Title: Learning Together to promote mental health and wellbeing (LTMH)
Funder: Department of Health and Social Care

Abstract: Mental health problems such as depression and anxiety now affect about 1 in 6 to 8 young people. The UK government is increasing funding for services to improve young people’s mental health. Most of this funding is for services for those with existing problems rather than to prevent such problems in the first place. Making schools more supportive and inclusive is one way to promote mental health and this the focus of our research._x000D_ _x000D_ We have previously evaluated ‘Learning Together’, a programme which aimed to reduce bullying in secondary schools. Learning Together provided the following for schools: a report on student needs; training for teachers; an external facilitator who helped schools form an action group of students and staff to make decisions; and social and emotional skills lessons for students. Learning Together was effective in reducing bullying and improving students’ mental health. _x000D_ _x000D_ We now aim to modify this programme to increase its focus on mental health, calling it ‘Learning Together for Mental Health’ (LT-MH). We aim to pilot LT-MH for one year in four secondary schools in England to see if it feasible to deliver and acceptable to students and staff. This would help us decide whether it would be useful to then do a larger study of LT-MH’s impacts on mental health. _x000D_ _x000D_ LT-MH will focus on emotional issues, self-esteem, body image, eating problems and self-harm. We will refine the programme in collaboration with Place2Be (the charity who will deliver the new programme) and teachers, students and other participants so that:_x000D_ _x000D_ a) the student needs report focused on mental health to help schools set priorities,_x000D_ b) the Action Groups focused on changing school systems and policies to promote mental health,_x000D_ c) the curriculum focused on mental heath and emotional learning._x000D_ _x000D_ As we pilot LT-HM, we will explore its feasibility and acceptability using questionnaires and interviews with staff and students as well as other data. We will only collect data from those who have given their informed consent to participate. All the research we do will be approved by an ethics committee. _x000D_ _x000D_ We are a proven research team, and young people have been central to developing this application._x000D_ Our aim is to give schools new evidence-based tools to promote young people’s mental health. We believe our proposal is sensible given the previous investments in LT and its proven effectiveness.

Lay abstract: Research question_x000D_ Feasibility study: Is it possible to refine the Learning Together (LT) intervention to promote mental health wellbeing (to develop LT-MH)?_x000D_ _x000D_ Background_x000D_ Schools influence mental health in multiple ways. The most effective interventions in schools are those that address multiple mechanisms operating at multiple levels. Such ‘whole-school’ interventions include environmental and curriculum components and have broad efficacy against a range of health outcomes. Yet existing school environment interventions have little addressed mental health and wellbeing. _x000D_ We undertook the Inclusive Trial of the Learning Together (LT) intervention, with significant impacts upon a broad range of outcomes including behaviour and mental health. We propose to modify LT to focus on mental health and wellbeing. _x000D_ _x000D_ Aims and objectives_x000D_ i) To refine LT stakeholders and young people _x000D_ ii) To assess the feasibility and acceptability of implementing the LT-MH intervention in 4 schools_x000D_ iii) To determine whether progression to a phase III trial is justified and disseminate findings_x000D_ _x000D_ Methods_x000D_ Two phases of research, followed by a potential phase III trial_x000D_ A. Intervention refinement phase: We will work with stakeholders in a period of co-creation and refinement, co-producing an intervention that is likely to be acceptable in schools. _x000D_ Tasks:_x000D_ 1. Elaboration of the intervention theory of change, logic model and overall approaches._x000D_ 2. Refinement of the student needs survey, manual guiding the Action Group and needs assessment guide/algorithm._x000D_ 3. Identify best-evidenced SEAL curriculum._x000D_ For each phase, we will optimise through review of existing systematic reviews and two waves of PPI discussion._x000D_ B. Feasibility study phase: feasibility study to test the intervention for one school year. All schools will receive the intervention in order to assess feasibility of implementation across schools varying by need (measured by deprivation level) and by school capacity (Ofsted rating). _x000D_ Setting: Four state secondary schools in southern/central England._x000D_ Population: The intervention will target all young people in years 7-11 (age 11-16) in participating schools. The research evaluation will focus on students in year 7 at baseline but on year 10 at 12-month follow-up to pilot response rates and measures rather than to estimate intervention effects._x000D_ Allocation: All to intervention. _x000D_ _x000D_ Outcomes: Primary outcome will be feasibility and acceptability of delivery of LTMH, assessed through meeting prespecified progression criteria. We will also measure indicative primary and secondary outcomes to inform a future phase III trial._x000D_ Indicative primary outcome: Strengths and Difficulties Questionnaire (SDQ_x000D_ Indicative secondary outcomes: measures of a range of constructs related to mental health_x000D_ Integrated health economic evaluation and process evaluations will be undertaken. _x000D_ _x000D_ Timelines for delivery_x000D_ Month(M)1 (Nov 2021) to M9: refinement of intervention, recruitment of 4 schools_x000D_ M9: Baseline survey_x000D_ M9-22: Feasibility study: intervention delivery, with integral process evaluation_x000D_ M20-21: Follow-up survey_x000D_ M22-25: write up and dissemination_x000D_ _x000D_ Anticipated impact and dissemination_x000D_ Key impact will be progression to a phase III trial if progression criteria are met. In addition, we will publish in NIHR Public Health Research journal and two open access papers plus dissemination seminars to policy and practice fora.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: MENTAL HEALTH