Be You: A national education initiative to support the mental health of Australian children and young people

Abstract

Early learning services and schools provide unique settings for mental health promotion and early intervention due to the potential for population-level dosage and reach in terms of reducing multiple risk factors and enabling protective factors among young people. Educators play a key role in supporting children and young people’s experiences of, and access to mental health promotion opportunities, and hold unparalleled opportunity in terms of creating mental health–promoting learning environments. In 2018, the Australian National Mental Health in Education Initiative, Be You, was launched. Be You is a multi-million-dollar Australian government–supported initiative, freely available to all 24,000 early learning services, primary and secondary schools throughout Australia. The potential for subsequent population reach is proposed to potentially exceed that of any mental health promotion initiative for children and young people previously observed in Australia. Be You aims to foster mentally healthy learning communities across Australia through building capacity among educators to embed mental health promotion strategies. The Initiative was developed based on a review and integration of previous national mental health promotion frameworks, with an overall alignment to existing state and territory education, social and emotional well-being frameworks, and the Australian Curriculum. In delivering facilitated support from specialised consultants to early learning services and schools participating in the initiative, Be You draws on professional learning principles designed to build capacity in educators and educational systems relating to mental health promotion. It uses an updated, multi-module online platform providing interactive, evidence-based resources. This paper presents the Be You framework, describes the evidence sources used to inform the underlying principles and objectives, discusses the specific components that form the initiative, details the professional learning modules and content, and discusses potential implications for population mental health and prevention efforts.

Background

Early life is a known optimal age period for prevention and early intervention for mental disorders (Kessler et al., 2007). Early learning services and schools are promising intervention settings because of their potential to reach an entire population of children and young people within an environment where they spend a large proportion of their time.

There is a substantial body of evidence on the types of interventions that are the most effective mental health promotion approaches in learning settings (e.g. Fenwick-Smith et al., 2018). The breadth and heterogeneity of these approaches reflects the complexity of risk and protective factors underpinning mental health conditions and the associated emotional problems. Therefore, a collective, overarching framework to guide learning communities and educators to support best practice implementation is needed alongside the ever-evolving evidence base.

The Australian Government has an extensive history of supporting the development and implementation of early learning and school-based mental health and well-being frameworks for children and young people. MindMatters and its primary school and early learning service setting equivalent KidsMatter were designed, developed and implemented by the Australian Psychological Society, Beyond Blue, Early Childhood Australia and Principals Australia Institute, and delivered locally by Principals Australia Institute and Early Childhood Australia. A review of the mental health frameworks of the MindMatters and KidsMatter initiatives, led by Beyond Blue, supported the appropriateness of the existing programmes to assist early learning services and schools in delivering mental health promotion activities. However, the evaluation noted that implementation could be improved with better integration of primary and secondary school efforts as an end-to-end (i.e. covering all education settings from early learning services to secondary schools) model. Further findings were that the linear progression model of MindMatters and KidsMatter, which required modules to be completed sequentially, could be improved. Implementation barriers identified included difficulties in navigating the plethora of components and modules available, compounded by an already demanding curriculum and time poor staff. A hybrid implementation model, with Actions Teams supported by facilitation consultants available to each learning community, was identified as a potentially effective model. Finally, review findings suggested that sharing best practice through networking and professional development activities, while engaging school leadership, was likely to improve uptake and subsequent implementation quality.

This evaluation and implementation study, with a number of strands of research and evidence, informed the development of the Be You framework. In practice, the Be You framework supersedes and incorporates the previous Australian government initiatives such as MindMatters and KidsMatter, to develop a new framework that better reflects the current evidence base and lessons learnt from previous mental health promotion efforts.

In 2018, the National Mental Health in Education Initiative, Be You, was launched. Be You is a multi-million-dollar Australian government–supported initiative, freely available to all 24,000 early learning services, primary and secondary schools throughout Australia. It has the potential for very large population reach relative to that of previous mental health promotion initiative for children and young people.

