ and promote wellbeing. Place2Be used their own evaluation forms for the initial workshop (Appendix N). MHC teaching staff completed written forms on their opinions of the training containing two open ended questions on how useful they had found the training and how they would support the ambassador going forward (Appendix O). The data from primary schools was provided to the evaluation team in anonymized format. 42nd Street also conducted their own independent evaluation of YHA training for secondary school students to ensure the students were appropriate and capable of fulfilling the role of YHA.

YHA Celebratory Event and Evaluation All schools that had trained YHA were invited to attend a celebratory event at the end of the programme which was held at the Etihad stadium. At the conference YHA listened to talks from participating organisations (AFL, Greater Manchester NHS, Greater Manchester Combined Authority, YST), were shown a celebratory video of photographs of the event, and took part in additional workshops conducted by Place2Be (primary), 42nd Street (secondary) and YST. 20 schools attended the event. The evaluation team developed a bespoke evaluation form for all YHA to assess their experiences of taking part. Place2Be reviewed the form prior to it being distributed at the conference. This included questions on whether they enjoy being YHA, their experiences so far, their confidence, and what they have achieved so far, what they have enjoyed or found difficult, any support needed to continue in their role, their understanding of the role and whether they would recommend becoming YHA to others (Appendix P). The form was completed at the conference by all attendees. The Place2Be workshop consisted of students completing the feedback form in an interactive session. Tables were set up with numbers 1-5 and the students walked to the table that matched their answer where they were asked to give more information. For questions with yes or no answers they were placed at separate parts of the room and students had to run to which ever one they ticked on their form. Completed forms were collected at the end of the day in anonymized form. Students also made bunting with drawings on to represent their experience of being YHA. 42nd Street conducted an interactive consultation with the secondary school students discussing what support they would like to see in schools. A table top discussion was guided by key themes arising from the second consultations with nurture groups. Feedback was collected from YHA on 5 key issues: 1. How can students be heard in school and why is it important? 2. How can schools support parents and carers? Is this important? 3. What help and support in relation to health and wellbeing would you like to see in your school and your wider community? 4. What do staff need to help them support students around emotional health and wellbeing? 17

5. What should peer support look like in schools? They also completed the feedback forms at the end of the session which were collected by the evaluation team. YST sessions included all students (both primary and secondary) working in small groups to create a ‘Dragon’s Den’ style pitch of a wellbeing project for within their schools.

Experience of Athlete Mentors, Trainers and Facilitators The evaluation team aimed to capture the experience of Athlete Mentors, trainers and facilitators of each of the programme components. This was conducted using a bespoke questionnaire, which was administered after all of the workshops and training had been conducted2. Purposive sampling was used and all Athlete Mentors, trainers and facilitators were emailed an invitation to complete an online questionnaire hosted on ‘Survey Monkey’. At the request of YST, Athlete Mentors completed paper copies of the forms at a later meeting and the evaluation team input their responses onto the online platform. The questionnaire contained items on barriers/facilitators to delivering the intervention, a selfassessment of what went well and what challenges were faced and whether any changes to the training were needed over time or across different schools, (Appendix Q).

Whole School Ethos Teacher Questionnaire The overall programme aimed to develop a whole school approach to improve student and staff wellbeing to support students’ mental health. In order to assess the impact of the programme on the whole school ethos, a bespoke questionnaire was created for all teaching staff, regardless of their participation or otherwise in any of the mental health training. The questionnaire assessed teachers’ knowledge, confidence, skills, and general school environment/attitude towards mental health and wellbeing (Appendix R). It contained 24 questions or statements where the teacher could respond on a scale of 1-5 from Disagree to Agree. For example,

Q.7 Since the programme, I feel like I now have the appropriate skills to be able to support students with their mental health. Disagree,

Slightly Disagree,

Neither,

Slightly Agree,

Agree

An email link was sent out to head teachers and lead contact at all 31 schools by Alliance for Learning, prior to the end of term and once all the workshops and training had taken place. ‘Survey Monkey’ was used to administer the questionnaire electronically, and collect and analyse the responses. Teachers and school staff were all informed that they were entered into a prize draw to win a £30 voucher.

2

This excludes the ongoing MHC STL training which is continuing into September 2018.

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Welfare Services The programme aimed to improve skills and confidence in identifying mental health issues and improve confidence in referring students to in-school services and NHS services. The 10 schools selected for the in-depth evaluation were approached to assess the impact the programme had on welfare services. Head teachers at the schools were contacted by YST to request further information. This included school counselling services and wider members of the pastoral care teams. A brief survey was developed by the evaluation team to understand the impact the programme had on referrals to the welfare services, whether they have been appropriate and if they felt supported or not (see Appendix S). Schools were also asked about any CAMHS input and how they have found the support. Welfare services were given the option of completing a paper version of the form, an electronic copy (via email) or completing it over the phone/in person with one of the evaluation team to try and capture as many responses as possible. Email versions of the form were sent out on multiple occasions to the head teachers and lead contacts at the schools. Despite frequent attempts to contact the welfare services across schools, responses could only be retrieved from two schools. One staff member completed a paper copy and engaged in a brief discussion about their answers with the evaluation team. A further electronic copy was emailed back by another school. Due to the low response rate, the data is presented as case studies in the results section. The teacher questionnaires discussed above also included questions on whether they had made referrals to the welfare services, how comfortable and confident they felt and if they would be able to recognize when they needed to refer students. This is presented separately in the results section.

Additional Evaluations Additional feedback and evaluations were conducted by each of the organisations. This did not form part of the independent evaluation of the programme.

Sample The pilot scheme was conducted in 31 schools across Greater Manchester. This included 14 primary schools and 17 secondary schools (14 mainstream, 2 SEN, 1 PRU). The sample for each intervention and evaluation component varied.

Nurture Groups The evaluation team were unable to determine whether the programme reached its intended audience. The original brief stated 30 primary students and 15 secondary students per school. Attendance was not recorded at each of the nurture groups and not all pre-post questionnaires were received. The results presented refer to the amount of questionnaires received back from the schools and thus represents the feedback and evaluation of the programme on behalf of those who returned their forms, not all students who participated in the programme.

Primary Schools Primary nurture groups consisted of up to 30 students from year 5 classes in 14 different primary schools across Greater Manchester.

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A total of 281 students completed pre-evaluation questionnaires and 184 students completed follow-up questionnaires from 14 schools. Feedback forms were returned from 365 students from 10 schools. (See Appendix V for a full breakdown of the schools who responded to the evaluations and Appendix Z for pre-post questionnaires).

Secondary Schools Secondary school nurture groups consisted of up to 15 students from year 10 classes in 17 secondary schools (including 2 SEN, and 1 PRU). Students were identified by school staff as experiencing anxiety, stress or other mental health issues, or those students identified as vulnerable to these issues. A total of 73 students completed pre-evaluation questionnaires and 39 students completed follow-up questionnaires from 11 schools. Feedback forms were returned from 120 students from 5 schools. An additional 22 feedback forms did not include the name of the school or workshop. (See Appendix V for a full breakdown of the schools who responded to the evaluations and Appendix Z for pre-post questionnaires).

Focus Groups A total of 6 focus groups were conducted containing 45 students (4 Primary Schools; 2 Secondary Schools). The number of students in the focus groups ranged from 5 to 10, and contained both males and females. A mixture of students from the nurture groups and YHA took part. Purposive sampling was used so that students across all local authority areas were represented. The focus groups were conducted in the following schools:

Table 2: Schools that took part in focus groups

Schools that took part in focus groups St Hilda’s Primary

Sale High School

St Wilfrid’s CofE Primary

ESSA Primary Academy

Rushbrook Primary

Our Lady’s RC High School

Young Health Ambassadors Data from the initial workshops conducted by P2B contained responses from 67 YHA from across the primary schools and qualitative feedback from 10 SLT trained as MHC. Students from 20 schools attended the YHA conference. 93 feedback forms were completed by YHA (40 secondary, 50 primary, 3 unknown).

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MHFA Attendees A total of 60 staff members provided evaluation forms for Mental Health First Aid Lite training, and 53 provided evaluation forms for Mental Health First Aid Youth training.

Teachers Twenty-seven teachers completed the online questionnaire from 13 schools. This consisted of 9 School Leaders (e.g. head teachers), 6 teachers, 5 teaching assistants, 4 special educational needs coordinators, as well as one therapist and one other member of staff. All but one respondent was aware of the Mentally Healthy Schools Programme, and 24 (89%) had completed additional training as part of the programme, (See Appendix Y for a breakdown of what schools responded to the questionnaire, and demographics of the respondents).

Trainers and Facilitators Seventeen trainers and facilitators of the programme completed the feedback questionnaire. This included 6 Athlete Mentors from YST, 6 42nd Street facilitators, 3 Place2Be counsellors and 2 AFL trainers.

Welfare Staff The welfare services at two secondary schools were available to complete the welfare questionnaire and provide feedback to the evaluation team.

Analysis Quantitative Analysis All quantitative data was entered onto specially created databases using SPSS (Version 22 IBM). Descriptive statistics were used to present means, standard deviations and proportions for survey data. Data was anonymized and stored on secure NHS servers. Teacher and Athlete Mentor/trainer questionnaires were input via ‘Survey Monkey’ and data exported into a word document.

Qualitative Analysis The focus groups were audio-recorded and transcribed verbatim into password protected word documents. Responses were anonymized and no names were used within the transcripts. Data was analysed using thematic analysis which results in a rich and accessible account of qualitative data. A realist perspective was adopted to report the experiences of participants. Themes were coded inductively at a manifest level. Transcripts were reviewed and coded systematically and iteratively. The data was organized using NVivo software. Qualitative responses from student, teacher and trainer/facilitator feedback forms was collated and grouped into similar themes. Qualitative feedback was reviewed and common responses were identified and used to inform recommendations.

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Case Studies Case studies are presented throughout the report to highlight examples of feedback and results. The data from welfare services is written up as a case study with permission of the staff member involved. Where possible photographs were taken of the work students had completed as part of the workshops. This is presented within the report and no identifiable or sensitive images have been used.

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Section 3: Results Process Evaluation Place2Be School Leaders Mental Health Champion Training Dose & Reach The pilot aimed to train two senior team leaders in each of the 31 schools taking part in the pilot. 62 Mental Health Champions (MHC) were trained in 17 secondary and 14 primary schools. This is in line with the original brief.

Feedback on process so far The training is ongoing and thus cannot form part of this evaluation. The MHC who have engaged in the training provided feedback on whether they would recommend it to others and their thoughts and feelings about the course. The feedback has been positive as displayed by the examples below: ‘The course is a significant investment in mental health, not a quick fix or ‘tips for teachers’ but the opportunity for a deep systematic consideration of improving mental health for all’ ‘Everyone owes it to their children and staff to ensure MHFA/wellbeing remains a priority. No budget or external pressures should prevent this’ ‘A complete eye opener! I felt that I knew about mental health before I started but soon realised I didn’t. So useful and has had a huge impact’ ‘Empowering; insightful; child focussed; powerful; reflective; enjoyable’

Feedback from all the trainees can be found in the Appendix (Appendix T) and this component of the programme will be evaluated independently by Place2Be and Alliance for Learning after the final consultations in September 2018.

Mental Health First Aid Training Dose and Reach The pilot aimed to train 2 middle leaders in each of the 31 schools in MHFA Youth. 53 staff members engaged in the two-day MHFA Youth training reaching 85.5% of the intended audience.

Fidelity and Context The fidelity of the training and whether it had to be adapted across schools was assessed using the trainer questionnaire. The responses were collected for all trainers and facilitators and the results are presented under section titled ‘Running of Whole Programme’.

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MHFA Youth Training Evaluation Attendees completed evaluation forms after the two day training and 100% of attendees rated their instructor ‘Very Good’, and all expressed satisfaction with the overall course.

MHFA Youth Feedback Very Good Good Neither Poor nor Good Poor Very Poor 0

20 40 Overall Course

% of attendees

60 Trainer

80

100

Figure 1: MHFA Youth Feedback

For the first set of training (n=26) participants were satisfied with the training materials used, and practical issues such as the content and structure of the course.

Evaluation of Training Materials Very Good Good Neither Poor nor Good Poor Very Poor

Practical Issues Very Good Good Neither Poor nor Good Poor

0

20

40

60

80

100 120

Very Poor

% of attendees

0

20

40

60

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% of attendees Presentation Slides

Video Clips

Manual Information

Learning Exercises

Course Structure

Course Content

Environment

Figure 2: MHFA Youth Feedback - Training Materials and Practical Issues

The direct impact of the training was evaluated in the updated feedback form provided to the 26 participants who took part in the second set of sessions. 96.2% (n=253) strongly agreed or 3

The remaining person who answered neither reported that they did not do this in the first place

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agreed that as a direct result of the training they would be less likely to judge people with mental health issues negatively. Further, all participants agreed (30.8%) or strongly agreed (69.2%) that as a result of the training they were more likely to consider mental health and mental ill health a normal part of everyday life.

Mental Health First Aid Lite Training Dose and Reach The pilot aimed to train 2 ‘wellbeing champions’ in each of the 31 schools in MHFA Lite. 60 staff members engaged in the half-day MHFA Lite training reaching 96.8% of the intended audience.

Fidelity and Context The fidelity of the training and whether it had to be adapted across schools was assessed using the trainer questionnaire. The responses were collected for all trainers and facilitators and the results are presented in section titled ‘Running of the Whole Programme’.

MHFA Lite Evaluation Attendees completed evaluation forms on the day of the training and left overwhelmingly positive feedback. All were extremely satisfied with the overall course and the trainers from Alliance for Learning.

MHFA Lite Feedback Very Good Good Neither Poor nor Good Poor Very Poor 0

20 40 Overall Course

% of attendees

60 Trainer

80

100

Figure 3: MHFA Lite Feedback

The structure, content and delivery materials (such as video clips) all received a rating of good-very good. Attendees were also happy with practical issues such as course content

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and structure, although two people were unhappy with the location due to issues with traffic.

Evaluation of training materials

Practical Issues Very Good Good Neither Poor/Good Poor Very Poor

Very Good Neither Poor/Good Very Poor 0

20

40

60

80

100

0

20

% of attendees

40

60

80

100

% of attendees

Learning Exercises

Manual Information

Environment

Course Content

Video Clips

Presentation Slides

Course Structure

Figure 4: MHFA Lite Feedback - Training Materials and Practical Issues

Attendees provided more information about their responses. They described in detail how much they enjoyed the course. Many wanted to attend the full 2-day course and the trainers were spoken of highly. Many commented on the friendliness of trainers, and how they were fun but also able to tackle sensitive issues. See Box 1 below.

Box 1: MHFA Feedback

MHFA Qualitative Feedback I thoroughly enjoyed today’s course despite some of the sensitive content. Lisa presented the course in a professional, yet down to earth manner, particularly using true-life examples. Very funny too! Super! Enthusiastic, inspiring and very supportive.

Fantastic, relaxed and informative delivery of mental health issues. Lisa has an engaging personality. It is great to be able to laugh during some sombre topics! Funny and down informative too!

to

earth.

Very

There was also support for the materials used, and how they were well presented, clear to use and appropriate for use in schools.

YST/P2B/42nd Street workshops Dose & Reach The number of young people attending the workshops was not recorded routinely throughout the programme, therefore, the true reach of the programme cannot be established. However, the evaluation team did record the amount of students present on the day during the observations in 1 primary, 1 secondary, 1 SEN and 1 PRU. :

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Primary: 29 students Secondary School: 13 students SEN: 10 students PRU: total 7 students (although varied across the day) Assuming the same number of students attended workshops in the remaining schools a total of 406 students would have been trained in primary schools and 221 in secondary/SEN/ PRU. This gives a total estimate of 627 students, compared with 690 stated in the original brief (90.87%). For future programmes, the evaluation team recommend that the number of students attending each session be recorded on the day to ensure the true reach of the programme can be established.

Fidelity and Context The fidelity of the training and whether it had to be adapted across schools was assessed using the trainer questionnaire. The responses were collected for all trainers and facilitators and the results are presented in the section titled ‘Running of whole programme’.

Mechanisms of Impact – Student Evaluation Forms Students were asked for their feedback on the workshops using one-page evaluation forms given at the end of both workshop 1 and 2. Feedback was combined for both workshops to reflect the students’ overall satisfaction of the programme. 477 forms were returned from 15 different schools (10 primary schools; 5 secondary). Response rate was higher for the first workshop. 290 students from 11 different schools provided feedback on workshop 1; 165 students from 10 schools gave feedback on workshop 2. 22 of the forms returned did not specify which school, nor the workshop they related to. [See Appendix V for a full summary of response rates]. Overall, students enjoyed taking part in the workshops (average score 8.8, range 0-10)4. (Note: 19 students who were so enthusiastic about the programme they gave it ratings such as 111, 999999999 and 1 million). On a scale of ‘Hated it! – Loved it!’ the students also expressed positive feedback for the workshops as indicated in the graph below.

% of responses

Overall enjoyment of workshops 80 60 40 20 0 Hated it! Disliked it Neutral

Liked it Loved it!

Figure 5: Student Feedback on the Workshops

4

The 19 extreme values were transformed to a maximum of 10 and were included in the analysis.

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Primary Students Primary school students were extremely happy with the workshops and rated on average 8.9 out of 10. 88.8% of primary students who completed the feedback forms either ‘Liked it’ (20.9%) or ‘Loved it!’ (65.5%).

Primary students: enjoyment of workshops

% of responses

100 80 60

40 20 0 Hated it!

Disliked it

Neutral

Liked it

Loved it!

Figure 6: Student Feedback on the Workshops - Primary

Students reported their experience of the workshops. They rated how much they agreed with the following statements. Almost all primary students who responded found the workshops interesting (72.9% a lot; 25.4% a little), and reported learning something new (96.6%). Only 7.3% of students would not like to take part again.

Primary Feedback- Positive I would take part again

I learnt something new

It was interesting

I enjoyed taking part 0

20 Not at all

40 A little

60

80

100

A lot

Figure 7: Positive Feedback on the Workshops (Primary)

The number of students who did not understand the workshops was low (7.6% rated ‘a lot’), and only a minority thought it was boring (3.1%) or disliked the whole thing (4.6%).

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Primary Feedback - Negative I didn't understand it

I disliked it

It was boring

0

10

20

30

40

50

60

Not at all

70 A little

80

90

100

A lot

Figure 8: Negative Feedback on the Workshops (Primary)

Students said what they enjoyed most and least about individual workshops.

Favourite Part Primary school students described;     

The active parts of the workshops and games (such as the games e.g. skipping game, emoji game, rock/paper/scissors) Social factors (such as making new friends, encouraging others) Meeting the athlete and trying out their sport Learning new things (about mental and physical health) The meditation and breathing exercises

The table below contains some examples (a full table of all responses is contained in the Appendix (Appendix W).

Box 2: Primary Student Feedback - What did you enjoy most?

Primary Student Feedback – what did you enjoy the most? I enjoyed it because this lesson has made me believe in myself and made me more confident to do more things. EVERYTHING! Putting the healthy food on the food plate. I liked all of it, it was awesome! I enjoyed figuring out how many sugar cubes are in the food and drinks The bit about trying to progress this school and all the children in it

I loved it when the lady put the music on and spoke to make us feel like we are someone and we matter. I enjoyed learning to eat and drink more healthily. Learning how I can improve in basically everything. The rope game, I liked encouraging others to cross. I enjoyed when we did the Judo moves because I think it was fun The games and information, everything!

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Additionally, some students were so enthusiastic about the workshops they could not pick their favourite part. Many students gave answers such as ‘All of it!’, ‘Everything, I can’t decide’ and ‘Everything, I learnt new things!’

Least Favourite Part When asked what they least enjoyed, 49 primary students claimed there was nothing they could think of. For example, ‘Nothing! It was amazing I enjoyed the whole thing!’, ‘I wouldn’t say I disliked anything’ and ‘I did not enjoy it I loved it!’ Yet despite this enthusiasm, there were some elements of the workshops, which not all students enjoyed. This generally related to some of the activities (e.g. the sugar cube task, the breathing activities), issues which arose on the day (e.g. behavior of others) and some of the physical activities. Box 3 contains some examples.

Box 3: Primary Student Feedback - What did you enjoy least?

Primary Student Feedback – what did you enjoy the least? Doing the stretches Playing the rock, paper, scissors game The visualisation because I found it hard to keep still The running game when we had to run in the hoops Working in a team doing breathing techniques

The healthy and unhealthy drinks part Naming and trying the vegetables The skipping rope because I don’t do it I enjoyed the least was seeing the sugar and not being able to eat it When my friend was swearing

Secondary Secondary students rated the workshops an average of 8.5/10 (78 responses). Only 5% of secondary students claimed to dislike the workshops.

Secondary students: enjoyment of workshops % of responses

100 80 60 40 20 0 Hated it! Disliked it

Neutral

Liked it

Figure 9: Student Feedback on the Workshops (Secondary)

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Loved it!

The majority of secondary students agreed with positive statements about the workshop. All students who responded said they had learnt something new and enjoyed it. Only 4.6% would not take part again. Additionally, many disagreed with negative statements about the programme. From those who responded, only 4.4% did not understand it, and 2.3% found it boring.

Secondary Feedback - Negative

Secondary Feedback - Positive I would take part again

I didn't understand it

I learnt something new I disliked it It was interesting It was boring

I enjoyed taking part 0 Not at all

20

40

A little

60

80

100

A lot

0 Not at all

20

40

A little

60

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A lot

Figure 10: Positive and Negative Feedback on the Workshops (Secondary)

Favourite Part Secondary students also discussed a range of factors which they enjoyed most, including gaining knowledge of mental health and wellbeing and taking part in the physical activities (such as doing the plank and sugar cube activity). Secondary students in particular tended to describe factors relating to the Athlete Mentor as their favourite part such as their ‘humor and excitement’ and learning how to do their sport. See the box below: Box 4: Secondary Student Feedback - What did you enjoy the most?

Secondary Student Feedback – what did you enjoy the most? Learning different ways of achieving what you want When we went on our bellies on the skateboard and raced Learning all the skateboarding tricks and expressing myself more, I loved all of it

I enjoyed the skateboarding lesson. It allowed me to step out of my comfort zone Knowing the kind of food to eat and stay healthy Learning things I could do to improve life

Least Favourite Part Again, some of the students could not identify anything they disliked about the workshops answering, ‘Nothing because it was awesome’, and ‘I loved all of it, nothing bad’. However, some of the secondary students reported specific activities as being their least favourite (such as the breathing exercises, the plank and shock ball, the 42nd Street session and ‘the session with the mind map’). Several students reported discussing their feelings and addressing stress as being their least favourite part of the workshops, and others referred to the written tasks. See Box 5:

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100

Box 5: Secondary Student Feedback - What did you enjoy the least?

Secondary Student Feedback – what did you enjoy the least? Nothing because it was fun Falling off the skateboard After the boxer left Probably coming up with things to write

Talking about our feelings and why we felt the way we did to the rest of the class The one where we got sugar cubes out because I love sweets The talk about stress and anxiety with 42nd Street Losing at the card game

Focus Groups Primary Focus groups were conducted in four primary schools with 30 students (ESSA Primary, Rushbrook Academy, St Hilda’s Primary and St Wilfrid’s).

Understanding and delivery of the programme Students spoke freely to the evaluation team regarding what they had been doing as part of the Mentally Healthy Schools programme. They generally described it as a fun experience, and spoke about it with enthusiasm and excitement. The main components the students remembered about the workshops were:    

Learning meditation and breathing exercises Taking part in games and activities; such as the emoji card game, the glitter bottle concentration game and the teamwork skipping rope task Meeting the Athlete Mentors and trying out their sport Learning about physical and mental health

From speaking with the students, it became clear that the content and delivery of the workshops differed across schools and a range of activities were used, rather than one specific programme. Although some parts of the programme remained the same in each school, students described taking part in different tasks and activities. For example, some schools did not take part in the skipping rope task, or the healthy eating food relay, and only one of the schools reported a visual perception activity (horse and frog image). In some schools, the students reported being initially confused about what the programme was going to be about and did not know what to expect. For example: ‘We knew that she was going to come in, but we didn’t know what it was going to be about. Everyone thought we were doing Judo’ ‘The first-time they came in – I was like ‘why are these people here’ – and then when we came deeper into the lesson I understood who she was and why she was here’

Some expressed initial apprehension, fear and uncertainty about what they were going to be doing but after taking part they enjoyed it. Yet for some, they remained confused about why they were learning about mental health and wellbeing from Athletes and not sport and this was not clarified at the workshops (e.g. ‘Why didn’t she teach Judo and taught mental health instead?’). Therefore, some individuals did not understand the link between physical and mental health and in future it would be useful to clarify this at the start of the programme.

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Favourite parts of the programme Students used a variety of positive words to describe the programme including; ‘fun, enjoyable, interesting, different, exciting, happy, cool’.

