Health Promotion International, 2015, Vol. 30, No. S2 ii36–ii76
doi: 10.1093/heapro/dav053
Promoting equity in the mental wellbeing of
children and young people: a scoping review
Jennifer Welsh1,*, Lyndall Strazdins1, Laura Ford1, Sharon Friel2,
Kerryn O’Rourke3, Stephen Carbone3, and Leanne Carlon3
1
National Centre for Epidemiology and Population Health, Research School of Population Health, Australian
National University, Canberra, ACT 2601, Australia, 2Regulatory Institutions Network (RegNet), Australian
National University, Canberra, ACT 2601, Australia, and 3Victorian Health Promotion Foundation
(VicHealth), Melbourne, VIC 3053, Australia
*Corresponding author. E-mail: [email protected]
‘Fair Foundations: The VicHealth framework for health equity’ was developed by VicHealth under the leadership of
author O’Rourke. It was published in 2013. It is a conceptual and planning framework adapted from work done by
the WHO Commission on the Social Determinants of Health (Solar and Irwin, 2010). Social determinants of health
inequities are depicted as three layers of influence – socioeconomic, political and cultural context; daily living
conditions; and individual health-related factors. These determinants and their unequal distribution according to
social position, result in differences in health status between population groups that are avoidable and unfair. The
layers of influence also provide practical entry points for action (VicHealth, 2013). Fair Foundations can be accessed
at www.vichealth.vic.gov.au.
Summary
There is increasing emphasis on wellbeing as a target for mental health promotion, especially during
the formative period of childhood. Despite growing research on the importance of mental wellbeing,
there is little information on how to effectively promote it or how to promote it equitably. This article
presents a scoping review of interventions which seek to promote mental wellbeing and reduce
inequities in children and young people living in high income countries. We used Fair Foundations:
The VicHealth framework for health equity (VicHealth (2013) Melbourne, Australia: The Victorian
Health Promotion Foundation) to identify points of entry at three layers of influence: (i) socioeconomic, cultural and political contexts, (ii) daily living conditions, and (iii) individual and family
health-related factors. We identified more than 1000 interventions which aimed to prevent or treat
childhood mental illness, but there were far fewer that aimed to promote children’s or young people’s
mental wellbeing. The interventions we studied were either universal or specifically targeted children
from disadvantaged families: none explicitly used an equity framework to guide their design or evaluation or addressed social gradients in wellbeing. Most interventions remained focused on proximate
factors, although we also identified a handful of interventions that sought to address children’s access
to services and their educational and neighbourhood environments. However, we found encouraging
evidence that interventions in family and educational settings were successful in building children’s
strengths and supporting positive parenting, universally and within disadvantaged groups. Such
© The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: [email protected]
Promoting equity in the mental wellbeing of children and young people, 2015, Vol. 30, No. S2
ii37
positive programme evaluations signal the potential for using a proportionate universalism approach
that emphasizes equity in the promotion of mental wellbeing.
Key words: wellbeing, mental health, children, social determinants, review
INTRODUCTION
Mental wellbeing has been described as a fundamental
human right and an essential ingredient for a sustainable
and functional society (Barry and Friedli, 2008; Friedli,
2009). It is related to the quality of people’s lives, capabilities and their contributions to society (Barry, 2009). The
concept of mental wellbeing is broad, and the terms positive mental health, mental health, psychological wellbeing
and mental wellbeing are often used interchangeably
(Herrman, 2001). When operationalized, it can encompass concepts such as resilience, mental assets and
resources, capabilities, self-esteem, self-efficacy and optimism to name a few (Barry, 2009). In this article, we use
the term ‘mental wellbeing’ to refer to ‘a state of wellbeing
in which every individual realizes his or her own potential,
can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution
to her or his community’ [(WHO, 2001), p. 1]. This definition encompasses the two key components central to all
terms used within this literature: (i) mental wellbeing is a
positive state which is more than the absence of mental
illness and (ii) is demonstrated by both positive affect
and positive functioning (Keyes, 2002; Huppert and
Whittington, 2003). Distinct from mental wellbeing is
mental illness, which refers to ‘conditions characterized
by alterations in thinking, mood (emotions) or behaviour
associated with personal distress and/or impaired functioning [(WHO, 2001), p. 21] and while they are related,
emerging research indicates they can be viewed as separate
continua, although the extent they have differing determinants is not clear (Keyes, 2002)’.
In terms of intervention, mental wellbeing and mental
illness are starkly different: mental wellbeing (‘flourishing’:
Keyes, 2002) can only be promoted, while mental illness is
either prevented, subject to early intervention or treated
(Mrazek and Haggerty, 1994). In this article we focus on
promoting mental wellbeing, emphasizing the positive
state but recognizing the overlap with mental illness prevention in practice. We also emphasize equity, seeking to apply
approaches well developed within population health.
Health inequities are differences in health status between
population groups that are socially produced, systematic
in their unequal distribution, avoidable and unfair
(Whitehead, 1992). Just as there exist inequities in who experiences mental illness, there may also exist inequities in
who flourishes, although there is less research or theory
on the latter. Assuming similar models apply, addressing
wellbeing inequities will require a focus on social determinants, that is, on understanding the social, political, economic and structural forces that produce systematic
differences in who flourishes or not. We therefore use Fair
Foundations: The VicHealth framework for health equity
(VicHealth, 2013) as the review’s conceptual basis.
Our review takes a life course approach to mental
wellbeing and interventions that seek to promote it, and promote it equitably. Infancy and childhood are critical years
for the acquisition of mental capital and capabilities
(Barry and Friedli, 2008), where patterns of thinking, feeling
and behaving are established through neural embedding,
emotional regulation and gene expression (Huppert,
2009). Early developmental factors, such as secure attachment, warm parenting and supportive family and learning
environments influence the way a brain develops, accumulating to create life course trajectories of social and emotional prosperity, or social and emotional disadvantage (World
Health Organization and Calouste Gulbenkian Foundation,
2014). Intervening early in life and childhood is likely to be
the best and most cost-effective way to promote mental wellbeing, and equity therein (Friedli, 2009), but it embeds significant challenges. Interventions need to be ‘matched’ to the
child’s developmental stage and contexts, and models of
health (wellbeing) inequity need to include developmentally
specific determinants.
In adults, mental wellbeing is associated with a range
of health benefits, including: longevity (Danner et al.,
2001); improved overall health (Benyamini et al., 2000);
protection from stroke (Ostir et al., 2001) and cardiovascular disease (Keyes, 2004); improved sleep, physical activity and diet (Pressman and Cohen, 2005); healthier
lifestyles (Watson, 1988); fewer chronic diseases and
lower health care utilization (Keyes, 2007); and pro-social
behaviour (Lyubomirsky et al., 2005). A review of prospective research found a temporal (and therefore potentially causal) relationship between wellbeing, health and
longevity (Diener and Chan, 2011).
Despite evidence that mental wellbeing promotion can
be so beneficial, there is little information on the prevalence, social patterning or determinants of wellbeing in
children and young people (Barry, 2009), particularly
when compared with the extensive data available on mental illness in this age group. In perhaps the only study on
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the prevalence of mental wellbeing in children, just 40% of
American young people were mentally healthy, 55% had
moderate mental health, and 6% were ‘languishing’
(Keyes, 2006). Australian data on young children suggest
inequities in wellbeing are present and distributed along
social, cultural and economic lines. Children living in
poorer households, in rural areas and from culturally
and linguistically diverse (CALD), or Indigenous backgrounds report lower rates of cognitive, social and
emotional wellbeing than their counterparts (Centre for
Community Child Health and Telethon Institute for
Child Health Research, 2009).
Evidence on what promotes children’s mental wellbeing is limited. Although research has made progress in
defining and operationalizing the concept, it continues to
rely heavily on illness models and evidence when making
recommendations on how to promote wellbeing (Barry,
2009). Similarly, there is growing evidence on the social
determinants of mental illness but it is not certain whether
this can be inverted and applied to the positive state of
mental wellbeing. Within the health-illness model, different social groups, by virtue of their social status (class,
gender, ethnicity, for example), are differentially exposed
to risks and protective factors, and this generates inequities in the prevalence and severity of health problems
and ill-health (Whitehead, 1992). Consistent with the
Fair Foundations framework, which recognizes that social
determinants shape health and health inequities across the
population as a whole, interventions which are universal
but proportionate to need are accepted as best practice
for addressing inequities (World Health Organization
and Calouste Gulbenkian Foundation, 2014).
For children and young people, there is a clear and consistent social gradient in mental illness linked to socioeconomic status (SES) and material deprivation (Bradley
and Corwyn, 2002). Material deprivation is usually ongoing, chronic and daily in nature, and its effect on health
accumulates (Reiss, 2013). In Australia as well as other
high income countries, disadvantage in mental illness follows gendered, cultural and geographic lines as well as
socioeconomic, signalling higher order social, political,
economic and cultural determinates of wellbeing. For example, adolescent girls, and children living in urban areas
report poorer quality of life and higher rates of mental illness compared with their counterparts, as do Aboriginal
and Torres Strait Islander Australians (Sawyer et al.,
2001; Jorm et al., 2012).
There is also consistent research evidence that developmentally specific psychosocial factors are critical for children (Sawyer et al., 2001). Quality of care, parents’
availability and wellbeing, family relationships and interactions, and supportive learning environments are neither
J. Welsh et al., 2015, Vol. 30, No. S2
necessarily nor simply a function of material resources,
but reflect the importance of social bonds, warmth and
care environments (Gubhaju et al., 2015). Thus both material and psychosocial assets may be fundamentally important to whether children flourish or not with their
interplay creating a system of mutually reinforcing determinants (Friedli, 2009). For example, employment policies
which create harsh working conditions and job insecurity
affect parent health and family resources, which in turn affect child wellbeing (Strazdins et al., 2010). The extent to
which employment supports or conflicts with family care
and relationships will shape parental capacity to engage
in employment (and therefore earn income) and their availability, parenting style, daily stresses, and children’s care
(Strazdins et al., 2013). Differential exposure and/or vulnerability to these social determinants as they affect parents
could create intergenerational wellbeing inequities that
begin in infancy and continue as children grow.
There has been research which has aimed to review
interventions to promote mental health of children and
young people (see, for example, Arksey and O’Malley,
2005; Commonwealth of Australia, 2009), however little
is known about how to promote mental wellbeing specifically, or how to promote it equitably. The aim of this article is to perform a scoping review on interventions which
are or could be used to promote mental wellbeing and reduce inequities in children and young people. We focus on
interventions that address the social determinants of wellbeing by using the Fair Foundations framework to identify
different layers and sources of inequities. Specifically, our
aims in this article are two-fold: (i) to identify best or
promising practice within high income countries at each
layer of the framework, and (ii) to identify limitations
and gaps in the evidence base and make recommendations
for future research and practice.
METHODS
A scoping review of the literature was conducted in May–
July 2014 to identify interventions which addressed the
social determinants of inequities in mental wellbeing in
children (aged 3–15 years) and young people (aged 15–
25 years). Scoping reviews can be used to describe a
large body of literature and are useful in summarizing
the current state of research activity (Arksey and
O’Malley, 2005). Our search examined the effect of any
programme, policy, intervention or service related to the
promotion of equity in mental wellbeing or mental illness
prevention in children and young people. We recognize
that national differences will shape the inequities that
exist in mental wellbeing and the efficacy of the interventions used to address them and thus, performed our review
Promoting equity in the mental wellbeing of children and young people, 2015, Vol. 30, No. S2
on the relatively homogenous context of high income
counties, using Australia as a case study example where
specific country information was needed.
The search strategy was conducted in two phases. The
first phase identified peer-reviewed publications, including
meta-analysis, systematic reviews, reviews and evaluations
of specific interventions used to promote wellbeing or prevent mental illness. Our strategy included developmentally
sensitive search terms to capture outcomes relevant at each
stage of child development (e.g. internalizing and externalizing disorders are more appropriate terms used to describe
mental ill-health in young children). Search terms were entered into six bibliographic databases: Web of Knowledge,
Scopus, Google Scholar, psycINFO, MEDLINE and
Cochrane Library (for a full list of search terms, see our
full report, Welsh et al., 2014). Due to the scoping nature
of this review, no restrictions on study type, quality or
age of publication were employed; however interventions
identified in this phase were not included without a formal
evaluation.
The second stage involved scanning relevant government websites, including Government departments, and
key national and international institutions and research
centres. We started this stage by scanning Australian
Federal and State Government websites for mental health
and child development plans, using this information to
identify the key policies and organizations operating in
this space. We also conducted Google searches to identify
any additional national and international institutions and
research centres not mentioned in key policy documents.
We included grey literature on interventions focussing on
mental wellbeing in children and adolescents, with an emphasis on interventions operating at the socioeconomic,
political or cultural layer of the framework. Material at
this layer was included without a formal evaluation.
Material identified during both phases of our search
was excluded if it was: purely theoretical or conceptual
in nature; conducted in low or middle income countries;
published in a language other than English; not applicable
to children or young people; relevant only to the treatment
of mental illness or disorders; or relevant only to developmental disorders such as autism or intellectual disability.
Two reviewers searched, screened and coded the suitability of studies for inclusion.
RESULTS
Overview
Our review identified over 1000 studies describing or
evaluating interventions that were potentially relevant.
However, few studies provided direct evidence on
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wellbeing interventions specifically, with substantially
more interventions either preventing or intervening in
the development of mental illness. Further, we found
very few interventions specifically designed to address inequities or evaluated in regard to differential impact, however some were delivered and evaluated in disadvantaged
or high-risk groups (which could potentially contribute to
reducing inequities). Interventions were categorized into
the level of the framework they aimed to address: socioeconomic, political and cultural contexts; daily living conditions; and, individual health and family factors.
Due to the large number of interventions identified, it
was not possible to provide an overview of all interventions
within the ‘Results’ section. Instead, below we present a
critical analysis of the types of interventions identified, evidence of their effectiveness and the implication for equity;
summaries of the specific interventions can be found in
Tables 1 and 2. Table 1 provides a summary of the aims
and evaluation outcomes (where available) of interventions
within Australia at the socioeconomic, political and cultural context. Table 2 presents a detailed summary of the
aims and key evaluation outcomes of the interventions
identified in high income countries targeting the daily living
conditions and individual health factors. A full list of the
references relating to the interventions reviewed here are
available as Supplementary Material.
Socioeconomic, political and cultural context
Mental health policy in Australia
Australian mental health policies, at both the federal and
state level, include mental health promotion (including a
wellbeing perspective) and recognize the need to address
social determinants of mental health. The Second
National Mental Health Plan (1998–2003) included a
separate life course approach plan for promotion, prevention and early intervention (PPEI) of mental health. The
third (2003–2008) and fourth (2008–2014) plans have
continued the PPEI approach to mental health, adding a
whole of government approach and continuing to highlight the importance of addressing high-risk groups.
Reflecting principles of race-based equity, a separate mental health and social and emotional wellbeing plan was
also developed for Indigenous Australians, recognizing
the higher rates of social and emotional wellbeing problems in this population and the need for culturally sensitive programmes. However, little detail is given as to how
to achieve these aims, or how to measure or evaluate success and there is continued emphasis on mental illness prevention and treatment, particularly in the allocation of
funding (Jorm, 2014). Equity is evident in these plans
only to the extent that specific ‘at risk’, often traditionally
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Table 1: Interventions identified within Australia at the socioeconomic, political and cultural context
Intervention and target population
Summary and aims of the intervention
Socioeconomic, political and cultural context
Mental health policy
This document summarizes the direction the governments will take on issues
The Roadmap for National Health
relating to mental health and wellbeing over the next 10 years. This report
Reform (2012–2022) (Council of
Australian Governments, 2012)
Evaluation and key outcomes
This plan has not yet been evaluated.
also established new governance and accountability arrangements that
will engage stakeholders and ensure governments are held to account.