This Viewpoint presents the resultant Be You framework, describes the evidence sources used to inform the underlying principles and objectives, discusses the specific components of the initiative, and details and discusses potential implications for population mental health and prevention efforts.

National Mental Health in Education Initiative – Be You

Objectives

The long-term goal of Be You is to improve the mental health of children and adolescents through creating mentally healthy learning communities across Australia. Consistent evidence points to collective, co-ordinated efforts within communities as a major facilitator to successfully achieving health goals (Hung et al., 2014). This is particularly relevant in the context of mental health conditions that are preceded by multiple and varying factors, largely affected by the environment and context in which an individual exists.

The identified target group of this initiative are educators (both current and future), including early childhood educators, managers and other support staff in early learning services, school teachers, principals, other school and community leaders, trainee educators and student teachers. While mental health promotion is inherent in good teaching practice, full implementation of the initiative augments the mental health literacy of educators, which in turn supports the implementation of evidence-based mental health promotion activities for children and young people, ultimately supporting better mental health outcomes. Learning communities are encouraged to set up Action Teams to lead the implementation of the community approach and to ensure Be You is tailored to meet the needs of individual learning communities.

The working hypothesis of Be You is that through the professional development of educators, the initiative will:

• Promote social and emotional learning and mental health outcomes in learning communities:

• Provide guidance to current and future educators in how to effectively influence positive mental health;

• Build the confidence and capacity among educators and wider learning communities (staff, parents/guardians and students) to intervene early to address mental health problems;

• Proactively support suicide prevention in addition to rapid response to events in learning communities;

• Improve educators’ mental health literacy.

Evidence sources

Existing mental health promotion initiatives in Australia, MindMatters and KidsMatter, were integrated, revised and superseded by Be You. Another Australian initiative that targeted pre-service teachers, ResponseAbility, was also integrated (Beyond Blue, 2018). Components and processes of headspace School Support (Cox et al., 2016), a suicide postvention programme, also contributed significantly to the Be You Initiative.

Be You was informed by a number of evidence syntheses and reports including the 2018 Lancet Commissions on Global Mental Health (Patel et al., 2018), the Australian Research Alliance for Children & Youth Review on Research and Practice for Prevention and Early Intervention (Fox et al., 2015), Australian Government Student Wellbeing, Engagement and Learning across the Middle Years (Evans-Whipp et al., 2017), and the Australian Government National Mental Health Commission (2014) Review of Mental Health Programmes and Services.

Furthermore, a number of key mental health frameworks and initiatives informed the content of Be You including the World Health Organization Comprehensive School Mental Health Programme and Health Promoting Schools framework (Hendren et al., 1994), Collaborative for Academic, Social, and Emotional Learning Framework for Systemic Social and Emotional Learning (Payton et al., 2000), Promoting children and young people’s emotional health and wellbeing: A whole school and college approach (Lavis and Robson, 2015), Positive emotion, Engagement, Relationships, Meaning, Accomplishments framework (Seligman, 2012), and the Australian Student Wellbeing Framework. Further information on the evidence sources has been published elsewhere (Beyond Blue, 2019).

Initiative components

A number of evidence-based components, developed by mental health and education research experts and professionals, form the Be You initiative. The initiative provides multiple evidence-based professional learning modules, information toolkits and resources that allow educators and Actions Teams to develop and implement preventive and promotional mental health strategies. Critically, these resources are designed to allow early learning services and schools to identify and harness their community’s strengths and develop tailored mental health strategies in response to their community’s unique needs. The toolkits are designed to improve accessibility and availability of evidence-based resources and to improve uptake and implementation through flexibility to context.

A panel of mental health clinicians, researchers and education experts developed a suite of evidence-based resources that are accessed via an online platform. The resources are designed to promote positive mental health, foster resilience, identify and assist at-risk children and young people and their families with emerging or current mental health conditions, and provide specific resources for suicide prevention and response. The content of the online modules is further described below under Professional Learning. The online delivery allows capacity to deliver information at scale, flexibility for access across learning settings and capacity to undertake professional development at required pace.