Students reported their favourite aspects of the programme and the parts that they enjoyed. Similar to the responses collected on the workshop evaluation form, many students reported enjoying it all, and being unable to identify one thing they enjoyed the most e.g. ‘I don’t have any favourite, all of it was my favourite!’ They discussed many different parts, and spoke in detail about why they liked them. See Box 6 below for some examples:

Box 6: Primary Focus Groups - Favourite Parts

Primary Focus Groups – Favourite Parts ‘The games were good because they were fun and they were helpful Physical Group Activities

Meeting the Athlete Mentor and trying out their sport

Breathing exercises and learning about meditation

Activities about feelings and emotions Working together with their peers

like, and we could exercise, like we could run’ ‘My favourite part was when we were throwing the ball to each other because of the concentration’ ‘learning about more judo because she like basically made me feel like I can do anything and nothing can stop me doing anything, and if I want to do anything I can do it’ ‘I loved the whole thing, because that’s the first Olympian I have met in my entire life’ ‘I liked the games and the breathing exercises. My favourite breathing exercise was with the teddy bear’ ‘We got like a piece of paper and wrote what stresses us out and then we had to put it into a little bowl and aim it into the bin’ ‘What made me interested was like the yoga… when I’m thinking about it I’m imagining in my head ‘I’m a bridge but there’s a troll under me!’ ‘I liked drawing the bus!’ ‘I was excited about when we were doing the feelings part!’ ‘Even if I don’t get to be in a group with my friends I can still be good and cause I know my friends, I won’t really learn everything off them cause I have learnt nearly everything off them, so if I am in a group with other people I can learn more off them’ ‘We had to do the top five ones like what makes a good team leader and that showed me that like my team actually knows how to make a good team’

Primary students particularly enjoyed the active games. This included running under the skipping rope and encouraging others to do so, playing rock, paper, scissors and throwing the ball whilst trying to keep focussed on a glitter bottle. This was because they found the games ‘fun’ and ‘interesting’. Another reason for enjoying the tasks was that it encouraged them to work as part of a team, and interact with their fellow students, some of whom they did not know previously. Many students spoke about initially wanting to be with their friends but that they learnt more and got more benefit from working with other people they did not know as well. Indeed a common theme across all of the focus groups was the element of teamwork and the social cohesion between students which arose as a result of the group activities. Students commented that they enjoyed working as part of a team, making new friends, and learning from other people.

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‘It was fun and it made me a bit competitive, but that’s the point of games sometimes, it also helped me to be competitive with my team and being more friendly’ ‘I liked it because it was quite calm but, but if you lost and like the other team was like no it made you quite calm’

Meeting the Athlete Mentor, learning about their background and trying out their sport was spoken of highly. The Athlete Mentor was seen as a role model and someone to look up to, and students in one of the schools said they felt like they had been listened to and taken seriously by the Athlete. They also enjoyed learning different techniques to keep calm with many describing the breathing exercises, meditation, and relaxation as their favourite parts. Students said talking about their feelings and playing games with the emoji cards was something they really enjoyed, and something they had not done before. Two of the schools in particular expressed great enthusiasm about the ‘drawing the bus’ task and the students got extremely excited and animated when talking about what they did. For this task, the students drew a bus and drew their family members and friends on it to represent their support network. They then drew the smoke and fumes from the back of the bus as their worries and people or things that had a negative impact on their life. The purpose of this task was to encourage students to think about their wellbeing and environment around them.

Least favourite parts Not all feedback was positive, with some elements of the programme being described as ‘boring’, ‘pointless’ and ‘cringey’. See below: ‘I didn’t enjoy the meditation… it made me feel really weird for some reason. It’s cause of the voice, just like the voice… it’s really creepy’ ‘I didn’t really enjoy it that much because the meditation, cause it took up the last part of the lesson and it was really cringey and the voice was a mess – like a robot’

Additionally, some students did not like the activities such as drawing the bus, writing feelings on paper and putting them on a stick man and trying out the Athlete’s sport. This contrasts to other students’ favourite parts, showing the mixed feedback across schools. One of the main reasons for students expressing their dissatisfaction with activities was not knowing why they were doing the task. This is highlighted by the following quote; ‘When everyone like did the emoji’s and the books… I think it was a bit boring, because one you had to draw and two I didn’t really know what it was for and I didn’t really understand it.’

This echoes the apprehension of students about the whole programme as described above, as some students were unclear about the nature of the workshops. Students also reported finding a lot of the less interactive, and sedentary tasks ‘boring’ and ‘uninteresting’. For example, some did not like having to sit and listen to talks about mental and physical health and some disliked tasks which involved writing and drawing, (e.g. ‘probably it was boring because we did so many other activities’). Other reasons included not being good at the task, not enjoying the type of activity (e.g. drawing), behaviour of other students (such as friends messing about), and being uncomfortable engaging in physical activities.

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Knowledge learned and the usefulness of the programme Students discussed how useful they found the programme, and spoke in detail about what they had learned. In line with the original aims of the Mentally Healthy Schools Programme, this included increased knowledge of mental health and wellbeing, increased awareness of physical health and skills to deal with stress.

Box 7: Primary Focus Groups - Knowledge Learned

Primary Focus Groups – Knowledge Learned ‘I actually learnt a lot about how to use breathing patterns’ Techniques for staying calm and ‘If you’re angry… fighting is never the answer’ ‘Helpful – because if you get frustrated a lot and you’re angry, you can use dealing with one of them techniques and it can calm you down’ stress ‘You must drink… something to eight glasses of water a day. I‘ve tried to do it, I got about seven and a half’

Looking after physical health

‘We can teach ‘em like these sports like Judo, because most people don’t do Judo, they’re more into football, we could teach ‘em new sports and they are like ‘this is so cool, this is my first time doing it’ ‘Knowing when you should go to the doctors’

Awareness of mental health

‘when we done the Judo, so we learned more skills, I literally thought that judo was just fighting’ ‘Mental health can sometimes help you in life’ ‘Mental health is when someone is low and they don’t know what to do’

The immediate impact of the programme was evident, as many students had tried some of the techniques they had learned. This was mainly the breathing exercises and meditation, which they tried at home after the sessions and some reported finding them useful for dealing with stressors at home, such as conflict with siblings and family members. ‘I did that one when my sister was annoying me a bit, erm… I just went away and did that, it made me calm and stuff’ ‘I did the one where you put the teddy on your belly. It helped me because it calmed me down’ ‘It can help with your behaviour… erm because if you’re using them techniques a lot you’ll be a lot more calmer and then it can change your behaviour, like make your behaviour better’

This led them to share the information, skills and knowledge they had learned with others including their friends and family. For example; ‘I wanna tell them [friends] like how to do the breathing because… it helps me calm down so I think it will help others do the same.’

Furthermore, some of the students recreated the activities they took part in during the workshops back at home, with one student reporting making their own glitter bottle to practice concentration. The workshops also had an impact on their physical health and behaviour. The most common topic arising in all of the focus groups was that the students had learnt the importance of drinking enough water. Healthy eating was also discussed but in less detail and the students were quite vague when describing what they had learnt about consuming a healthy diet.

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‘So we have to drink our water, and if you go to the toilet and if there is dark colour you have not drank enough water’

Impact on whole school Although students reported making individual changes to their behaviour as a result of the programme, the impact it had on the whole school was limited. The main impact had been the introduction of YHA and how they were going to take on the role in September. ‘It’s changed so far… if we need someone to help, but we don’t feel comfortable telling the teacher, erm you can tell one of them, erm champions’

Despite this, students did report feeling hopeful and optimistic that the programme will help change things in their school in the future. In particular, they mentioned how talking about mental health and learning techniques to stay calm might have an impact on the behaviour of other students in the future. For example; ‘I hope it will make the school better, and also if people are getting nicer they can start helping people’ ‘It’s changed the behaviour on other people… cause now some people used to be angry a bit and now, now they’re just friendly after that’

Young Health Ambassadors Several YHA took part in the focus groups. Student understanding of the YHA role was generally good in both those who had training and their peers. Establishing YHA was seen as a positive aspect of the programme and well received by the other students. However, one school was an exception as students were unaware of the YHA (e.g. ‘No I don’t think we have one here, I don’t know), with the teacher commenting that they were going to promote the role in September and so it had not yet been implemented. The students described the role of the YHA as being a useful person to help them calm down, and an additional source of support and knowledge: Box 8: Primary Focus Groups - Description of YHA

Primary Focus Groups – Description of YHA ‘If we go a bit out of control, they can give us tips of how to calm down’

‘I think it’s a little bit more safe and… you feel like a bit more comfortable and you’ve got a bit more protection around you… you don’t always have to rely on the teachers’

‘They went out and did the breathing thing and they did loads of things to calm down, they can help you if like angry or something they can help you calm down’

‘like in class, er just knowing that say something does happen and that you have someone there to help you, you know that you’ll be free and you know what to do if you’ve been hurt or something’

‘Say your friend’s busy or you fell out with your friends and your parent might be doing something and the teacher is somewhere and you can’t go… you know that the health ambassador is there’

‘It was good because if I have a problem or something, I can go to Sally* or Max*, or they come to me because sometimes we can understand each other’s’ problems’

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The YHA claimed that being chosen made them feel ‘proud, happy and really good about themselves’. Indeed students that were not chosen to be YHA also reported being proud of their peers and expressed admiration for them taking on their role. They felt the appropriate people were selected for the roles. ‘I was proud of the ambassador because they can teach you how to calm down the stress’ ‘Even though I didn’t get chosen, the other people er in my class who really wanted to get chosen got the opportunity to be health ambassador so I was like happy for them’ ‘The ambassador, because it is kind of a tough job to learn about all that at this age and to be able to do it’

The impact of the YHA was evident in three of the schools, with students commenting how useful it was to have someone to talk to when they would have previously had to go to their teacher, or friends/family, and how it could have a larger impact on the whole school.

Student Recommendations Across the four schools, students really enjoyed the programme and most would recommend it to their peers in different schools, and of different ages. Some of the students commented that it should be offered to students both younger, and indeed older than themselves. For example: ‘I’d say younger people, because maybe younger people will have more problems than older people because older people know more’ ‘You could also have it to like teenagers and stuff… cause teenagers go through a lot of pressure in high school.’

Students felt strongly about training YHA at an earlier age than year 5. This was mainly because they would only have one year left in the school to help others and take on the role. They also felt that equipping younger students with the skills to be able to help people at a later date would be more useful given that their initial knowledge about mental health may be more limited than their own. For example; ‘Younger people because they can learn from it, and when they get older they can use the techniques and know how to use them and help other people as well’

A couple of students came up with the idea of them training the year below once they return in September, so there is an ongoing process of mental health training. ‘Every time like year 5s move up… to use like two more ambassadors or maybe… because then [there would be] two or three more ambassadors’ ‘Take some time at lunch if they wouldn’t mind a break, to go and teach the young receptions and moving up… when they get older they can be ambassadors and they can do what we do and teach the younger ones and it would be like a circle’

Further recommendations regarding how they would improve the programme included adding in more interactive games and working together (e.g. ’we did quite a lot of active stuff but we would like to do more stuff like that’), having more time with the Athlete Mentor and meeting athletes from other sports (e.g. ‘meet a different athlete’; ‘different types because different sports get different injuries’) and to make it clear why they are doing the programme, (e.g. ‘they could have told us that we would do judo AND we would do mental health’).

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Secondary Students Two secondary schools took part in focus groups with 15 students (Sale High and Our Lady’s).

Delivery of Programme The students spoke highly of the programme and said they had enjoyed taking part. Across the two schools they described it as: ‘fun’, ‘a good thing’, ‘useful’, ‘helpful’, ‘dead good’ and ‘enjoyable’

One group consisted of both YHA and nurture group students, whereas the other consisted solely of YHA. They both described the training and workshops they had done with the Athlete Mentors and 42nd Street counsellors, and spoke about how they had learnt more about physical and mental health. Students stated the workshops were different from what they expected, and some even stated that they thought they were not going to enjoy it but actually did. For example: ‘I thought we were just gonna like sit in a room and someone was going to come in and like, speak to us in a really weird baby voice and ask us if we were okay and what we thought and stuff.’ ‘They thought they wouldn’t enjoy it but in the end they was all leaving with happy faces!’

The focus groups highlighted that the delivery and content of the programme differed between the two secondary schools. The first school engaged in lots of physical activities and games such as the skipping rope task, outdoor skateboarding, and interactive discussions of mental health/stress, while the second school was asked to complete the drawing the bus task, and reported more discussion and paper based activities, The feedback from the first school was more positive than the second. Additionally, feedback from the first school was more positive for the Athlete Mentor and the activities during their part of the workshops, and less positive for the discussions and consultations with 42nd Street, for example; ‘I thought he was very interesting.. Yea he told us his background story… erm and how he got to his point in life, and like from being like very small and not many people knowing him to being the world’s best skateboarder’

The opposite was reported in the second school with more positive feedback for the 42nd Street sessions, for example: ‘I like a bit at the start of the 42nd Street because she did like a piece of paper and she made you like draw loads of circles with things that like made you scared or made you upset and then told you to like scrunch it up at the end’

Favourite parts and what they enjoyed Students enjoyed taking part in the programme and all reported aspects of the workshops or consultations that they enjoyed. Some students could not identify a favourite part, for example: ‘The good part was when she told us how, both women told us how we could be happy within ourselves so like… I don’t think there was a best part I think it was all good and all of it was useful and all of it was like inspiring’.

Other students described their favourite parts in detail, (see Box 9 for a summary):

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Box 9: Secondary Focus Groups - Favourite Part

Secondary Focus Groups – Favourite Parts Meeting the Athlete Mentor ‘When the athlete shown us the video of how she overcame everything that she thought would stop her throughout her whole and trying their sport

Learning about how to be healthy

Breathing exercises and learning calming techniques

Workshop Activities

life, I think that was really inspiring’ ‘Skateboarding because I have always wanted to try it but I’ve not necessarily been like confident enough to do it because I feel like I would get bored of it and give up’ ‘Finding out how to be long-term healthy, because obviously being healthy isn’t just physical it’s mental and social’ ‘learning if you just sit there and just drink and smoke it’s gonna be okay at that time… which it is… but then afterwards you don’t think of like the aftermath and she kind of told us about it’ ‘I really enjoyed the day… like she showed us like ways to distress and made us like meditate’ ‘Where the 42nd Street woman was sort of there and we talked about like long term and short term causes [of mental health]’ ‘The start of the 42nd Street because she did like a piece of paper and she made you draw loads of circles with things that like made you scared or made you upset and then told you to scrunch it up… it was just calming’ ‘I liked doing the team building to be honest… with like the hoop and the rope and all that lot it was fun because it was dead competitive’ ‘Where we had to stand on the emoji that we were feeling because it’s like a way to say how we feel but without saying it’ ‘Socialising at the Etihad because we had like different groups from different schools and we got to be like, together and meet people’

Social Factors such as working together and meeting new people ‘Just chilling out and being able to get out of lessons!’ Doing something different

Compared with primary students who described one main activity, secondary students generally described their favourite parts in terms of what they gained from the workshops and enjoyed the most about the overall programme. This meant that they discussed issues such as the knowledge they had gained, the skills they had learned and the benefits they received from it. In contrast with primary students, secondary students in these schools expressed their enjoyment for the educational tasks and activities where they learnt something useful, rather than when they were running about doing more activity based games.

Least favourite parts As with primary students, and noted in the evaluation forms, some students could not identify anything they did not like (e.g. ‘I found it all interesting!’). However, students in both schools discussed aspects of the workshops which they did not enjoy and their reasons why. See box 10:

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Box 10: Secondary Focus Groups - Least Favourite Parts

Secondary Focus Groups – Least favourite parts Specific tasks and activities ‘Didn’t enjoy doing the bus really to be honest, I thought that was a bit boring, it was a bit patronising’ being boring

Not being given a choice

Feeling uncomfortable

Being given false hope

‘Answering some of the questions [at the Etihad] because they were quite repetitive… in the way they were worded’ ‘the first part was a bit boring where we were sat around the table and we had to put different names of all these mental health issues because once we got through the obvious ones like everyone was just sat there for like 5 minutes trying to think of names’ ‘I told her the reason that I didn’t want to do it but she still forced me to do it when I didn’t really want to do it so…’ ‘people saying do you want to do it or if you want to do it come and do it… if you don’t go and have a break’ ‘Things that weren’t dead straight forward like you had to write down people that made you angry, like you had to write specific things and it was just a bit, not personal but it was a bit too much to put on display’ ‘The worst bit for me was when she kind of got my hopes up for school because she said that we might be getting like 200 grand or something to get like new things in school and then she was like but it might not happen’

Again, students generally discussed this in terms of feelings they experienced because of the workshop as a whole, and made recommendations on how this can be improved (see below).

Usefulness and impact of the pro gramme Students reported learning a lot from the programme and increasing their knowledge, skills and self-belief. Many students learnt that mental health can be good and bad, and how mental health can affect people in lots of different ways. They also described learning about the importance of looking after their physical health, and developing skills to help them increase their confidence and self-esteem. Box 11: Secondary Focus Groups - Knowledge Learned

Secondary Focus Groups – Knowledge Learned ‘I only thought mental health was like bad, but I didn’t think it was Mental Health Knowledge

Physical Health Knowledge

Confidence and Self-Belief

good as well, like people can have good mental health’ ‘How mental health is important because some people just think it’s bad but some people think it’s good so maybe you could explain both perspectives’ ‘Keeping your body healthy, exercising and drinking a lot of water, getting the right amount of sleep’ ‘If you eat loads of junk food you don’t feel like as good in yourself whereas when you eat healthily and like you work out… she was just saying you feel better and more confident about yourself’ ‘The skateboarding one it was like how you find confidence in yourself and how you can instil it in others’ ‘To believe in themselves because they know that they can do it but maybe they don’t want to try’ ‘He taught us how to be more confident with ourselves and how to work together’

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Students claimed the workshops could be a useful addition to schools. For example, ‘It went really good because then it showed us what our school should have to help further with people that do suffer with mental health’ ‘Shows that you could help people if you did bring that stuff into schools and how you could help solve it’

Despite this, students reported their frustrations about whether they will see any changes as a result of the programme. This was again, related to the time of year it was conducted (e.g. ‘it hasn’t happened yet because we haven’t had enough time to like do it all’). Students at one school were more optimistic about the impact of the programme and claimed that although they have not seen any changes yet, they remain positive that more support will be put in place over the summer holiday. However, students at the other school expressed disappointment and claimed they did not envisage any changes being made as a result of the programme. The students described how they have been promised support in the past which has not been followed through and that despite them being positive about the programme, they do not see the point in getting involved as they will not benefit from it by the time it is implemented. The quotes below highlight some of the issues the young people raised: ‘She said to us we could have like an AstroTurf and everything but it won’t be built when we’re here … we’ll already be gone, so it won’t affect us but that’s what like obviously people in like the year below us… like we’re not going to have it for long so what’s the point’ ‘They only happen like once in a blue moon and then we’re told to do feedback and things but you just think that we’ve had such a good day why not make that more than, more often’

Mental health in schools A key theme across both schools was that mental health is not addressed well in schools and how programmes like this could help. For example, students discussed having long waiting lists to meet counsellors if they do have a problem and that they do not always have access to support (e.g. ‘it’s a long waiting list because she only ever comes once a week’). They expressed this is not in line with what they want and does not reflect the student need for mental health support, given the ongoing pressures of exams, social media and other stressors. They recommended having more frequent access to existing sources of support (e.g. counsellors) and having ‘more people for the pastoral office’ whom they could go to before problems get too much to deal with. One student described how one of the tasks of the workshop had been particularly useful as it facilitated discussions about mental health, which were much needed, but lacking within their school: ‘I liked the first workshop where we had to write out the emotions because it actually shows, it actually explored all the things that happens in school that no one ever really talks about’

Students also claimed one of the main barriers that stops young people seeking out support for their mental health was distrust of others. This was spoken about in relation to their friends, family and members of the pastoral team. Even when they did speak to someone about their mental health in schools they feared it would not be truly confidential. This lack of trust extended to speaking to their peers and talking to people online, and often prevented people from speaking out. Another barrier was fear that they would not be taken seriously, and some felt that their problems would be trivialised by others. See Box 12 for some examples:

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Box 12: Secondary Focus Groups - Barriers to Seeking Mental Health Support

Secondary Focus Groups – Barriers to Seeking Mental Health Support ‘People always say we’re here for you and you can talk to us but like really you can’t because it’s never 100% confidential’ ‘If I ever had something going on with me I wouldn’t tell school because if you tell them they tell mum and dad’ ‘When you’re not in a good place you don’t really know where… people always say we’re here for you and that but you can never fully open up to somebody because of like reasons… not reasons but like safety…’

‘This is why so many children like give up… gonna get a bit deep now but give up with life’ ‘Maybe some people feel like they are being stupid when they say it and stuff like that’ ‘Some people struggle to tell people in person, so if you can’t tell someone in person … you tell it over social media and people can save that and like… even take a screen shot… and they can hold it against you… you can’t trust anyone’

Students had several recommendations for improving mental health support in their schools, including integrating mental health into the curriculum, having anonymous help boxes and addressing issues which are raised to them across the whole school.

Box 13: Secondary Focus Groups - Improving Mental Health Support in Schools

Secondary Focus Groups – Improving Mental Health Support in Schools ‘we said about the box as well where you can put a message in but you don’t have to put your name on it so it can be anonymous… but you can just put your year group, just you know to make it a bit easier and they can put how they are feeling’ ‘We were saying about how we could do a mental health day… we come up with ideas how you can link it back to mental health… like history, the history of mental health, maths- how many people go through it a year… and English could be the article on mental health and so on’ ‘Put your form number… Then you could speak to the whole form about the problem that they are going through but not say who it is… if you find out… just tell them how to get through it and who can help and how to like prevent it’

YHA All of the YHA who took part in the focus groups felt positive about their role stating that they ‘Loved it!’ ‘Felt Proud’ and it was good because they were ‘all different people in different ways’. It was also received well by their peers, highlighted by the following: ‘It’s good that like there is people who are willing to help other people who are not 100% in themselves’

The students referred to the YHA as being a useful addition to the schools for young people who need additional support with their mental health or wellbeing. In both schools they were seen as tackling an unmet need for support and that students would feel more comfortable talking to them rather than going to a teacher who may tell their parents. They also stated it would release the burden on teachers who often appear too busy: ‘We have an opportunity to help our friends rather than teachers doing it, because teachers don’t have much time because they are all a bit… probably doing loads of work teaching or planning lessons… whereas we’ve got lunchtime and break time and after school or before school to speak to them about it’

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Despite this, some of the YHA expressed concerns that they would not be taken seriously, and the trust issue would still prevail: ‘They might know who we actually are and what we actually do so they won’t trust us as much because like, they might think that we could tell other people.’

YHA said they would be promoting their role on their return in September.

Characteristics of Athlete Mentors and Trainers For secondary students in particular, the relationship and rapport with the Athlete Mentors and Trainers came out as a particularly strong theme. The person delivering the training workshops and consultations had an effect on the young people’s overall enjoyment of the programme. The feedback received for some of the Athlete Mentors and Trainers was extremely positive in many cases, and this was discussed in detail. They were referred to as: ‘Inspirational, interesting, confident, energetic, enthusiastic, engaging understanding and kind’

However, some students provided negative feedback on the Athlete Mentor or Trainer which hindered their experience of taking part. See Box 14 below:

Box 14: Secondary Focus Groups - Characteristics of Trainers

Secondary Focus Groups – Characteristics of the trainer Athlete Positive 42nd Street Positive ‘when the athlete showed us the video of how she overcame everything and she though it would stop her throughout her whole like er, I think that was really inspiring’ ‘He was like a dead confident speaker and he like moved around a lot!’ ‘He told us his background story… erm and how he got to his point in life and like from being very small and not many people knowing him to being the world’s best skateboarder!’ ‘She built you up a lot, like she’d tell you to like work through whatever it was that like was holding you back and don’t knock it till you’ve tried it kind of thing’

‘42nd Street woman was just so calm, like you could talk about anything that you couldn’t talk about with anyone else’

Athlete Negative

42nd Street Negative

‘She was too enthusiastic… not like in a bad way but she wanted everyone to do it and not everyone knew what to do and it was a bit hard to get your head around’ ‘The worst bit for me was when she kind of like got my hopes up for school because she said that we might be getting like £200k…to get new things in school and then she was like but it might never happen’ ‘And she was a bit forceful as well… she still forced me to do it when I didn’t really want to do it…’

‘It was just like he was an ordinary teacher, whereas the athlete felt like a friend’

‘They should replace counsellors in the school with that woman from 42nd Street’ ‘She was enthusiastic but not in like a psycho way’

‘She was dead like erm, outgoing so she like didn’t mind if like we said something that she didn’t really agree with because she just wanted to know what we wanted to do and what we thought of it’

‘He was good but I don’t think he was as engaging’

‘She was trying to get you to open up but it didn’t really help’

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Students discussed what would help overcome their negative experiences with the trainers. For example, hearing their background story had a strong impact on the student’s ability to identify with them and see them as a role model. This did not happen in one of the schools and students reported being confused and stated how it would have helped them to understand and engage more with the session if they had known more about the trainer. For example: ‘He didn’t tell us how he got to this place and…what happened to him… or did he go through anything with mental health, whereas the Athlete did… and he told us how he stopped it carrying on’. ‘I don’t expect you to come out with some big inspirational story like the Athlete had but I just want to know a bit more about you I guess’

In one school, they also discussed being offered a choice to take part is important, as this led to conflict with one student providing a lot of negative feedback on the day when she felt like she did not have control over whether she could take part. The same student also commented on the enthusiasm of the trainer being a little too high and that it would be useful if they were receptive to how the young people are feeling at the time. This is supported by the following quotes: ‘She come across like really energetic and you’re there like, might be feeling a bit low… and she’s being really energetic and telling you to like, trying to build you up… she’s buzzing and I’m not in the mood for it…calm down!’ ‘People saying do you want to do it or if you want to do it come and do it… if you don’t go and have a little break’

Student Recommendations In one of the schools, some students expressed their disappointment that they were not invited to participate in the second workshops, and how they were not told it was going to be taking place. This is despite finding it useful the first time round and looking forward to attending the next session. This again emphasises the importance of keeping students informed about why they are doing the programme and involving them in the process. ‘People who were chosen for the first didn’t get chosen for the second and it was kind of like… if you’d done it the first time and you… if you’ve enjoyed it the first day then why not’

Similarly, students discussed how it should be available for everyone to take part in as some students may have benefitted more from it. They also wanted programmes like this to occur more often, and were disappointed that they do not get the opportunity. ‘The worst thing about it is these things they only happen once in a blue moon and then we’re told to do like feedback and things but you just think we’ve had such a good day, why not make that more often’ ‘It could have been for more people, there was specific reasons why people were chosen, but then there was other people that would have benefitted from it more’

Students expressed dissatisfaction with the time of year and the speed of the programme. This is similar to the views of teaching staff across the schools. Alternatively, they recommended conducting sessions over a longer duration so that content is not rushed, and

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running them at the start of the year so that there is sufficient time and motivation to implement any changes. For example; ‘If it was at the start of the year then it could take place and then people would know it rather than like erm… half-way in-between… near the summer holidays where people are just tired and ready to go home by that point.’