This report uses a social determinants of health framework and
recognizes the need to develop mental health services and supports across
all relevant government portfolios, including employment, housing,
homelessness and the justice system. The report also notes that the risk of
developing a mental illness is higher when a person is experiencing social
exclusion, poverty, neglect, trauma or is in poor physical health. This
report places a strong emphasis on stigma reduction and discrimination.
National Mental Health Strategy
(1993–1998)
(National Mental Health Strategy
Evaluation Steering Committee for
the Australian Health Ministers
Australia’s first National mental health strategy.
Advisory Council, 1997)
This plan succeeded the National Mental Health Strategy. This plan was
(1998–2003)
(Australian Health Ministers’
Advisory Council by the Steering
Committee, 2003)
developed in response to the evaluation of the first National Mental
Health Strategy. The strategy was built on the foundation of the first
strategy, but was extended to include a more prominent focus on
promotion and prevention.
funding at the national and state and territory level had facilitated these
improvements. The evaluation also found that there was dissatisfaction with
mental health services, including a focus on serious mental illness. A Second
National Mental Health Plan was endorsed as a response to this evaluation.
The evaluation focused on four key areas: consolidation of existing reform;
promotion and prevention; partnerships in service reform and quality and
effectiveness. The evaluation found that Australia has continued to make
progress towards implementing the objectives of the first and second
strategy, however the progress achieved towards each objective was not
universal, due primarily to failures in investment and commitment. Areas of
particular concern were the dissatisfaction among mental health care
consumers and carers.
J. Welsh et al., 2015, Vol. 30, No. S2
Second National Mental Health Plan
In 1997, an evaluation of this strategy found that significant advancements had
been made. These included an improvement to the number, range and
quality of mental services available and that there had been an increase in
number of service systems operating outside the traditional mental health
boundaries, including housing and employment. It noted that additional
mental health (2000)
(Commonwealth Department of
Health and Aged Care, 2000)
National Mental Health Plan
(2003–2008)
(Australian Health Ministers, 2003)
(Curie and Thornicroft, 2008)
A companion document to the National Action Plan for Promotion,
Prevention and Early intervention for mental health was also developed:
promotion, prevention and early intervention for mental health—a
monograph. The document sets out the conceptual framework for the
National Promotion, Prevention and Early Intervention for Mental
Health Action Plan. The objectives of the plan were to enhance social and
emotional wellbeing among populations and individuals; to reduce the
investment had been made towards improving mental health knowledge and
promoting mental health, particularly through media and school initiatives.
They noted that many states and territories had incorporated mental health
PPEI approaches in their own plans. The evaluation demonstrated that there
had been advances in working with the media to reduce the stigma of mental
incidence, prevalence and effects of mental health problems and mental
disorders and to improve the range, quality and effectiveness of mental
health promotion strategies.
illness, but acknowledge that people with mental illness continue to
experience stigma and discrimination. This report concluded by stating that
the aims of the National Mental Health Strategy had not yet been fully
translated into the expected benefits for consumers, carers or the general
population and stressed the need for a long-term approach to the
This was the third national mental health plan. This plan build on the
foundations of the First and Second National Plans, addressing gaps
identified in the previous plans. The priority themes in this plan were to
promote mental health and prevent mental health problems and illness;
increase service responsiveness; strengthen quality and foster research,
innovation and sustainability.
Fourth National Mental Health Plan: an
agenda for collaborative government
action in mental health (2009–2014)
(Commonwealth of Australia, 2009)
The evaluation of this plan done as part of the broader evaluation of the
Second National Mental Health Plan demonstrated that considerable
This plan sets an agenda and framework for government action on mental
health. The plan outlines five priority areas: social inclusion and recovery;
prevention and early intervention; service access, coordination and
continuity of care; quality improvement and innovation; and
improvement to national mental health.
The evaluation of this plan demonstrated significant improvement to mental
health ( promotion) services in Australia. There had been an increased level
of awareness of mental health promotion and mental health problems,
particularly around depression. Stigma associated with serious mental illness
remained unchanged. Early intervention featured heavily in the Council of
Australian Governments (COAG) Action plan, including the introduction of
specific early intervention programmes for parents, children and young
people. A number of promotion/ prevention services had been funded by the
government, including MindMatters.
No evaluation of this plan was found; however, this report placed greater
emphasis on the monitoring outcomes, and national reports are produced
annually on key mental health statistics (see below).
accountability, measuring and reporting progress. These priority areas
are underpinned by eight core principles, many of which have an equity
focus, including recognition of social, cultural and geographical diversity
and experience, and service equity across areas, communities and age
groups.
Continued
Promoting equity in the mental wellbeing of children and young people, 2015, Vol. 30, No. S2
National Action Plan for Promotion,
Prevention and Early intervention for
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Table 1: Continued
Intervention and target population
Summary and aims of the intervention
Evaluation and key outcomes
A National Strategic Framework for
Aboriginal and Torres Strait Islander
This is a framework for improving the mental health and social and
emotional wellbeing for Aboriginal and Torres Strait Islander People,
This framework was developed within the National Strategic framework for
Aboriginal and Torres Strait Islander Health and the National Mental
Peoples’ Mental Health and Social
and Emotional Wellbeing (2004–
2009)
(Social Health Reference Group for
National Aboriginal and Torres Strait
Islander Health Council and National
Mental Health Working Group,
2004)
Building the Foundations for Mental
Health and Wellbeing: Review of
Australian and International Mental
health Promotion, Prevention and
Early Intervention Policy (Patterson,
2009)
recognizing the holistic and whole of life view of health, which refers to
the social, emotional and cultural wellbeing of the whole community.
Health Plan (2003–2008). The nine guided principles outlined in the Ways
Forward policy document were used in the development of this framework,
which had three key strategic directions. This framework is currently being
renewed by the Department of Health and Ageing. Many mental health,
social and emotional wellbeing issues are addressed in the National
Aboriginal and Torres Strait Islander Health Plan (2013–2023).
This is a review on current policy directions commissioned before the
development of an action plan for Tasmania.
This report summarizes the current key policy directions relating to mental
health promotion, prevention or early intervention, and issues relating to
mental health and related sectors in Australia (national and state level) as
well as other HIC. Policy approaches to suicide prevention are also reviewed,
with the authors noting that many HIC counties, including Australia, have
separate frameworks and plans for suicide and self-harm prevention.
The report notes that there is considerable variability across states and
territories and counties in their focus and emphasis on PPEI. They note that
there are also differences in the emphasis on prevention or recovery,
differential emphasis on health sector or all community sectors, and the
framework’s approach to the social determinants and equity issues, with
(Department of Human Services,
2009)
This plan outlines the 10-year vision for mental health reform in Victoria.
The aim of this framework is designed to help inform investment in the
most effective interventions to maximize health, social and economic
benefits for individuals and communities. The framework is based on a
social model of health that acknowledges social determinants of health.
treatment and services for children and adolescents; providing targeted
support for high-risk or vulnerable groups; and building stronger more
resilient families related to mental health or drug and alcohol problems. This
framework has a strong equity focus, detailing mechanisms for identifying
differences in access and health inequalities by specific population and
geographical groups. This framework has not yet been evaluated.
J. Welsh et al., 2015, Vol. 30, No. S2
Because Mental Health Matters:
Victoria mental health reform strategy
(2009–2019)
Victoria and South Australia leading the states and territories in their
approach to addressing inequities.
Goals identified under the early life reform area include strengthening
identification and interventions through universal services such as early
childhood, primary health care and education; delivering age appropriate
This plan outlines the Queensland Government’s 10-year plan to reform
and improve mental health services.
Queensland Centre for Mental Health Promotion, Prevention and Early
Intervention had been established, 10 000 community service workers had
received training and targeted PPEI programmes had been delivered to
Aboriginal and Torres Strait Islanders, people from CALD communities and
other at risk groups. Population levels of psychological distress showed a
(Queensland Government, 2011)
Western Australia: Mental Health 2020:
making it personal and everybody’s
business. Action plan
(Government of Western Australia,
2011)
New South Wales Community Mental
Health Strategy (2007–2012)
(NSW Health, 2008)
South Australia’s Mental Health and
Wellbeing Policy (2010–2015)
(South Australian Health, 2010)
A four-year report was released that documents the progress achieving the aims
of the plan. The report found that funding targets had been met, a
A 10-year strategic policy for mental health in Western Australia developed
as part of the newly developed Mental Health Commission. The action
areas addressed in the plan include good planning, services working
together, a good home getting help earlier, addressing the needs of
specific populations (including aboriginal people, people with complex
and co-occurring needs, CALD communities, infants, children and youth,
older people and fly-in/fly-out workers), justice, preventing suicide,
sustainable mental health workforce and ensuring a high quality system.
Provides a strategy for community mental health across the spectrum of
mental health, from promotion to recovery.
This strategic plan documents the reforms and developments needed in
mental health across South Australia. It builds on the former plan
‘Stepping up: a social inclusion Plan for Mental Health Reform
2007–2012’ and a review of community mental health services in South
Australia.
downward trend between 2005 and 2011; however, it was noted that this
decline may stall due to the number of Queenslanders who had experienced
a natural disaster in the summer of 2010–2011.
An evaluation of the 2011–2012 progress has not yet been published, however
included in this plan are six outcome statements on (i) health, wellbeing and
recovery, (ii) a home and financial security, (iii) relationships, (iv) recovery,
learning and growth, (v) rights, respect, choice and control and (vi)
community belonging.
This strategy takes a community health approach to the prevention and
treatment of illness across the spectrum of illness. The plan details
information on promotion, prevention and early intervention, as well as
emergency and acute care and continuing care, rehabilitation and recovery.
The plan details age-specific services and identified at risk groups such as
Aboriginal and CALD communities. No evaluation found.
The plan outlines four objectives for the future of mental health in SA,
including: promoting positive mental health and wellbeing and preventing ill
health; protecting the human rights of people with a mental illness and
supporting those who experience ill health, without stigma or
discrimination; prioritizing early intervention in a way that is culturally
respectful and meets the needs of all South Australians, regardless of age,
disability, cultural background, geographical location or circumstances in
life and promoting principles that strategies recovery. No evaluation of the
progress to date was found.
Promoting equity in the mental wellbeing of children and young people, 2015, Vol. 30, No. S2
Queensland Plan for Mental Health
2007–2017
Continued
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Table 1: Continued
Intervention and target population
Summary and aims of the intervention
Evaluation and key outcomes
Building the Foundations for mental
health and wellbeing: A strategic
Tasmania’s framework and strategic plan for mental health promotion,
prevention and early intervention.
Framework is born out of the evidence that prevention and promotion
initiatives exist in many forms, including a healthy start to life, parenting
framework and action plan for
implementing PPEI approaches in
Tasmania (Australian Network for
Promotion Prevention and Early
Intervention for Mental Health
programmes, school-based interventions, support for children of parents
with mental illness, workplace interventions. This framework also places
strong emphasis on the social determinants of health. Action items under
priority number five include: identifying the needs of people living in rural
and remote areas, developing initiatives for drought affected farmers,
(Auseinet, 2009)
producers and communities; ensuring the PPEI needs of Aboriginal people
are identified; supporting the children of parents with a mental illness;
promoting initiatives in correctional settings; addressing the needs of CALD
communities; and ensuring that a life course approach is recognized and
Mental health service system
development strategy project for the
Northern Territory (Healthcare
Management Advisors, 2003)
A review of government funded mental health services in the Northern
territory was undertaken to make recommendations on (i) the level, mix
and integration of services, (ii) potential areas of disinvestment and
reinvestment within the mental health services and (iii) priorities for
future funding in relation to specific mental health services.
targeted.
The report made over 37 recommendations to improve the mental health
services in the Territory, including: expand the breadth of services to
encompass the whole continuum of care form promotion to long-term care;
promote the application of whole of government approaches; expand
linkages between service sectors and increase the involvement of
stakeholders in the ongoing planning, development and review of the service
system and individual services.
Early childhood policy
National Early Childhood Development
Strategy, Invest in the Early Years
building blocks for a child friendly
city 2010–2014
(ACT Department of Disability
Housing and Community Services
and ACT Health, 2010)
wellbeing outcomes.
This Plan sets out a whole of Government approach to support the best
The agreement included a number of national reform initiatives that sought to
improve early childhood outcomes including ensuring universal access to
quality early childhood education and development of an early intervention
and prevention framework.
The outcomes on children’s wellbeing are evaluated annually in a series of
development for ACT children aged 0–12 years.
The ACT children’s plan is embedded within The Canberra Plan and the
Canberra Social Plan, which called for improvements to social, economic
and environmental factors to address the social determinants of health,
including mental health. The aim of the Children’s Plan was to make
reports describing the trends in key indicators, including health, wellbeing,
learning and development outcomes for children and young people. The
2013 key wellbeing outcomes showed positive results, including: fewer
children being admitted to hospital for psychiatric or behavioural disorders
and fewer children classed as developmentally vulnerable on the AEDI, with
Canberra a safe place for children and to ensure their needs are a priority
for the government and the community.
79% of children classed as ‘on track’ with their emotional maturity
compared with a national average of 78.1%.
J. Welsh et al., 2015, Vol. 30, No. S2
(COAG)
(Council of Australian Governments,
2009)
The ACT Children’s Plan: Vision and
An agreement by the Council of Australian Governments to support a
strategy for investment into the early years of children lives to improve
Framework for integrated early
childhood development (Queensland
Government, 2013)
Kids Come First Blueprint
(Child Family Community Supports
& Services, 2009)
A framework to support all early childhood professionals to work together
with families to achieve common outcomes for children. This report states
that it is during early childhood that the foundations for social, emotional
and spiritual wellbeing are laid.
This framework develops a model of support integration across the early
childhood development sector.
learning and development and (iii) reflective: reflective practice. This has not
yet been evaluated.
This framework embeds many wellbeing outcomes but does not address
mental wellbeing or resilience specifically. No evaluation of this was found.
The Kids Come First project provided a way for the Tasmanian Government
to monitor how children and young people were faring across a number
of developmental outcomes (including mental wellbeing) and to identify
where action areas were needed.
Evaluation of the framework is done in part through the Kids Come First
Report (Child Family Community Supports & Services, 2009), which
provides data on 92 indicators across 30 broad health, safety, learning,
development and wellbeing areas. The framework emphasizes the
This is an initiative of the Tasmanian Government designed to use key
outcomes based framework to monitor and evaluate the health and
wellbeing of Tasmanian children.
Northern Territory Early Years
Framework
(Education Advisory Council for the
Minister for Employment Education
& Training and Minister for Health
& Community Services, 2004)
Headline Indicators for Children’s
Health, development and wellbeing
(Australian Institute of Health and
Welfare, 2001)
Outcome criteria for each learning and development goal are made explicit and
are developmentally sensitive and include whether the programmes are (i)
collaborative: family-centred practice; partnerships with professionals; high
expectations for every child, (ii) effective: equity and diversity; respectful
relationships; integrated teaching and learning approaches; assessment for
This report serves as a guide for policy and action in the Northern Territory
on children’s early years. This report notes that early care and learning
opportunities in children aged 0–8 years are the best and most
cost-effective time to support children to reach their full potential.