Trained Be You consultants with a range of education, mental health and health promotion expertise are located and accessible nationally to facilitate support for schools and early learning services to implement Be You into their learning community. National partnerships involving the initiative developers Beyond Blue and partners Early Childhood Australia and headspace have been formalised to support implementation. Consultants work within learning communities to enhance profes-sional learning of educators through facilitated, local support. Early learning services and schools are supported to establish an Action Team, comprising school leaders, students, families and educators, who will be responsible for the implementation of Be You within their learning communities. Implementation of Be You will enable learning communities to identify the external mental health services they require.

The Be You initiative provides educators with trackable personalised records which contribute to their Continuing Professional Development. Furthermore, specific resources targeting pre-service educators are included in the information toolkit, designed to support educators across all career stages. A comprehensive advocacy strategy is underway for the introduction of Be You into pre-service training in tertiary and Vocational Education Training providers. Aligning the Be You initiative to existing professional development requirements allows for the integration of efforts to further enhance implementation success.

Be You provides a dedicated suicide response service for secondary schools in the event of a suicide death. Clinical consultants are available to schools in the period immediately after a death to provide on the ground support to affected students, staff and families. Support is focused on providing practical guidance to school staff on how to manage the trauma associated with a suicide and the impact it can have on a school community. Additionally, a Suicide Response Toolkit is available online. This toolkit is divided into sections that focus on what to do straight after the suicide, in the first 24 hours, in the first week, in the first month and longer term. The suicide response service builds on, and is guided by, the toolkit. The toolkit also provides information about preparedness plans aimed at ensuring schools have suitable policies in place to respond should a death by suicide occur.

Professional learning

Be You is designed to build capacity among educators through professional learning to promote and support positive mental health, and respond to the mental health needs of children and young people. To achieve this, the Victorian Department of Education principles for effective professional learning informed (Fraser, 2005) the production of the professional learning modules. They included focus on student outcomes, embedding in teacher practice and operations of the school culture, evidence-based learning and teaching, collaboration, reflection and feedback, and individual and collective responsibility across all levels of school system.

The content framework of Be You includes both a structure for professional learning and specific actions for learning communities to implement a whole school approach to mental health and well-being. The content, provided on the online platform as described above, is grouped under five domains: Mentally Healthy Communities, Family Partnerships, Learning Resilience, Early Support and Responding Together. The domain aims and sub-modules are summarised below. The professional learning has been developed to align with existing state and territory education, and the Independent and Catholic sectors’ social and emotional learning and student well-being frameworks. It also aligns with the National Quality Standard and Australian Professional Standards for Teachers, the Australian Curriculum, Australian Professional Standards for Principals, Australian Student Wellbeing Framework, Early Years Learning Framework and My Time Our Place.

Domains of professional learning

Mentally healthy communities

The Mentally Healthy Communities domain introduces mental health concepts, including risk and protective factors, and discusses the roles and responsibilities of educators to support well-being, including their potential impact, in mental health of children and young people. It demonstrates actions for creating environments that support positive mental health and highlights the importance of staff well-being in creating these healthy environments. This domain explores social connectedness, transition between home environment and across learning communities, positive peer relationships, and introduces bullying and its impact upon mental health. It also addresses diversity and inclusion and the potential for positive mental health and well-being in communities that are supportive and inclusive.

Family partnerships

The Family Partnerships domain emphasises the role of the educator in working in partnership with individuals in the home environment of the child or young person, with the objective of fostering positive mental health opportunities beyond the learning community setting. It also focuses on defining positive relationships with families, developing effective communication strategies, supporting social and emotional learning in the home environment and developing a culture of mutual support among educators and home caregivers.

Learning resilience

The Learning Resilience domain draws upon social and emotional learning concepts to enhance educators’ capacity to foster and teach resilience, respectful relationships and help-seeking behaviours. It focuses on empowerment of children and young people to foster independent and responsible behaviours in learning communities. Strategies are provided to implement and integrate social and emotional learning strategies in day-to-day educational practice.