They also recommended that the structure of the day should be different, and would be better over 2 days, or contained in shorter sessions over the whole of the term. This was because they disliked moving from a more active session with the Athletes in the morning to a less active, more discussion based session with 42nd Street in the afternoon. ‘Make sessions longer, it all felt like rushed… like you were doing skateboarding and being really active, then all of a sudden we were all sat down in like one big room together’ ‘I felt like I had a lot of spare energy and I needed to burn it off’

Observations The evaluation team made observational field notes in the four schools they visited whilst the workshops have taken place. The evaluation team observed a high level of engagement with the programme, with the majority of students being active participants across the day. This was judged by students volunteering answers, engaging in conversations, working with others and taking part willingly in tasks or games. Athlete Mentors were very engaging and achieved rapport with the students and were generally well liked by students. This was evident from student comments throughout the day and feedback at the end of the sessions. The Athletes facilitated the workshops with energy, charisma and passion, which encouraged students to get involved with the activities. Some students were more reluctant to get involved, and needed extra encouragement to participate in the more active tasks e.g. skipping rope game. However, the Athlete Mentors and trainers used different approaches and offered alternatives. In some cases this gradual encouragement and offer of choice resulted in young people taking part and getting involved. The P2B counsellors were present throughout the day for primary schools and conducted observations on YHA during the workshops. They also participated in group activities and engaged with students throughout the day. Most facilitators showed excellent interpersonal skills and used the following techniques to achieve rapport and engagement with the students:  Making an effort to get to know each student  Making the content relatable to them  Acting as a role model  Joking and laughing  Listening to what the students are saying  Giving the students alternatives when they feel uncomfortable or apprehensive The 42nd Street workshops aimed to reduce the energy levels of the class to enable a more in-depth discussion and to facilitate different learning and engagement styles. The evaluation team observed this energy shift. Some students reported finding this change in delivery style useful and interesting, and some students who previously did not get involved in the active tasks volunteered answers to questions in this workshop. However, some students found this change in format more difficult to engage with, became restless and did not engage with the conversation afterwards.

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While there were few incidents; the evaluation team did observe the following:  Students being rebuked for talking  Students rolling their eyes at the trainer  Inappropriate jokes and comments made by students  Overexcitement and speaking over the Athlete Mentor and other students  Walking out of the room  Not answering questions (lack of interest/nervousness)  Student falling asleep  Student putting hood up over face  Student isolating self from the rest of the group and sitting in the corner

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Case Studies A series of case studies were drawn up to highlight examples of how the programme was conducted and give examples of the impact it had on students and staff. Case Study 1: Pupil Referral Unit

CASE STUDY 1: The Mentally Healthy Schools Pilot in a Pupil Referral Unit and an example of a behavioral incident with one of their students Demographic Pupil Referral Unit This case study was formulated from observations made by the evaluation team who attended the first ‘nurture’ workshop and had a discussion with teaching staff at the end of the day. The case study contains a description of the workshop in a PRU setting and an example of the impact of the training on one individual. Description of Workshop The evaluation team attended a Pupil Referral Unit to observe the first ‘nurture’ workshop conducted by the Athlete Mentor from YST. This differed to the typical approach in other schools for a number of reasons. First, at the PRU students were able to attend of their own volition and therefore, the Athlete Mentor was unaware of how many students would be participating. They were also leaving and attending at their own will, with many disruptions throughout the day where students came in late. Additionally, the school environment was loud and students would bang on the door during the course of the session when they were going past causing added distractions to the day. Example of student experience One student really engaged and was involved with the morning session with the YST Athlete Mentor. Despite being fairly resistant at the start of the day, and sceptical about why they had to do it, he participated in most group activities. Initially, he responded with some sarcastic comments but as soon as he listened to the Athlete Story and spoke with him, he appeared more interested. He would make statements to latecomers such as ‘Listen to him, he’s dead good’ and encouraged others to get involved with tasks, even facilitating the discussions himself. The teacher claimed he had not seen this student sitting in the same room for so long before, as he would struggle with his temper and behaviour. When 42nd Street arrived for their workshop, the student disengaged and expressed his disappointment that it was not the Athlete Mentor leading the session. He showed visible signs of lack of interest (such as putting his hood up, walking over to the window and putting his head on the desk), he then left the room quietly after 15 minutes and did not return until the next session with the Athlete. The teacher expressed his surprise as the student would usually ‘lash out and throw a table’ if he had to do something he did not want to do. He said the student struggles with anger and is very difficult to engage in tasks and school. The teacher claimed it was probably due to the fact the athlete mentor was there and he had achieved a high level of rapport with the student.

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Case Study 2: Special Educational Needs School

CASE STUDY 2: The programme in a Special Educational Needs School and an example of the impact on one of their students Demographic Pupil Referral Unit This case study was formulated using observations made by the evaluation team who attended the first ‘nurture’ workshop and had a discussion with teaching staff at the end of the day. The case study contains a description of the workshop in a SEN setting and an example of the impact of the training on one individual. Description of Workshop The evaluation team attended a Special Educational Needs School to observe the first ‘nurture’ workshop conducted by the Athlete Mentor from YST. This differed to the typical approach in other schools for a number of reasons. First, at the SEN, the students who attended and participated in the session had a range of complex needs including physical and mental disabilities, learning difficulties, behavioural issues and mental health needs. Some students required aids to assist them, such as a projector for written tasks and a couple of students held items of their own throughout the day for comfort/distraction such a cuddly toy or a pack of cards. The evaluation team noticed the young people asked numerous questions about why they were participating and required more reassurance that it was okay for them to be doing something other than their usual lessons. The Athlete and the 42nd Street trainers simplified the content of the workshops and used less information within the sessions. The students engaged well, although many were apprehensive at first. Two support staff were present throughout the day and worked alongside the students who were struggling. This was evident from behaviours such as the students standing to one side away from group tasks, not engaging with conversation, and becoming restless or agitated.

Example of student experience One of the students who took part struggled to engage with the morning workshops and did not volunteer responses to the Athlete Mentor. He kept his head down most of the day but did nod and listen to the session. When the interactive group tasks were taking place he initially stood on the edge of the room, and gradually built up to sitting with his fellow students, but still did not contribute to the conversation, only non-verbal cues (such as nodding) and brief noises of acknowledgement (e.g. ‘Mmhmm’). During the afternoon session with 42nd Street, the students were in a small classroom, and the counsellors were discussing factors relating to stress and mental health. Students were shouting out suggestions and the student volunteered two answers on two separate occasions. The teacher at the school was surprised and reported that the student had elective mutism. The teacher double-checked to confirm it was the correct student as she was so surprised, given that he usually remains silent and even has difficulty engaging one on one with other students/staff.

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Case Study 3: Impact on Student Mental Health

CASE STUDY 3: How the programme helped one young individual with their own mental health difficulties Demographic Primary School Staff Member Mr. Dillon* Occupation Head teacher This case study was provided by Alliance for Learning. A head teacher from one of the participating primary schools sent a written narrative of the experiences of one of their students, and the impact it had on his mental health. ‘A Year Five student at our school suffers tremendously from high levels of anxiety and incredibly low self-esteem. Last year was a particularly challenging year where access to learning became very difficult. He frequently talked about hearing voices in his head and had a very low mood. He would talk about suicidal thoughts and would talk about what he would do though said he would never do it. Through his braveness and desire to feel much happier, he has been very open about his thoughts with a couple of school staff. This lead to his expressive interest in getting involved in training to be a youth mental health champion/ambassador with the pilot project. We were really happy to get involved as we already work with the Teaching School- Alliance for Learning & trust the quality of anything they are involved with. All who know this boy would rightfully question whether it was appropriate to have him involved as a ‘champion’ given his own personal battles but he persevered through the training and seemed to very much enjoy it though he still continued to find school and day to day life very challenging. Understandably, deciding whether to attend the celebration event at the Etihad Stadium was difficult due to the large numbers of new people, the unfamiliar setting and the expectation that full participation would be required. He decided to attend and on the day came to school wearing his usual oversized blue hoody. Though this is not true school uniform he has been allowed to wear it as this has been his way of ‘hiding’ in school. Even during the extremely hot weather during the summer term, the hoody never came off. Upon arrival at the stadium, all students were provided with a black t-shirt to wear. Without hesitation, he changed into the t-shirt without putting his hoody back over the top. Even when returning to school that day, the hoody remained in his bag. Taking part in the training and the work leading from this has really supported a young boy who will in turn be able to fully support other children in school. Following the event, he presented to the Principal and SLT and has agreed to wear a special champion/ambassadors uniform in school next year. Without the opportunity to become a youth mental health ambassador, he would not have made the steps forward that he did. His confidence and outlook improved and the message to his peers is that difficulties can be overcome- this is incredibly important. The blend of training was excellent- we particularly enjoyed the MHFA training from Alliance for Learning & the work of the Youth Sport Trust. These two elements have had the most impact on staff & students. We loved the Etihad event too- thanks for involving us!’ Primary Head teacher- in Greater Manchester

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Case Study 4: Impact on Whole School Ethos

CASE STUDY 4: The impact of the programme on staff and the whole school ethos at a secondary school Demographic Academy School Staff Member Mr. Alli Occupation Vice Principal Pastoral Lead This case study was provided by Alliance for Learning and describes the impact of the programme on staff, and provides positive feedback for the training and the Athlete Mentor from YST. I can only describe the pilot and in particular the MHFA training as eye-opening and enlightening. Despite being steeped in the myriad of issues surrounding pastoral care and having a general awareness of Mental Health issues, the staff who underwent the training were amazed at the depth of the issue. We were able to take so much from the training delivered by the Teaching School ‘Alliance for Learning’ a detailed introduction to mental health and really useful statistics & practical advice that we have been able to include in our own training sessions. The billions of pounds lost to mental health issues and workforce absence is astonishing. The MHFA training has focused our Pastoral Team and as a direct result of this training we include mental health specifically in our weekly Pastoral Team meetings. We now have a designated member of staff who is a fully trained counsellor to pick up any concerns or MH issues at an early stage. We feel more confident in identifying MH issues and acting upon them. As a result we reached to and worked with more students via our early intervention unit ‘Ivy Cottage’. We now have Pastoral Briefings every week where we can discuss MH, alert staff to issues and increase vigilance and awareness around school. This has resulted in a whole school ownership of MH. We also now include the SEND Team in our weekly meetings due to the training. I feel it has also made us think more about the ‘grey middle’ who don’t always show the more obvious signs of MH problems. In short, it has made us take nothing for granted. The training also made us look at staff needs and the effects of an incredibly stressful job on us a staff. CPD has been tailored to staff wellbeing with a real drive on our Team. There has been a palpable impact with a staff BBQ and other social events. I really feel there is more of an emphasis on team work and solutions rather than the ‘toxic staffroom’ and culture of complaining that some schools have. The athlete mentor from Youth Sport Trust also had a huge impact on our students. He was enthusiastic, outgoing and incredibly funny and the students took to him straight away. To have such a streetwise and successful mentor was a real boost to our chosen students. I observed several of the sessions and I saw students’ confidence growing before my eyes. They were really keen for the follow up sessions to come around. We couldn’t attend the Etihad event because it clashed with our Sports Day. We were disappointed to miss out on this especially when the feedback from the schools that did attend was so positive. I have to say that we, as an Academy, feel that the pilot has been a huge success and we would like to see it continue and develop.

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Case Study 5: Impact on Staff and Workforce

CASE STUDY 5: Impact of the training on staff and personal reflections from a safeguarding lead at a secondary school Demographic Secondary School Staff Member Ms. Turner* Occupation Safeguarding Lead This case study was provided by Alliance for Learning. It describes how the training has benefitted the workforce at a secondary school. The safeguarding lead also describes their personal experience and development as a result of the training. The MHFA Training has really helped our staff feel more confident in intervening much earlier with our students when they are having, or are about to have a mental health crisis. The course has equipped us with the right skills to help our students during what are very often extremely difficult times for them, it has also taught us how to approach these situations and to have those difficult conversations with confidence. Because we know our students and staff better than any other agency we might refer to, we are ideally placed to spot any changes in behaviour that could indicate an underlying mental health problem. The training has also enabled us to consider our own wellbeing as a staff: - We now have two members of staff who have completed the Place2be training programme - 5 members of staff have completed the Youth MHFA training - 2 members of staff have completed the Youth MHFA Lite training - 2 members of staff have completed the adult MHFA training

We are really pleased that we now have a substantial Mental Health and Wellbeing Team at our school. This is encouraging conversations around mental health and is helping us to break down the barriers of stigma and discrimination which are slowly but surely diminishing throughout our academy. For me having the opportunity to complete all of the above courses has had a massive impact on me personally and in the way in which I can now, much more confidently support people. I have learned to - *Spot the early signs of a mental health issue *Feel confident in how to offer and provide initial help to a person experiencing a mental health issue *Help stop mental health from getting worse *Promote the recovery of good mental health *Guide people towards appropriate treatment and other sources of help *Understand the stigma that exists around mental health I use the ALGEE (MHFA Action Plan), to firstly check if there is any risk of suicide / self-harm when supporting people. Since completing the Adult MHFA training, I can confidently reassure people that some of the issues they discuss with me are common, it isn't seen as a weakness and that it is ok to feel 'not ok' sometimes. I am also able to give lots of information about other agencies that could help them and discuss ways in which they can help themselves and regain control of situations that make them feel mentally unhealthy, e.g. relaxation techniques, mindfulness, exercise, eating healthily, getting enough sleep, talking to someone they trust and feel comfortable with etc. I feel that I have a much deeper understanding of Mental Health issues and am now able to deal with them in a more confident, appropriate and professional way.

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YHA Dose & Reach A total of 67 YHA were recruited in primary schools, and 90 YHA were recruited in secondary schools. This exceeds the original figure of 155 stated in the brief, thus indicating the training was successful.

YHA Questionnaire YHA attended a celebratory event at the Etihad Stadium at the end of the workshops. Here they completed forms to provide feedback on their experience of becoming YHA and how it has affected them. Primary schools completed these forms in an interactive workshop with P2B and secondary schools completed them at the end of a consultation workshop with 42nd Street. 93 forms were completed, (50 primary students from 11 schools; 40 secondary students from 9 schools; 3 unknown). Due to the differences in the way the programme was delivered, the training providers and the way the questionnaires were administered primary and secondary data have been analysed and presented separately. Students from all schools indicated that overall, they very much enjoyed being YHA and scored their experience on average 4.4/5 (range 2-5).

Figure 11: Experience of being YHA

Primary YHA 66% of primary students said being YHA was not what they expected. Despite this, 96% would recommend it to a friend. This suggests that although the role may differ from what they previously thought, they have enjoyed it.

Impact on Confidence/Knowledge and Ability Primary students were asked how becoming YHA has impacted on their confidence, knowledge and ability to recognize mental health and wellbeing issues. They rated how much they agreed/disagreed with the following statements:

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Primary: Since becoming a YHA.... I feel like I have achieved something I know where to tell my friends to go if they are worried or upset I can recognise when my friends are worried or upset I can talk to my friends about their health I know what to do if I am feeling worried or upset I am more aware of things I can do to reduce stress I know more about health and wellbeing I feel more confident

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Figure 12: Primary YHA Experience

According to the self-report statements shown above, becoming YHA had a significantly positive effect on individuals’ confidence, and knowledge of mental health and wellbeing. 70% felt able to talk to their friends about mental health, and 88% could recognize poor mental health in their peers. However, there was less confidence in how they could address their own mental health, as 24% did not know what to do if they felt worried or upset. This could be used to inform future training as students may need more support for how they can help themselves, as well as being ambassadors for everyone else.

Challenges The following challenges were experienced:

Primary: Since becoming a YHA.... I don't get enough support I feel embarrassed It takes too much of my time It isn't what I expected I didn’t like the trainer I don't feel confident I didn't like the training People don't listen to me 0

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Figure 13: Primary YHA Challenges

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Although, the majority of students disagreed with the statements, 25.5% of individuals agreed that being YHA was not what they expected. Additionally, 44.9% of students either agreed or neither agreed/disagreed that they did not feel listened to as YHA. This suggests that students could be better supported by MHC and schools to encourage them to engage with their other students.

Students reported any other challenges they faced in their own words. Several responses were collected including: ‘Containing my emotions and people understanding me’ ‘Trying to keep my emotions to myself and others bullying and making me feel frustrated. People can’t try and understand me’

How young people feel about being YHA Students reported on a scale of 1 (Lowest) to 5 (Highest), how being YHA made them feel.

Primary: Being a YHA makes me feel... No Different Worried Under Pressure Stressed Embarrassed Valued Proud Special Confident Happy 0

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Figure 14: Primary YHA Feelings

Students felt more positive emotions on becoming YHA, for example higher average scores were associated with feeling happy (4.58, range 2-5), valued (4.27, range 2-5) and confident (4.37). Despite this, some students did report feeling worried, under pressure and stressed when taking on the role.

What does it mean to be YHA? They described in their own words what being YHA means to them. Students reported many positive emotions such as feeling ‘amazing, happy, proud, rewarding and fun’. They also valued

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the opportunity to be involved with the training. Some defined their role in relation to their responsibilities. Some also identified challenges such as it being ‘complicated’, and ‘boring, but kinda good’.

Some examples are shown in Box 15:

Box 15: Descriptions of YHA (Primary)

Primary YHA: How would you describe being a YHA? Amazing, excellent, rewarded and proud, magnificent! Helping people who are stressed and worried. It is interesting and amazing. I would describe being a YHA as the greatest thing ever because I got more than I deserved

Being YMHC was amazing. I didn’t expect it and it boosted my confidences I think that it is not what I expected. I thought there would be like discussions but there are also games I would describe that I help my friends, other people and help them to make sensible choices

Students described up to three things they had done in their role as YHA. Box 16: Achievements as YHA (Primary)

Primary YHA: What have you achieved so far? ‘Helping about mental Health’ Helping others Provided social support Learned new things Shared their knowledge and skills with others Engaged in training and activities Developed ideas for improving their school Made new friends and interacted with other people

‘Helping someone have more friends’ ‘I’ve given someone courage; ‘Helped someone who was sad’ ‘I listened to people who are upset’ ‘Learned meditation and breathing exercises’ ‘Learned mindfulness’ ‘How much sugar is in things’ ‘Shared how you need to sleep’ ‘Teaching people what I know’ ‘Showed my class some breathing exercises’ ‘Meeting the Athlete Mentors from Youth Sport Trust’ ‘Attended the conference’ ‘We’ve done training in the Etihad stadium’ ‘Suggested an area for people with mental health problems’ ‘I’ve talked with teachers on how to help MHC children’ ‘We tried to make a comfortable place with the Athlete Mentor’ I’ve interacted and chatted with other MHC’ ‘Spoke to other children about mental health and my job’ ‘Making friends’

They also reported what support they felt they needed going forward in their role. Box 17: Support for the YHA (Primary)

Primary YHA: What would support you in your role? ‘Purchasing new equipment’ Practical help and ‘A private area so we can talk to the people who need it’ resources ‘Being more confident with people’ Encouragement to ‘Get more confident’ increase confidence ‘Year 5/6 assemblies about mental health’ Support from the school ‘Need more help from Miss Smith* (teacher)’’ ‘I would like help with being more collaborative’

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‘Information about people with mental health issues’ ‘More training’ ‘More meetings’ Ongoing Meetings ‘More time out of classrooms to meet together’ ‘Wearing a badge so people know who you are’ Their role being ‘Getting lanyards’ highlighted in schools ‘Healthy posters’ Support promoting ‘Do more sport activities’ physical health *(the name of the teacher has been anonymised)

Continued training

Secondary YHA 52.6% of secondary students said being YHA was not what they expected. Despite this, 90% would recommend it to a friend suggesting overall satisfaction with the role.

Impact on Confidence, Knowledge and Ability Students rated how becoming YHA has impacted on their confidence, knowledge and ability to recognize mental health and wellbeing issues. They rated how much they agreed/disagreed with the following statements:

Secondary: Since becoming a YHA.... I feel like I have achieved something I know where to tell my friends to go if they are worried or upset I can recognise when my friends are worried or upset I can talk to my friends about their health I know what to do if I am feeling worried or upset I am more aware of things I can do to reduce stress I know more about health and wellbeing I feel more confident 0

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Figure 15: Secondary Experience of YHA

Students’ knowledge about mental health and wellbeing increased (92.5%) as well as their awareness on how to deal with their own mental health and how to reduce stress. Compared

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with primary age students a lower percentage of secondary school students reported being able to recognize when their friends are worried (66.7% v 88%) and talk to their friends about health (65% v 70%). This could be used to inform future training of YHA and highlights differences in how the training was received.

Challenges The following challenges were experienced by students in their role as YHA:

Secondary: Since becoming a YHA.... I don't get enough support I feel embarrassed It takes too much of my time It isn't what I expected I didn’t like the trainer I don't feel confident I didn't like the training People don't listen to me 0

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Figure 16: Secondary YHA Challenges

Few challenges were experienced by the secondary school students, although only 50% of students felt like people listened to them in their role.

How young people feel about being YHA Students reported on a scale of 1 (Lowest) to 5 (Highest), how being YHA made them feel.

Secondary: Being a YHA makes me feel... No Different Worried Under Pressure Stressed Embarrassed Valued Proud Special Confident

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Figure 17: Secondary YHA Feelings

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Students felt more positive emotions on being YHA than negative. For example higher average scores were associated with feeling confident (4.07), happy (3.87) proud (3.84). However, the average scores were lower than those reported by primary students. Despite this positive feedback, some students did report feeling worried, under pressure and stressed when taking on the role.

What does it mean to be YHA? The majority of secondary school students described being YHA as a positive and useful experience. Rather than describing what the role entails, the secondary school students tended to describe how it made them feel and the positive impact the role had on their confidence, self-esteem and personal development. They reported feeling honored and appreciative of the opportunity. Some examples are shown in the box below:

Box 18: Description of YHA (Secondary)

Secondary YHA: How would you describe being a YHA? Good, you get to talk to lots of people and it’s amazing knowing you’ve helped It gives you a deeper understanding of mental health Proud, trained and confident in their ability as a champion

I feel very honoured about being chosen to be a YMHC It has been an excellent role and very unique position It is life changing and I feel special

Students described up to three things they had done in their role as YHA so far. The secondary students primarily stated being a role model to their other students, and listening to other students about their difficulties. They commented on how they had learned from the training (e.g. ‘learned to cope with stress’) and how they had worked together to engage in the training and workshops. Many students described how they had further discussions about what they could do in their schools going forward and generated ideas about how to improve their school (e.g. ‘made a plan to make school better’). Many also commented taking on further roles such as ‘anti-bullying ambassadors’. They were finally asked what support they felt they needed going forward in their role. Secondary students mainly wanted further training and support within their schools from teachers and other staff with their role. They also felt having further discussions about being YHA and recognizing/addressing mental health would be useful, as would meeting others who are doing the same role.

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Outcome Evaluation The outcome evaluation consisted mainly of short-term outcomes.

Place2Be School Leaders Mental Health Champions Training A designated school lead for mental health was established in all 31 schools with the roll out of Mental Health Champion training provided by Place2Be.

Whole school ethos School staff reported their views of the whole school ethos following the programme. 27 staff members from 13 schools responded with very positive views about the impact of the programme on their school. Over 80% staff agreed with all statements about positive school ethos towards mental health, with only the statement about staff mental health and wellbeing promotion receiving slightly less endorsement at 79%. See Figure 18.