A national data source that provides indicators of child development and
wellbeing, including child abuse and neglect, early education, family
economic situation and transitions to primary schools. The data are
available for a number of specific groups, including CALD backgrounds,
family type, Indigenous status, remoteness, sex and socioeconomic status.
importance of optimal antennal and infant development, strong social and
emotional development, positive child behaviours and mental health and
pro-social lifestyles, healthy parent lifestyles and parenting skills, good
mental health, positive family functioning and a healthy and supportive
community.
The scope of this report is larger than this review, however the wellbeing
indicators were generally positive, but revealed concern in the following
areas: young people’s self-reported use of alcohol, tobacco and drug use;
chid protection indicators and attendance at child health checks.
As a result of this report, the Ministers for Health and Community Services and
Employment, Education and Training endorsed a number of action items,
including the framework for policy action, and a quarterly reporting to
ministers on implementation.
Findings of interest to this report included that in 2011 it was reported that
there was no national data recommended for the Headline Indicator for
social and emotional wellbeing. In 2009, approximately one-quarter of
Australian children were developmentally vulnerable on one or more of the
Promoting equity in the mental wellbeing of children and young people, 2015, Vol. 30, No. S2
The Victorian Early Years Learning and
Development Framework: for all
children from birth to eight years.
(Department of Education and Early
Childhood Development, 2011)
domains of the AEDI. This proportion was higher in the Indigenous
population.
Continued
ii45
Intervention and target population
ii46
Table 1: Continued
Summary and aims of the intervention
Evaluation and key outcomes
This vision of this organization is a digitally connected world where
technologies are used to support young people to feel safe, healthy and
A number of research projects directly relating to positive mental health and
wellbeing in young people are currently underway as part of this
Governance
Young and Well Cooperative Research
Centre http://www.youngandwellcrc.
org.au/
headspace: Australia’s National Youth
Mental Health Foundation
http://www.headspace.org.au/
resilient. This organization is producing research, education and training
on the role of digital technologies in youth mental wellbeing.
headspace offers help to 12–25 year olds on general health, mental health
and counselling, education, employment, alcohol or other drug services.
It is a carefully constructed and selected system of 30 ‘communities of
youth services’, or integrated service hubs and networks, across the
nation, supported by programmes for community awareness, workforce
training and evidence-based resource material that is funded by the
Commonwealth Government of Australia (McGorry et al., 2007).
organization. Examples of projects include e-tools for Wellbeing, Safe and
Well Online, Gaming Research Groups, Mapping Digital Inclusion and
Exclusion and an e-Mental Health clinic. Education and training are also
occurring as part of organization, including supporting young and early
career researchers, as well as community education for young people,
professionals, parents and the wider community.
An independent evaluation of headspace found that headspace has been
effective in promoting and facilitating improvements in young people’s
mental health, alcohol or drug use, and their social and economic
participation. In addition, the evaluation found that young people did
increasingly seek assistance from services that were accessible, of good
quality, evidence-based, holistic and coordinated, although the programme
is not as integrated as the initial model intended it to be (Kieling et al., 2011).
A qualitative study examining the experience of young people with
depression accessing a headspace programme, found that for some young
people and school counsellors, physical location and the initial ‘no cost’
service acted as facilitators to the service. Barriers included physical location
for some, unfamiliarity with the service, delays in obtaining initial
appointments and a limit on the number of funded sessions (McCann and
An initiative by the Australian Government, which aims to encourage
responsible, accurate and sensitive representation of mental illness and
suicide in the Australian mass media.
Lubman, 2012).
An evaluation of the media portrayal of mental illness in 2006–2007 showed
considerable improvements to media articles from the baseline period of
2000–2001. There was an increase in the media items that involved suicide
or mental illness by approximately two-and-a-half-fold, however there was a
reduction in the number of items that described self-harm. Furthermore, the
majority of items did not stereotype mentally ill people as violent,
unpredictable and unable to work, weak or untrustworthy. The number of
items which did use negative stereotypes was down from 14.3 to 10.6%.
There was a 10% increase in the number of items which provided
information on help services available.
J. Welsh et al., 2015, Vol. 30, No. S2
Mindframe National Media Initiative
(Pirkis et al., 2008)
ii47
disadvantaged groups (such as Indigenous or CALD
Australians and prisoners) are recognized as having specific and often greater need relative to the general population.
advantaged households.
a snapshot of early childhood development revealed differences in
development by socioeconomic status, geographical area and language
spoken at home. For example, 11.8% of children living in the most
disadvantaged households reported being developmentally vulnerable on
the emotional maturity domain, compared with 6.3% of those in the most
life. It also quantifies inequities in child development.
governance, quality and stability of the AEDI. The evaluation found strong
support for future use of the AEDI. The key findings from the evaluation
were that it meets a major need in an area of national priority; has
substantial potential to impact on early childhood development outcomes
and has potential as a progress measure and headline indicator. A report on
social competence, (iii) emotional maturity, (iv) language and cognitive
skills and (v) communication skills and general knowledge. In 2010 the
AEDI was implemented nationwide. This index will enable communities
and governments to pinpoint the types of services, resources and supports
young children and their families need to give children the best start in
(Atelier Learning Solutions, 2010)
(Centre for Community Child Health
and Telethon Institute for Child
Health Research, 2009)
Australian Early Development Index
(AEDI)
The AEDI is a national measure of how children in Australia are developing.
There are five elements to the index: (i) physical health and wellbeing, (ii)
An evaluation of the implementation was conducted in 2010 with a view to
establishing the measures appropriateness, effectiveness, efficiency,
Promoting equity in the mental wellbeing of children and young people, 2015, Vol. 30, No. S2
Early childhood policy
The Australian Government has developed the National
Early Childhood Development Strategy to improve early
childhood outcomes from birth to five years. This approach provides universal support for all Australian children and directs additional support to children with the
highest need, reflecting principles of proportionate universalism. This strategy has been translated into national and
state/territory level policies, but no evaluation has yet
taken place, performance indicators are not identified,
and little detail given as to how the Government would
achieve these goals. The Australian Government has however invested in the Australian Early Development Index
(AEDI), a national measure of how Australian children
are faring across a number of developmental areas, including social competence and emotional maturity which
could be considered aspects of wellbeing.
Governance
The World Health Organization (WHO), World Federation
for Mental Health and UNICEF are all active in the area of
mental health promotion of children; however, by far the
most active in this area is the WHO. The WHO has set mental health and wellbeing in the centre of the public health
agenda and continues to release high level and influential
reports on mental health (see, for example, Herrman et al.,
2005). The recognition of social determinants of health and
the inequities they create is strongly represented in WHO
documents.
In Australia, mental health action plans and strategic
frameworks are available at the federal level and for most
states and territories. In these plans, addressing inequities
is framed in terms of high-risk groups, such as Indigenous
Australians, CALD communities and young people in the
justice system. It is difficult to assess the extent improvements to wellbeing have resulted with wellbeing indicators
rarely specified and published evaluations unavailable.
A number of non-government organizations are active
in youth mental health issues, but our search revealed only
one organization with a focus on wellbeing. Young and
Well Cooperative Research Centre (CRC) is an organization which aims specifically to improve the mental wellbeing of Australian young people. CRC examines the
potential for digital technologies to prevent mental health
problems, promote mental wellbeing and offer new modes
of mental health care delivery; however, evaluations of
wellbeing-based interventions were not available, and
ii48
Table 2: Interventions identified in high income countries within the daily conditions and individual health-related factors layers of the framework
Intervention and target population
Summary and aims
Evaluation and key outcomes
Daily living conditions
Early childhood care and education settings
Systematic review of interventions in
early childhood aimed at improving
psychosocial conditions (Wise et al.,
2005)
Review of 32 early childhood interventions where programme
efficacy had been well researched, or where a cost–benefit analysis
had been undertaken. Large-scale, well-established public
programmes were given priority. Twenty-two interventions were in
the USA, with the remaining interventions in Canada, UK,
Australia, Turkey, and Bolivia.
Strategies in promoting children’s social
and emotional wellbeing in childcare
centres located in disadvantaged areas
(Davis et al., 2010)
This exploratory descriptive study using qualitative methods aimed to
review the strategies used by childcare centre staff to promote
children’s social and emotional wellbeing, the challenges in doing
so, and the views of staff regarding facilitators for promoting such
wellbeing, focusing on childcare centres located in disadvantaged
areas.
Play therapy is a developmentally responsive intervention. A
meta-analysis of 93 controlled outcome studies was conducted to
assess the overall efficacy of play therapy and to determine factors
that might impact its effectiveness.
Supported playgroups for children and
their parents in Western Sydney
The Australian supported playgroup aims to support the
development and wellbeing of children and their parents.
Supported playgroups offer children opportunities to play, learn
and socialize.
outcomes tended to diminish over time. One of these interventions though did
retain a small effect at follow-up 22 years after participation (Brooks-Gunn, 2003).
In another intervention with a family economic/welfare focus, small to medium
effect sizes were seen in the intermediate term (Huston et al., 2001). However, no
evaluation can demonstrate that a programme that worked well in one setting will
have similar positive results when adopted in a new location (Wise et al., 2005).
Strategies for promoting children’s social and emotional wellbeing were grouped
across three levels: the individual child, centre-wide approaches and linking with
the wider community. Challenges included difficulties communicating and forming
relationships with parents, difficulties in communicating with children,
inconsistent behaviour management, difficulties with provision of staff training
and lack of resources and support for children. Facilitators included cohesive staff
team, open door policy for parents, ability to communicate with parents and
peer-support for directors. Authors identified opportunities for further promotion
of children’s social and emotional wellbeing to be communication booklets and
extra staff (Davis et al., 2010).
The meta-analysis revealed a large and significant treatment effect (0.80 ± 0.04) of
play therapy interventions for children suffering from various emotional and
behavioural difficulties. Play therapy appeared equally effective across age, gender
and presenting issues, and using parents in play therapy produced the largest
effects (Bratton et al., 2005).
Using multi-case study methodology with an adapted ecological framework, an
evaluation examined the interrelationships between children, parents and staff and
found that children’s developmental outcomes were influenced by their
interactions with playgroup participants and by the experience of their parents
within the groups (Jackson, 2013).
J. Welsh et al., 2015, Vol. 30, No. S2
Review and meta-analysis of the efficacy
of play therapy with children (Bratton
et al., 2005)
Evaluations of interventions ranged from very good integrity to very poor integrity,
with most evaluations including some objective measures, as well as parental
reports. Many reviewed evaluations did not provide effect sizes. The largest effect
sizes were found for interventions that were centre-based, preschool child focused,
but most effects were negligible to small and the positive effects on cognitive
Connections
Early childhood education and care
workforce
Sure Start
Children under 4 years of age and
their families in the UK
A national initiative that uses a whole-service framework and
provides resources to early childhood education and care service
educators and families, while fostering partnerships with health
and community organizations. The core content is comprised of (1)
An evaluation of a trial of KidsMatter Early Childhood in 111 long day care services
and preschools during 2010 and 2011 showed that it better met the needs of
children with difficulties, improved staff–child closeness, improved child
temperament and reduced mental health difficulties. In addition KidsMatter Early
creating a sense of community, (2) developing children’s social and
emotional skills, (3) working with parents and carers, (4) helping
children who are experiencing mental health difficulties.
Childhood increased knowledge, competence and confidence in relation to
supporting the development of children’s social and emotional skills (Slee et al.,
2012a). The professional learning aspect of this study was highly valued in settings
with a high proportion of Aboriginal and Torres Strait Islanders (Slee et al.,
2012b).
Connections is a two-stage project aimed at building the capacity of
early childhood education and care (ECEC) workforce to support
the mental health and wellbeing of children. Stage one involved
investigating the key competencies of the ECEC workforce and
releasing recommendations in a report. Stage two, which is
A report from stage one identified five key domains of practice relating to children’s
mental health and wellbeing (the environment, child development, early
intervention, partnerships, and professional practice), based on analysis of policy,
research and expert opinion and working in consultation with representatives from
both the early childhood and mental health sectors (Hunter Institute of Mental
currently in progress, involves the development of a mental health
resource for the ECEC workforce.
Sure Start local programmes (SSLPs) represent a large-scale effort by
the UK government to enhance the health and development of
children under 4 years and their families who live in socially
deprived areas. SSLPs aim to improve services and create new ones
in small areas.
Health and Community Services & Health Industry Skills Council, 2012).
A quasi-experimental observational study of 93 disadvantaged SSLP areas with 72
similarly deprived areas in England observed beneficial effects associated with the
SSLPs for five of 14 outcomes including social development, social behaviour,
greater independence and less negative parenting. Authors conclude that children
and their families benefited from living in SSLP areas (Melhuish et al., 2008).
However, a quasi-experimental, cross-sectional study of 150 communities with
ongoing SSLPs and 50 comparison communities, found that the differences
between SSLP areas and comparison areas were limited, small and varied by degree
of social deprivation. Therefore, SSLPs seem to benefit relatively less socially
deprived parents and their children, but seem to have an adverse effect on the
most disadvantaged children (Belsky et al., 2006).
Promoting equity in the mental wellbeing of children and young people, 2015, Vol. 30, No. S2
KidsMatter Early Childhood
http://www.kidsmatter.edu.au/
Continued
ii49
ii50
Table 2: Continued
Intervention and target population
Summary and aims
Evaluation and key outcomes
Project Head Start and the HighScope
A preschool programme run to help disadvantaged preschool
There is much research on the Head Start Programme. A lifetime effects study found
Perry Preschool Project
Preschool children aged 3–5 from
disadvantaged backgrounds in the
USA
children get a ‘head start’ by starting elementary school with
competence levels similar to their peers. The HighScope Perry
Preschool Project helped support the creation of Head Start and
today about one fifth of Head Start programmes use the HighScope
Curriculum in their preschool classrooms.
that adults at age 40 who had had the preschool programme had higher earnings,
were more likely to hold a job, had committed fewer crimes and were more likely to
have graduated from high school than adults who did not have preschool
(Schweinhart et al., 2005). An early evaluation of the Head Start programme
concluded there were significant immediate gains in cognitive test scores,
socioemotional test scores and health status for children enrolled; however
socioemotional test scores do not stay significantly different in the long run
(McKey et al., 1985). Another evaluation found that Head Start children showed
significantly larger gains on the Preschool Inventory and Motor Inhibition tests
than comparison groups; however, Head Start children were still behind their peers
in terms of absolute cognitive levels after a year in the programme (Lee et al.,
1988). More recently, Head Start has shown to improve cognitive language
development, decrease aggressive behaviour, and improve school readiness (Love
et al., 2005, Peck and Bell, 2014).
Let’s Start
Programme for Aboriginal families
and children aged 4 to 6 in the
Northern Territory
Let’s Start is a therapeutic parenting programme that helps support
the social and emotional needs of children as they transition to
school. Let’s Start brings together expertise about child
development, early learning and parenting support and works with
local organizations like schools, preschools, health care centres,
childcare centres and child protection services to ensure that
parents are supported in their local communities.
An evaluation of a 10 week Lets Start Programme could not definitively attribute
outcomes as the evaluation research design did not include randomization and
control groups. There was a significant drop in participation from referral to
programme commencement and from commencement to 6-months follow-up.
However both quantitative and qualitative analyses of responses to the programme
Interventions in school settings
Review of systematic reviews covering
mental health promotion and
prevention in school settings
(Arksey and O’Malley, 2005)
Fifty-two systematic reviews and meta-analysis of mental health
programmes and interventions in schools. A wide range of
outcomes were studied, including social, emotional and
educational in children, their families and communities.