Early support

The Early Support domain focuses on noticing and acting upon early signs of mental health problems that may precede mental health conditions. It provides information on recognising changes in indicators such as behaviours, emotional responses, learning outcomes and social interactions that may reflect early signs of mental health problems. Noticing, responding to, and providing appropriate support for mental health concerns are covered in this domain, as is information to support collaborative stepped care in the mental health system.

Responding together

The Responding Together domain supports educators to recognise and respond to critical incidents likely to impact on mental health. It outlines key considerations when responding and provides strategies for collaborative good practice response. The purpose of this domain is to guide school communities to work collaboratively with their local health and community services in the critical incident response to minimise future negative impact on the wider community.

Implications for population mental health of children and young people

There are a number of features of the initiative which may have implications for population mental health. Some of these implications have been highlighted previously, including the need for rigorous outcome, process and other evaluation (Hoare et al., 2019), and further detailed here.

The Be You Initiative promotes an integrated approach to mental health promotion, whereby activities and efforts are implemented at all levels of the learning community. This includes learning and teaching programmes, building positive relationships with children and young people, families, and leadership, and revised school and early learning services policies and procedures. Integrated approaches, also referred to in the public health literature as whole systems approaches, have been promoted in response to the inadequacy of stand-alone programmes which have failed to enable long-term sustainable change after the conclusion of the programme, activity or funding (Weare, 2013). Whole systems approaches are designed to be adaptive to the complexity of school and early learning service settings, and the interacting nature of multiple levels surrounding children and young people are assumed to contribute to health outcomes. The Be You initiative is a multi-component intervention and combines professional learning for educators, strengthened family, home and community support service partnerships, role modelling of teachers and other staff, and skilled facilitation, all of which are underpinned by evidence-based information resources. The design of the initiative aligns closely with recommendations for good educational practice and also for preventing complex health conditions. It also offers benefits and potential for sustainability that would unlikely be achieved in stand-alone, one-off programmes.

The long-term goal of the initiative is to improve the mental health of children and young people. It must be acknowledged that the impact and outcomes of the initiative are likely to be multi-faceted and influenced by the ever-evolving school and early learning service systems in which the initiative implementation occurs. As such, traditional individual-level indicators alone are likely to be insufficient to account for the multiple levels the initiative is designed to reach and may not provide true insight into the population mental health implications. Importantly, the same limitations have been observed in broader public health literature, such as obesity prevention efforts which target and improve obesity-promoting settings. Such initiatives are time consuming to implement, and there is an assumed time lag between efforts, behavioural change and outcome individual health indicators (McGlashan et al., 2016). Furthermore, the contextual and setting-specific characteristics are also assumed to impact upon implementation and the course and trajectory of children and young people’s health outcomes (Aldridge and McChesney, 2018). It is therefore expected that time lag, multiple endpoints and context-specific characteristics should be built into future evaluation efforts.

Specific limitations related to the online delivery of the initiative components are recognised. For example, the delivery of the online components assumes a digital approach to learning and implementation practices, which may form a barrier to some population groups who are dependent on more traditional, non-digital methods. For socioeconomically deprived, culturally and linguistically diverse, regional and remote communities, this may form an additional barrier to receiving mental health support. The appropriateness of the Be You components for culturally and linguistically diverse child and young adult populations requires further evaluation, as does the content suitability for rural, regional and Indigenous populations. This includes extent to which the Be You concepts align with cultural understandings of mental health. Appropriateness for non-traditional education settings such as distance education, home schooling, education in hospital and detention settings also require further consideration. The investigation of these specific issues, and how to best support implementation in unique settings and sub-population groups, is ongoing.

Conclusion

Be You is the first end-to-end initiative to address mental health promotion, prevention, early intervention and postvention in Australian learning communities. Be You has been designed as an evolving and iterative initiative, with new resources being developed in response to both feedback from participating educators and new and emerging scientific evidence on best practice prevention and promotion for child and young people’s mental health. Be You therefore represents Australia’s commitment to mental health and has the potential to inform international efforts to support the mental health of future generations.