The Mentally Healthy Schools Programme has been beneficial to our school. Since the programme, staff attitudes towards mental health have become more positive. Since the programme, there has been a greater interest in looking after mental health in our students and staff. My school actively promotes mental health and wellbeing of staff. My school actively promotes mental health and wellbeing of students. Since the programme, mental health and wellbeing is spoken about more often in our school. Mental health is spoken about openly in our school. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Strongly agree

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Figure 18: Teacher Feedback on Whole School Ethos

Confidence, Knowledge and Awareness of Mental Health School staff reported their confidence, knowledge and awareness of mental health following the programme. 27 staff members from 13 schools responded with the majority agreeing that their knowledge and confidence of mental health and wellbeing has increased since the programme and that they understood how and when to refer students for additional support. Of those responding to the survey, only 4% felt they did not have the appropriate skills to support students with their mental health.

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I know what contributes to poor mental health and wellbeing. I feel confident referring people to the school counselling services if I think they need further help with their mental health. I know where to send students to access help and support for their mental health. Since the programme, I am able to recognise when I need to refer students on for additional help or support for their mental health Since the programme, I feel like I now have the appropriate skills to be able to support students with their mental health. Since the programme, I feel more confident recognising mental health difficulties in students. Since the programme my knowledge and understanding of mental health has increased.

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Figure 19: Impact of Programme on Teacher Knowledge, Understanding and Attitudes

Mental Health First Aid and Mental Health First Aid Lite Pre-post confidence and knowledge of mental health Attendees at MHFA Lite and MHFA Youth self-reported their confidence supporting young people with a mental health problem and their knowledge/understanding of how to support young people, both before and after the training. Confidence increased from an average of 5.7 prior to the training, to 8.8 afterwards for MHFA Lite and 4.4 to 8.6 for MHFA Youth.

Figure 20: Change in confidence (MHFA Lite)

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Figure 21: Change in Confidence (MHFA Youth)

Knowledge and understanding increased from an average of 5.6 prior to the training, to 8.9 afterwards for MHFA Lite and 4.4 to 8.8 for MHFA Youth.

Figure 22: Change in Knowledge (MHFA Lite)

Figure 23: Change in Knowledge (MHFA Youth)

Both the MHFA training courses increased staff confidence and knowledge of mental health in young people. When asked for feedback on the training, some attendees gave more detail about this and how they thought it impacts on their role, for example;

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‘I have gained good understanding of mental health first aid. I feel more confident and will feed back information to our school.’

Pre-Post Referrals The evaluation team were unable to assess the amount of pre-post referrals to welfare services and other health providers due to time constraints. As the programme did not finish until July 2018, there was a limited amount of time before the schools finished for the end of term. Additionally since referrals to welfare services may vary according to time of year (e.g. higher referrals during the build up to exams) there was insufficient time to collect any meaningful data in relation to this evaluation aim.

Welfare Service Questionnaires Out of the 10 schools targeted, only two members of welfare services at secondary schools were available to provide feedback on the programme. The responses are presented below as case studies.

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Case Study 6: Impact of Programme on Welfare Services

CASE STUDY 6: IMPACT OF PROGRAMME ON WELFARE SERVICES IN A SECONDARY SCHOOL Demographic Mainstream Secondary School Staff Member Miss Platt* (pseudonym) Occupation Head of Pastoral Care Miss Platt completed a specially designed questionnaire about the impact of the Mentally Healthy Schools Programme. Following this she engaged in a discussion with the evaluation team to provide further context and information. Responses to questionnaire: Since the mentally healthy schools program has taken place…. (Tick one answer per row) Less

How many referrals have you received to the school counselling service? How many of these referrals would you class as appropriate? How many have been inappropriate and not suitable for your service? How well do you feel able to cope with the demands on the school counselling service? How much pressure do you feel under? How well supported do you feel by the rest of the school? How aware do you think the students and staff are at your school of mental health and the school counselling service?

About same

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How have you found the support you have received from CAMHS? Very Poor Poor Neither Poor/Good Good 1 2 3 4

X X X X

Very Good 5

Discussion and further feedback: Miss Platt spoke about the general running of the programme in their school and the impact it had on their students and staff. Their students had enjoyed taking part in the workshops and provided positive feedback about the Athlete Mentor who facilitated this and the activities they engaged in throughout the day. Miss Platt said that the staff who had received additional training (e.g. MHC, MHFA) were enthusiastic to continue their role as mental health leads. The staff who attended MHFA Lite expressed their desire to attend the full training. Despite this, Miss Platt stated the programme had a limited impact on the school as a whole, due to several issues that had hindered the potential beneficial effect mental health schemes can have in schools. Notably, the time of year was the key issue (also discussed by many other staff members across schools). Due to the rapid nature of the pilot, and the short period of time it took place across in the second half of the school year, Miss Platt claimed teachers could not fully embrace the programme. This is because teaching staff had other priorities and the second half of term is a particularly busy time (e.g. exams, trips, work experience placements, coursework, older students leaving and school events). Therefore, little change was seen by the welfare staff. Miss Platt claimed over a longer period of time, with more interventions there may be a culture shift in the school.

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This school had also received previous involvement from CAMHS as part of a different pilot scheme, and rated this other scheme’s input as 4/5. The CAMHS support was extremely useful for the young people and Miss Platt said their input was very much needed and well received. Students felt supported and this increased the amount of referrals. The additional support from CAMHS was valued by teachers as they felt more supported and felt like they could make referrals for students and be confident that despite long waiting lists, they would eventually get access to support. However, when this support was removed at the end of the pilot the school struggled as the support and services they had been offering to students was no longer provided. This then meant teachers were reluctant to refer students to the wellbeing services, and the welfare services felt frustrated knowing that the students needed help but would face a long wait before receiving help, as they would take longer to get appointments and assessments. Miss Platt claimed it was a great idea, but only if there was adequate support for the teachers and students to follow on. This is in relation to the long-waiting times, poor access to appointments and services. She reflected on previous attempts to promote health and wellbeing in their school, such as running mental health sessions as part of the curriculum. However, this was not successful, as staff did not feel confident addressing mental health issues in their students and did not feel like they had enough training to deliver the content. They also did not feel supported if students came to them with mental health difficulties, nor did they feel confident enough recognizing when a young person was struggling. Staff wellbeing and mental health also was not taken into account, which should be considered prior to asking them to support others, and adequate provisions put in place to cope with additional demand for mental health support.

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Case Study 7: Impact of Programme on Welfare Services (2)

CASE STUDY 7: IMPACT OF PROGRAMME ON WELFARE SERVICES IN A SECONDARY SCHOOL Demographic Mainstream Secondary School Staff Member Mrs MacKenzie* (pseudonym) Occupation Head of Pastoral Care Mrs MacKenzie completed a specially designed questionnaire about the impact of the Mentally Healthy Schools Programme and returned it via email. Responses to questionnaire: Since the mentally healthy schools program has taken place…. (Tick one answer per row) Less

How many referrals have you received to the school counselling service? How many of these referrals would you class as appropriate? How many have been inappropriate and not suitable for your service? How well do you feel able to cope with the demands on the school counselling service? How much pressure do you feel under? How well supported do you feel by the rest of the school? How aware do you think the students and staff are at ……………….. of mental health and the school counselling service?

About same

the

More

/ All None / / / /

How have you found the support you have received from CAMHS? Very Poor Poor Neither Poor/Good Good 1 2 3 4

Very Good 5

For future programmes, the evaluation team recommend that it is important to address the concerns of the welfare services in schools and make adequate time provisions to contact them for their views.

Whole School Staff Survey: referrals to school welfare services School staff were asked if they felt they had referred more students for further support with their mental health since the programme. 27 staff members from 13 schools responded with mixed views about whether they had referred more students. 36% staff agreed they had made more referrals, 54% neither agreed nor disagreed and 11% disagreed with this statement.

Since the programme, I have referred… 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

Figure 24: Change in Referrals to Counselling Service

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YST/P2B/42nd Street workshops Workshop evaluation Primary schools A total of 281 students completed the pre-workshop questionnaire and 184 completed the post workshop questionnaire. The majority of those completing the pre-workshop questionnaire were male (51%), 46% were female, 2% chose not state their gender and 1% left this question blank. This was similar in the post-workshop questionnaire, although slightly more females completed the second questionnaire (50%) than males (48%), and 2% chose not to state their gender. The questionnaire asked if students felt they had any health problems that prevented activity. In the pre-workshop questionnaire, 11% said yes they did have a health problem that prevented activity, and in the post-workshop questionnaire 8% said they had a health problem that prevented activity.

Levels of activity Students commented on how often they were active in a normal week. Questionnaires shows that students were generally more active post workshops:

I am active…..

I generally do more than 60 minutes of activity a day in total …

In a normal week I would be active….

Levels of activity Pre-workshop

Post workshop

Pre-workshop

Post workshop

Pre-workshop

Post workshop

0%

10% 20% 30% Never Some days

40% 50% Most days

60% 70% Every day

80%

90%

100%

Figure 25: Activity Levels (Primary)

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Students were also asked to estimate how many minutes of activity they did on an average day5. This slightly increased post workshop:

Average minutes of activity per day 80 60 40 20 0

Pre-workshop

Post workshop

Figure 26: Change in Minutes of Activity (Primary)

Beliefs about activity and exercise

I understan d it is My family important and friends to keep help me to active be active

I enjoy being active

I had fun I feel bad if when I am not taking part being in P.E. active

Beliefs about activity were generally very positive prior to the workshops and this remained the case after the workshops with a slight increase in positive beliefs:

Beliefs about activity and exercise Pre-workshop Post workshop Pre-workshop Post workshop Pre-workshop Post workshop Pre-workshop Post workshop Pre-workshop Post workshop 0%

Not at all

20%

40%

Not much

A little

60%

80%

100%

A lot

Figure 27: Beliefs About Exercise (Primary)

5

A cut off >300 minutes per week was applied upon analysis as it was clear some of the results were not feasible.

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Wellbeing Students were asked to complete the World Health Organisation Wellbeing Index before and after the workshops. Wellbeing was generally quite high in comparison to UK normative data (WHO, 1998; Topp et al., 2015) and remained similar post workshops. A change of 10% or more is indicates a significant change (Ware, 1995).

World Health Organisation Wellbeing Index 100 90 80 70 60 50 40 30 20 10 0 Pre-workshop

Post workshop

Figure 28: Change in WHO Wellbeing Index (Primary)

Knowledge and awareness of mental health and support available Students reported whether they knew about where to get support if they or someone they knew was worried or upset. Students already felt confident that they knew where to get support before the workshops and this remained similar after the workshops:

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I know who I know what I know what to tell if my to do if my I know who I know what can make friends are friends feel to tell if I to do if I people feel upset or upset or am upset or feel upset upset or worried worried worried or worried worried

Knowledge and awareness of mental health and support available Pre-workshop Post workshop Pre-workshop Post workshop Pre-workshop Post workshop Pre-workshop Post workshop Pre-workshop Post workshop 0%

10%

Not at all

20%

30%

Not much

40%

50%

A little

60%

70%

80%

90% 100%

A lot

Figure 29: Knowledge and Awareness of Mental Health and Support (Primary)

School Satisfaction Students were asked how they felt about school both before the workshops and after them. Average ratings were similar after the workshops, increasing slightly from 3.8 out of 5 to 3.9 out of 5 after the workshops.

How do you feel about school? 5 4.5 4 3.5 3 2.5 2 1.5 1 Pre-workshop

Post workshop

Figure 30: Satisfaction with School (Primary)

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Strengths and Difficulties Questionnaire (SDQ) SDQ is a brief behavioural screening questionnaire which includes 5 subscales: emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems and prosocial behavior. Students’ responses to the SDQ before and after the workshops is shown in the graph below. Scores were generally the same before and after the workshop for each of the domains, although there was a slight increase in total scores. Total scores were higher than the UK norms for children age 5-10, particularly for emotional symptoms. All other domains were similar to UK norms (Meltzer et al., 2000).

Strengths and Difficulties Questionnaire 14 12 10

8 6 4 2 0

Preworkshop mean

post workshop mean

Figure 31: SDQ (Primary)

Secondary Schools A total of 73 students completed the pre-workshop questionnaire and 39 completed the post workshop questionnaire. 49% of those completing the pre-workshop questionnaire were male, 48% were female, 3% chose not state their gender. This was similar in the post-workshop questionnaire, with 63% of completers being male and 37% were female. Secondary students were asked to state their ethnic background. The majority of those who completed the questionnaire identified themselves as White British, as can be seen in the chart below.

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White British

5%

Ethnicity

Asian/British Asian

3%

10% 10%

Black / African / Caribbean / Black British Other

60%

12%

Figure 32: Ethnicity (Secondary)

The questionnaire asked if the students felt they had any health problems that prevented activity. In the pre-workshop questionnaire, 15% said yes they did have a health problem that prevented activity.

Levels of activity

I am active…..

I generally do more than 60 minutes of activity a day in In a normal week I would be active…. total …

Students were asked to comment on how often they were active in a normal week. Questionnaires shows that students were generally more active post workshops:

Levels of activity Pre-workshop

Post workshop

Pre-workshop

Post workshop

Pre-workshop

Post workshop

0%

10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Never

Some days

Most days

Every day

Figure 33: Activity Levels (Secondary)

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Students also estimated how many minutes of activity they did on an average day. This decreased post workshops:

Average minutes of activity per day 80 60 40 20 0

Pre-workshop

Post workshop

Figure 34: Change in Mins of Activity (Secondary)

Beliefs about activity and exercise

I exercise because It's my importa I feel friends nt for I don't guilty or me to see why when I family exercise I should don’t say I regularly exercise exercise should

I have fun when taking part in I enjoy P.E. exercise

Beliefs about activity were generally mixed prior to the workshops and this remained the case after the workshops with an increase in positive beliefs, including an increase in the number who recognised the importance of regular exercise:

Beliefs about activity and exercise Pre-workshop Post workshop Pre-workshop Post workshop Pre-workshop Post workshop Pre-workshop Post workshop Pre-workshop Post workshop Pre-workshop Post workshop 0% 10% 20% 30% 40% 50% 60% 70% 80% 90%100%

Not true for me

mostly not true for me

sometimes not true for me

mostly true for me

very true for me

Figure 35: Beliefs About Exercise (Secondary)

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Body Image Secondary school students were also asked about their perceptions of themselves. Generally, perceptions of the self were relatively stable between the pre and post questionnaires although results were mixed. For example, there was a slight decrease in those who never worry about the way they look, and those who never like what they look like in pictures.

I like what I look like I wish I in looked pictures better

I like I worry what I about look like the way in the I look mirror

Body image Pre-workshop Post workshop Pre-workshop

Post workshop Pre-workshop Post workshop Pre-workshop Post workshop 0%

Never

Not often

20%

Sometimes

40%

Often

60%

80%

100%

Always

Figure 36: Body Image (Secondary)

Wellbeing Students were asked to complete the World Health Organisation Wellbeing Index before and after the workshops. Wellbeing was generally quite high in comparison to UK normative data (Topp et al., 2015; WHO, 1998), and increased post workshops.

World Health Organisation Wellbeing Index 74.5 74 73.5 73 72.5 72 71.5 71 70.5 70 69.5 69 Pre-workshop

Post workshop

Figure 37: Change in WHO Wellbeing Index (Secondary)

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Knowledge and awareness of mental health and support available Students were asked if they knew about where to get support if they or someone they knew was worried or upset. Confidence increased for all areas of understanding how to look after their own and others mental health and how to get support. However, understanding the causes of stress and anxiety remained similar:

understanding understanding of the impact of understandng understanding understanding of the casues of stress/anxiety of how to look of how to where to go for stress and on physical and after your own support others support for anxiety mental health mental health mental health stress/anxiety

Knowledge and awareness of mental health and support available

pre workshop post workshop pre workshop post workshop pre workshop

post workshop pre workshop post workshop pre workshop post workshop 0%

10%

20%

1-Lowest

30% 2

40%

50%

3

4

60%

70%

80%

90%

5-highest

Figure 38: Knowledge and Awareness of Mental Health (Secondary)

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100%

School life and confidence Students were asked to rate how they feel in various aspects of their school life. Almost all aspects of school life showed improved ratings after the workshops apart from ‘people at school care about me’ which decreased slightly from 45% very true or true all the time to 40%.

School life I positively influence others

I work well within a team

I communicate well with others

I achieve the things I want to

I am able to solve problems I am able to set personal goals

People at school care about me

Most days I feel like I've achieved something from studying I am free to express my ideas and opinions at school People at school tell me that I am good at what I study I like the people I am in school with I feel in control of my school work

Pre-workshop Post workshop… Pre-workshop Post workshop… Pre-workshop Post workshop… Pre-workshop Post workshop… Pre-workshop Post workshop… Pre-workshop Post workshop… Pre-workshop Post workshop… Pre-workshop Post workshop… Pre-workshop Post workshop… Pre-workshop Post workshop… Pre-workshop Post workshop… Pre-workshop Post workshop… 0%

Not at all true

Very untrue

20%

Somewhat true

40%

Very true

60%

80%

100%

True all the time

Figure 39: Satisfaction with School Life (Secondary)

Strengths and Difficulties Questionnaire (SDQ) SDQ is a brief behavioural screening questionnaire which includes 5 subscales: emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems and prosocial behavior. Students’ responses to the SDQ before and after the workshops can be seen in the graph below. Scores were similar before and after the workshop, although there

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was a slight increase in total scores and a clear decrease in the emotional problems scale. Total scores were on average higher both pre (14.6) and post (15.5) than UK norms for adolescents 11-15 years old (10.3). For the individual domains, scores were higher for emotional symptoms compared with the UK norm (2.8), hyperactivity (3.8), and peer relationships (1.5). All other domains remained similar (Meltzer et al., 2000).

Strengths and Difficulties Questionnaire 18 16 14 12 10 8 6 4 2 0

Preworkshop mean

post workshop mean

Figure 40: SDQ (Secondary)

Absenteeism, Truancy and Behavioural Issues School staff commented on whether they thought the programme had any impact on behavior and absenteeism as part of the teacher questionnaire. 27 staff members from 13 schools responded. Most staff members felt that there had been no change in behaviour, absenteeism or truancy. One staff member thought that incidents of bad behavior had decreased and attendance rates had increased. Two staff members disagreed that rates of bad behavior had decreased (i.e. did not believe that bad behavior had increased), two staff members agreed that attendance had increased (11%).

Since the programme, incidents of bad behaviour have decreased. Since the programme, truancy rates have been higher in school. Since the programme, attendance rates have been higher in school. 0%

Strongly agree

Agree

10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Neither agree nor disagree

Disagree

Strongly disagree

Figure 41: Absenteeism and Truancy

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YHA Place2Be Assessments and YHA Characteristics Place2Be counsellors completed initial assessments with the primary school YHA during the first workshops in order to identify whether they were suitable for the role. Students were observed by the counsellors throughout the day and completed a brief interview. 67 assessments were completed in 13 primary schools. Prior to the training, students self-reported how confident they felt becoming YHA. Students felt moderately confident with an average score of 6.6 out of 10 (ranging from 1-10). However, following the training, their confidence in the role grew and students reported an average score of 9.5 out of 10 (ranging from 7-10) (See below).

Figure 42: Confidence Levels Pre-Post YHA Training

Place2Be counsellors assessed the YHA skills and ability to take on the role, rating their competency in domains such as listening to others, and willingness to engage. Students were rated on a 5-point scale ranging from ‘Low Skills’ to ‘Exceeding’.

Figure 43: YHA Skills Rating

Skills of YHA Skill Required

Willingness to Engage Self-awareness Skills Confidence/Others Accepting of Others Empathy Skills Listening Skills 0

10

20

30

40

50

60

70

Amount of Students Low Skill

Fairly Low Skill

Competent

Skilled

Exceeding

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The majority of students identified were competent and capable of taking on the role of YHA. Average scores, highlighted with some examples of the behavior are presented below.

Table 3: Place2Be Observations of YHA Skills

*Some counsellors rated students between categories YHA Observations Skill Mean Range Example Descriptions Score (1-5) ‘Is able to listen well, occasionally distracted in larger groups’ Listening Skills 3.4 2-5 ‘Listened well and was able to feed back to a larger group’

Empathy Skills

3.1

1-4/5*

‘’Showed good listening skills and reflections’ ‘Showed signs of empathy and understood importance of shared experiences’ ‘Respectful of others – on occasions had more thought on themselves’

Accepting of Others

3.3

1-4

‘was very expressive and understood her own weaknesses’ ‘Respected others views and did not show judgement’ ‘Did have a tendency to speak over others, but was encouraging of others to join in activities’

Confidence with Others

3.4

2-5

‘Was willing to work with others who engaged, was not distracted by silliness as the day went on’ ‘Was happy to share learning and guide group’ ‘He seemed to have confidence in workshop 1 and was reflective, however he seemed reluctant to join in workshop 2’

Self-awareness

3.3

1-5

‘Was confident in small group but she had concerns when expected to deliver to larger group’ ‘Good self-awareness of himself, understanding and honest of his emotions’ ‘Really good awareness of herself and what she needs to do to be healthy’

Willingness to Engage

3.6

2-5

‘Very self-conscious when asked to do tasks that takes him out of comfort zone’ ‘Happy to lead activities and try to keep people focussed’ ‘Very much willing to engage, however, her initial excitement tended to make her tell the others what to do’ ‘Very willing to engage did not let her (initial) lack of confidence affect her’

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Support Needed P2B counsellors discussed with the students what support they would need to continue with their role as YHA. Students generally reported needing further help with:     

Practical issues such as organizing projects, promoting the role, having appropriate resources, and help with writing tasks Improving their confidence in the role and influencing others Emotional support and guidance to deal with others if they are struggling Encouragement from others to continue with the role Reminding what the role is and what is expected of them

For example, ‘I would forget a few things, I would use my other ambassadors to help me out. My support would be from others and teachers’ ‘Encouragement for me to be healthy from the school and reminders so can do the same for others’

Student Understanding Whether the students understood the role was also captured by asking them how they would explain it to a friend. Their understanding was mixed with some having a good knowledge of what was expected of them, for example: ‘Helping people with their worries and difficulties, referring them to a teacher if need be’.

Indeed, most students described their role in terms of being there to help other students who might need extra support, or who are struggling with their wellbeing. Many also discussed how they should be promoting physical health and advising their peers to drink more water, eat healthily, and be more active. For example: ‘I am a Young Health Ambassador, I am going to help other people keep healthy, fit and strong’.

However, some students reported being a little unsure about the role, and some expressed they thought the role was only for helping people with a specific condition e.g. learning difficulties, or mental health problems, rather than the whole school. For example: ‘People who have disabilities, who need to cope with it, my role is to help them’.

General Feedback The primary students also reported enjoying the day and commented how they found it fun, looked forward to helping others and that they felt proud and excited in their new role, for example: ‘I like being a health ambassador, my struggles will help me understand others’

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Mental Health Champion Feedback from Senior Leader Staff The STLs trained as Mental Health Champions were consulted at the end of the day in 10 primary schools (the remaining were unavailable due to time constraints) about the training the YHA had received. MHC rated the training as extremely useful with an average score of 9.1 out of 10 (range 710). MHC provided positive feedback on the running of the programme, the activities and the enjoyment of the children:

Figure 44: Usefulness of YHA Training

‘The children have had an amazing experience and they have loved the whole day!’ ‘It has been really useful to spend some quality time with a small group of children from my class and to focus on the skills highlighted in the observations. It was good to have an objective point of view’

Despite this positivity, MHC highlighted some challenges observed with the training, such as it being ‘pitched a little too old’ for the children, that there was a lot of content in a short time and raised concerns about the suitability of some of the YHA; ‘I feel like one of the children chosen wasn’t quite ready to be an ambassador’

MHC described how they would support their YHA going further. This included:     

Further developing skills and confidence with the YHA Reminding them of their role and what they should be doing Providing ongoing feedback on their role and supporting them to develop further Meeting with other staff members to identify ways they can support YHA Sharing the responsibility with YHA to promote their role in schools

Observations from Conference The primary YHA made bunting within the workshops at the celebratory conference to reflect what it means to them to be YHA. Students drew many positive images such as holding hands, love hearts, stars, and pictures representing health including people exercising, strong muscles and healthy food. See Image 2 for an example:

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Image 2: Bunting Made at the YHA Celebratory Event

During the interactive P2B feedback session, students reported in more detail how they felt about being YHA and what it meant to them. They discussed how although it was not what they expected they found it a positive experience both on a personal level and for the wider community. For example: “I’ve made Manchester better and all of us together we have all made a massive difference” “I thought it was all about helping other people but realised it is for my benefit too.”

Running of the whole programme Feedback from Trainers 17 facilitators and trainers from across the different organizations provided their feedback on the programme. This consisted of 6 Athlete Mentors from Youth Sport Trust, 6 staff members from 42nd Street who worked with secondary school students, 3 staff members from Place2Be who trained the primary school YHA and assisted with the primary school workshops and 2 trainers from the Alliance for Learning who trained staff members in MHFA/ MHFA lite. Six of the questionnaires were completed on paper, with the remainder completed online via ‘Survey Monkey’. On average, the trainers reported that they enjoyed taking part (average rating 86%, scores ranged from 5-100): Hated it

Loved it

Figure 45: Trainer Satisfaction of Programme

Trainers also reported that they felt the training went well (average rating 83%, scores ranged from 5-100): Hated it

Loved it

Figure 46: Trainer Experience of Training Process

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All trainers and facilitators rated how much the agreed/disagreed with the following statements:

Figure 47: Trainer Feedback

Trainers reported that both they and the attendees generally enjoyed the training; they felt supported and achieved the aims of the training. Trainers reported the training as stressful (31%) and challenging (53%) in some cases. Only a minority (47%) felt there was enough time to prepare for the training, a sizable minority reported that not everything went as planned (35%) and most (65%) reported that they had to adapt the training to suit each school.