The results of the review were largely positive, with positive effects evidence for
children, their families and communities across a range of mental health, social and
emotional and educational outcomes. The authors noted while the effect sizes were
small to modest, the anticipated outcomes at the population were significant.
Successful interventions were characterized by programmes that focused on
positive mental health (wellbeing) and had a balance of universal and targeted
approaches. Consistent and accurate implementation were also important.
J. Welsh et al., 2015, Vol. 30, No. S2
were positive, with statistically significant reductions in problem and risk
behaviour among participating children both at home and at school. Authors also
observed reductions in child anxiety, reductions in aversive parenting, improved
reciprocal responsiveness between parent and child and improved parental
confidence or assertiveness (Robinson et al., 2009).
2014)
Meta-analysis of school-based, universal
social and emotional learning (SEL)
programmes involving 270 034
students of all ages (Durlak et al.,
2011)
Meta-analysis of school-based, indicated
social and emotional learning (SEL)
programmes in kindergarten to grade
eight (Payton et al., 2008)
Synthesis of reviews on interventions to
improve the social and emotional
wellbeing of primary school-aged
Systematic review, including 11 school-based interventions in high
income countries. Interventions reviewed focused on creative arts;
cognitive-behavioural therapy; trauma-focused
Both the cognitive-behavioural therapy and creative-art based interventions led to
significant reductions in symptoms of depression, anxiety, PTSD functional
impairment and peer problems. Authors conclude that interventions delivered in
cognitive-behavioural therapy; individual, family and supportive
therapy; and exposure through writing.
Systematic literature review and meta-analysis of 213 school-based
universal programmes that promote students’ social and emotional
development. Effects were explored across social and emotional
school settings can be successful in helping children overcome difficulties
associated with forced migration.
School staff carried out SEL programmes effectively, indicating that interventions can
be incorporated into routine educational practices and do not require outside
personnel. Participants in universal SEL programmes demonstrated improved
skills, attitudes towards self and others, positive social behaviour,
conduct problems, emotional distress and academic performance.
social and emotional skills, attitudes, behaviour and academic performance.
Effects remained significantly significant for a minimum of 6 months after the
intervention. SEL programmes were found to be successful at all education levels
and in urban, suburban and rural schools, although they have been studied least
often in high schools and in rural areas. Authors suggest further research of
Systematic literature review and meta-analysis of 80 school-based
indicated programmes that focused on the needs of students who
already show signs of social, emotional and behavioural or
learning problems. Students in these programmes most frequently
displayed conduct problems, emotional distress and problems with
peer relationships. The same outcomes were explored as by Durlak
et al. (Durlak et al., 2011).
Eighty reviews of intervention effectiveness covering 322 primary
studies were reviewed. The majority examined classroom-based
interventions.
children (Green et al., 2005)
Meta-analysis of school programmes
targeting stress management or
coping skills in children aged 9–14
years (Kraag et al., 2006)
Systematic literature review and meta-analysis of 19 randomized
controlled trials or quasi-experimental studies. Experimental
groups received an intervention of (i) relaxation training, (ii) social
problem solving, (iii) social adjustment and emotional self-control
or (iv) a combination of these interventions.
conducting sub-group analyses to determine if certain participants receive more or
less benefit from an intervention (Durlak et al., 2011).
Significant mean effect sizes were achieved in all outcome categories (social and
emotional skills, attitudes towards self and others, positive social behaviour,
conduct problems, emotional distress and academic performance). Although the
magnitude of effects were lower at follow-up, they were still significant in all
outcomes except academic performance. Similar to the universal SEL programmes,
school staff carried out indicator SEL programmes effectively. SEL programme
effects were achieved in student populations that were diverse racially-ethnically,
socioeconomically and geographically, although half the programmes were in
urban areas (Payton et al., 2008).
This review found that interventions with a sustained focus on the promotion of
mental health, on self-esteem and coping outcomes within the broad school climate
achieved greater effectiveness results. Also, interventions replicating positive
impacts rather than the prevention of mental health problems showed to be more
effective. However, the authors note that conclusions are limited by the short
duration of studies and lack of detail of interventions (Green et al., 2005).
Meta-analysis findings indicate significant positive effects for the evaluated
Promoting equity in the mental wellbeing of children and young people, 2015, Vol. 30, No. S2
Systematic review of school-based
interventions for refugee and asylum
seeking children (Tyrer and Fazel,
programmes and showed positive effects in reducing stress symptoms and
enhancing coping skills. No effect was found for self-efficacy. This study was
limited by heterogeneity for both overall effects and for the effect per outcome.
There was no analysis of effects in sub-groups (Kraag et al., 2006).
Continued
ii51
ii52
Table 2: Continued
Intervention and target population
Summary and aims
Evaluation and key outcomes
Synthesis of reviews on evaluations of
universal and early intervention
health promotion initiatives for
Synthesis of reviews that discussed efforts to reduce deficiencies
related to depression, anxiety, externalizing/internalizing or other
psychological/social problems, reductions in risky behaviours,
The synthesis finds that although universal or early intervention programmes to
develop protective factors are more effective than programmes to reduce existing
negative behaviours, programme effectiveness can vary by age, gender and
children at risk (Browne et al., 2004)
Systematic review of universal
approaches to mental health
promotion in schools (Wells et al.,
2003)
Systematic review of psychological and
A systematic review of 17 (mostly US) studies investigating 16
interventions with universal approaches to mental health
promotion in schools. The majority of schools studied were in
socioeconomically deprived areas and many also had a high
proportion of children from ethnic minority groups.
Fifty-three randomized controlled trials of psychological or
educational prevention programmes, or both, compared with
placebo, any comparison intervention, or no intervention for
young people aged 5–19 years old, who did not currently meet
diagnostic criteria for depression or who were below the clinical
range on rating scales of depression were reviewed.
Systematic review of school-based and
early intervention programmes for
depression in children and adolescents
(Calear and Christensen, 2010)
Forty-two randomized controlled trials relating to 28 individual
school-based programmes in high income countries were
identified. A large proportion of the programmes were based on
cognitive-behavioural therapy and were delivered by a mental
health professional or postgraduate student over 8–12 sessions.
ethnicity of children. Younger children, either preschool age or in early grades,
benefit more than older children, but programmes for some older children are also
effective. Programmes to address a specific problem or problems which are
sensitive to cultural or gender-based differences have greater effect than broad,
unfocused interventions. In addition, programming that has multiple, integrated
elements involving more than the single domain of school is likely to have positive
results than single focus, single domain interventions. The continuing presence of
appropriate adult staff, and mentoring or a stable relationship with a successful
adult were important aspects of programme delivery (Browne et al., 2004).
Positive evidence of effectiveness was found for programmes that adopted a
whole-school approach, were implemented continuously for more than a year and
were aimed at the promotion of mental health as opposed to the prevention of
mental illness. Long-term interventions promoting the positive health of all pupils
and changes to the school climate are more likely to be successful than brief
class-based mental illness prevention programmes (Wells et al., 2003). The review
included studies that were carried out with minority ethnic groups and included
participants from socially deprived areas, but no information was provided in the
review about the effectiveness for programmes for different socioeconomic or
cultural groups (Tennant et al., 1999).
The risk of having a depressive disorder post-intervention was reduced immediately
compared with no intervention, at 3–9 months, and at 12 months. There was no
evidence for continued efficacy at 24 months, but limited efficacy at 36 months.
Authors conclude that there is some evidence that targeted and universal
depression prevention programmes may prevent the onset of depressive disorders
compared with no intervention. There was significant heterogeneity in the findings
and no evidence of efficacy in the few studies that compared intervention with
placebo or controls (Merry et al., 2012).
Only half of the trials reviewed reported a significant reduction in depressive
symptoms at post-test or follow-up. Indicated programmes that targeted students
exhibiting elevated levels of depression were found to be most effective. Some
universal programmes were also found to be effective and authors conclude that it
may be the quality of the universal programmes being implemented that are not
producing significant effects, rather than the universal delivery style itself (Calear
and Christensen, 2010). There was no mention of equity in this review.
J. Welsh et al., 2015, Vol. 30, No. S2
educational interventions for
preventing depression in young people
aged 5–19 years old (Merry et al.,
2012)
outcomes to increase competence and resilience through various
protective strategies, or programmes with a combination of both
outcome strategies. The majority of reviews contained
school-based programmes to promote positive behaviours and
prevent psychosocial problems (Browne et al., 2004).
2000)
MAKINGtheLINK
Curriculum-based programme for
schools to promote help-seeking for
cannabis use and mental health
problems piloted in a Victorian
high-school
Doc On Campus (DOC) Programme
Regional secondary school students in
South Australia
Review of 47 studies on school-based mental health programmes that
used a randomized, quasi-experimental or multiple baseline
research design; included a control group; used standardized
outcome measures; and assessed outcomes at baseline and
post-intervention.
MAKINGtheLINK has four components: an implementation guide,
staff professional development information session, parent
information session and the Student Helpseeking Programme. The
Student Helpseeking Programme includes a teacher manual,
clinical syndromes. Important features of the implementation process that increase
the probability of service sustainability and maintenance include the inclusion of
parents, teachers or peers; the use of multiple modalities; the integration of the
programme content into general classroom curriculum and developmentally
appropriate programme components (Rones and Hoagwood, 2000).
MAKINGtheLINK was evaluated using a 16-item programme satisfaction survey,
specifically developed for evaluating the acceptability of the content and teaching
methods, and the feasibility of implementing the programme within school settings
(Berridge et al., 2011). MAKINGtheLINK was found to be both acceptable and
classroom activities, ‘Mates Help Mates’ DVD and an information
flyer and programme poster.
feasible within a school setting. However, the programme was only piloted in one
metropolitan school that was overwhelmingly monocultural, and students with
substance abuse and/or mental health issues may have been more likely to be
absent on the day of the programme and less likely to be involved in evaluation
(Berridge et al., 2011).
A student-friendly service for early detection and intervention in
order to contribute to student health and wellbeing and to decrease
incidence of mental health issues in adulthood. The DOC
programme provides students with affordable and confidential
access to mental health care by having psychological support for
Evaluation of the DOC programme was based on consultation with both present and
past students, teachers, school staff and health care professionals (Doley et al.,
2008). The programme exceeded expected objectives and outcomes, including a
reduction in the number of incidents of severe cases of self-harm over the first 4
years of the programme. All providers witnessed significant improvements in a
students on campus.
KidsMatter Primary
Primary schools across Australia
Authors found that there are a strong group of school-based mental health
programmes that have evidence of impact across a range of emotional and
behavioural problems; however, no programmes reviewed specifically targeted
Flexible, whole-school approach to improving children’s mental
health and wellbeing for primary schools. Schools undertake a
two-to-three year process that promotes positive school
community, social and emotional learning, working authentically
with parents, carers and families, support for students who may be
experiencing mental health difficulties. There are almost 100
KidsMatter programmes which can be used to suit individual
school situations.
majority of adolescents enrolled in the programme. Authors state that this initiative
has proved itself a worthy model of early intervention in adolescent mental health,
and it could effectively be replicated in other rural communities (Doley et al.,
2008). Long-term benefit and cost-effectiveness need to be evaluated.
An evaluation of a two-year trial of the programme (2006–2008), where the
programme was piloted with almost 5000 children in 1000 schools across
Australia, found that there were positive changes to schools, teachers, parents/
caregivers and children associated with the trial. KidsMatter was associated with
statistically and practically significant improvement in students’ measured mental
health, in terms of both reduced mental health difficulties and increased mental
health strengths, especially for students with higher existing levels of mental health
difficulties or disabilities (Dix et al., 2010, Slee et al., 2009). However, an
evaluation found that during a two-year period, parents did not, in general, feel
that KidsMatter Primary had a strong impact on their capacities to help children
Promoting equity in the mental wellbeing of children and young people, 2015, Vol. 30, No. S2
Review of school-based programmes
providing mental health services to
children (Rones and Hoagwood,
with social and emotional issues, particularly so for parents of students with a
disability (Dix et al., 2010).
ii53
Continued
ii54
Table 2: Continued
Intervention and target population
Summary and aims
Evaluation and key outcomes
MindMatters
Secondary schools in Australia.
MindMatters has been adapted in
Germany (Franze and Paulus, 2009)
and the USA (Evans et al., 2005)
MindMatters combines a selective and a whole-school approach, and
supports schools around Australia to foster the mental health of
their students; provides training for schools using the framework;
assists secondary schools and health services to work more closely
together; encourages secondary schools and families to work more
The MindMatters pilot programme provided a framework for mental health
promotion in widely differing school settings (Wyn et al., 2000). The MindMatters
programme has also created a framework and kit for effective school case
management (Repetti et al., 2002). A qualitative evaluation of the ‘whole-school’
buddy support scheme identified less bullying and more student participation,
closely together; and provides useful resources and links for young
people, families, teachers and schools.
connectedness, networking with outside agencies and increased confidence in
showcasing their programmes. Challenges included engaging culturally and
linguistically diverse communities and indigenous communities; resources; support
from the school executive and staff transitions, time, skills and motivations (Wyatt
Kaminski et al., 2008). In a review of the development and implementation of
RAMP (Risk Assessment and
Management Process)
At risk students in Australia
RAMP aims to improve the wellbeing and access to learning
opportunities for at risk students. It is a whole school approach
factors and their ability to identify students at risk and all school staff reported
being satisfied with student outcomes as a result of the RAMP process. The
evaluation also found that RAMP improved communication within the school and
between school and Child and Adolescent Mental Health Services staff (Kumpfer
and Alvarado, 2003). No evaluation on the effectiveness of the intervention at
improving mental wellbeing for at risk students found.
J. Welsh et al., 2015, Vol. 30, No. S2
which uses an evidence-based risk and protective factor framework
to identify at-risk students and develop student action plans.
MindMatters, Rowling (Rowling, 2007) summarizes that MindMatters
demonstrated intermediate health promotion outcomes of health literacy, social
action and influence and healthy public policy and organizational practice.
A process evaluation of RAMP was conducted using six primary and three secondary
schools. School staff reported improved knowledge of risk factors, protective
The FRIENDS Programmes are a suite of group-based learning
programmes. The primary components of the program include
Over 20 studies have been published on different aspects of the FRIENDS
Programmes. Early publications investigated and validated the effectiveness of
Friends for Life (ages 8–11); My
Friends Youth (ages 12–15) and Adult
Resilience (ages 16–18+). The
FRIENDS Programmes originated in
relaxation, cognitive restructuring, attention training, graded
exposure to anxiety-provoking situations and problem solving,
which are facilitated by peer and family support (Barrett and
Turner 2004). FRIENDS was originally designed as a group
FRIENDS in significantly reducing anxiety and depressive symptoms, when
delivered by classroom teachers for children aged 10–13 (Barrett and Turner,
2001; Lowry-Webster et al., 2003). The intervention effects were found to be
robust and positive gains were maintained over time, with treatment effects greatest
Australia and have been implemented
in 13 other countries
intervention which is suitable for use in a clinic or a school setting,
but can be run individually. FRIENDS consists of four
programmes for different age groups. Fun Friends helps guide the
social and emotional development of children aged 4–7 by using
fun, play-based group activities. Friends for Life is based on the US
for children in late primary school (Barrett et al., 2006; Lowry-Webster; Barrett
and Lock, 2003). A recent study evaluating the effectiveness of the FRIENDS
programme in younger children (ages 4–7) found that the intervention group
achieved greater reductions in behavioural inhibition, child behavioural difficulties
and improvements in social and emotional competence. Improvements in
Coping Cat programme and builds social skills and resilience in
children aged 8–11. My Friends Youth is a group-based
development programme that gives participants the tools to cope
with new challenges and experiences that come with the 12–15 age
group. Finally, the Adult Resilience course is targeted at students in
parenting distress and parent–child interactions were also seen (Anticich et al.,
2013). One study evaluates the universal-school-based prevention programme
exclusively in disadvantaged schools, using the FRIENDS for Life programme.
Authors found that participants reported significantly fewer anxiety and depressive
symptoms post-intervention and positive treatment gains were maintained at 12
year 11 or 12 as they start to deal with a dramatic increase in
schooling, social and home pressures. The FRIENDS programme is
also a KidsMatter programme.
month follow-up. Improvements in self-esteem and psychosocial functioning were
also seen (Stopa et al., 2010). In addition, the FRIENDS programme has shown to
result in significantly improving self-esteem, fewer internalizing symptoms and a
less pessimistic future outlook in culturally diverse migrants of non-English
speaking backgrounds at all levels of education (Barrett et al., 2003), as well as
Cool Kids Programme: School Version
Children aged 8–11 years in schools in
Australia
Cool Kids Programme is a cognitive behaviour therapy programme
that targets children who have met the diagnostic criteria for a
principal diagnosis of any anxiety disorder or who report high
levels of anxious symptoms. It includes psychoeducation about
anxiety, cognitive restructuring, exposure hierarchies, social skills,
assertiveness training and coping with teasing. The programme
was delivered in eight weekly sessions during normal school time,
and two additional parent information sessions. The Cool Kids
programme is also a KidsMatter programme.
significantly less internalizing symptoms in former-Yugoslavian teenage refugees in
Australia (Barrett et al., 2000).
One study looking at children from schools with a high concentration of
socioeconomically disadvantaged families found that participants in the
intervention condition demonstrated significant decreases in anxiety symptoms
relative to the control group, on both self-report and teacher-report measures.
Positive gains were maintained at 4 months follow-up. Authors conclude that
school-based early intervention appears to offer an effective means of reducing
anxiety symptoms in economically disadvantaged populations (Mifsud and Rapee,
2005).
However, the Cool Kids Programme employs a selective prevention model,
focusing on a small group, so it is not known whether this intervention would be
sufficient for a less selective group in a disadvantaged population, given the
increased risk of more serious emotional/behavioural problems (Stopa et al.,
Promoting equity in the mental wellbeing of children and young people, 2015, Vol. 30, No. S2
The FRIENDS Programmes
Consists of Fun Friends (ages 4–7);
2010).
ii55
Continued
ii56
Table 2: Continued
Intervention and target population
Summary and aims
Evaluation and key outcomes
Aussie Optimism programme
Children in primary and lower
secondary schools
The universal prevention programme is designed for teachers to use
with a whole class in school over a term with one session a week
and includes teaching on social life skills (designed to assist
children with deficits in social skills and social problem solving,
low social support and friendship difficulties) and optimistic
A randomized control trial of 496 children (aged 11–13 years) from disadvantaged
schools found that there were no significant differences in self-reported anxiety and
depressive symptomatology between the intervention and control groups
post-intervention, or at the 6-month or 18-month follow-up time points. However,
parents of children in the intervention group reported significant decreases in
thinking skills (focuses on reducing negative cognitive elements).
Delivered by school teachers as a series of 60-min lessons over a
20-week period. This programme is also a KidsMatter programme.
internalizing symptoms post-treatment, relative to parents of children in the control
group. These between-group differences had disappeared by six months follow-up.
The results indicate that the intervention may have resulted in some improvements
in child anxiety symptoms in the short term, but that it was very largely ineffective
in reducing childhood anxiety in the long term (Roberts et al., 2010).
The aim of this whole-school intervention was to promote health and
emotional wellbeing of young people by increasing connectedness
and skills for managing life’s ups and downs. The project’s areas
for action were to build a sense of security and trust; increase skills
and opportunities for good communication and build a sense of
A school-based cluster randomized controlled trial to determine the effect of the
Gatehouse Project on adolescents’ emotional wellbeing and health-risk behaviours
found a comparatively consistent 3–5% risk difference between intervention and
control students for any drinking, any regular smoking and friends’ alcohol and
tobacco use. There was no significant effect of the intervention on depressive
The Gatehouse Project
Victorian secondary schools
positive regard through valued participation in aspects of school
life.
symptoms and social and school relationships. Therefore, while this intervention
had a substantial impact on important health-risk behaviours, it did not have a
substantial impact on emotional wellbeing, perhaps because the key determinants
of depressive symptoms may differ from those of substance use, or the intervention
was either not sufficiently specific or sustained to produce an effect on those
The Classroom Dinosaur Curriculum is used by teachers as a
prevention programme for an entire classroom of students. The
curriculum is delivered two to three times per week by teachers in
outcomes (Bond et al., 2004).
Numerous studies have been published on the Classroom Dinosaur Curriculum and
accompanying teacher training programmes from the Incredible Years (e.g.
Hutchings et al., 2007; Webster-Stratton and Reid, 2003; Webster-Stratton and
Child training programme for
classrooms of students aged 3–8 in
several countries
20–30 min circle time lessons, followed by small group practice
activities and promotion of skills throughout the school day. There
are three sets of lesson plans (level 1: ages 3–5, level 2: ages 5–6,
level 3: ages 7–8). The Incredible Years also has three teacher
training programmes to promote emotional, social and academic
Reid, 2004). These studies suggest that the intervention teaches children to develop
more appropriate social and problem-solving skills; increases social and emotional
competence with peers in the classroom; reduces behaviour problems and increases
academic readiness and cooperation with teachers. The Classroom Dinosaur
Curriculum and teacher training has shown to be effective in a developing country,
competence and to prevent, reduce and treat behavioural and
emotional problems in young children.
in different ethnic groups, and in disadvantaged children (Baker-Henningham
et al., 2009; Barrera et al., 2002; Webster-Stratton and Reid, 2008).
J. Welsh et al., 2015, Vol. 30, No. S2
The Incredible Years Classroom
Dinosaur Curriculum and Teacher
Training
Primary school children in the USA
and other high income countries
The Good Behaviour Game is a universal classroom behaviour
management method that rewards children for displaying
appropriate on-task behaviours during instructional times.
When the Game was first evaluated and in large-scale population-based field trials, it
was found to be an effective means of increasing the rate of on-task behaviours
while reducing disruptive behaviour (Barrish et al., 1969; Harris and Sherman,
1973; Ialongo et al., 1999; Kellam et al., 2011; Leflot et al., 2010; Medland and
Stachnik, 1972; Reid et al., 1999; van Lier et al., 2004). Fourteen year follow-up to
a trial of the Good Behaviour Game on first and second grade classes in Baltimore
in 1985–1986 found significantly lower rates of drug and alcohol use disorders,
regular smoking, antisocial personality disorder, delinquency and incarceration for
violent crimes, suicide ideation, and the use of school-based services among
students who had played the Game (Kellam et al., 2011). Seventy-five percent of
Positive Education (as part of the Penn
Resiliency Programme)
Positive Education is a whole school approach that aims to build a
positive culture that places wellbeing at the core of education
original participating students were interviewed at follow-up. All students in the
trial were of lower middle socioeconomic status and 70% were African American.
Effects were greater for males and the first grade cohort (Kellam et al., 2011).
The Penn Resiliency Project has been evaluated in numerous controlled studies,
suggesting that the programme prevents symptoms of depression and anxiety,
Positive Education is a Penn
Resiliency Programme with students
grades K-12 at Geelong Grammar and
Northern Bay College in Australia.
The Penn Resiliency Programme also
through integrating themes of resilience, optimism and other
components of Positive Psychology into the school’s curricula,
boarding house life, athletics and administration. Positive
education is a project of the Penn Resiliency Programme, which is a
group intervention for late elementary and middle school students
although inconsistent findings have been reported (Gillham et al., 2006; Jaycox
et al., 1994; Pattison and Lynd-Stevenson, 2001; Roberts et al., 2003). Studies also
suggest that the programme is affective in some low income minority students
(Cardemil et al., 2007; Cardemil et al., 2002). Three evaluations of the Penn
Programme in Australia did not find evidence of a significant decrease in the
has projects in the USA and the UK
that uses the curriculum to teach cognitive-behavioural and social
problem-solving skills.
emergence of depressive symptoms, either at the completion of the programme or
at 6-month and 8-month follow-up (Pattison and Lynd-Stevenson, 2001; Quayle
et al., 2001; Roberts et al., 2003). This may have been due to programme duration
or sample differences.
The Resilience Doughnut
Primary and secondary school
students in Australia, Japan, South
Africa and the UK
The Resilience Doughnut is a practical, strengths-based Australian
model for building resilience in children and young people. The
centre of the Resilience Doughnut represents the person’s beliefs,
the way they see the world and how they see themselves in the
world. The outside is made up of seven factors that identify the
areas of influence around a person’s life ( parenting, skills,
community, family, peers, school and finances). The Resilience
Doughnut is implemented in schools through teacher training,
parent information sessions and embedding it in the school
curriculum.
A qualitative pilot study using the Resilience Doughnut model in four inner city
Catholic primary schools in the inner western suburbs of Sydney found that
parents who attended the seminars reported positive connections and an awareness
of the resources in their community, families and schools. All teachers noted value
in the programme across all curriculum areas. There were no significant differences
in student attendance or student involvement, but there was a reported change in
attitude across all primary schools involved (Worsley, 2008). Larger studies
measuring student outcomes are needed to assess the effectiveness of this
intervention.
Promoting equity in the mental wellbeing of children and young people, 2015, Vol. 30, No. S2
Good Behaviour Game
Continued
ii57
ii58
Table 2: Continued
Intervention and target population
Summary and aims
Evaluation and key outcomes
Families and Schools Together (FAST)
At risk students in various locations
A two-year, school-based early intervention programme for children
and families to build resilience and protective factors through an
Evaluations suggest that FAST led to decreases in identified behaviour problems of
children, increased child and parental self-esteem, improved educational success,
8-week intensive course and a two-year programme involving
monthly self-help meetings and ongoing family support. FAST is a
KidsMatter programme option.
Success for All is a whole-school, achievement-oriented programme
involving a family support team. The programme aimed to
improved family cohesion and parental involvement and increased social capital
(McDonald et al., 2006; McDonald and Sayger, 1998; Sayger and McDonald,
1999; Terrion, 2006).
In reviewing the research on the efficacy of Success For All, Slaven et al. (Slaven et al.,
2002) show that intervention has had a substantial positive effect on student
promote parental involvement and build child resiliency through
improved reading skills, reduced special education referrals and
repeated grades, increased school attendance and addressing
family needs.
The Peer Support Programme is a peer led approach to enhance the
reading achievement throughout primary school, as well as improving attendance
and reducing special education placements and retentions.
A mixed-methods evaluation of 930 Grade 7 students at three schools in NSW over 2
mental, social and emotional wellbeing of young people and it is
integrated into school curricula and sustained throughout all year
groups. It provides training and professional development for
teachers; student leadership training and resources; experiential
years suggests that the Peer Support Programme was largely successful in
enhancing students’ self-concept, school citizenship, sense of self and possibility,
connectedness and resourcefulness (Ellis et al., 2009). As the sample was drawn
from one Australian State, it may not be generalizable to other areas. There is no
learning modules focussed on relationships, optimism, resilience,
anti-bullying and values and free consultancy to assist schools.
mention of the demographics of sample students or differences in the results
between students.
including the USA, Australia, Canada,
Germany and Austria
Success for All
Disadvantaged students from grades
K-12 in the USA
Peer Support Australia
1400 schools throughout Australia.
Similar models have been adopted by
schools in the USA, UK, New Zealand
and Singapore
Online settings
ReachOut.com
Young people aged 16–25 years
ReachOut.com is an online youth mental health service that provides
factsheets, stories, videos, guides, tools, apps and forums. The
website provides resources for wellbeing to improve the everyday
lives of youth.
One study found that ReachOut.com effectively engages young people, particularly
those who are experiencing high levels of psychological distress and supports
young people to be service ready (Collin et al., 2011). Another study indicates that
contacted a mental health professional (Nicholas, 2010). The services of
ReachOut.com are available to all those with internet access, but no particular
youth groups are targeted and there is no available evidence on use or efficacy by
sub-group.
Smiling Mind
Young Australians aged 7-adult
Smiling Mind is a web and App-based programme developed by a
team of psychologists with expertise in youth and adolescent
therapy, Mindfulness Meditation and web-based wellness
programmes.
There have been a number of papers published to support the effectiveness in
participating in mindfulness courses (Biegel et al., 2009; Shapiro et al., 2011;
Shapiro et al., 2008); however, an evaluation of the Smiling Mind programme
specifically could not be found.
J. Welsh et al., 2015, Vol. 30, No. S2
young Australians trust Reach Out, use it as a source of information and support
for mental health issues, and benefit from using it, with enhanced knowledge about
mental health issues and increased help seeking (Burns et al., 2009). This research
is limited though by potential response bias and a potentially unrepresentative
sample of Reach Out users. After visiting ReachOut.com ∼38% of young people
The MATE Programme was a pilot programme that involved 6 weeks
of weekly online mindfulness training, which aims to enhance
The pilot programme showed that young people were eager to engage with the design
and provide input into this health promotion programme. All interviewees believed
Young Australians aged 16–26
individuals’ ability to be aware of their feelings and choose how
intensely to engage with them. The programme also involved
meditation session, an online discussion forum, and an evaluation.
that young people would find the programme desirable. A randomized control trial
is needed to further evaluate the programme (Monshat et al., 2012). Online
mindfulness training has found to be an acceptable and accessible intervention,
which reduces stress, anxiety and depression in adults (Cavanagh et al., 2013;
Krusche et al., 2013).
There are a number of Youth Development programmes used to
address various health and social issues among young Aboriginal
peoples Australian communities. These programmes include sports
and recreation activities, family interventions, cultural camps and
A review of youth programmes promoting Indigenous social and emotional wellbeing
found that overall the evidence base is limited, but there are some strong,
resourceful and resilient Indigenous youth programmes operating throughout
remote and non-remote Australia. Authors identified successful attributions of
Community interventions
Aboriginal Youth Development
Programmes
Aboriginal Youth in Australia
community leadership programmes.
programmes such as, addressing the upstream social determinants of social and
emotional wellbeing as well as current issues; recognizing and building on the
strengths of Indigenous culture, community and family; paying careful attention to
both content and process; developed and led by local people and have an impact at
multiple levels and engaging the broader community (Haswell et al., 2013). A
review of youth development programmes in Central Australia found that
participants’ perceptions of effective programmes vary within communities and
throughout the region; however there are some identifiable common characteristics
of effective programs, such as constant, reliable and regular delivery; contextually
specific, culturally relevant and age and gender appropriate activities; and, the
Communities that Care
The USA, UK, the Netherlands and
four communities in Victoria and
Western Australia
A community planning system that has the potential to encourage
crime prevention, alcohol and drug abuse prevention, and mental
health promotion.
involvement, guidance and support from older family members and employed
youth workers (Lindeman et al., 2013).
A large effectiveness trial in the USA found Communities that Care to be effective in
encouraging and strengthening community prevention coalitions over time and
assisting them to develop evidence-based local prevention plans (Greenberg et al.,
2005). A randomized controlled study found that students in control communities
were significantly more likely to initiate delinquent behaviour between grades 5
and 7 than were students in Communities that Care (Hawkins et al., 2008).
Available Australian community results reveal population-wide improvements in
Promoting equity in the mental wellbeing of children and young people, 2015, Vol. 30, No. S2
Mindful Awareness Training and
Evaluation Program (MATE)
youth reports of community social environments and reductions in problems such
as alcohol and drug use and precocious sexual activity (Williams and Smith, 2007).