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What Went Well Trainers were asked to comment on what they felt went well, with four trainers noting the content of the training was good with comments including: “The content - it suited the audience and everybody enjoyed it” “I loved the programme as its content is relevant”.

Three trainers mentioned the importance of collaborative working across the organisations and other successes mentioned included engagement with young people and the role of the young health ambassadors.

Challenges The following challenges were reported by trainers:       

Communication difficulties (n=7) Time (n=6) Poor engagement (n=3) Lack of support (n=2) Lack of clarity over what was expected of them (n=4) People not turning up (n=2) Poor organisation of the programme (n=4)

Many reported that the schools were not organized and did not allocate enough time for the training. This made it difficult to arrange their visits to complete workshops, for example having to postpone visits due to teachers not having enough time to prepare for the sessions. Trainers were asked what would be useful to improve the programme. Several trainers mentioned the structure/format or timing of the sessions could be improved: “I would change the format to 3 morning half-day sessions or 1 morning with the YHA group followed by a full day with the nurture group” “Deliver to the YHA first. Select the group instead of allocating a whole class” “Extra time was needed to spend with the Health Ambassadors to fully explain the role to them. Workshop 1 & 2 needs to be on separate days so not to rush.” Time, planning and preparation was also a consistent theme for what could be improved: “More time for teachers to plan athlete visits.” “More clarity and preparation time for all parties” “More time to prepare - ability to co-write training”

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Long-term outcomes – Teacher Feedback It was not possible to present long-term effects, but recommendations are included below based on teacher responses. Our school will continue to promote mental health and wellbeing in our pupils and staff.

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

Figure 48: Long-term Impact on Schools

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Section 4: Discussion Summary of Results The programme was delivered to 31 schools across Greater Manchester. 62 senior leaders in schools received Mental Health Champion training over four sessions. This aimed to positively change the whole school ethos and ensure that a designated person at each school was responsible for supporting mental wellbeing in students and staff, and knowing how to and when to refer students to welfare and specialised mental health services. School leaders reported increased confidence in dealing with students with mental health problems, improved knowledge about how to refer students to specialised services, and increased awareness about the importance of staff health and wellbeing. 53 school middle leader received MHFA training. This aimed to train two middle leaders from each of the schools to improve their confidence, competence, knowledge and motivation in supporting young people with mental health issues. Middle school leaders reported enjoying the training and improved attitudes towards mental health. 60 school staff received MHFA Lite training. This aimed to train two support staff from each school to become wellbeing champions to support students with their mental health needs. Middle school leaders reported enjoying the training and that they had improved knowledge about mental health. They also wanted to engage with the full 2-day training course. Year 5 primary school students at all 14 schools received co-designed and co-facilitated YST/Place2Be workshops. Workshops were generally well received with students reporting enjoying the active games, social nature of the workshops, meeting the athlete and trying their sports and learning about mental health. Students reported improved confidence, knowledge of mental and physical health and skills they had learned. Some of the written and more sedentary tasks were reported as less enjoyable and less helpful by some students. Some students were also confused by the workshops and did not understand why they were taking place. Outcomes of physical activity levels, beliefs about activity, wellbeing, school satisfaction and emotional wellbeing and behavioural conduct as measured by the bespoke questionnaire were unchanged following the workshops. Secondary school students at 17 schools received co-designed and co-facilitated YST/42nd Street workshops. Workshops were generally well received with students reporting enjoying learning about mental and physical health, the discussions on stress management and meeting the athlete mentors. Tasks such as drawing their support networks and worries in the form of a bus, talking about stress and their feelings in front of the class and trying out some of the breathing techniques were reported as less enjoyable and less helpful by some students. Outcomes of wellbeing and emotional stress and knowledge of mental health support were improved following the workshops. Students reported feeling more confident and discussed many skills which they had learned from the workshops. Outcomes of physical activity levels, beliefs about activity, body image, understanding of metal health, school satisfaction and emotional wellbeing and behavioural conduct as measured by the bespoke questionnaire were unchanged following the workshops. 67 primary school students received training to become Youth Health Ambassadors. Primary students reported enjoying the training and described feeling proud and confident about being chosen. However understanding of the role varied, with some believing it involved helping others with their mental health and being a source of support for their peers and others not realising they would also learn to look after their own mental health. School leaders reported feeling positive about the YHA programme, and optimistic that it would be useful addition to

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schools. Both students and school leaders thought that ongoing support, such as further training and confidence building was important for YHA. 90 secondary school students received training to become Youth Health Ambassadors. They reported feeling proud and happy about being chosen and enjoyed the training. Understanding of the role was generally good and they felt empowered and optimistic they could make a difference in their schools. School leaders reported feeling positive about the YHA programme, providing staff also receive further support to encourage the YHA to fulfill their role. Both students and school leaders thought that ongoing support, such as help organising assemblies and events, and continued emotional support and encouragement was important for YHA. Feedback from people providing the training across all 4 organisations was generally positive and supportive of the programme. However most trainers described feeling that they did not have adequate preparation time and that the schools were often not ready to receive the training. Most trainers reported having to adapt their training across different schools, often at last minute.

Good Practice & Challenges Examples of good practice Throughout this rapid pilot programme, observations from the evaluation team and feedback gathered from all those involved, has highlighted many examples of good practice. Several examples are described below.      

Delivery of programme Training of staff Programme content Expertise and qualities of facilitators Engagement with programme Feedback from trainers and teachers

Delivery of Programme The four organisations came together to deliver the programme on time and largely according to the original brief. All 31 schools who signed up to be part of the Rapid Pilot received each of the four interventions within the short time scale. The training was delivered on time, with some elements being continued in September.

Training of Staff In all 31 schools, staff attended additional training in either Mental Health First Aid, Mental Health First Aid Lite or Place2Be Mental Health Champion Training. This training was well received by the staff who attended and increased their skills, knowledge and confidence recognising/addressing mental health needs. Therefore, this represents a valuable addition to the workforce of 31 schools in Greater Manchester, who now have designated members of staff in post who possess extra skills to support young people with their mental health and wellbeing, because of the programme. This work is currently ongoing, and Place2Be will conduct further evaluations.

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Programme Content The content of the co-facilitated workshops was comprehensive and covered many important topics of healthy living. The students learnt about physical activity, diet, living a healthy lifestyle, sleep, emotions, mental health and looking after their wellbeing. In the focus groups the students described enjoying learning about the issues covered in the workshops and that they had increased their knowledge of both mental and physical health. They also described learning new skills to deal with stress and promote relaxation (such as meditation and breathing techniques), many of which had been tried at home after the workshops. Due to the varied content of the programme, and many different approaches used to deliver the programme, all students could identify elements of the workshop that they enjoyed or did not enjoy. For example, many reported enjoying the active tasks and interacting with the Athlete Mentor. Others preferred the discussion based tasks. The content was covered in a relatively short space of time and pitched at an appropriate level for the majority of the students. Most students understood what was expected of them and engaged well with the tasks. The trainers were satisfied with the content of the training for example when asked what went well, one of the Athlete Mentors reported ‘The content- it suited the audience and everybody enjoyed it!’ The activities and tasks were enjoyable for students and trainers and Athlete Mentors reported feeling well equipped to deliver the programme, e.g. ‘Having all the information I needed to deliver help and support’. The flexibility of the content meant that the programme could be adapted across schools. This is a strength, given that schools across Greater Manchester fulfil a variety of demographic and socioeconomic characteristics. In some schools, the trainers were able to amend this accordingly depending on the context of the school. The evaluation team observed similar topics and tasks taking place in different schools, which were modified according to the students’ ability. See Box 1 below for an example.

Box 19: Flexibility of Programme

Flexibility of programme Primary School Healthy Food Choices – Vegetables The focus was on making healthy choices for diet. The students were in the sports hall and all sat on the floor while the athlete mentor discussed the importance of a balanced diet. A group discussion was held about different food groups and then focused on fruit and vegetables. On one side of the room the athlete had laid out different fruit and vegetables and the students worked in teams to run to collect different coloured items – creating a rainbow of food. They then were told the names of the fruit and vegetables and what they can be eaten with.

Secondary School Healthy Food Choices – Meal Planning Secondary school students also discussed the importance of a balanced diet, and the different food groups. Their task was then to work in groups to plan out the meals/snacks for an athlete for a full day. This was then discussed as a group and they were given advice on how to improve their diet. Students were encouraged to think for themselves what they could do to make small changes to what they eat.

Future programmes could use a similar approach to ensure that whilst the content remains the same, it could be delivered in slightly different ways as appropriate for the audience (as per the example above).

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There are also activities which appeared to work well in different settings, without needing to be adapted. For example, the stepping choices game. In this game the students lined up and stepped left or right depending on their preferred choice between two options e.g. crisps v chocolate. The options were initially quite trivial and fun such as football teams, TV programmes, and eventually built up to more serious topics and discussions around mental health (e.g. happy v healthy). This game was observed in all four schools including the PRU and SEN, and all students took part willingly.

Learning Point 1 Ensure future programmes have flexible course content with modules that can be adapted, added or omitted to meet the needs of each school and/or class. Modules should include a mixture of physical activities and games, as well as discussion and classroom based tasks.

Expertise and Qualities of Facilitators Facilitators and trainers were highly skilled, and experienced in working with young people. Across all organisations, praise and positive feedback was received for the Athlete Mentors, trainers and facilitators. They generally achieved a high level of rapport and overall engagement with the students and attendees of training. The evaluation team observed some incidents where the students lost interest or became less focussed, however the Athlete Mentors recognised this and brought their attention back to the tasks. All organisations also covered sensitive topics in a relatable and respectful way.

Learning Point 2 The high level of skills and experience of the facilitators was essential for the success of the programme. Facilitators should continue to be trained and supported to a high level to enable them to engage and support students.

Engagement with Programme The evaluation team observed high levels of engagement in a number of the schools. The programme appears to be very well received and students have commented how much they enjoyed the day. Feedback from all those involved has been largely positive (albeit with some challenges discussed later in this report). There have been high levels of active participation in both individual and group-work, and few incidences of non-participation. Athlete Mentors commented on how ‘The interaction with the young people and their response to the activities’ was a particular strength of the programme. The evaluation team have witnessed relatively few behavioural incidents in the workshops, and students have generally behaved well. Across the evaluation process it is clear that all those involved agree that a programme of this nature addressing both physical and mental health in schools is needed in Greater Manchester.

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Feedback from Trainers and School Teaching Staff The trainer feedback was very positive, as collected by the questionnaire described earlier in this report, and discussions with the evaluation team during the observations. They expressed satisfaction with the levels of engagement and how they had managed to complete it in a short time frame. Athlete Mentors and trainers have enjoyed being part of the Mentally Healthy Schools Rapid Pilot Programme, and feel strongly that there is a need for this type of integrated programme within schools. Trainers were satisfied with the resources provided to them to conduct the workshops and expressed their enthusiasm for working with young people. Athlete Mentors and trainers highlighted the rapidity of the programme and although they have enjoyed it, all raised the issue that this has been a challenging process, (this will be discussed in more detail in the challenges section below). Teachers have been positive about the impact of the programme, and the benefits it has had for their students and their workforce. The level of input of staff members has varied at each school, and some teaching staff and schools in particular have embraced the programme. For example one year 5 teacher had attended the MHC training and discussed with the evaluation team how they planned to increase conversations about mental health in their school. This teacher worked with students beforehand to prepare them for the session, was present throughout the day and had arranged to meet with the YHA after the training on a regular basis. Similarly, in one of the primary schools, students were asked to research the athlete mentor prior to the session, and the teacher (who had also taken part in the MHC training) had prepared a PowerPoint of learning objectives for the workshop. Addressing mental health and wellbeing was a priority of this particular school. It was evident from other observations around the school such as a ‘worry monster’ in the reading corner of the room where the children could post their worries and these would then be addressed during their form time. In contrast, at the Pupil Referral Unit, although there was a teacher present all day, they attended with the purpose of monitoring student behaviour. There appeared to be little or no preparation for the workshop and students did not appear to have been informed the workshop was taking place. This issue was raised by several of the trainers and Athlete Mentors with some claiming the schools that got most out of the programme had active involvement from the teaching staff and rest of the school; ‘Teachers should remain in sessions to gain a better understanding of the programme and see the impact’.

Learning Point 3 Ensuring schools are fully engaged with the programme from the start and continue to integrate their learning into daily school life is an essential for success. The programme could consider awarding certificates to schools who take part, and introducing a system of recognition for schools who complete and implement various stages of the programme which could become recognised across Greater Manchester as a standard for Mental Health in schools.

Examples of Challenges Some challenges associated with delivering the programme across schools in Greater Manchester have occurred. Several examples are described below.

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      

Delivery across schools Collaboration between organisations CAMHS involvement Feedback on YHA role School Involvement Timeframes Selection of Students

Delivery Across Schools The delivery of the programme varied across schools, and a different approach was needed in some settings. For example, in the Pupil Referral Unit, students are able to attend school of their own volition and therefore, attendance for the full day was not compulsory. This meant that the teacher was unaware of how many students they would have and people turned up at different times throughout the day, interrupting sessions. They also required a more interactive approach and lost focus if they were being spoken at for too long, so the tasks were shortened. Additionally, Pupil Referral Units experience a high turnover of students. Therefore, when workshop 2 took place, only one student who had taken part in the first workshop was still attending the Pupil Referral Unit. This meant that focus group and more in depth evaluations could not take place with this school. Some of the programme and evaluation materials are not appropriate for all schools. For example, the evaluation questionnaires for students were not appropriate for SEN schools, and students struggled to complete these. The evaluation team spoke with teaching staff at the SEN schools who recommended working with them at the schools prior to the programme, to ensure all materials are appropriate and pitched at the correct level. The times of the programmes varied across schools depending on the school day and fitting the workshops within this. Some of the Athlete Mentors and facilitators found this challenging as they sometimes found out the school timetable on the day and had to ‘think on their feet’, removing some parts of the workshop. In some cases, the schools were unprepared and unsure of what space to use for the sessions. However, the majority of sessions were conducted in the schools and the flexibility of the content meant that Athlete Mentors were able to adapt their workshops according to the needs and facilities of the schools.

Learning Point 4 Further work should be conducted with staff and students from the PRU and SEN to consider any further adaptations needed to successfully offer the programme in these settings. Further pilot work followed by further evaluation is needed in these settings to determine if this approach is appropriate to meet the needs of these groups.

Collaboration Between Organisations The programme was delivered largely to the original plan, and all four organisations came together to deliver their respective training packages and workshops. Primary school workshops appeared to demonstrate particularly good collaborative working between the athlete mentors and Place2Be facilitators. This appeared to be primarily because Place2Be

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were present alongside the athlete for the whole workshop, allowing joint working throughout the session. In contrast, there appeared to be confusion about the timings of the secondary school workshops and occasionally there was evidence of a lack of communication between facilitators, for example, uncertainty about which topics had already been covered in the previous session or what time the next session would take place. Learning Point 5 All organisations should continue to work closely to develop the programme. In particular, athlete mentors and facilitators from Place2Be and 42nd Street should be funded to co-facilitate the workshops with young people for the whole day rather than having separate sessions. This ensures a trained mental health professional is present throughout the day, and allows for a more seamless and collaborative approach to delivering the workshops. This was a successful approach in primary schools and should be replicated in secondary schools. CAMHS Involvement and Other Schemes Following the first series of workshops, and after the delivery of the original brief, the evaluation team were informed that CAMHS were also involved with the programme. Unfortunately, due to the fact that the evaluation had already begun, and the CAMHS interventions were already running by the time the evaluation team were informed, this component of the programme could not be included in the final evaluation. However, a question was included on the teacher questionnaire administered in July 2018 asking whether they had additional involvement from CAMHS, and if it was useful. Additionally, the welfare staff were asked for their satisfaction on any CAMHS involvement. Furthermore, as the programme developed it became clear that some of the schools had also received additional interventions and programmes focussing on mental/physical health from their individual localities. This included more intensive CAMHS involvement, additional support for physical activities, and other programmes/workshops addressing mental health and wellbeing. It is unclear which schools received additional interventions and those who only received the Mentally Healthy Schools programme. Therefore, the true impact of the programme cannot be determined, as some students may have had additional input from other providers. Learning Point 6 Any future roll out of the Mentally Healthy Schools Programme should firstly consider any existing similar schemes in the area, and whether these would complement each other or be competing schemes with competing demands on staff and student time. In order to fully evaluate the programme as a standalone package, schools would need to only have involvement in one scheme. Feedback on the Young Health Ambassador role The original brief described training Young Health Ambassadors across each of the schools. In the initial workshops, young people were referred to as ambassadors however, during the course of the pilot the title was changed to Young Mental Health Champions, and it is unclear why this is the case. This was mentioned during the concluding conference by several members of the participating organisations, as well as the students themselves. Place2Be provided feedback on the training, generally stating that it went well. However, not all students who were put forward were seen as suitable for the role. This was attributed to a

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lack of knowledge about the role and what it entailed. One suggestion from Place2Be was to use a ‘job description’ in the future, which clearly states the role and what is expected of the student. This is due to confusion over what the role is, on behalf of the students who were selected, and the teachers who had to identify students. This is further supported by student feedback, stating that they did not know what to expect when they started the training, and that it was different to what they thought, albeit in a good way. Some claimed they knew they would learn to help others with their mental health but did not realise they would learn to help themselves also. However, the trainers have generally expressed satisfaction with the students who they felt were suitable for the role. They were impressed by their suggestions, and their engagement with the training. Learning Point 7 A job description for the Youth Health Ambassador role should be developed and agreed with young people, teachers and trainers. This should be provided to students and teachers in advance, so schools are fully aware of what is involved and what to expect from the training. A number of trainers, teachers and students in the secondary schools commented on the structure of the training and how it would be more useful and beneficial to follow the same structure as the primary school training. In the primary schools, this involved training the YHA in a separate session prior to the nurture group, and then using them to help facilitate some of the activities. In the secondary schools, the YHA were trained separately in the afternoon sessions and in many cases did not attend the main nurture groups, or would miss some of the content/workshops (see case study 8 from one of the focus groups). Case Study 8: Feedback on YHA Training

Case Study 8 – Student Feedback Secondary School A Five of the Mental Health Champions from one of the secondary schools took part in a focus group conducted by the evaluation team. This was an example of one of the schools who differed from the original brief as the students identified were from year 9 (as opposed to year 10). Students were trained in their YHA role after the morning nurture workshops had taken place (which they did not attend). This included both the initial Athlete Mentor session and the 42nd Street introductory workshop. They reported that it would have been more helpful if they had been trained in the YHA role first, and then attended the main nurture groups afterwards and integrated with the rest of the group. One student said the structure of the training meant that people did not really know who the YHA were and what their role was supposed to be. Further adding to this, they said they did not feel confident in their role at an early stage so would not promote it themselves, however if they would have been integrated earlier then they would have been able to embrace the role further. In this particular school, the athlete mentor and teaching staff also provided feedback to the evaluation team that it would have been more beneficial to the students to follow the same structure of training as the primary schools. This is supported by feedback from the Athlete Mentors e.g. ‘I would change the format to 3 morning half-day sessions or 1 morning with the YHA group followed by a full day with the nurture group’.

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Learning Point 8 The structure for training YHA in primary schools should be replicated across all schools. This would allow the YHA to be trained first, then attend the nurture workshops and integrate with fellow students. YHA can then help facilitate activities and promote their role from the outset.

According to the original brief, YHA were required to engage in a project to establish a ‘legacy’. The students described many innovative ideas, presented these at the celebratory conference and discussed them in detail during the focus groups. However, a number of students reported feeling disheartened as they felt there was no point starting anything as they were coming to the end of term and would not have time before they break up. One student also claimed that they felt like if they had the correct support they would be able to follow through with their ideas, but did not think it was going to be likely when they returned after the summer break, for example:

‘It hasn’t happened yet because we haven’t had enough time to like, do it all’ ‘we could have like an AstroTurf and everything but it won’t be built when we’re here …we’ll be already gone, so it won’t affect us’ ‘the worst thing about it is these things they only happen once in a blue moon..’

School Involvement The evaluation team observed that whilst some schools fully embraced the programme and were involved in every aspect, others embraced the programme less and consequently appeared to be more disorganised and did not allocate as much time for the programme. This was reflected in the feedback from some of the trainers, for example: ‘Had to postpone a visit due to teachers not having enough time to prepare for the visit’

Additionally, not all staff members at the schools (including key contacts for arranging visits such as receptionists and secretaries) were aware of the programme which indicates a lack of communication. The evaluation team had several interactions with administrative staff when confirming their attendance to observe sessions and conduct interviews. Feedback from trainers has also highlighted this issue. One athlete mentor discussed how there is a discernible difference across schools that is detrimental to the impact of the programme and adds further challenges to their role. This is often down to a lack of communication (e.g. staff turnover, lack of email contact), or alternative priorities (e.g. exam times taking preference). An example is described in more detail in Box 20.

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Box 20: Facilitator Feedback on Preparation

Facilitator Feedback Secondary School A A YST athlete mentor was due to attend a school on a Monday and had tried to make contact with the head teacher and point of contact several times in the previous week. The head teacher had changed, and finally made contact on Friday afternoon (after the end of the school day). The nurture workshop was described and the athlete informed the head teacher they would have to pick 15 students to take part in the workshop. As this was planned for Monday morning, the students were not informed until the morning of the session. Therefore, they were unprepared for taking part and had to abandon the lessons they had for the day. The athlete reported that this had potential to cause distress and anxiety in some students.

Teachers also reported that they had reservations about getting involved at this stage, despite recognising the benefits the programme could have. Again, this was in relation to the timing of the programme being at the end of the school year and the start of the summer break.

Learning Point 9 As well as ensuring flexible course content, schools should be provided with an introductory pack, which details what to expect from the course, facilities needed on the day and suggested preparation materials. Mental health champions should ideally be part of the workshops with young people so they are fully aware of the course content and integrated into the sessions with the students. All school staff, including administration teams, should be made fully aware of the programme and timetables in advance of the start dates. Timeframes Two challenges emerged in relation to timing; the time of year it was conducted (all within the second half of term) and the duration of the scheme (including the limited time allocated for schools and organisations to prepare). The programme took place during the final term of the school year which caused various difficulties. Firstly, schools were busier at this time of year with assemblies and school trips, and consequently found it difficult to identify time for the programme sessions. Secondly, many students were completing exams at this time of year, so teachers and students were understandably prioritising and focussed on exam preparation. Thirdly, schools were reluctant to implement any changes following the programme as they only had limited time to do so before the end of term. Instead, many said they would focus on implanting changes in the September, but also noted they may find it difficult to remember parts of the programme by that stage. Finally, as discussed later in this report, the timing of the programme impacted on the evaluation itself, with schools being particularly busy and in the final two weeks of term when the evaluation team were visiting schools and conducting focus groups and leaving limited time to collect data assessing the impact of the programme.

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Learning Point 10 Consideration should be given to the timing of any future programmes. Consultation with school staff and students suggests that they would prefer to start the programme earlier in the school year and potentially over a longer period to enable them to fully implement what has been learnt and make changes in their schools. Some suggestions for addressing this challenge included teachers saying it would be better earlier on in the school year when there are less events and pressure on staff/students. A number of the students also recommended starting a similar programme in the autumn term and conducting it over a longer period of time, with more frequent but shorter sessions throughout the school year. This is because some of the students acknowledged how it could benefit them when they are experiencing exam stress but the whole programme was too much content in a short time.

Selection of Students for the Nurture Workshops The evaluation team were unable to determine whether the original brief was met regarding the amount of students who were targeted for the workshops. The original brief aimed to deliver the programme to 450 year 5 pupils and 240 year 10 pupils. However, attendance sheets were not kept for the nurture workshops and the evaluation team did not receive back all of the pre-post questionnaires provided to the schools. The selection of the students for nurture workshops was not always seen as appropriate by the trainers, particularly in the secondary schools. A number of the feedback sheets from Athlete Mentors and workshop facilitators stated how some of the students selected were not appropriate for the workshops. In a couple of cases this was attributed to the teacher being unsure of who they should have chosen, and selecting students they felt needed additional interventions (e.g. those with behavioural issues or specific needs). This lack of clarity and preparation was particularly detrimental to the sessions according to the Athlete Mentors who claimed: ‘Schools that had selected the right nurture group and involved the students in choice… so were overall better prepared got more out of it… some didn’t have the right students involved’ ‘Nurture Groups tended to have been thrown together with a few of the group not interested in the subject or material’

As discussed earlier in this report, a similar issue was experienced with selection of the young health ambassadors, although not to the same extent. Additionally, not all students were of the intended target, for example some of the students taking part in the secondary school nurture groups were taken from year 9 rather than year 10. It also became clear that in some schools not all students who participated in the first workshop attended the second. This may have been down to students not being available on the day, absenteeism or school trips. However, in one of the focus groups with secondary school students, the students reported that they were not told the second workshop was taking place or invited to attend, and how this had resulted in them feeling disappointed when they weren’t invited to take part, given how much they had enjoyed the first, e.g.: ‘We were on the first day but not on the second one so we were like oh… [Shrugged Shoulders]’

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‘They looked at the survey at the end and they went oh right…. Because like second time around I know that when we went there was some people that were there before but that weren’t in the second day’

Learning Point 11 As discussed earlier, an introductory pack for schools taking part would be useful and this could include more information about the content of the nurture workshops and the ideal students for this programme. A simple tick list of suggested characteristics and needs would be ideal to allow teachers to select appropriate students. Additionally, involving the Mental Health Champions at each school in this process of selection would utilise their knowledge and training fully and integrate them in the whole programme.