Continued
ii59
ii60
Table 2: Continued
Intervention and target population
Summary and aims
Evaluation and key outcomes
Community-Middle School Consortium
Middle school students in Aurora
Illinois USA
Multiple community social service agencies were incorporated into a
partnership with the middle school, the city and Aurora University
School of Social Work designed to meet the needs of students,
Through the Consortium, 12 community-based social services agencies are providing
programmes at the school, through home visits, and visits to agencies. Several
students receive support with food and clothing, 236 students have participated in
parents and the community at large. The Consortium provides
accessible free services to a disadvantaged community.
Good Sports Programme
Mental health programme is operated
in sports club in rural and regional
Victoria, NSW and Tasmania
Read the Play
Mental health literacy programme in
junior levels of sports clubs in
Victoria, New South Wales and
Western Australia
clubs in Moreland Australia
Health module launched in 2009, aims to raise mental health
awareness and community capabilities in regional and rural areas
through working directly with community sports clubs.
Read the Play involves an 8-hour training programme developed by
Orygen Youth Health Training & Development team and
community members; the proximity of services and the trust and relationships staff
built with youths and their families over the long term.
A pilot evaluation of the Good Sports Programme found that implementation of the
Good Sports accreditation strategy was associated with lower alcohol consumption
in sports clubs (Rowland et al., 2012). While the website claims Good Sports
Mental Health is evaluated regularly, an evaluation could not be found.
Read the play was evaluated through pre- and post-training questionnaires, which
measured improvement in knowledge of mental health and mental illness. The
delivered by experienced mental health clinician trainers in sports
clubs. Participants receive a Youth Mental Health First Aid
Manual and a resource pack along with the training. The content
covers helping young people in the early stages of mental health
evaluation showed that the course led to significant improvement in knowledge
about mental disorders, increased confidence in helping someone with a mental
disorder and more positive attitudes towards people with mental disorders. These
results suggest that training programmes delivered within sporting settings may be
problems as well as mental health crises and includes case studies,
didactic presentations, group exercises, problem solving,
brainstorming and homework.
AllPlay aims to develop more supportive and inclusive club
environments that facilitate increased participation of people from
effective in improving mental health literacy; however further evaluations are
needed to see whether these changes are sustained over time (Bapat et al., 2009).
diverse and disadvantaged backgrounds in sport and physical
activity. AllPlay involves three 2-h sessions over three consecutive
months.
Pre- and post-surveying was conducted with participants at the commencement of
session one and again at the conclusion of session three. Participants were also
asked to evaluate each session’s content, style and delivery success as well as overall
effectiveness. All participants thought AllPlay was very helpful or helpful, and
believed it should be delivered on a larger scale. At the completion of the project,
there was a 40% increase in participant’s belief that they are able to recognize when
someone is potentially experiencing mental health issues (Pawsey et al., 2013).
J. Welsh et al., 2015, Vol. 30, No. S2
AllPlay
Members of Australian Rules Football
The Good Sports programme strives to make community sporting
clubs healthier, safer and more family-friendly places, with an
emphasis on responsible drinking. The Good Sports Mental
anger management groups and 46 individuals have been referred for mental health
treatment (Morrison et al., 1997). Morrison et al. (Morrison et al., 1997), Lerner
(Lerner, 1994) and Schorr (Schorr, 1988) discuss attributes that make effective
community-based programmes, such as the Consortium, including the
interdisciplinary effort among teachers, social workers, agency staff and
community arts on health
Literature review of the available studies on the links between arts
and indicators of mental, social and physical health including both
published literature and ‘grey’ literature.
The literature conclusively demonstrates that community arts can have an effect on
participants’ health, but it is difficult to make generalized claims based on the
literature identified in the review. Many studies, especially those dealing with
children and adults on the social margins or groups at risk, describe a rise in
self-confidence or self-esteem resulting from participation in community arts
(McQueen-Thomson and Ziguras, 2002) There is also a wider body of evidence for
the positive role of the arts in providing social support, building social capital and
encouraging urban renewal (McQueen-Thomson and Ziguras, 2002).
Physical environment interventions
Community-initiated urban
development
Portland, Oregon
Rental Voucher Programmes
Low-income families in the USA
An urban intervention in three neighbourhoods, which included
community-designed street murals, public benches, planter boxes,
information kiosks with bulletin boards and trellises for hanging
gardens in the public right-of-way.
Rental voucher programmes assist in moving families to less
impoverished or less racially segregated areas by subsidizing the
cost of housing secured by low-income households within the
private rental market through the use of vouchers or direct cash
subsidies.
Multivariate analysis of a sample of residents within a two block radius of each
intervention showed statistically significant improvements in mental health after
the intervention. Multivariate analysis also showed a significant increase in sense of
community and an overall expansion of social capital (Semenza et al., 2007).
Reporting residents were all over the age of 21, so more research is needed to
determine if this intervention is applicable to people under 21 and to other settings.
Urban re-design can be expensive.
A systematic review of 12 studies (in 23 papers) on the effectiveness of rental voucher
programmes in improving community health outcomes found that these can
improve household safety through reduced exposure to crime and decreased
neighbourhood social disorder. Three of the reviewed studies found a median
difference decrease of youth risk behaviours/behavioural problems by 7.8%, and
two reviewed studies reported a median difference decrease of depression and
anxiety symptoms by 8%. However, authors conclude that the effectiveness of
rental voucher programmes on youth health-risk behaviours, mental health status
and physical health status could not be determined because there were too few
studies of adequate design and execution that reported these outcomes (Anderson
et al., 2003). A randomized controlled trial of one voucher programme in the USA
found that interventions to encourage moving out of high-poverty neighbourhoods
were associated with increased rates of depression, PTSD and conduct disorder
among boys and reduced rates of depression and conduct disorder among girls
Promoting equity in the mental wellbeing of children and young people, 2015, Vol. 30, No. S2
Literature review of the impacts of
(Kessler et al., 2014; Osypuk et al., 2012).
Continued
ii61
ii62
Table 2: Continued
Intervention and target population
Summary and aims
Evaluation and key outcomes
Neighbourhood Renewal
Disadvantaged neighbourhoods in
Victoria
Neighbourhood Renewal aims to improve the amenity of
disadvantaged neighbourhoods and narrow the social and
economic gap between these neighbourhoods and the broader
A quasi-experimental community trial found that neighbourhood renewal strategies
can be effective in improving trust in government, perceptions of community
participation, influence and control over community decisions and improved
community. The Neighbourhood Renewal initiative brings
communities together with government, businesses, schools, police
and service providers to tackle disadvantage in their local area. A
central focus is lifting employment, learning and local economic
activity.
services in disadvantaged communities that are at increased risk of social exclusion.
Surveyed participants were all 18 years or older (Shield et al., 2011). A
before-and-after study using two cross-sectional community surveys found that
there was no evidence that neighbourhood renewal had an effect at a whole of area
level; however, the health and life satisfaction of people living in neighbourhood
renewal areas who participated in the neighbourhood renewal improved relative to
those not participating in neighbourhood renewal and in the same local
government area (Kelaher et al., 2010).
Individual health-related factors
Parenting/family
Systematic review of interventions which
support parents, parenting and the
parent child relationship to foster
mental health from the antenatal
period to adolescence
Systematic review of 52 systematic reviews on the relationship
between parenting factors and child mental wellbeing outcomes.
(Commonwealth of Australia, 2009)
Systematic review of behavioural and
cognitive-behavioural group-based
Cognitive-behavioural group
family-based intervention for
childhood anxiety disorders in
Brisbane Australia
parents of children aged–to 12 years with conduct problems.
A randomized clinical trial of a 12-week child-only
cognitive-behavioural treatment (using the Coping Koala Group
Workbook) and a 12-week cognitive behavioural plus family
management treatment (using the Coping Koala Group Workbook
and The Group Family Anxiety Management Workbook). The
family-based intervention includes group training for parents.
and approaches that have been demonstrated to work. The discussion on at risk
groups had an equity focus, however the authors noted that more research was
needed on interventions which could be effective in high-risk groups.
Authors found that behavioural and cognitive-behavioural group-based parenting
interventions are effective and cost-effective for improving child conduct problems,
parental mental health and parenting skills in the short term. Seven of the 13
studies reviewed were based on population samples characterized by high levels of
socioeconomic disadvantage and sub-group analysis indicated that positive results
for child conduct problems may also be achieved for interventions delivered in
service settings to parents of lower socioeconomic status. In addition, parenting
programmes appear to be effective for parents regardless of socioeconomic status
(Furlong et al., 2012).
There were no significant socio-demographic conditions across treatment groups.
Results indicated that at across treatment conditions, 64.8% of children no longer
fulfilled diagnostic criteria for an anxiety disorder in comparison with 25.2% on
the waitlist for treatment. At 12-months follow-up, 64.5% of children in the
child-only cognitive-behavioural treatment and 84.8% in the family-based
intervention were diagnosis free. Self-report measures showed marginal added
benefits for the family-based intervention (Barrett, 1998).
J. Welsh et al., 2015, Vol. 30, No. S2
parenting programmes for early onset
conduct problems in children aged
3–12 (Furlong et al., 2012)
Review of 13 trials and two economic evaluations of behavioural and
cognitive-behavioural group-based parenting interventions for
Programmes were synthesized under four headings: (i) perinatal programmes, (ii)
parenting support programmes, (iii) formal parenting programmes focussed on
children’s behaviour and (iv) programmes for high-risk groups and robust evidence
was found for the implementation of all types. They concluded that these
programmes require a skilled workforce and careful application of programmes
Review of 11 randomized control studies investigating the treatment
effect of traditional cognitive-behavioural therapy with a parental
component.
The authors found that randomized controlled trials have not shown unequivocal
support for the enhancement of cognitive-behavioural therapy with a parental
component, as the results were inconsistent and ambiguous. A lack of effect may be
due to differences in treatment delivery, unsystematic targeting and treatment of
parental factors, failure to describe underlying theoretical model, different
outcome measures, failure to differentiate who benefits from specific treatments,
and studies being too inclusive of parental components (Breinholst et al., 2012).
A programme for parents of preschool
children with behavioural inhibition
The programme comprised of six sessions of group-based, parent
education programme. Parents were allocated to this programme
or to no intervention and were contacted at 1 year follow-up for
assessment.
There were no significant effects of intervention on temperament; however, children
of parents in the education programme showed a significant decrease in anxiety
disorder diagnoses compared with those whose parents received no intervention
(Rapee et al., 2005). No information on socio-demographics and no mention of
equity.
Children of Parents with a Mental Illness
(COPMI) Initiative
National Australian Initiative
The COPMI initiative develops information for parents, their
partners, family and friends in support of these children. COPMI
also offers online training courses for professionals to support
families individually or through community services and
programmes.
There have been several evaluations of programmes using resources from the COPMI
initiative. A programme aimed at parents has shown to reduce the number of
dysfunctional parenting strategies and parent-report child behavioural problems
(Phelan et al., 2012). Programmes aimed at children have shown significant
differences in children’s hope, connections outside the family, personal strengths
and contribution to others’ wellbeing (Foster et al., 2014a, b). However, one study
only found significant changes in children aged 7–11, with no changes in outcome
measures for children aged 12–17 (Matthews and Nicholls, 2012). A review of
programmes targeting children whose parents have a mental illness, found that
family-intervention programmes indicate positive results in terms of children’s
Prevention Intervention Project
Families with parents’ with depression
and a child between the ages of 8 and
15 in Boston, USA
Families either received a lecture intervention, which was presented in
a group format to several families at once, or a clinician-facilitated
intervention, where interveners met with each individual family. In
symptoms (Reupert et al., 2012).
Sixty-four percent of the families included in a large-scale efficacy trial of the two
interventions fell within the top two socioeconomic levels on the
Hollingshead-Redlich classification. In both interventions, parents reported a
the lecture intervention, there was no attempt to link material to
families’ individual experiences, was given to parents only, and was
given over two sessions with follow-up contact offered but not
prearranged. The clinician-facilitated intervention offered parent
and child meetings, up to 11 sessions with telephone or refresher
significant change in child-related behaviours and attitudes and children reported
increased understanding of parental illness attributable to participation in
intervention programmes. Authors conclude that both interventions were effective
and by increasing children’s understanding of parental mood disorder, the
interventions were found to promote resilience-related qualities in children at risk.
meetings, and psychoeducational material was linked to the
families’ experience.
(Beardslee et al., 2003)
Promoting equity in the mental wellbeing of children and young people, 2015, Vol. 30, No. S2
Review of cognitive-behavioural therapy
with a parental component
Continued
ii63
ii64
Table 2: Continued
Intervention and target population
Summary and aims
Evaluation and key outcomes
Triple P—Positive Parenting Programme
Triple P—Positive Parenting Programme is not a single programme,
There are more than 250 published articles, including more than 140 clinical trials
Family intervention for parents of
children up to 12 years old (Teen
Triple P is for parents of 12–16 year
olds) used in 25 countries, including
Australia
and evaluations of the Triple P—Positive Parenting Programme. A systematic
review and meta-analysis of the effects of the Triple P system on a broad range of
children, parent and family outcomes found significant short- and long-term effects
for children’s social, emotional and behavioural outcomes, parenting practices,
parenting satisfaction and efficacy, parental adjustment, parental relationship. The
and messages. Level 2 provides brief one-off assistance to parents
who are generally coping well but have one or two concerns with
their child’s behaviour or development. Level 3 is targeted
counselling for parents of a child with mild to moderate
behavioural difficulties. Level 4 is for parents of children with
flexibility of the programme is particularly useful for families living in rural or
remote areas where access to parenting services may be more limited (Sanders et al.,
2014). The cultural appropriateness of the Triple P programme was assessed for
Indonesian parents of children aged 2–12 years old residing in Australia. Parents
reported a high level of acceptability and satisfaction with the programme content.
severe behavioural difficulties. Level 5 is intensive support for
families with serious problems.
Parents also reported less frequent use of dysfunctional parenting practices and
reduction in the intensity of child emotional and behavioural problems 3 weeks
after a seminar. The effect was maintained at 3-month follow-up. Translated
materials, culturally relevant examples and opportunity for questions appeared to
be sufficient for Indonesian parents (Sumargi et al., 2014).
The Aboriginal Dads Programme supports young Aboriginal fathers
in positive parenting and community involvement through
mentoring. The programme includes a peer project worker,
mentoring support, capacity building and leadership development,
promoting community development activities, getting people out
bush to chat with them, family focused activities, teaching and
culture and strong partnerships.
No formal evaluation found. However, an analysis of data collected over the period
2007–2009 found that the Aboriginal Dads Programme has contributed to an
increase in the number of Aboriginal children participating in playgroups and
preschool. In addition, as a result of the project, young Aboriginal fathers are
getting involved in their children’s learning and development (Child Family
Community Australia, 2010).
J. Welsh et al., 2015, Vol. 30, No. S2
Aboriginal Dads Programme
Aboriginal Dads in Port Augusta,
South Australia
but rather a suite of interventions of increasing intensity for parents
of children from birth to 16 years. Within each level of intensity,
there is also a choice of delivery methods. Level 1, or universal
Triple P, is a communications strategy designed to reach a broad
cross-section of the population with positive parenting information
UK, Australia and eight other
countries
The general aim is the treatment of child aggressive behavioural
problems and ADHD; prevention of conduct problems,
delinquency, violence and drug abuse; promotion of child social
There have been several randomized trials of the parenting programmes by
Webster-Stratton and colleagues (e.g. Reid et al., 2003; Webster-Stratton and
Hammond, 1997; Webster-Stratton et al., 2004) and independent replications.
competence, emotional regulation, positive attributions, academic
readiness and problem solving; improved parent–child interactions
and relationships; improved teacher classroom management skills
and teacher–parent partnerships. There is a BASIC and
Numerous independent randomized trials have also been conducted in the USA,
Norway, Canada, New Zealand, and the UK (e.g. Gardner et al., 2006; Jones et al.,
2007; Patterson et al., 2002; Scott et al., 2001). These studies have shown that the
Incredible Years intervention successfully: increased parental praise and reduced
ADVANCE parent training programme. Each parent group session
is 2–2.5 h long and conducted at weekly intervals. Typically food,
childcare and transport are provided for each session.
criticism; increased effective parental limit-setting; reduced parental depression
and increased parental self-confidence; increased positive family communication
and problem solving; reduced conduct problems in children’s interactions with
parents and increases in positive affect, social competence and compliance;
improved externalizing behaviour of children from 2 to 9 and the benefits are
maintained up to 2 years after the programme. The Incredible Years Parenting
programme has been implemented across cultural backgrounds (Webster-Stratton,
2009) and found to be effective in families involved in the child welfare system
(Webster-Stratton and Reid, 2010), or the most disadvantaged and distressed
families (Gardner et al., 2010).
The Family Check-Up
Children and families in a variety of
cultural communities in the USA
The Family Check-Up is an adapted and tailored family-centred
intervention that is based on a 60-min initial interview, an
ecological assessment of the family’s experience, and a feedback
session. In the feedback session, the family can choose one or more
of the available intervention options: a brief family-centred
intervention; parent groups; family therapy; child interventions;
school interventions or ecological management (e.g. community
referrals).
Parent–Child Interaction Therapy
(PCIT)
Conduct-disordered young children
and their parents in the USA
PCIT is a treatment for conduct-disordered young children, which
places emphasis on improving the quality of the parent–child
relationship and changing parent–child interaction patterns.
Parents are taught specific skills to establish a nurturing and secure
environment. The treatment has two interventions: child directed
interaction (similar to play therapy) and parent directed interaction
(clinical behaviour therapy where parents learn specific behaviour
management techniques as they play with their child).
Numerous studies have been published on the Family Check-Up interventions,
showing they improve social behaviour and emotional adjustment in children and
adolescents (e.g. Fosco et al., 2013; Moore et al., 2012).
A randomized intervention trial found that embedding Family Check-Up services
within the context of social, health and educational services in early childhood can
potentially prevent early onset trajectories of antisocial behaviour (Dishion et al.,
2014). Another study showed the family-centred parenting-intervention can be
beneficial in low-income, distressed and disadvantaged families (Moore et al.,
Dishion and Shaw, 2012, Weaver et al., 2014). The Family Check-Up has even
been shown to promote academic achievement (Brennan et al., 2013).
There have been many studies on PCIT. Recent studies suggest that the intervention is
a promising treatment for preschoolers with depression (Lenze et al., 2011);
combined with self-motivational orientation has demonstrated to reduce child
welfare recidivism in the laboratory and in the field (Chaffin et al., 2011) and may
lead to positive behaviour changes in a variety of cultures including disadvantaged
young African American children (Fernandez et al., 2011), Puerto Rican preschool
children (Matos et al., 2009) and Chinese families (Leung et al., 2008).
Effectiveness has been shown in-home deliver and in community settings (Lanier
et al., 2011). PCIT has also been applied as a universal prevention programme in
Promoting equity in the mental wellbeing of children and young people, 2015, Vol. 30, No. S2
The Incredible Years Parent Programme
Parents and children aged 1 month to
12 years widely used within the USA,
preschool-setting serving primarily low-income, urban, ethnic minorities through
Teacher Child-Interaction Training (Gershenson et al., 2010; Lyon et al., 2009).
ii65
Continued
ii66
Table 2: Continued
Intervention and target population
Summary and aims
Evaluation and key outcomes
Nurse and volunteer home visiting
programmes
At-risk families
The Family Home Visiting model, developed in the USA, is becoming
increasingly common in developed nations. The purpose of home
visiting is to provide children with the best possible start in life and
A literature review conducted by the Department for Communities in Western
Australia found that successful home visiting programmes are associated with a
number of factors including a means of addressing social inequalities in children’s
to assist families in providing the best support possible for their
children (McDonald et al., 2012, Sivak et al., 2008).
health, school readiness and development, improved mother–child interactions
and improvements in the mental health and physical growth of children
(Government of Western Australia, 2012). An evaluation of a home visiting
programme for Aboriginal families in South Australia found that extremely
positive feedback was given about the programme by almost all families who
participated in the evaluation. Participants identified significant benefits including
practical assistance, information and referrals for health and other issues, feeling
more socially involved, more supported in their parenting decisions and generally
more confident in themselves and their parenting (Sivak et al., 2008).
Public awareness campaigns
Time to Change anti-stigma campaign
UK
A social marketing campaign to reduce stigma and discrimination
against people with mental health problems.
Like Minds, Like Mine was developed to counter the stigma and
discrimination associated with mental illness. The public education
See me
programme includes television advertising campaigns,
communications and event management, provider education and
training, national information free phone service and
anti-discrimination activities in local communities.
A publicity campaign to raise public awareness of the impact of
Scotland
stigma on people with mental illness and to improve understanding
of mental illness. Youth are one of the targeted groups of the
campaign.
discrimination. Equal status in social contact was seen as an important factor in the
quality of contact and engagement (Evans-Lacko et al., 2012). Only adults were
included in the evaluation.
An evaluation of the Like Minds, Like Mine programme found significant
improvements in general attitudes as a result of mass media advertising. More than
80% of survey participants felt that the ads were helping to reduce stigma and
discrimination associated with mental illness, with the main effect seen to be
increased awareness and understanding (Vaughan and Hansen, 2004).
An evaluation of the early effects of the see me campaign found a deterioration in
negative attitudes of respondents in Scotland and England; however, there was a
lack of deterioration in Scotland compared with England, which may be related to
the campaign (Mehta et al., 2009). See me’s evaluation report found that most
respondents believe that the campaign has made a difference to how people with
mental health problems feel about themselves and half saw an improvement in how
others treat them and in how the media reports on mental ill-health (McArthur and
Dunion, 2007). Young people were the focus of the see me campaign called ‘just
like me’ launched in 2005, which addressed young people’s attitudes towards each
other (Dunion and Gordon, 2005). No evaluation of just like me was found.
J. Welsh et al., 2015, Vol. 30, No. S2
Like Minds, Like Mine
New Zealand
A localized, shorter version of the Time to Change campaign was implemented in
Cambridge. Campaign awareness was not sustained following campaign activity,
but significant and sustained shifts occurred for mental health-related knowledge
items (Evans-Lacko et al., 2010). An evaluation of the full programme suggests that
social contact interventions can work on a mass level in reducing stigma and
The Compass Strategy was a mental health literacy community
awareness campaign targeting young people age 12–25 in the
western metropolitan Melbourne and Barwon regions of Australia.
The campaign included the use of multimedia, a website, and an
information telephone service. The health promotion
Precede-Proceed Model guided the population assessment,
campaign strategy development and evaluation (Wright et al.,
2006).
beyondblue awareness campaign
beyondblue: the national depressive initiative is a national,
independent, non-profit organization funded by Australian
national, state and territory governments. They run a community
awareness and destigmatization campaign as one of their five
The campaign had significant effects on the awareness of mental health campaigns;
self-identified depression; help for depression sought in the previous year; correct
estimate of the prevalence of mental health problems; increased awareness of
suicide risk and a reduction in perceived barriers to help seeking (Wright et al.,
2006). The website was the most frequently used source of information and was
more effective at attracting the target age group of young people (Wright et al.,
2006).
One study found that beyondblue has had a positive effect on some beliefs about
depression treatment, and about the value of help-seeking in general. These
findings suggest that national awareness campaigns may be effective in improving
mental health knowledge (Jorm et al., 2005).
priority areas.
Physical activity/exercise
Synthesis of reviews investigating
physical activity and mental health in
children and adolescents
(Biddle and Asare, 2011)
Review of studies investigating physical activity and depression,
anxiety, self-esteem and cognitive functioning in children and
adolescents, to assess the association between sedentary behaviour
and mental health.
The synthesis of reviews found that physical activity potentially has beneficial effects
for reduced depression and anxiety, but the evidence is limited. Physical activity
has also shown to lead to improvements in self-esteem, at least in the short term;
however there is a paucity of good quality research. Reviews on physical activity
and cognitive functioning have provided evidence that routine physical activity can
be associated with improved cognitive performance and academic achievement,
but these associations are usually small and inconsistent. Primary studies showed
consistent negative associations between mental health and sedentary behaviour
(Biddle and Asare, 2011). Effects in sub-group analysis were not considered.
Systematic review of the psychological
and social benefits of participating in
sport for children and adolescents
(Eime et al., 2013)
Systematic review of 30 studies addressing mental and/or social
health benefits from participation in sport.
Authors conclude that there is substantive evidence of psychological and social health
benefits from sport, with the most common being improved self-esteem and social
interaction followed by fewer depressive symptoms. Participation in team sports
rather than individual activities was associated with better outcomes (Eime et al.,
2013). One study showed a significant effect of team sports for females, but not for
males (Eime et al., 2013). Access to sports and physical activities is required for
these observed benefits.
Promoting equity in the mental wellbeing of children and young people, 2015, Vol. 30, No. S2
The Compass Strategy
Young people 12–25 years in
Victoria, Australia
Continued
ii67
ii68
Table 2: Continued
Intervention and target population
Summary and aims
Evaluation and key outcomes
Systematic review of the health benefits
Among other health outcomes, a systematic review of six studies on
Three observational studies on the association between physical activity and
of physical activity and fitness in
children and youth
(Janssen and Leblanc, 2010)
the association of physical activity and depression.
depression reported small and insignificant or modest relations. Three
experimental studies observed significant improvements in at least one depressive
symptom measure in response to 8–12 week exercise programmes, but the effect
sizes were small to modest with broad confidence intervals. Only the high intensity
programme resulted in significant improvements in depression scores compared
with the control group (Janssen and Leblanc, 2010). One of the reviewed studies
observed the associations between physical activity and mental health in Hispanic
and non-Hispanic children and found no significant interactions between physical
activity variables and sex and ethnicity. Students who participated in 3–5 days per
week of physical education were less likely to feel sad than those participating in PE
American College of Sports Medicine’s
vigorous-intensity physical activity
Undergraduate students in
Switzerland
of vigorous physical activity per week.
Physical activity was measured as participating in sports or physical
activity so hard that a person had high respiratory frequency,
sweated or had an increased heart rate for at least 20 min.
with less stress, pain, subjective sleep complaints and depressive symptoms.
Authors conclude that this study provides evidence that vigorous physical activity
meeting the standards of the ACSM is associated with improved mental health and
more successful coping among young people (Gerber et al., 2014). This study is in
a small heterogeneous population and it is not clear if the results are generalizable
to other groups.
Hierarchical multiple regression analysis of the cross-sectional survey results showed
a negative association between the resilience factors and depressive symptoms.
Higher levels of physical activity were associated with lower levels of depressive
symptoms for girls, but there was no significant association for boys. There was,
however, an interaction effect for boys indicating that the association between
structured style, and depressive symptoms depends on the frequency of physical
activity (Moljord et al., 2014).
J. Welsh et al., 2015, Vol. 30, No. S2
Physical activity and resilience in relation
to depressive symptoms
Norwegian adolescents (13–18 years
old)
The American College of Sports medicine’s vigorous-intensity
physical exercise guidelines require three or more 20 min sessions
0–2 days per week, after controlling for sex, ethnicity, age, school, classroom, body
mass index, smoking, drinking and grades in school (Brosnahan et al., 2004).
A study examining whether young adults who engage in vigorous physical activity
have improved mental health found that vigorous physical activity was associated
Promoting equity in the mental wellbeing of children and young people, 2015, Vol. 30, No. S2
addressing inequities does not appear to be a core focus.
Three more organizations, headspace, Beyondblue and
the Black Dog Institute, were active in youth mental
health, but do not primarily promote wellbeing or directly
focus on inequities. A number of campaigns run by these
organizations seek to challenge cultural and societal
norms or improve wellbeing outcomes, however their primary focus is mental illness early intervention and
treatment.
Daily living conditions
Interventions occurring within the daily living conditions
layer can address the determinants themselves or they can
be conducted in the settings that occur within the layer.
For example, an intervention might aim to improve educational outcomes (the determinant) or it can be conducted
within a school (the setting). Both types of interventions
are reviewed below.
Early childhood care and education settings
Early childhood interventions in playgroups, childcare
and preschool settings show mixed and limited results. A
review on the effectiveness of early childhood intervention
found small, short-term positive outcomes in children’s
wellbeing and development. However, this same review
concluded that there was little data on the long-term
benefits of early childhood interventions, or the costeffectiveness of these programmes (Wise et al., 2005).
There is more consistent evidence for the benefits of
playgroups; play therapy can be used to foster better developmental outcomes in young children, and it appears to
be effective across different ages, genders and presenting
conditions (Bratton et al., 2005).
Evaluations of early childhood programmes designed
to improve child wellbeing in disadvantaged areas show
promising results. The HighScope Perry Preschool programme, and more recent Sure Start, Head Start and
KidsMatter programmes appear to effectively promote
wellbeing. For example, the KidsMatter Early Childhood
Programme leads to improvements in child temperament,
fewer mental health difficulties and improved knowledge,
competence and confidence in education and care staff
(Slee et al., 2012). Similarly, evaluations of Sure Start
and Head Start have found improvements in social behaviour, school readiness, independence (Melhuish et al.,
2008), aggressive behaviours and cognitive, social and
language development (Love et al., 2005). There may
also be some long-term benefits: one study reported that
adults aged 40 who had participated in the HighScope
Perry Preschool Study had higher earnings, employment
rates and high school completion rates compared
ii69
with those who did not participate in the programme
(Schweinhart et al., 2005).
Encouragingly, the equity implications of these programmes have been evaluated; although evidence on the
extent to which they are successful is mixed, even within
the same programme. One evaluation of Sure Start demonstrated that this programme may further engrain inequities, with the relatively less disadvantaged benefiting
more than the most disadvantaged children. This evaluation tested outcome interactions by markers of disadvantage (e.g. lone parenthood, parental unemployment and
income) and demonstrated that children living in more socially deprived areas were adversely affected when the programme was delivered in their area (Belsky et al., 2006).
Lack of resources required to access services and the
view that increased attention could be viewed as intrusive
by disadvantaged parents were discussed as the reason for
this discrepancy. In contrast however, a similar evaluation
of Sure Start using the same methodology concluded that
benefits were broadly delivered to all programme participants, regardless of demographic sub-groups (Melhuish
et al., 2008). After testing 84 interactions with markers
of disadvantage, all but one test showed that the benefits
of the programme were delivered universally. A significant
difference was found only for one ethnic group for one
outcome: the programme had a beneficial effect on
positive social behaviour overall, but black–Caribbean
children living in areas which received the programme
showed less positive behaviour compared with white
children living in the same areas.
Interventions in school settings
School-based programmes such as MindMatters and
FRIENDS were the most common form of wellbeing interventions found and were often designed to improve
wellbeing in low income or disadvantaged children.
Universal and targeted school-based interventions appear
to improve mental wellbeing, attitude, behaviour, selfesteem and resiliency in students in high income countries
(Arksey and O’Malley, 2005; Durlak et al., 2011).