Limitations of the Evaluation As well as the challenges experienced by the staff delivering the programme, there were several challenges experienced by the evaluation team itself that may limit the findings of this report but also provide useful learning points for future evaluations. These are summarized under the following headings:     

Meeting the primary outcomes of the brief Limited Sample Validity of Data Lack of long term outcomes and evaluation Lack of opportunity for teacher and trainer/facilitator feedback

Meeting the primary outcomes of the brief The primary outcomes as specified in the brief, as noted above are:       

Reduction in/or increase in referrals to wellbeing support within or beyond the school (4 weeks) and how welfare staff are coping with this Reduction in absenteeism/behavioural incidents in designated groups Increase in staff competence and confidence to support and refer Changes in self-reported attitudinal data relating to school life Increased reported happiness/wellbeing/readiness Return on investment Impact on wellbeing of designated staff themselves

However, the following outcomes were unable to be measured by the evaluation team. 1) Reduction in/or increase in referrals to wellbeing support within or beyond the school. This could not be measured because it was not feasible to conduct this within the timescale of the evaluation. Furthermore, to understand trends of referrals we would need a full year worth of data to account for fluctuations in the stress levels of students at various times of year. 2) Reduction in absenteeism/ behavioural incidents. This could not be measured for the same reason as above. 3) Return on investment. It was not clear to the evaluation team how this would be assessed. A full cost-effectiveness analysis was beyond the resources of the team, in addition, many parameters would be relevant to this outcome such as;

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a. effect of the intervention on primary care and secondary mental health service use by students b. indirect costs such as carer time for mentally unwell young people c. improved life-readiness and number of young people continuing education and employment d. reduction in number of young people not in employment, education and training e. improved physical health and reduction in NHS service use for problems such as obesity and diabetes f. increased educational attainment The evaluation team planned on assessing the impact of the nurture workshops across both primary and secondary schools as one programme. However, due to the differences in content, delivery and format of the primary and secondary workshops, they were evaluated as separate programmes.

Limited Sample The evaluation aimed to collect data across the whole range of schools, students and staff involved in the programme, including a bespoke questionnaire for all young people taking part, staff surveys and in depth case studies at a sample of schools. However, there were numerous challenges with this approach, which has meant the evaluation team were not able to collect data from as comprehensive a sample as originally planned. For example, there were numerous challenges when conducting the in depth case studies and focus groups with schools. As discussed previously, when arranging the focus groups it became apparent there were some communication issues, which meant that some staff members were unaware of the programme. The evaluation team contacted all of the schools in a number of ways including by phone, email, leaving telephone messages and in person, yet in some instances the schools were unavailable to arrange the sessions. Due the timing of the focus groups, it was also difficult for schools who were contactable to find time for the focus groups around school trips, exams and other end of year events. Even when focus groups were arranged with the schools and booked in several weeks in advance, the evaluation team experienced difficulties. For example, a focus group was booked in with a member of staff for one of the participating secondary schools. When the evaluation team arrived to conduct the session the administration staff had not been informed and could not get in touch with the member of staff who booked it in. The team waited for 45 minutes, and eventually had to leave as it was the end of the school day on the last day of term and, even had the students been willing to take part, there was not enough time to speak with them before the end of the school day. Similarly, although the Pupil Referral Unit were aware of the programme and were willing to host the focus groups, it became clear that only one young person who took part in the workshops was still in attendance, and therefore a focus group would not have been possible. This feedback would have been invaluable in assessing suitability of the programme for other referral units. Despite this, the sample is adequate for assessing this pilot stage of the programme. Further evaluation, especially for any PRU, should be built in to any future roll out of the pilot.

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Validity of Data The evaluation team aimed to provide an independent evaluation of the whole programme via collection of data from all key stakeholders. However, due to limited funding and resources, it was decided that the evaluation team would not be responsible for distributing and collecting the bespoke pre-evaluation questionnaires. The programme delivery team agreed that the workshop facilitators would be responsible for distributing and collecting these questionnaires. However, due to various difficulties, not all workshop participants received and completed the pre-evaluation forms before the workshops. This is a threat to the validity of the outcomes of the workshops, as there is no pre-workshop baseline of attitudes to help-seeking, mental health literacy and importance of exercise. Therefore, the differences in responses may not represent the true effect and impact of the programme. Additionally, students may not have felt able to respond to the questionnaires honestly, as the person distributing and collecting the questionnaires was the person delivering the training. This may have led to some bias of responses. However, independent focus groups have enabled unbiased data collection.

Lack of long term outcomes and evaluation As discussed previously, due to the timeframes given to the complete the evaluation, it was not possible to complete any long-term follow up on the impact of the programme. Students provided feedback immediately after the workshops and within two weeks of finishing the programme. Teachers provided feedback immediately after the end of the programme. In order to assess the long-term impact of the programme it would have been useful to have time allowed for a longer follow up period. Additionally, as discussed under heading ‘meeting the primary outcomes of the brief’ above, the evaluation was unable to assess any long-term outcomes such as return on investment without the timeframes to collect this type of data. This information is vital to assess the long-term sustainability and impact of the programme as a whole. Any future roll out of the programme would need to include collection of this data and factor in time for a longer follow up and data collection period. As noted earlier, schools also stated that they had yet to start implementing some of the ideas and training and were postponing this phase of the programme until the new term in September. There are also some elements of the programme being conducted with schools in September. Consequently, this evaluation may not capture the impact of the overall programme on the school.

Lack of opportunity for teacher and trainer/facilitator feedback Another impact of the short timeframe and the timing of the programme coinciding with the end of the school year was the lack of opportunity to gain feedback from other key stakeholders. For example, the evaluation included a survey of all school staff conducted online. Unfortunately, due to the short timeframe between completion of the programme, start of summer holidays at the schools and delivery of the evaluation report, the number of responses was limited, leading to a lack of feedback from staff in the schools. Additionally, a survey for trainers was circulated and although response rates were good, further discussions and focus groups conducted by the independent evaluation team with trainers/facilitators to gain their feedback and recommendations would have been invaluable.

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Recommendations Key recommendations for future roll out of the programme Based on this independent evaluation, the following key recommendations are made for future programmes: 1. Allow more time for trainers across different organisations to work together and plan activities for the sessions. 2. The training and workshops should be adapted for different schools and environments depending on the needs of the school (e.g. SEN schools, PRU). 3. Within schools, a designated contact person should be put in place and engaged early on in the delivery of the programme to ensure the programme runs smoothly and all organisations have a key point of contact. Clear timetables, schedules and preparations are made for trainers and facilitators and reminders provided on a regular basis. 4. Consider running the programme earlier in the school year and over a longer period of time to enable schools to fully implement what has been learnt and make changes in their schools. 5. The evaluation team should be engaged early, before the beginning of the programme. Clear procedures for assessing the delivery and impact of each component of the programme are in place and communicated with the training organisations, trainers and schools before the start of the programme.

Additional learning points to be considered Learning points are presented throughout the report in their relevant sections and are listed below for ease of reference:

1. Ensure flexible course content with modules that can be adapted, added or omitted to meet the needs of each school and/or class. 2. Modules should include a mixture of physical activities and games, as well as discussion and classroom based tasks. 3. A high level of skills and experience of the facilitators was essential for the success of the programme. 4. Facilitators should continue to be trained and supported to a high level before and throughout the programme to enable them to engage and support students. 5. Ensuring schools are fully engaged with the programme is an essential criteria for success. The programme could consider awarding certificates to schools who take part, and introducing a system of recognition for schools who complete and implement various stages of the programme. This system could then become recognised across Greater Manchester as a standard for Mental Health in schools. 6. Further work should be conducted with staff and students from the PRU and SEN to consider any further adaptations needed to successfully offer the programme in these settings. Further pilot work followed by further evaluation is needed in these settings to determine if this approach is appropriate to meet the needs of these groups. 7. All organisations should continue to work closely to develop the programme. In particular, athlete mentors and facilitators from Place2Be and 42nd Street should be funded to co-facilitate the workshops with young people for the whole day rather than having separate sessions.

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8. Any future roll out of the Mentally Healthy Schools Programme should firstly consider any existing similar schemes in the area, and whether these would complement each other or be competing schemes with competing demands on staff and student time. In order to fully evaluate the programme as a standalone package, schools would need to only be involved in one scheme. 9. A job description for the Youth Health Ambassador role should be developed and agreed with young people, teachers and trainers. This should be provided to students and teachers in advance, so schools are fully aware of what is involved and what to expect from the training. 10. The structure for training YHA in primary schools should be replicated across all schools. This would allow the YHA to be trained first, then attend the nurture workshops and integrate with fellow students. YHA can then help facilitate activities and promote their role from the outset. 11. Schools should be provided with an introductory pack, which details what to expect from the course, facilities needed on the day and suggested preparation materials. 12. Mental health champions should ideally attend the nurture workshops with young people so they are fully aware of the course content and integrated into the sessions with the students. 13. All school staff, including administration teams, should be made fully aware of the programme and timetables in advance of the start dates. 14. Consideration should be given to the timing of any future programmes. Consultation with school staff and students suggests that they would prefer to start the programme earlier in the school year and potentially over a longer period to enable them to fully implement what has been learned and make changes in their schools. 15. An introductory pack for schools taking part would be useful and this could include more information about the content of the nurture workshops and the ideal students for this programme. A simple tick list of suggested characteristics and needs would be ideal to allow teachers to select appropriate students. 16. Mental Health Champions should be involved in selection of students for the nurture workshops at each school. This would utilise their knowledge and training fully and integrate them in the whole programme.

Future Impact The Mentally Healthy Schools Programme has potential to positively impact on young people and their understanding of mental health and wellbeing, as well as offering school staff further training and support networks in their schools. Young people who took part appeared to enjoy the opportunity to learn about health and wellbeing and take part in the programme, and said that they would recommend the programme to friends. The programme has proven to be an excellent opportunity to start a conversation with schools about how to tackle mental health and wellbeing for young people. However, this evaluation has not captured the long-term impact on young people and whether the programme has been helpful or harmful to their own mental health as well as their understanding of health and wellbeing more generally. Careful consideration of these factors should take place before any future roll out of the programme, including built in mechanisms to conduct further evaluations. Further development of the programme should take place working alongside key stakeholders such as students, parents/carers, school staff and facilitators, as well as an independent evaluation team.

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Conclusions The Mentally Healthy Schools Rapid Pilot was implemented successfully over a short period of time. Overall, feedback from key stakeholders was very positive, with students generally enjoying the programme and school staff finding it beneficial to their schools. There is still further work required to address some key challenges. Recommendations for this are included in this report. Further work to evaluate the long-term impact on students, staff and schools as a whole is needed as part of any future roll out.

References Goodman. R. (2001). Psychometric properties of the strengths and difficulties questionnaire. Journal of the American Academy of Child and Adolescent Psychiatry, 40 (11), 1337-1345. Law, D., & Wolpert, M. (2014). Guide to using outcomes and feedback tools with children, young people and families. UK: Press CAMHS. Meltzer, H., Gatward, R., Goodman, R., and Ford, F. (2000) Mental health of children and adolescents in Great Britain. London: The Stationery Office Topp C.W., Østergaard S.D., Søndergaard S., & Bech P. (2015). The WHO-5 Wellbeing Index: A Systematic Review of the Literature. Psychotherapy and Psychosomatics, 84, 167-176. Ware Jr, J. E. (1995). The status of health assessment 1994. Annual review of public health, 16(1), 327-354. WHO. (1998). Wellbeing Measures in Primary Health Care/The Depcare Project. WHO Regional Office for Europe: Copenhagen.

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Section 5: Appendix A. Mental Health First Aid Youth Evaluation Forms

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B. Mental Health First Aid Lite Evaluation Forms

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C. Mental Health First Aid Updated Evaluation Forms (GDPR)

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D. Secondary Students Pre-evaluation Questionnaire

Mentally Healthy Schools – Pre-questionnaires Secondary Introduction Thank you for agreeing to fill in this questionnaire, which is part of the ‘Mentally Healthy Schools’ programme. This questionnaire will ask you some questions about what exercise you do and why. It will also ask about being active, your health and wellbeing, how you feel about school, your confidence and anything you might be finding difficult at the minute. This should take about 20 minutes to fill in and we will keep your responses safe so nobody will know it belongs to you. If you don’t want to take part that is fine, just tell your teacher and you will not have to fill in the questionnaire. If you change your mind while you are doing it that’s fine too. When you are filling in the questionnaire if you get worried about anything talk to your teacher and they will be able to help you. Remember there are no right or wrong answers so just select the option which is most right for you! I understand the purpose of this survey and I am willing to take part (Tick one) Yes No

Section 1: About you What is your gender? (Tick one) Male Female

Prefer not to say

What is your ethnicity? (Tick which best describes your ethnic group/background)

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Black / African / Caribbean / Black British

Mixed / multiple ethnic group

Asian / Asian British

White

Other

Prefer not to say

What school do you go to? (Tick one) Cedar Mount Academy Our Lady’s RC School Secondary Dean Trust Ardwick Phillips High School Secondary Essa Secondary Academy Pioneer House High School Lostock College St Gabriel’s RC High School Manchester Academy Sale High School Secondary Manchester Creative & Media Stretford Grammar Academy (MCMA) Secondary Manor House High School Trafford High School Melland High School Wellacre Academy Secondary Oasis Academy Wright Robinson Secondary About you What is your date of birth? (e.g. DD/MM/YYYY = 05/01/2005) Day Month Year What are your initials?

Do you have any health problems or disabilities which stop you from being active? (Tick one) Yes No Prefer not to say

Section 2: Being Active This part is all about being active. Being active includes anything that makes you feel warmer and makes your heart beat faster. This includes:

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Moderate activities: such as brisk walking, dancing, walking domestic animals, chores More vigorous activities: such as running, cycling, aerobics, swimming and competitive sports (football, basketball) (Tick one per row)

Never

Some days

Most days

Every day

I am active….. I generally do more than 60 minutes of activity a day in total … (this does not have to be all at once, it could be 30 minutes in the morning, 30 minutes in the afternoon) In a normal week I would be active….

On a normal day how many minutes are you active? Minutes per day

Exercise and Physical Activity We are interested in reasons why people do and do not exercise. Please answer each question below by selecting how true the reason is for you. Remember there are NO right or wrong answers! (Tick one per row) Not true for me

Mostly not true for me

Sometim es not true for me

Mostly true for me

Very true for me

It’s important for me to exercise regularly I don’t see why I should have to exercise I feel guilty when I don’t exercise I exercise because my friends or family say I should I have fun when taking part in P.E. I enjoy exercise

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Section 3: Health Wellbeing We are interested in your overall wellbeing and the way you feel. Please tick the box that is closest to how you have been feeling over the last two weeks. (Tick one for each row) At no time Over the last two weeks

Some of the time

Less than half of the time

More than half of the time

Most of the time

All of the time

I have felt cheerful and in good spirits I have felt calm and relaxed I have felt active and vigorous I woke up feeling fresh and rested My daily life has been filled with things that interest me

Body Image This section will help us understand how you feel about your body image. Please select how often the following statements apply to you on a scale of never to always. (Tick one for each row) Never Not Sometimes Often Always Often I like what I look like in pictures I wish I looked better I worry about the way I look I like what I look like in the mirror

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Section 4: Confidence Using the scale below, rate one response for how true each statement is for you. (Tick one per row) Not at all true

Very untrue

Somewhat true

Very true

True all the time

I feel in control of my school work I like the people I am in school with People at school tell me I am good at what I study I am free to express my ideas and opinions at school Most days I feel like I’ve achieved something from studying People at school care about me I am able to set personal goals I am able to solve problems I achieve the things I want to I communicate well with others I work well within a team I positively influence others

Section 5: Mental Health Stress and Anxiety On a scale of 1 to 5 how would you rate your knowledge and understanding of… (circle one per row) 1) …. The causes of stress and/or anxiety? 1 2 3 4 5 Lowest Highest 2) … The impact of stress and/or anxiety on your physical and mental health and wellbeing? 1 2 3 4 5 Lowest Highest 3) … How to look after your own mental health and wellbeing? 1 2 3 4 5 Lowest Highest 4) … How to support your friends and peers with their mental health and wellbeing? 1 2 3 4 5 Lowest Highest 5) … Who or where to go to for support if you or a friend/peer were experiencing stress and/or anxiety? 1 2 3 4 5 Lowest Highest

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Strengths and Difficulties For each item please tick the box for Not True, Somewhat True or Certainly True. It would help us if you answered all items as best you can even if you are not certain or it seems daft! Please give your answers on the basis of how things have been for you over the last six months. (Tick one per row) Not True

Somewhat True

Certainly True

I try to be nice to other people. I care about their feelings I am restless, I cannot stay still for long I get a lot of headaches, stomach-aches or sickness I usually share with others (food, games, pens etc.) I get very angry and lose my temper I am usually on my own. I generally play alone or keep to myself I usually do as I’m told I worry a lot I am helpful if someone is hurt, upset or feeling ill I am constantly fidgeting or squirming I have one good friend or more I fight a lot. I can make other people do what I want I am often unhappy, down-hearted or tearful Other people my age generally like me I am easily distracted, I find it difficult to concentrate I am nervous in new situations. I easily lose confidence I am kind to younger children I am often accused of lying or cheating Other children or young people pick on me or bully me I often volunteer to help others (parents, teachers, children) I think before I do things I take things that are not mine from home, school or elsewhere I get on better with adults than with people my own age I have many fears, I am easily scared I finish the work I’m doing; my attention is good

Thank you very much for filling in our questionnaire! 113

E. Secondary Students Post-evaluation Questionnaire

Mentally Healthy Schools – Post-questionnaires Secondary Cedar Mount Academy Introduction Thank you for agreeing to fill in this questionnaire. You have been given this because you have recently taken part in the Mentally Healthy Schools Programme. This should take about 20 minutes to fill in and we will keep your responses safe. If you don’t want to take part that is fine, just tell your teacher. If you change your mind that’s fine. If you get worried talk to your teacher and they will be able to help you. You may recognise some of the questions from last time, so remember there are no right or wrong answers and just select which is right for you! I understand the purpose of this survey and I am willing to take part (Tick one) Yes No

Section 1: About you What is your gender? (Tick one) Male Female

Prefer not to say

About you What is your date of birth? (e.g. DD/MM/YYYY = 05/01/2005) Day Month Year What are your initials?

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Section 2: Being Active This part is all about being active. Being active includes anything that makes you feel warmer and makes your heart beat faster. This includes: Moderate activities: such as brisk walking, dancing, walking domestic animals, chores More vigorous activities: such as running, cycling, aerobics, swimming and competitive sports (football, basketball)

(Tick one per row)

Never

Some days

Most days

Every day

I am active….. I generally do more than 60 minutes of activity a day in total … (this does not have to be all at once, it could be 30 minutes in the morning, 30 minutes in the afternoon) In a normal week I would be active….

On a normal day how many minutes are you active? Minutes per day

Exercise and Physical Activity We are interested in reasons why people do and do not exercise. Please answer each question below by selecting how true the reason is for you. Remember there are NO right or wrong answers! (Tick one per row) Not true for me

Mostly not true for me

Sometim es not true for me

Mostly true for me

Very true for me

It’s important for me to exercise regularly I don’t see why I should have to exercise I feel guilty when I don’t exercise I exercise because my friends or family say I should I have fun when taking part in P.E. I enjoy exercise

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Section 3: Health Wellbeing We are interested in your overall wellbeing and the way you feel. Please tick the box that is closest to how you have been feeling over the last two weeks. (Tick one for each row)

At no time Over the last two weeks

Some of the time

Less than half of the time

More than half of the time

Most of the time

All of the time

I have felt cheerful and in good spirits I have felt calm and relaxed I have felt active and vigorous I woke up feeling fresh and rested My daily life has been filled with things that interest me

Body Image This section will help us understand how you feel about your body image. Please select how often the following statements apply to you on a scale of never to always. (Tick one for each row) Never

Not Often

Sometimes

Often

Always

I like what I look like in pictures I wish I looked better I worry about the way I look I like what I look like in the mirror

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Section 4: Confidence Using the scale below, rate one response for how true each statement is for you. (Tick one per row) Not at all true

Very untrue

Somewhat true

Very true

True all the time

I feel in control of my school work I like the people I am in school with People at school tell me I am good at what I study I am free to express my ideas and opinions at school Most days I feel like I’ve achieved something from studying People at school care about me I am able to set personal goals I am able to solve problems I achieve the things I want to I communicate well with others I work well within a team I positively influence others

Section 5: Mental Health Stress and Anxiety Since taking part in the workshop, on a scale of 1 to 5 how would you rate your knowledge and understanding of… (circle one per row) 1) …. The causes of stress and/or anxiety? 1 2 3 4 5 Lowest Highest 2) … The impact of stress and/or anxiety on your physical and mental health and wellbeing? 1 2 3 4 5 Lowest Highest 3) … How to look after your own mental health and wellbeing? 1 2 3 4 5 Lowest Highest 4) … How to support your friends and peers with their mental health and wellbeing? 1 2 3 4 5 Lowest Highest 5) … Who or where to go to for support if you or a friend/peer were experiencing stress and/or anxiety? 1 2 3 4 5 Lowest Highest

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Strengths and Difficulties For each item please tick the box for Not True, Somewhat True or Certainly True. It would help us if you answered all items as best you can even if you are not certain or it seems daft! Please give your answers based on how things have been for you over the last 4 weeks. (Tick one per row) Not True

Somewhat True

Certainly True

I try to be nice to other people. I care about their feelings I am restless, I cannot stay still for long I get a lot of headaches, stomach-aches or sickness I usually share with others (food, games, pens etc.) I get very angry and lose my temper I am usually on my own. I generally play alone or keep to myself I usually do as I’m told I worry a lot I am helpful if someone is hurt, upset or feeling ill I am constantly fidgeting or squirming I have one good friend or more I fight a lot. I can make other people do what I want I am often unhappy, down-hearted or tearful Other people my age generally like me I am easily distracted, I find it difficult to concentrate I am nervous in new situations. I easily lose confidence I am kind to younger children I am often accused of lying or cheating Other children or young people pick on me or bully me I often volunteer to help others (parents, teachers, children) I think before I do things I take things that are not mine from home, school or elsewhere I get on better with adults than with people my own age I have many fears, I am easily scared I finish the work I’m doing; my attention is good

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The Future Totally Disagree Neither Agree Totally disagree agree or agree disagree I have hope and feel optimistic about my future I feel I will have a better standard of living than my parents I feel I deal well with unexpected events I feel supported to explore my strengths and talents and use that to make choices about potential jobs, education and training I feel that my curriculum/subjects will provide me with the skills and knowledge needed to succeed in the real world I feel if I try hard at school and apply for a job. I will be given an equal chance despite my gender, age or where I live

What do you think Life Ready means?

What do you need to achieve it?

Thank you!

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F. Pre-evaluation Guidance Notes

Guidance Notes Thank you for agreeing to take part in the Mentally Healthy Schools Programme. This guidance has been developed to go alongside the questionnaires which your students will be completing. We are evaluating the programme and whether it affects things like how active they are, their health, their confidence, how they feel about school and things they may find difficult. Here are a few tips which may be useful when helping students complete our questionnaires: General 

Reassure the students that there are no right or wrong answers to any question and if they are worried, tell them that nobody outside of our team will have access to their responses so they can be honest.  Remind them to select one response per question/statement, if they are unsure they can just pick which fits best!  Allow them to take a break if they need to and feel free to split it up into two sessions if needed. Being active 

Physical activity does not just include exercise or playing sport, anything which raises the heart rate and makes them breathe faster is counted. This includes things like playing outside with friends, riding their bike and walking the dog.  The 60 minutes of ‘exercise’ does not need to be done all in one go, it can be done over separate periods e.g. 2 x 30 minute bursts of activity. Wellbeing 

These questions are taken from a World Health Organisation measure of wellbeing and are validated for primary school age children and above.  We understand that it may take a little longer for younger children to fill this in due to the additional options but encourage them to take their time and read through it carefully. Strengths and difficulties 

This is another validated measure for use in primary school children and above. We understand some students may have difficulty with the responses. Here is an example:

I usually share with others (food, games, pens etc.)

Not True If they never share

Somewhat True If they sometimes share e.g. with certain people, or with specific items but not all the time

Certainly True If they are happy to share everything and this describes them



For primary school children we have also added in a visual aid which is a cross for not true, tick for somewhat true and two ticks for certainly true. If you have any feedback on Mentally Healthy Schools or the questionnaires please feel free to get in touch.

Thank you 120

G. Primary Students Pre-evaluation Questionnaire

Mentally Healthy Schools – Pre-questionnaires Primary [SCHOOL NAME……………………] Introduction Thank you for agreeing to fill in these questions, which is part of the ‘Mentally Healthy Schools’ programme. There are no right or wrong answers. Ask your teacher if you need help! This questionnaire will ask about:  Being active  Your health and body  Confidence  Wellbeing It will take about 20 minutes and we will keep it safe! Nobody will know this quiz is yours. If you don’t want to fill it in that’s fine, just tell your teacher  If you change your mind that’s also fine too!

I understand why I have been asked to do this and I am willing to take part (Tick one) Yes No

Section 1: About you Put a tick next to your answer Are you a …..? Boy

Girl

Do you have any health problems or disabilities that stop you from being active? (Tick one)

Prefer not to say

Yes

No

Prefer not to say

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Section 2: Being active This part is all about being active. Being active includes anything that makes you feel warmer and makes your heart beat faster. This includes things like:

Never

Some days

Most days

Every day

(Tick one per row) I am active….. I generally do more than 60 minutes of activity a day in total … (this does not have to be all at once, it could be 30 minutes in the morning, 30 minutes in the afternoon) In a normal week I would be active….

On a normal day how many minutes are you active? Minutes per day

How much do you agree with the following? (Tick one per row) Not Not A little at all much I understand it is important to keep active My family and friends help me to be active I enjoy being active I had fun when taking part in P.E. I feel bad if I am not being active

A lot

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Section 3: Your health

We are interested in how you feel. Please tick the box that is closest to how you have been feeling over the last two weeks. (Tick one for each row) At no Some Less More Most of All of the time of the than than the time time Over the last two time half of half of weeks…. the the time time I have felt cheerful I have felt calm and relaxed I have felt active I woke up feeling fresh and rested My life has been filled with things that interest me

Section 4: Wellbeing How much do you agree with the following? (Tick one per row) Not Not A little at all much I know what can make people feel upset or worried I know what to do if I feel upset or worried I know what to do if my friends feel upset or worried I know who to tell if I am upset or worried I know who to tell if my friends are upset or worried

How do you feel about school? (circle one) 1 2 3 Hate it!

4

A lot

5 Love it!

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Strengths and Difficulties For each item please tick the box for Not True, Somewhat True or Certainly True. It would help us if you answered all items as best you can even if you are not certain or it seems daft! Please give your answers based on how things have been for you over the last six months. (Tick one per row) Over the last six months…

Not True

Somewhat True

Certainly True

I try to be nice to other people. I care about their feelings I am restless, I cannot stay still for long I get a lot of headaches, stomach-aches or sickness I usually share with others (food, games, pens etc) I get very angry and lose my temper I am usually on my own. I generally play alone or keep to myself I usually do as I’m told I worry a lot I am helpful if someone is hurt, upset or feeling ill I am constantly fidgeting or squirming I have one good friend or more I fight a lot. I can make other people do what I want I am often unhappy, down-hearted or tearful Other people my age generally like me I am easily distracted, I find it difficult to concentrate I am nervous in new situations. I easily lose confidence I am kind to younger children I am often accused of lying or cheating Other children or young people pick on me or bully me I often volunteer to help others (parents, teachers, children) I think before I do things I take things that are not mine from home, school or elsewhere I get on better with adults than with people my own age I have many fears, I am easily scared I finish the work I’m doing; my attention is good

Thank you very much for filling in our questionnaire! 124

H. Primary Students Post-evaluation Questionnaire

Mentally Healthy Schools – Post-questionnaires Primary Acre Hall Primary Introduction Thank you for answering our questions. You might remember some of these questions from before, but that’s ok. There are no right or wrong answers. Ask your teacher if you need help! It will take about 20 minutes and we will keep your answers safe! Nobody will know these are your answers because it doesn’t have your name on it. If you don’t want to fill it in that’s fine, just tell your teacher  If you change your mind halfway through, that’s also fine too!

I understand why I have been asked to do this and I am willing to take part (Tick one) Yes No

Section 1: About you Put a tick next to your answer Are you a …..? Boy

Girl

Do you have any health problems or disabilities that stop you from being active? (Tick one)

Prefer not to say

Yes

No

Prefer not to say

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Section 2: Being active This part is all about being active. Being active includes anything that makes you feel warmer and makes your heart beat faster. This includes things like:

Never

Some days

Most days

Every day

(Tick one per row) I am active….. I generally do more than 60 minutes of activity a day in total … (this does not have to be all at once, it could be 30 minutes in the morning, 30 minutes in the afternoon) In a normal week I would be active….

On a normal day how many minutes are you active? Minutes per day

How much do you agree with the following? (Tick one per row) Not Not A little at all much I understand it is important to keep active My family and friends help me to be active I enjoy being active I had fun when taking part in P.E. I feel bad if I am not being active

A lot

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Section 3: Your health

We are interested in how you feel. Please tick the box that is closest to how you have been feeling over the last two weeks. (Tick one for each row) At no Some Less More Most of All of the time of the than than the time time Over the last two time half of half of weeks…. the the time time I have felt cheerful I have felt calm and relaxed I have felt active I woke up feeling fresh and rested My life has been filled with things that interest me

Section 4: Wellbeing How much do you agree with the following? (Tick one per row) Not Not A little at all much I know what can make people feel upset or worried I know what to do if I feel upset or worried I know what to do if my friends feel upset or worried I know who to tell if I am upset or worried I know who to tell if my friends are upset or worried

How do you feel about school? (circle one) 1 2 3 Hate it!

4

A lot

5 Love it!

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Strengths and Difficulties For each item please tick the box for Not True, Somewhat True or Certainly True. It would help us if you answered all items as best you can even if you are not certain or it seems daft! Please give your answers based on how things have been for you over the last two weeks. (Tick one per row) Over the last two weeks…

Not True

Somewhat True

Certainly True

I try to be nice to other people. I care about their feelings I am restless, I cannot stay still for long I get a lot of headaches, stomach-aches or sickness I usually share with others (food, games, pens etc) I get very angry and lose my temper I am usually on my own. I generally play alone or keep to myself I usually do as I’m told I worry a lot I am helpful if someone is hurt, upset or feeling ill I am constantly fidgeting or squirming I have one good friend or more I fight a lot. I can make other people do what I want I am often unhappy, down-hearted or tearful Other people my age generally like me I am easily distracted, I find it difficult to concentrate I am nervous in new situations. I easily lose confidence I am kind to younger children I am often accused of lying or cheating Other children or young people pick on me or bully me I often volunteer to help others (parents, teachers, children) I think before I do things I take things that are not mine from home, school or elsewhere I get on better with adults than with people my own age I have many fears, I am easily scared I finish the work I’m doing; my attention is good

Thank you very much for filling in our questionnaire!

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I. Post-evaluation Guidance Notes

Guidance Notes Please find enclosed the questionnaires and evaluation forms we would like your students to complete as part of the Mentally Healthy Schools Programme. The short questionnaire should take students approximately 15-20 minutes to fill in and will ask them about things such as physical activity, health, confidence and how they feel about school. We would be grateful if you could get any students who participated in the nurture groups or the Mentally Healthy Schools Programme to complete the questionnaires no later than FRIDAY 13TH JULY 2018. It is important that students have completed the second workshop with the athlete mentors prior to completing the questionnaires. We have also enclosed a 1 page evaluation form to be completed after the workshop to get their feedback on whether they enjoyed it or not. The questionnaires can be returned to the evaluation team either by post to: Greater Manchester Mental Health NHS Foundation Trust Psychosis Research Unit Rico House Bury New Road Manchester M25 3BL FAO: Rebekah Carney Alternatively, they can be scanned and emailed to [email protected] General Tips 

Reassure the students that there are no right or wrong answers to any question and if they are worried, tell them that nobody outside of our team will have access to their responses so they can be honest.



Remind them to select one response per question/statement, if they are unsure they can just pick which fits best!



Allow them to take a break if they need to and feel free to split it up into two sessions if needed.

Being active 

Physical activity does not just include exercise or playing sport, anything which raises the heart rate and makes them breathe faster is counted. This includes things like playing outside with friends, riding their bike and walking the dog.

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The 60 minutes of ‘exercise’ does not need to be done all in one go, it can be done over separate periods e.g. 2 x for 30 minute bursts of activity.

Strengths and difficulties 

This is another validated measure for use in primary school children and above. We understand some students may have difficulty with the responses. Here is an example:

I usually share with others (food, games, pens etc.)



Not True

Somewhat True

Certainly True

If they never share

If they sometimes share e.g. with certain people, or with specific items but not all the time

If they are happy to share everything and this describes them

For primary school children we have also added in a visual aid which is a cross for not true, tick for somewhat true and two ticks for certainly true.

If you have any feedback on Mentally Healthy Schools or the questionnaires please feel free to get in touch via the contact details above or call 0161 358 0830. Thank you

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J. Student Evaluation Forms

Mentally Healthy Schools –Feedback Thank you for agreeing to fill in this questionnaire. We are interested in what you thought of taking part. This should take 5 minutes to fill in and we will keep your responses safe so nobody will know it belongs to you. Remember there are no right or wrong answers! Let your teacher know if you need any help.

How much did you enjoy taking part? (Circle one) 1 2 3 Hated it!

4

5 Loved it!

Tick one answer per row Not at all

A little

A lot!

I enjoyed taking part It was interesting It was boring I disliked it I learnt something new I would take part again I didn’t understand it

3) What did you enjoy the most?

4) What did you enjoy the least?

How many marks would you give it out of 10?

/ 10

Thank you 131

K. Introductory letter to schools (template) [DATE] Dear [INSERT CONTACT],

Your school has recently taken part in the Mentally Healthy Schools Rapid Pilot Program. Thank you for your involvement and we hope it has been beneficial and enjoyable for your pupils and staff. An experienced team of researchers from the University of Manchester and Greater Manchester Mental Health NHS Foundation Trust are currently evaluating the program. This consists of: Professor Alison Yung: Director, Youth Mental Health Research Unit Dr Heather Law: Manager, Youth Mental Health Research Unit Dr Rebekah Carney: Research Associate, Youth Mental Health Research Unit In order to assess the impact it has had on student wellbeing and general school life they will require access to further information from your schools. This includes whether your students are accessing the school welfare services, if teachers are making appropriate referrals and whether the school welfare staff feel supported. One of the research team will contact you shortly and we would be grateful if your school will provide this information over the phone. They will also be sending out a short online survey towards the end of the school year via email to all teachers. Here they will be asking all staff at your school about mental health of students. Ten schools will also receive a more in-depth evaluation. If this is the case for your school, the researchers will visit before the end of term to conduct a small group discussion with 6-8 pupils who have taken part in the program. If you wish to contact a researcher in the meantime please email [email protected] or call 0161 358 1395.

If you have any issues, or questions please do not hesitate to get in touch.

Yours sincerely,

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L. Observational Data

Rapid Pilot Program Evaluation – Observations School Name: Date: Where it took place: (describe the surroundings)

# Pupils taking part over whole day: Other staff present: Summary of day

YST Conducted by Session

Morning Duration:

Afternoon

Summary of session

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Rapport with students Observe how well the programme is conducted with the students, how the facilitators develop rapport, whether this is achieved or not

Engagement Assess how engaged students are, do the facilitators need to prompt their engagement, do students seem happy with the programme, are they taking part willingly?

Non-verbal cues of the students

# Active participants

# Not participating

# incidents Include disruptive behaviour, attention seeking, telling off by teacher, removed from session, conflict between pupils, facilitators and staff

Any other observations of interest

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P2B or 42nd Street Conducted by Session

Morning Duration:

Afternoon

Summary of session

Rapport with students Observe how well the programme is conducted with the students, how the facilitators develop rapport, whether this is achieved or not

Engagement Assess how engaged students are, do the facilitators need to prompt their engagement, do students seem happy with the programme, are they taking part willingly?

Non-verbal cues of the students

# Active participants

# Not participating

# incidents Include disruptive behaviour, attention seeking, telling off by teacher, removed from session, conflict between pupils, facilitators and staff

Any other observations of interest

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Additional Notes:

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M. Focus Group Interview Schedules

Rapid Pilot Program Evaluation – Focus Group School Name: Date:

Introductions Introduce ourselves. You’ve all been invited because you were specially selected to take part in the [MENTALLY HEALTHY SCHOOLS] program. So that includes the athletes coming in [NAME ATHLETE] and [42ND St / Place2Be]. We’re here so that we can find out what you thought about it, what you liked or didn’t like about it, and if it has made any difference in your school. We don’t work for the people who run the program so you can be totally honest with us! We will just have a chat about it and feedback to them what people generally thought about it – without using any names or letting them know who said it. This will help if they are going to come into schools again and do it for other students like you. You don’t have to answer anything you don’t want to and if you want to take a break at any time that’s fine. It should last about [XX minutes] and we will record it but that’s so that we can chat with you rather than scribbling down everything you say!

1. Tell us about what you have been doing

Programme 2. What did you think of it? Guidance: discuss what they thought of the overall programme – use thumbs up/thumbs down. Go through each of the components and ask if they liked or didn’t like. PROMPTS: - overall

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- athlete mentor - wellbeing workshops - other components PROMPTS: - did you enjoy it? (why) - did you not enjoy it? (why) - was it what you expected?

Individual Responses 3. Favourite part Guidance: pass around a ball and get people to say their favourite thing about taking part, if they don’t want to say anything that’s fine just pass along to the next person.

4. Least favourite part Guidance: pass around a ball and ask to say the thing they’ve liked least about it, if nothing that’s fine - if you could change one thing what would it be - what would you change it to

5. Young Health Ambassadors Guidance: See if they are aware of YHAs and see how they feel about not being a part of it

Impact 5. How useful was it? [Guidance: thumb up and thumb down for usefulness, then pass around the ball and see if they can say one thing they have learned or become more aware of as a result of the programme. Prompt doesn’t have to be linked to school, can be something you have learned about yourself, can be something you have become more confident with]

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- what did you learn - how do you think it will help in the future - was it what you expected - would you take part again

6. We are interested in finding out how you feel in school. Has the program changed anything in your school? Or are you aware of where you would go for help if you needed it? [Guidance: prompt here to see if there has been any change to the whole school ethos, whether it has affected how aware people are of the counsellors/wellbeing advisors etc.] -

If you are struggling with your health or wellbeing where would you go? Prompt has this changed since the programme, did you know about it before, would you access it before

-

Have there been any changes around the school? (eg. Events, assemblies) How is mental health discussed in your school?

7. Would it work in other schools/for other students? [Guidance: encourage them to think about whether other people the same age as them would enjoy it, how about older kids, what about younger kids, other schools in different areas?]

Summary Thank-you for taking part, hope you enjoyed it, any questions for us?

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N. Place2Be Initial YHA Assessment

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O. Place2Be Evaluation Forms YHA – Mental Health Champion SLT

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P. Young Health Ambassador Evaluation Form

Young Health Ambassador Questionnaire Thank you for agreeing to fill in this questionnaire. You have received this because you have been selected as a young health ambassador. We are interested in finding out about your experiences and how you have found this. This should take approximately 15 minutes to fill in and your responses will be kept confidential. You do not need to complete this questionnaire if you do not want to, and you are free to change your mind at any time. Please give your honest opinion. Name of school:

1) How much have you enjoyed being a young health ambassador? (Circle one) 1 Hated it!

2

3

4

5 Loved it!

2) Tick how much you agree/disagree with the following: (one per row) Disagree

Neither agree/disagree

Agree

Disagree

Neither agree/disagree

Agree

Since becoming a Young Health Ambassador… I feel more confident I know more about health and wellbeing I am aware of things I can do to reduce stress I know what to do if I am feeling worried or upset I can talk to my friends about their health I can recognise when my friends are worried or upset I know where to tell my friends to go if they are worried or upset I feel like I have achieved something

3) What do you find difficult: (one per row)

People don’t listen to me I didn’t like the training

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I don’t feel confident I didn’t like the trainer It isn’t what I expected It takes too much of my time I feel embarrassed I don’t get enough support Other:

4) Being a YHA makes me feel… (Tick all that apply) Happy Confident Special Proud Valued Embarrassed Stressed Under pressure Worried No different Other:

1 Least 1 1 1 1 1 1 1 1 1 1

6) Is being a YHA what you expected? (Circle one)

2

3

4

2 2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4 4 4

Yes

5 Most 5 5 5 5 5 5 5 5 5 5

No

6) How would you describe being a YHA?

1. 5) Write down three things you have done in your role as a YHA 2. 144

3.

1. 5) Write three things you would like support with in your role as a YHA

6) Would you recommend being a YHA to other students? (circle one)

2.

3.

Yes

No

Thank you

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Q. Trainer and Athlete Mentor Questionnaire

Trainer Questionnaire Thank you for agreeing to fill in this questionnaire. You have received this because you have been part of the ‘Mentally Healthy Schools’ Pilot. We are interested in finding out about your experience as a trainer. This should take approximately 15 minutes to fill in and your responses are confidential. You do not need to complete this questionnaire if you do not want to, and you are free to change your mind at any time. Please give your honest opinion.

1. Please select your organisation

2. How much did you enjoy being part of this programme? (Circle one) 1 Hated it!

2

3

4

5 Loved it!

3. How well do you feel the training went? (Circle one) 1 Awful

2

3

4

5 Excellent

4. Select how much you agree/disagree with the following statements (Tick one per row) Strongly Disagree

I enjoyed delivering the training I found it challenging Everything went as planned There was enough time to prepare There was enough time on the day to deliver the training

Disagree

S e l e c t h o w m

S e l e c t h o w

Neither agree/ disagree

S e l e c t h o w m

Agree

Strongly Agree

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I could deliver the training to the best of my ability I knew what was expected of me The materials I used were appropriate Attendees seemed to enjoy it Attendees seemed bored or uninterested I had to adapt the training to suit each school The programme was well-organised I felt confident delivering the training Attendees were suitable for the training It was stressful I had enough support to deliver the training The schools were appropriate The aims of the training were met

5. What went well?

6. What challenges did you face? (Select all that apply) Communication Transport Time Poor engagement Lack of support Other:

Unclear what was expected Lack of training People did not turn up Poor organisation Conflict or incidents

7. How would you improve the programme?

Thank you

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R. Teacher Questionnaire Survey Monkey Questions Thank you for agreeing to complete our questionnaire. You have been invited to take part because you work at a school that has recently taken part in the mentally healthy schools rapid pilot program. We are interested in finding out how schools address mental health, and if the mentally healthy schools program has had any effect. This questionnaire should take approximately 10 minutes and your responses are confidential. If you wish to provide your email address, you will be entered into a prize draw to win a voucher for £30. 1. What is your job role? Administrator Teaching Assistant Teacher Special Educational Needs Co-ordinator Counsellor Therapist (inc OT, Physical Therapist, Intervention Specialist, Nurse) School Leader (Head Teacher, Assistant Head Teacher) Other (inc maintenance, technical support, librarian, domestic, volunteer) 2. What school are you based at? Acre Hall Primary Alexandra Park Primary School Bedford Hall Methodist Primary School Cedar Mount Academy Dean Trust Ardwick Essa Primary Academy Essa Secondary Academy Healthfield Primary School Lime Tree Primary Lostock College Manchester Academy Manchester Creative & Media Academy Manor High School Melland High School Oasis Academy Our Ladys RC School Philips High School Pioneer House High School Rushbrook Primary Academy Sale High School St Wilfrid's CofE Primary School St. Gabriel's RC High School St. Hilda's Primary

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St. Mary C of E School Prestwich St. Mary's Cof E School Stanley Grove Primary Academy Stretford Grammar School The Olive Tree Primary School Trafford High School PRU Wellacre Academy Wright Robinson College 3. Are you aware of the mentally healthy schools program that has been happening in schools across Greater Manchester? Yes No 4. Did you receive additional training as part of the programme (i.e mental health champion, mental health first aid training)? Yes No 5. Since the program my knowledge and understanding of mental health has increased. Strongly Disagree Slightly Disagree Neither Slightly Agree Agree 6. Since the program, I feel more confident recognising mental health difficulties in students. Disagree Slightly Disagree Neither Slightly Agree Agree 7. Since the program, I feel like I now have the appropriate skills to be able to support students with their mental health. Disagree Slightly Disagree Neither Slightly Agree Agree 8. Since the program, I am able to recognise when I need to refer students on for additional help or support for their mental health Disagree Slightly Disagree

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Neither Slightly Agree Agree 9. I know where to send students to access help and support for their mental health. Disagree Slightly Disagree Neither Slightly Agree Agree 10. I feel confident referring people to the school counselling services if I think they need further help with their mental health. Disagree Slightly Disagree Neither Slightly Agree Agree 11. Since the program, I have referred more students to the school counselling services or for further support with their mental health. Disagree Slightly Disagree Neither Slightly Agree Agree 12. Mental health is spoken about openly in our school. Disagree Slightly Disagree Neither Slightly Agree Agree 13. Since the program, mental health and wellbeing is spoken about more often in our school. Disagree Slightly Disagree Neither Slightly Agree Agree 14. I know what contributes to poor mental health and wellbeing. Disagree Slightly Disagree Neither Slightly Agree

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Agree 15. I know what to do to look after my own mental health and wellbeing. Disagree Slightly Disagree Neither Slightly Agree Agree 16. My school actively promotes mental health and wellbeing of students. Disagree Slightly Disagree Neither Slightly Agree Agree 17. My school actively promotes mental health and wellbeing of staff. Disagree Slightly Disagree Neither Slightly Agree Agree 18. Since the program, there has been a greater interest in looking after mental health in our students and staff. Disagree Slightly Disagree Neither Slightly Agree Agree 19. Since the program, staff attitudes towards mental health have become more positive. Disagree Slightly Disagree Neither Slightly Agree Agree 20. The mentally healthy schools program has been beneficial to our school. Disagree Slightly Disagree Neither Slightly Agree Agree 21. Since the program, attendance rates have been higher in school.

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Disagree Slightly Disagree Neither Slightly Agree Agree 22. Since the program, truancy rates have been higher in school. Disagree Slightly Disagree Neither Slightly Agree Agree 23. Since the program, incidents of bad behaviour have decreased. Disagree Slightly Disagree Neither Slightly Agree Agree

24. Our school will continue to promote mental health and wellbeing in our pupils and staff. Disagree Slightly Disagree Neither Slightly Agree Agree

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S. Welfare Services Questionnaire

School Welfare Services Questionnaire Thank you for agreeing to fill in this questionnaire. You have received this because your school has recently taken part in the ‘Mentally Healthy Schools’ Programme. We are interested in finding out how this has affected school welfare services and counselling services. This should take approximately 5 minutes to fill in and your responses will be kept confidential. You do not need to complete this questionnaire if you do not want to, and you are free to change your mind at any time.

Since the mentally healthy schools program has taken place…. (Tick one answer per row) Less

About the same

More

How many referrals have you received to the school counselling service? How many of these referrals would you class as appropriate? How many have been inappropriate and not suitable for your service? How well do you feel able to cope with the demands on the school counselling service? How much pressure do you feel under? How well supported do you feel by the rest of the school? How aware do you think the students and staff are at ……………….. of mental health and the school counselling service?

How have you found the support you have received from CAMHS? Very Poor

Poor

1

2

Neither Poor/Good 3

Good

Very Good

4

5

Thank you

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T. Place2Be School Leaders Mental Health Champion Training - Feedback Provided by Sarah Golden at Place2Be.

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SEMH is important; think about both child/adult wellbeing; be honest, don’t label; be reflective Extremely beneficial. Allows you to reflect on practice in such a key area. It underpins every learner – “A happy, healthy mind” To attend course; develop your understanding on attachment; think about developing mental health in school Get involved with the project – you will enjoy it! The course is a significant investment in mental health, not a quick fix or ‘tips for teachers’ but the opportunity for a deep systematic consideration of improving mental health for all This has been really useful. It has given me the confidence to try to implement strategies in school to support mental health Get on board with this fabulous programme! Definitely consider this if you want to support staff to support pupils Take the opportunity to attend course – very valuable information that can be shared across school to benefit pupils and staff Get involved; learn a great deal about yourself, your pupils and your staff This training is really worthwhile; brilliantly delivered, excellent content, a great starting point around whole school mental health For me it has been good to discuss SEMH with my colleague and other staff from different schools Get involved – if you can help each other identify and improve mental health, you can help your children Very inspiring! Makes you think about pupils’, parents’ and staffs’ mental health! As a process it is so worth investing the time in this. It will hopefully enable us to create a really comprehensive system of support for all Amazing opportunity to give dedicated time and headspace to the most important aspect for children, staff and parents Get booked on ASAP! It will transform your perception of mental health and give you a wealth of ideas Think about your offer and make it count. A brilliant chance to adapt what we do and make ‘health’ education really purposeful for ALL Do it! It will change your perception on pupils, families and other agencies. It will strengthen your school leadership dramatically Everyone owes it to their children and staff to ensure MHFA/wellbeing remains a priority. No budget or external pressures should prevent this. Invest your time in those you need to invest in you. Parents, staff, outside support, yourself. Very good training. You gain a vast amount from talking to staff from other schools and sharing ideas – things to try back at your school

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It puts the child and their development at the heart of the school with a by-product of emotionally healthy children being a good citizen ready to take their place Attachment styles are very relevant; supportive CPD to lead whole school change I would recommend the Place2Be sessions for any staff wanting to know more about how we can support children/parents with mental health needs in school. Because we have done each day with the same people it allows for honest, open dialogue. Helps leaders consider mental health and wellbeing for all stakeholders to ensure positive outcomes for children and young people Interesting, informative, supportive, interactive, practical, cathartic, funny, helpful, forward thinking The course has allowed me to consider mental health and how it impacts all members of the academy, including students, staff, parents and governors Excellent content and very informative Makes you take a step back and look at things with a different lens A chance to be able to think about how to address mental health issues and explore the possible causes Given me the confidence to ensure I can take a whole school approach to supporting mental health with practical strategies to engage and support Networking with other schools; creating a wellbeing audit to inform an action plan Informative; deeper understanding of mental health An opportunity to reflect on own practice and take away ideas from others and resources from the course Developed my own knowledge of chid development and attachment. Space to think and plan/share experiences and learn from other schools. Help to develop a school mental health strategy Very interesting view of CAHMs and how it’s changing. Very strong theoretical grounding Thought provoking. Well sized chunks of information Thoroughly enjoyable; developed a greater understanding of the impact poor mental health can have on everyone involved Outstanding. Very useful and have learnt A LOT about what we are already doing that is good and how far we still have to go to be the best we can be! Reassuring and informative; helped me in giving me the confidence to discuss mental health A really useful and safe space to discuss mental health. Allowing opportunities to reflect, learn and plan on how to make positive changes Information is great; well worth the time and effort – great benefit to school A very valuable course with both strategic and practical/operational aspects. It has changed my perception of mental health and is now positively informing our school strategy Excellent insight into the theory that underpins mental health

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What are your thoughts and feelings about the course?               