Encouragingly, even small and simple classroom interventions have been demonstrated to have beneficial lifetime
effects on wellbeing outcomes (Kellam et al., 2011).
A number of studies show that universal school-based
interventions are effective in improving mental wellbeing
in diverse groups, including low-income, disadvantaged,
non-English speaking and culturally diverse student populations (McDonald et al., 2006; Webster-Stratton and
Reid, 2008; Kellam et al., 2011). While we were unable
to locate evaluations which looked at inequities in the benefits of school-based interventions, the success of these
ii70
programmes in disadvantaged populations signals the
potential for these programmes to reduce inequities in
the future. Furthermore, there is limited evidence on the
long-term success of school-based programmes (Merry
et al., 2012), suggesting that a maintained promotion
effort may be needed throughout school years.
Online settings
Over 95% of young Australians use the Internet, and 91%
of adolescents indicate that it is a highly important part of
their life (ACMA, 2008). ReachOut.com promotes mental
health and wellbeing in young Australians and has been
demonstrated to effectively enhance knowledge about
mental health issues and increase help seeking behaviour
(Collin et al., 2011). The evaluation of this service did
not assess wellbeing specifically, however an evaluation
of Reach Out Central showed that online gaming programmes can improve life satisfaction in all participants
and resilience in young women (Shandley et al., 2010).
Evaluations of Internet-based programmes did not assess
the extent to which they addressed inequities or had differential impact by sub-groups other than gender.
Community interventions
Community or place-based interventions to prevent mental illness were also relatively common. However, these
community programmes remain focused on mental illness
prevention (rather than wellbeing promotion) and impacts
on inequity rarely documented. Communities that Care,
for example, promotes community partnerships, planning
and activities. The programme led to improvements in
young people’s social environments, mental health awareness, delinquent behaviour and alcohol and drug use
(Hawkins et al., 2008). Community interventions targeting disadvantaged groups have also been successful. For
example, the Let’s Start programme, which helps
Indigenous children transition to school by supporting
parents through networks of local community organizations, may have resulted in a reduction in problem and
risk behaviours, child anxiety and aversive parenting
(Robinson et al., 2009).
The physical environment
The physical environment (e.g. toxins, pollutants, noise,
crowding and housing, school and neighbourhood quality) also influences children’s cognitive and social development (Ferguson et al., 2013). The Neighbourhood
Renewal Strategy is a place-based programme aiming to
improve the amenity and social relationships of disadvantaged neighbourhoods, improve service access and
increase the health and life satisfaction of people in
J. Welsh et al., 2015, Vol. 30, No. S2
neighbourhood renewal areas (Kelaher et al., 2010).
Similarly, Rental Voucher Programs in the USA, which assist families to move to less impoverished or less racially
segregated areas by subsidizing the cost of housing, have
led to a 8% decrease in risky behaviours and behavioural
problems and a 8% decrease in depression and anxiety
(Anderson et al., 2003).
Individual and family factors
Parenting and family interventions
The parenting programmes identified in our search were
not designed to promote wellbeing in children, but were
designed to improve children’s behaviour or prevent behaviour problems. Parenting programmes, such as the
Triple P-Positive Parenting Program, are generally found
to be effective in improving child behaviour and emotional
adjustment, and in reducing behavioural problems
(Sanders et al., 2014); however, we were unable to locate
evaluations which tested for differential impacts other
than by gender of the child.
A number of parenting programmes have been implemented or designed for disadvantaged populations.
Evaluations of these programs are promising and suggest
that interventions within families are successful in improving child outcomes in disadvantaged families and could be
used to address inequities in wellbeing relating to parenting
knowledge and practices. However, a systematic review of
parenting interventions to promote child wellbeing concluded that more research is needed to identify the types
and features of parenting programmes needed for high-risk
groups (Commonwealth of Australia, 2009).
Family programmes have also shown some success in
reducing or offsetting inequities in wellbeing outcomes
for children living in families with mental illness
(Reupert et al., 2012); however, the long-term effects on
children’s mental wellbeing remain unclear. While some
programmes have failed to demonstrate behavioural or
emotional changes in children (Foster et al., 2014), an
evaluation of an extensive intervention (involving paediatricians, nurses and school counsellors) showed positive
and long-standing changes to children’s understanding
of mental illness and resilience (Beardslee et al., 2003).
Public awareness campaigns
Our review did not locate any public health campaigns
which promoted mental wellbeing in children and young
people specifically, or which were designed with an equity
focus. However, a number of campaigns were identified
which showed significant positive effects for mental illness
literacy and help seeing behaviours.
Promoting equity in the mental wellbeing of children and young people, 2015, Vol. 30, No. S2
Physical activity
Physical activity, particularly vigorous activity, can
improve self-esteem, sleep and cognitive functioning and
reduce anxiety, depression and negative mood (Sharma
et al., 2006). Physical activity interventions have been
used to promote wellbeing and prevent mental illness in
children and young people (see, for example, Gerber
et al., 2014). A review of interventions for depression,
anxiety, self-esteem and cognitive functioning in children
and adolescents concluded that physical activity was potentially beneficial; but characterized the evidence as relatively weak and inconsistent (Biddle and Asare, 2011). A
more recent review concluded that team sports, rather
than individual physical activity, are associated with better
psychological and social outcomes for children because of
the social nature of the activity (Eime et al., 2013). The evidence on the extent to which physical activity can be used
to address inequities in childhood wellbeing is preliminary
and mixed. Inequities in physical activity exist, with the
poorest population groups usually being the least active
in leisure time and often having unequal access to facilities
and environments that support physical activity (Cavill
et al., 2006). We found none specifically designed to
address inequities or which evaluated differential impact.
DISCUSSION
Using the Fair Foundations framework, we aimed to perform a scoping review of interventions that promote mental wellbeing and reduce inequities in children and young
people. Our search uncovered a vast intervention effort to
help children and young people, however the majority of
this effort was aimed at preventing or treating mental illness. We found only a handful of evaluated interventions
that specifically aimed to promote their wellbeing. We did
not find any which set out to address social gradients in
wellbeing, and only a few evaluations considered differential impacts across social groups. The interventions reviewed fell into two major groupings; universal (offered
to all) or targeting children from disadvantaged backgrounds. Some were clearly successful and these tended
to be delivered in family or education settings, focusing
on relatively proximate determinants of mental illness or
wellbeing, such as parenting skills or mental health
literacy.
Our review considered interventions that focussed on
socioeconomic, cultural and political contexts to wellbeing (mental health and early childhood policy, governance), daily living conditions (schools, childcare, or sited
in educational or care settings, neighbourhoods, community or physical environments) and individual and
family levels ( parenting, family programmes, awareness
ii71
campaigns, physical activity). The strongest evidence of
success was found for interventions in family and educational settings, such as the Triple P-Positive Parenting
Program or MindMatters, due to the high number of positive programme evaluation. Such programmes typically
aimed to foster a child’s strengths and assist parents to create a positive family environment. Parenting programmes
and programmes delivered to children in school-based settings demonstrated clear, short-term positive results for
behaviour change and the acquisitions of mental capital.
Encouragingly, positive effects were demonstrated for simple, low-cost programmes as well as complex multiservice
interventions.
The benefits of other interventions were less certain.
Evidence which supported the use of physical activity interventions, public awareness campaigns and online programmes (individually focussed), as well as interventions
that address the social and physical environment (daily living conditions) was limited due to the smaller number of
programmes delivered within these intervention types.
Furthermore, these interventions were designed to increase
mental illness awareness, increase help seeking behaviour
or prevent mental illness, none were designed with an
equity focus and programme evaluations did not test for
differential impact. However, the successful use of these
programmes to prevent mental illness and to improve
mental health literacy indicates that there may be value
in exploring these types of interventions in future wellbeing promotion activities.
Interventions at the socioeconomic, political and cultural context layer of the framework were difficult to
evaluate. At this layer, we found that policy documents,
strategic plans and key organizations do recognize the importance of wellbeing, the social determinants health and
wellbeing and the inequities they create. However, the policy documents tended to be vague about the steps needed
to implement the wellbeing plan, lacked performance indicators and were only rarely evaluated. The equity discourse in these documents also appears limited, with a
focus on ‘high-risk’ or disadvantaged groups rather than
a universal approach which acknowledges and aims to address the social gradient in mental illness and wellbeing.
Most of the interventions identified in this review were
primarily concerned with proximate determinants of mental wellbeing, with the most common form of intervention
being health education. This was true for the interventions
synthesized at all levels of the framework. For example, interventions occurring within daily living conditions were
delivered in settings relating to daily living conditions
but were often, in reality, individual education programmes rolled out in school-based settings. The only exceptions to this were place-based interventions targeting
ii72
aspects of the physical environment or community factors,
and a limited number of whole school programmes which
aimed to improve the psychosocial learning environment.
Interventions that considered daily living conditions largely centred on individual access to health care, educational
services or information; there was no evidence of policy
interventions which sought to change the structural
causes of wellbeing or health inequities, or the intermediary social determinants of inequities.
The equity benefits of the interventions reviewed here
also remain unclear. Despite growing emphasis on the social determinants of health and health inequities in academic literature and political discourse, there were no
interventions which actively sought to address gradients
in mental illness or wellbeing in children. Some interventions were applied to traditionally disadvantaged groups,
such as Indigenous people or children from low income
families, allowing us to gauge the extent to which programmes were effective in these groups. Encouragingly,
these programmes reported improvements to wellbeing
outcomes in disadvantaged children; however, the delivery
of programmes to disadvantaged groups alone does not
address the gradient in health outcomes, nor does it promote wellbeing at a population level. Creating interventions that address only the most disadvantaged all too
easily become ‘poor services’ which are potentially stigmatizing, often not sustained long-term, and may exclude
those who fall outside arbitrary cut-offs [(World Health
Organization and Calouste Gulbenkian Foundation,
2014), p. 39].
Best practice approaches to reducing inequities
emphasize universal interventions which provide support
proportionate to need ( proportionate universalism)
(World Health Organization and Calouste Gulbenkian
Foundation, 2014). We found no evidence of interventions which adopted this model. We did review a number
of universal interventions and a small number of these
evaluated the extent to which benefits were distributed
among different population sub-groups. A number of universal interventions reported stronger effects for those in
most need while other programmes seem to disproportionately benefit more advantaged children. The extent
these programmes address social gradients in wellbeing remain unknown. So too do best practice approaches to conducting formal evaluations of equity outcomes of
interventions. While tools are available which identify potential health differentials in policies (see, for example,
Simpson et al., 2005), we did not locate any material
which provided guidance on how to measure the social
gradient in health or wellbeing or progress towards reducing it. Lack of validated methods is likely to impede
future work of this nature.
J. Welsh et al., 2015, Vol. 30, No. S2
Despite the limitations we outline, we found encouraging evidence that there are some interventions that
could be used to promote wellbeing and reduce inequities
in the future. The interventions we reviewed were largely
successful in improving mental health and wellbeing outcomes. The success of these programmes in both universal
and targeted populations support the use of a proportionate universalism approaches to addressing inequities in
children’s mental wellbeing in the future. However, our review also revealed that some universal programmes have
the potential to engrain inequities by failing to reach
those with the greatest need. These differential impacts
should be monitored as the field develops.
Future directions
Our results highlight some of the current limitations to
wellbeing promotion, and signal areas for future research
and practice. Despite the growth of the wellbeing literature, there remains a scarcity of research on the prevalence,
causes, and social distribution of wellbeing. It is difficult to
advocate for and justify wellbeing promotion activities
without robust evidence which clearly details the nature
and extent of the problem, and what can be done to promote it. Related literatures on mental illness offer some
guidance, but more specific and reliable information is
needed on wellbeing. More research on mental wellbeing
promotion is required.
Many high quality research projects have investigated
and theorized the social determinants and inequities of
physical health (or illness) yet there still remains a scarcity
of research which theorizes inequities in mental health, and
even less on mental wellbeing (Huppert, 2009). While mental health is most often included in the broader discussion of
health (see, for example, Marmot et al., 2008), understandings of its unique determinants, the groups at most risk and
the broader social patterning remain largely untested and
under-researched (Huppert, 2009). There is evidence for a
socioeconomic gradient in mental health, but there is also
evidence of other axes of inequity linked to gender, ethnicity, discrimination, location and exclusion. For example,
African Americans report higher rates of wellbeing
compared with white Americans (Keyes, 2007). These differences were strengthened after adjustment for sociodemographic characteristics, signalling the importance of
norms, cultural expectations, social bonds and psychosocial factors in mental health and wellbeing. Indeed, for
mental health and wellbeing, social relationships, care
and support are central, yet they remain largely opaque in
the current social determinants framework. For infants,
children and young people, warm, nurturant and consistent
relationships are fundamental, yet theory on how they
Promoting equity in the mental wellbeing of children and young people, 2015, Vol. 30, No. S2
might be shaped by policy, cultural forces, political forces,
social structures and daily living conditions and evidence
on their social patterning are not well advanced.
Adequate material resources, especially income, are central
to how children fare. However other resources also affect
how parents and children interact, such as parents’ time
(Strazdins et al., 2012). Parenting and family interventions
were identified in this review, and the results were encouraging, but even with this type of research, relationships,
care and support are rarely considered to be socially determined the way material resources are. The social determinants of relationships could compound material-based
inequities in wellbeing, but they may also shape wellbeing
separately, revealing other gradients and ‘at risk’ understandings for mental health among children (see, for
example, Strazdins et al., 2013).
Our findings reflect the many challenges faced when
designing interventions to address inequity. Promoting
wellbeing among individual Indigenous children might
produce a desirable effect in a programme evaluation at
the individual level, but does little to address the structural
disadvantage experienced by this group, and their differential exposure and/or vulnerability to daily living conditions that are damaging to health. This signals the
importance of interventions at the level of the socioeconomic, political and cultural context, to produce structural changes to improve wellbeing. However, they also
signal the need for multiple and co-occurring interventions that promote wellbeing across levels of the framework. Without this, there is potential for mental health
promotion activities to be ineffective, or to distribute the
benefits unequally among children, further engraining,
or even worsening, inequities in children’s wellbeing.
We would also recommend a continued emphasis
throughout childhood and into young adulthood on wellbeing in mental health promotion. Our results revealed
that there was a focus on wellbeing in early childhood
and primary school settings, but a decreasing emphasis
as children grew into teens or young adults. Almost all interventions identified for adolescents and young people
aimed to prevent or intervene in the development of mental illness rather than promote wellbeing.
Investing in mental wellbeing could improve children’s
and young people’s lives, their capabilities and potential,
contributions and opportunities in life. This article has reviewed the available literature on interventions which address the social determinants to promote mental wellbeing
and reduce inequities throughout childhood. While there
is much to be done to advance the field, our results demonstrate that wellbeing promotion can be effective and
could have the potential to reduce inequities in children’s
and young people’s wellbeing.
ii73
SUPPLEMENTARY MATERIAL
Supplementary material is available at Health Promotion
International online.
ACKNOWLEDGEMENTS
The Authors wish to thank two anonymous reviewers for their
comments on an earlier draft and Julia McQuoid for her help preparing this manuscript.
FUNDING
This work was commissioned by VicHealth as part of a suite of
work undertaken to identify best and promising practice in the
promotion of health equity. L.S. is supported by an Australian
Research Council Future Fellowship (FT110100686). L.S. is supported by an Australian Research Council Future Fellowship
(FT110100686) and an Australian Research Council Linkage
Project (LP100100106), which also supported J.W.
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