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A complete eye opener! I felt that I knew about mental health before I started but soon realised I didn’t. So useful and has had a huge impact Enjoyed the chance to reflect. Feel it will enable me to develop as a leader Really enjoyable, loads of information and ideas. Lots to think about and reflect upon. Thank you! I feel more confident with my knowledge. Feel I could run INSET; motivated; feel I can initiate this positively in school Really informative, helped me in my new role and has given me and the school direction with our mental health and wellbeing Positive; provided knowledge/ understanding further about SEMH; useful; reflective Informative; helped to formalise my own thoughts and feelings on mental health. Provided lots of opportunities to discuss/network ideas/strategies Thought provoking; gives different perspectives; helpful in identifying areas you may have missed It’s been an amazing journey where I’ve had the time to understand how I can help children further Good to have time to come away from school, and think about ways to improve SEMH in our school Very informative; makes you think hard about your role and empathy for children – do you understand the full picture? An enlightening, interesting, enjoyable and fun course, giving me such a detailed insight into mental health awareness in schools Reflect on practice and how we can celebrate and improve what we do with our children Positive, challenging, thought-provoking, powerful So much more than “we better look at mental health”! Lots of ideas, sharing good practice; lots to think about with advice and opportunities for reflection and planning. Send at least 2 years! Informative; supportive; challenging; reflective; highlights what you need and want to change Empowering – it has made me really realise the importance of the whole child. I feel engaged, strong and ready to move forward to help children This workshop has been great. It has helped me look at our school, look at areas where we are strong and areas which could and will make us stronger. So helpful to listen to others It has been refreshing to talk about mental health within a school – both staff and pupils/parents Informative; worthwhile; good to talk about school issues – staff, children and parents Empowering; insightful; child focussed; powerful; reflective; enjoyable The Place2Be workshop has been a valuable learning experience in helping me better understand mental health in school for young people and adults. The sessions have been fun and informative and I have thoroughly enjoyed them A good introduction to mental health Awareness of attachment and how it impacts on behaviour

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An excellent way to evaluate your current mental health provision and look at ways to improve You will develop stronger links with CAHMs The course will give more confidence to deal with mental health issues If you are uncertain where to start formulating a holistic strategy, this course will give you practical strategies and approaches that you can use regardless of context or experiences Consider how the theory will apply practically in your school. It won’t be the same for everyone; no “one size fits all” Learn more about what Place2Be is about. Gain experience and take away resources on how to deal with mental health issues Training that encourages the opportunity to discuss, challenge and reflect. Punctuated with fun, interactive activities Chance to network and gain perspective. Develop your confidence in dealing with the growing issue of mental health issues in children Encourage all schools to undertake to allow for a deeper, clearer understanding of mental health Awareness of taking a holistic approach to mental health and the reasoning behind mental health issues Go with an open mind, get involved, you will take a lot away from the sessions Excellent opportunity to learn about aspects of mental health. I feel inspired and confident moving forward within my own school context with mental health at the heart of our overall strategy and curriculum The course has been really interesting, James is knowledgeable and empathetic. The information is really thought provoking and time to reflect has been beneficial. Thank you! Really useful to have the time and opportunity to explore mental health and how we prioritise and improve it in school for our staff, students and families A very useful period of reflective for me as well as lots of learning. I feel confident in moving forward in school but have a wider appreciation for mental health I can take into the world Very informative, lots of useful discussions and resources. Time given to think and do. Thank you! Very informative and thought provoking curse with many lightbulb moments. Please attend, you will learn a great deal about yourself, pupils and staff So useful to have discussions around mental health with other school leaders. I’ve learned a lot; lots of strategies to take aware and try in school Interesting, learning opportunity; engaging. Feel more knowledgeable and feel excited about developing further Helpful; develop understanding; confidence; feel able to implement changes Extremely useful; time to reflect and share practices and new idea. Reminder of what is going on under the surface I feel it’s something I have looked forward to; allowing a passion I have always had to be better informed and utilised in my role

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U. MHFA Qualitative feedback All very good Although a difficult subject, the course was delivered brilliantly! Belinda waas an excellent trainer! Amazing course. Fantastic information, exactly what I needed for my CPD Amazing! Thank you Belinda delivered an excellent course and her own experiences and insight was really useful. The day was enjoyable, despite the difficult content that had to be delivered Belinda is excellent, extremely knowledgeable and engaging. Thanks very much Belinda is hilarious and this helps with the nature of the course. Belinda I think you should be on the stage Belinda was a great course leader, really engaging and explored subjects using relevant and relatable cases. Brilliant resources to take and use in settings. Belinda was fab! Very enaging and full of knowledge. Great course Best course I've ever been on. Very well run and organised, great resources. So informative learnt loads. Lots of learning that I can take back to school to support me in my role. Thank you so much Lisa. Brilliant - Gained a great understanding Brilliant :) Brilliant course, really enjoyed it. Thank you very much. Could listen to Lisa all day, Thanks Excellent Excellent course - very thought provoking - difficult at times but lisa used humour when needed. I would definitely recommend to colleagues Excellent course and very informative. The instructor was brilliant! Excellent course which was wonderfully delivered Excellent course! Excellent instructor, Thanks Lisa Excellent Lisa! Thank you Excellent! Excellent! Very enjoyable and informative. Thank you! Fantasic, funny, real!!! Fantastic instructor - excellent course

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Fantastic, relaxed and informative delivery of mental health issues. Lisa has an engaging personality. It is great to be able to laugh during some sombre topics. Thank you very much! Fantastic! Fantastic!! Very informative in a relaxed environment! Brilliant! Good pace Great content, well delivered in a light hearted manner making it easy to follow and understand Great instructor, Great shoes! I found both days very interesting. The instructor was excellent and I really enjoyed the course. (neither agree nor disagree with judgement as didn't judge people negatively before) I have gained good understanding of mental health first aid. I feel more confident and will feed back information to our school. Belinda was a fabulous trainer and delivered the course in an enjoyable way. I thoroughly enjoyed todays course despite some of the sensitive content. Lisa presented the course in a professional yet down to earth manner, particularly using true-life examples. Very funny too! I thought Belinda was the best instructor I have had. She was insightful and refreshing. A very charismatic person. Content was excellent, especially on the second day. I wish the time were longer. I've really enjoyed it despite it being a heavy subject. It's been interesting and extremely useful. I love all the opportunities to reflect. It's been very fun! In 15 years in the job, this is by far the best course I've been on Lisa is amazing! I learnt loads. Will consider the 2 day course. Lisa was fantastic! So approachable, clear and knowledgeable about the subject and life! I have thoroughly enjoyed the course and developing my skills and own knowledge. I will hopefully attend more courses in the future Lisa was fantastic. Personal and client experiences really help. Location - would have been better if the course was local (nightmare traffic to get here for 9). Day 1 was a long day Real, honest delivery Really enjoyed it - informative and thought provoking - I feel as if I have gained some toold to bring back to the job Really enjoyed it. Great speaker. Really enjoyed the course- thank you! Really enjoyed the course. Made me feel that we need to do more at school and more input in the curriculum Really enjoyed this course - great instructor

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Really interesting course with lots of useful resources to take back and use. Would love even more information. Superb delivery, very informative and enjoyable Thank you Thank you lisa, really helpful course The course was educating and informative. Course instructor (Lisa) was excellent, clear and very understanding. Really enjoyed both days and would 100% recommend to schools/establishments :) The course was really good and the instructor was very good and funny. Thank you Lisa. I would love to do whole school training. The course was very helpful and the course leader was brilliant, very clear, fun and helpful Thoroughly enjoyed the course. Well presented and informative. I look forward to further training. Very comfortable atmosphere, safe environment to ask questions and contribute to discussions. Facilities very good. Very enjoyable course, lots of reassurance not to be afraid to challenge behaviours and talk about mental health Very friendly and welcoming. Very concerned about our wellbeing. Shared experiences which was nice. Very informative - best course for a long time Very informative, Belinda is fab Well delivered, lots of great information Wish I'd done the longer course Would like to attend the 2 day course Would love to do the 2 day course

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V. Demographics and response rates – workshop evaluations School Name Secondary School Wellacre Academy Our Ladys RC High School Pioneer House High School Manchester Academy Unknown Secondary Overall: Primary School St Hilda’s Primary Bedford Hall Methodist Primary Acre Hall Primary Heathfield Primary Rushbrook Academy St Wilfrid’s CofE Primary Stanley Grove Primary Academy St Mary CofE (Prestwich) Alexandra Park Primary Lime Tree Primary Overall: Unknown School Overall Total

Total Received 23 9 16 9 30 120

55 56 37 58 30 23 27 28 21 30 365 22 477

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W. Table of responses – favourite v least favourite Primary – Favourite Part All All of it! ll of the activities All of the games At the end with the skipping rope Being encouraged that I can get across the rope without getting hit Boxing Breathing By not eating rubbish food Card teamwork game Choices Clapping when the ball bounded from land, boat, water Cup game Doing all of the games Doing boxing Doing the breathing patterns Doing the exercises I enjoyed Drawing the bus Emoji part Emojis End Everything Everything including the activity Everything, I can't decide Everything, I learnt new things Exercising Exercising your feeling Favourite food Flipping the skate board Flipping the skate board over Food, health, mind Game: rock, paper, scissors Games Getting calm Going to Etihad stadium Going under the rope Going under the rope with my friends Guessing how much sugar was in drinks Guessing how much sugar was in the drinks Health How secret it was and no-one knows I don't know I enjoy everything I enjoyed all of it especially the ball activities I enjoyed all of it the most but I liked the emoji game the most I enjoyed because I met someone famous who is kind and caring I enjoyed doing Judo I enjoyed doing the breathing activities I enjoyed doing the exercises and ninja tools I enjoyed doing the group work I enjoyed everything but mostly the fitness and the [unclear], rock, paper, scissors I enjoyed figuring out how many sugar cubes are in the food and drinks I enjoyed giving and hearing ideas I enjoyed it all I enjoyed it because this lesson has made me believe in myself and made me more confident to do more things I enjoyed it when we did the different walks I enjoyed learning about mental health

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I enjoyed learning how much sugar is in different liquids I enjoyed learning how much sugar is in the things we eat and that we should eat healthily I enjoyed learning how much sugar is in things I enjoyed learning to eat and drink more healthy I enjoyed making a tower of sugar I enjoyed making the ideas for the project I enjoyed running about I enjoyed the best part is because of the rock, paper, scissors game and Brooke won I enjoyed the bit where we had to pick the Emojis I enjoyed the bit where we stood in a circle and got to choose our exercises I enjoyed the breathing exercises most I enjoyed the breathing exercises the most I enjoyed the choices most I enjoyed the emotions lesson because it helped me learn something new I enjoyed the end I enjoyed the food table I enjoyed the game and the meditation I enjoyed the game with the cards I enjoyed the Judo the most I enjoyed the meditation I enjoyed the meditation the most I enjoyed the most was seeing how much sugar was in coke with the sugar tower I enjoyed the most was where we had to try and stand up I enjoyed the most when we were doing the running and when the woman was telling us to do different things I enjoyed the one where there were Emojis on the floor and we had to go to it I enjoyed the one where you walk around feeling an emotion I enjoyed the part where we exercised I enjoyed the part with the emoji cards I enjoyed the rope game I enjoyed the skipping rope because everyone was cheering I enjoyed the skipping rope where you had to run I enjoyed the standing up part I enjoyed the videos I enjoyed walking around and funny walks I enjoyed when everyone was in the hoop I enjoyed when he was talking about health I enjoyed when we did the Judo moves because I think it was fun I enjoyed when we used the pods I enjoyed when we worked together as a team I enjoyed working with a friend I enjoyed working with new teachers I liked all of it, it was awesome!!! I liked everything I liked it when we did the mind map in tables and shown them in the class I liked it when you have to move left and right I liked making the sugar cubes I liked the emoji thing where we picked up our feeling and described why we felt like that I liked the games I loved it when the lady put music on and spoke to make us feel like we are someone and we matter I loved the outdoor activities I loved the tic tac toe it was challenging and so fun Jogging on the spot Jumping through the rope Last bit Laughing on the skate board Learning Learning about everything Learning about exercises Learning about healthy options

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Learning about how to get to sleep in different ways Learning about my health Learning about stress Learning how I can improve in basically everything Learning how much sugar are in things Learning how much sugar it had Learning Judo Learning new things Making sugar cube towers Making the list of what the guy had for breakfast dinner and stuff Meditating Meditation Meeting new people Most games was my best Nothing Noughts and crosses Planning the activities Playing games Playing the game where you couldn't sit down Playing the rock, paper, scissors game Racing with the skateboard Racing with the skateboards Rock, Paper, Scissors Rope game Running through rope Running through the rope Running through the skipping rope Running under the rope Running underneath the rope Sharing our emotions with others Sir asks a question and we go to one side Sitting Skipping Skipping Skipping rope Stress, calming Sugar Sugar cube towers Talking about how I feel Talking games, drawing pictures Team work part The activities The ball rolling game The beginning The big group where we came up with ideas The bit about trying to progress this school and all the children in it The bit making sugar cube towers The bit where we had to write on the sticky notes The bit with the emojis The boxing The boxing and how we could calm down after The boxing and I learnt how to kick box The boxing because we got to work together The breathing exercises The card game The card game because it helped us with teamwork The cards The choice game The confidence rope The emoji card feelings

164

The emoji cards The emoji feelings and the [unclear] The emoji game The emoji part The emojis The end when me charlie, toby, reily, harrison, samson and mckenzie won the rope thing The end when you relax The exercise it made me warmer 10/10 The exercises and the health and relaxation bit The feeling and strong poses game The feelings game and the bouncing game The food The food plate, putting healthy food on it The food table The fun activities The fun games The game The game at the end The game where you have to go through the rope The games The games (everything) The games and information, everything! The group activities The judo group work The Judo moves and the breathing The judo training The looking part The meditating The meditating exercise

165

Primary – Least Favourite Food About writing how to be healthy All of the writing Athlete diet Athlete's meal Athletes food Beginning Building with the sugar cubes Checking how much sugar there was Checking the sugar Dance Doing the breathing Doing the breathing exercises Doing the questionnaires Drawing faces Eating the sprouts thing Emoji walking around Emojis Ending it Ending it Enjoyed it all Everything Everything else Everything was amazing Exercising Feeling stressed First bit Going to different stations of how you are feeling How we had to go through it slowly How you feel I did not dislike anything I did not enjoy my finger on my hand I did not enjoy it I loved it I didn't dislike anything I didn't enjoy anything the least, I enjoyed everything I didn't enjoy it when the team was co-operating I didn't enjoy nothing I didn't enjoy the yoga I didn't like drawing the faces I didn't like it when it was over I didn't like the drawing I didn't not enjoy anything I didn't not like any of it I didn't really like the sugar cube where we had to build how much sugar in the drink I disliked nothing I disliked the relaxing I don't know I don't know - Nothing I enjoyed every activity I enjoyed everything I enjoyed everything, nothing was boring I enjoyed it all I enjoyed the least was seeing the sugar and not being able to eat it I hated when we had a squat challenge I liked everything I liked everything but it would be talking about our feelings I liked it all I liked them all I loved it all

166

I only disliked the skipping rope activity, but just because I was nervous we'd have to skip (I don't do it) I wouldn't say I disliked anything Learning Listening Lying down on the board Naming the vegetables None None of it Not anything. I enjoyed all of it! Not much at all Not sure Nothing Nothing Nothing everything was great thanks Nothing all good Nothing at all Nothing because it was all funny Nothing I didn't enjoy Nothing I didn't like Nothing I enjoyed everything Nothing I enjoyed it a lot Nothing I liked it all Nothing it was enjoyable Nothing it was nice Nothing really I loved everything Nothing, everything was just fun Nothing it was all great Nothing it was amazing I enjoyed the whole thing! Nothing On the skateboard One of the videos Pen game Picking the emoji and how we felt Rock, Paper, Scissors Running Running around Running under the hoop Sitting Sitting down and doing nothing Skipping Sleep because I don't like sleeping at all Sleeping Standing Standing up Stretches Sugar cubes Sugar tower was the least Taking part Talking Talking about ourselves Talking about sugar Talking Telling people what I like to do The beginning The bit where was drawing on move and hurt my hand The bit where we just sat down and copied facts The booklet The breathing The breathing activity

167

The breathing in and out The card game The cards The cards finding The circle The emoji The end The end! The exercises The exercises of breathing The first session The food part The groups The healthy and unhealthy drinks part The listening The listening to the lady talk about school The listing food The meditation The meditation part The name a food bit, the choosing food like beginning with J The numbers The plank The Relay The rock, paper, scissors game The running bit The running game that you have to run in the hoops The silliness The squatting because my legs were shaking so much The story was too long The stress video The sugar cubes The sugar tower The sugars on paper The talking The video The visualisation because I found it hard to keep still The visualisation part The work The writing The writing stuff down on a post it note There isn't anything I disliked There was nothing I didn't enjoy There was nothing that I did not like There was nothing that I didn't enjoy There's nothing that I didn't enjoy Throwing beanbags in the circle Walking into the ring Wasting time Well the first had to do with sticky notes but it was quite boring but I still enjoyed it a little Were we was playing rock, paper, scissors game When it ended When my friend was swearing When we did the visualisation When we didn't do it When we had to breathe When we had to write stuff on the piece of paper When we was writing When we were going to the emojis When we wrote about foods Where we had to jog on the spot

168

Working in a team doing breathing techniques Working in pairs Writing Writing down all the things Writing down what stressed us Writing notes Writing on the notes Writing on the sheet Writing the diet of Usain Bolt

169

Secondary – Favourite Part Activities All of it Doing the crossed/uncrossed activity Doing tricks on the skateboard Drawing Everything Game Games Getting up and doing activities Getting up and moving around during activities Group activities Having a race on the skateboards I enjoyed most was the game I enjoyed Neil's speech I enjoyed the electric bit I enjoyed the post it note parts I enjoyed the skateboarding lesson. It allowed me to step out of my comfort zone I enjoyed the would you rather game I liked when we played that game where we had to touch the other persons shoulder Knowing the kind of food to eat to stay healthy Learning about being positive Learning about daily foods we eat and the effect they have Learning about the right food to eat and doing a few exercises Learning all the skateboarding tricks and expressing myself more, I loved all of it Learning different ways of achieving what you want Learning how to do tricks on a skateboard Learning how to help myself and skateboard race Learning how to manage stress Learning new things Learning things that I could do to improve life Learning tricks on the skateboard Learning what foods to eat Making decisions Most activities, talking Neil Neil's bit Neil's humour and excitement Organising sessions Passing the pen around seeing others get frustrated Relaxing part Riding the skateboard Skateboarding Skateboarding race Solving how much sugar was in energy drinks Taking part in activities The activities The board flick The electric ball The electrocution The first session in school (describing emotions) The games The group activities The pen game The physical activities The plank The plank and the sugar cube activity The session with Neil where we skateboarded and looked at our emotions The shock ball

170

The shock ball game and activities The skateboard part The skateboard race The skateboarding The skateboarding activity When Neil was here When we did the eating plate and shock ball When we went on our bellies on the skateboard and raced Where we did skateboarding Where we did skating Where we did tricks on the skateboard

171

Secondary – Least Favourite 42nd Street 42nd Street Session Acting After the boxer left Anticipation of the shock ball Being scared of doing the tricks Doing the work Don't really know Drawing food on paper plates, the shock ball Enjoyed everything Eurovision Video Falling off the skateboard Filling out surveys Hurting my wrist I did not like everyone else's speech I don't know I enjoyed acting I enjoyed everything I loved all of it, nothing bad It was little boring Looking at the sugar as he told me I couldn't have any Loosing at the card game None of it Not being consistent Nothing Nothing at all Nothing because it was awesome Nothing because it was fun Nothing it was perfect Nothing really Nothing specific Probably coming up with things to write Repetitive questions Talking Talking about our feelings and why we felt the way we did to the rest of the class The ? ball The [unclear] of taking part The breathing The end The last session with the mind map The one where we got sugar cubes out because I love sweets The other bit The plank The plank and shock ball The post-its The shoulder game The speeches without us involved The starter activities The sugar in drinks The talk about stress and anxiety with 42nd Street The talking When we was talking about what's healthy for you When we were talking about sugar Writing

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X. Demographics of response rates – YHA Conference School Name Secondary School Wellacre Academy Our Ladys RC High School Manchester Academy Cedar Mount Academy Lostock College Manchester Creative and Media Academy St Gabriels RC High School Stretford Grammar School Wright Robinson Overall: Primary School St Hilda’s Primary Bedford Hall Methodist Primary

Total Received 3 4 4 4 4 4 5 5 4 50

4 6

Acre Hall Primary Heathfield Primary Rushbrook Academy Stanley Grove Primary Academy St Mary CofE (Prestwich) St Mary CofE (Manchester) Alexandra Park Primary ESSA Primary Academy The Olive Tree Primary Overall:

5 4 5 5

Unknown School Overall Total

3 93

2 4 5 4 6 40

173

Y. Demographics of Teacher Responses Acre Hall Primary Alexandra Park Primary School Bedford Hall Methodist Primary School Cedar Mount Academy Dean Trust Ardwick Essa Primary Academy Essa Secondary Academy Healthfield Primary School Lime Tree Primary Lostock College Manchester Academy Manchester Creative & Media Academy Manor High School Melland High School Oasis Academy Our Ladys RC School Philips High School Pioneer House High School Rushbrook Primary Academy Sale High School St Wilfrid's CofE Primary School Gabriel's RC High School Hilda's Primary Mary's C of E School Prestwich Mary's Cof E School Manchester Stanley Grove Primary Academy Stretford Grammar School The Olive Tree Primary School Trafford High School PRU Wellacre Academy Wright Robinson College

Administrator Teaching Assistant Teacher Special Educational Needs Co-ordinator Counsellor Therapist (inc OT, Physical Therapist, Intervention Specialist, Nurse) School Leader (Head Teacher, Assistant Head Teacher) Other (inc maintenance, technical support, librarian, domestic, volunteer)

0.00% 0.00% 0.00% 11.11% 3.70% 0.00% 0.00% 3.70% 0.00% 7.41% 3.70% 0.00% 3.70% 0.00% 0.00% 3.70% 11.11% 0.00% 22.22% 0.00% 0.00% 3.70% 18.52% 0.00% 0.00% 0.00% 0.00% 0.00% 3.70% 3.70% 0.00% Answered Skipped

0 0 0 3 1 0 0 1 0 2 1 0 1 0 0 1 3 0 6 0 0 1 5 0 0 0 0 0 1 1 0 27 1

0.00% 22.22% 22.22% 14.81% 0.00% 3.70%

0 6 6 4 0 1

33.33% 3.70%

9 1

174

Answered Skipped

27 1

Z. Demographics of Pre-Post Workshop Evaluation Questionnaire School Name

Total Received PreEvaluation

Total Received PostEvaluation

Secondary School Cedar Mount Academy Lostock College Melland High School* Oasis Academy Sale High ESSA Secondary Academy Manchester Creative & Media Academy Trafford High School Phillips High School Dean Trust Ardwick St Gabriel’s RC High School Wellacre Academy Our Lady’s RC High School Manor High School Pioneer House High School Stretford Grammar School Wright Robinson College Manchester Academy (Secondary)

2 0 0 4 0 5 0

0 0 0 0 0 0 7

3 13 5 15 13 13 0 0 0 0 0

0 0 0 0 13 9 0 0 0 10 0

Unknown Secondary Overall:

0 73

0 39

Primary School St Hilda’s Primary Bedford Hall Methodist Primary Acre Hall Primary Heathfield Primary Rushbrook Academy St Wilfrid’s CofE Primary Stanley Grove Primary Academy St Mary CofE (Prestwich) St Mary CofE (Manchester) The Olive Tree Primary Alexandra Park Primary Lime Tree Primary ESSA Primary Melland (SEN) Overall:

29 29 32 31 0 0 27 28 28 15 25 30 0 7 281

26 27 7 27 27 20 26 0 0 0 0 0 24 0 184

175