A cost-consequence and cost-benefit analysis of interventions to improve social, emotional and mental wellbeing in schools: Social, Emotional and Mental Wellbeing in Primary and Secondary Education

Excerpt

Background: The National Institute for Health and Care Excellence (NICE) worked with Public Health England to develop a guideline scope for social and emotional wellbeing in primary and secondary education. The guideline will update and replace the NICE guidelines on social and emotional wellbeing in primary education (PH12) and social and emotional wellbeing in secondary education (PH20). The guidelines were combined so that commonalities and differences between interventions for children and young people at different ages and life stages can be addressed. Full details are set out in the surveillance review decision [1]. This guideline will also complement legislation such as the Department for Education’s:

1. Keeping children safe in education [2],

2. Supporting pupils with medical conditions at school [3],

3. Preventing and tackling bullying [4],

4. Mental health and behaviour in schools [5],

5. Relationship’s education, relationships, and sex education (RSE) and health education [6].

Primary and secondary schools help children and young people learn social and emotional skills through both the taught and wider curriculum (such as activities outside the classroom). Schools can provide the nurturing environment that supports positive social, emotional and mental wellbeing. Schools are also key settings in which to identify and provide early intervention for children and young people at increased risk of mental ill health. However, a key challenge for schools is knowing what approaches improve student outcomes in a specific school setting. Schools may not have the time or resources to assess the effectiveness of programmes they use or provide quality assurance of interventions.

NICE has commissioned York Health Economics Consortium (YHEC) to carry out a systematic cost-effectiveness review and conduct an economic evaluation. This document outlines the objectives, methods, and results of the economic evaluation.

Objectives: The Public Health Advisory Committee (PHAC) prioritised questions in the NICE scope for further economic analysis. Key issues and draft questions were to identify whether an intervention, or combination of interventions, that promote social, emotional and wellbeing in children and young people in primary and secondary education, and young people with SEND in further education, are effective and cost-effective.

The key intervention approaches identified were:

1. Universal

   1. ○

      Curriculum content and classroom-based interventions focused on social, emotional and mental wellbeing. This includes lessons on resilience, self-esteem, coping skills (such as dealing with bereavement or adverse childhood events), mental health awareness, managing social relationships (to avoid bullying, including online bullying) and the appropriate and safe use of the internet and social media.

2. Whole school

   1. ○

      The whole-school approach is an integrated approach that includes and goes beyond teaching and learning in the classroom to all aspects of the life of a school including culture, ethos and environment, as well as partnerships with parents or carers and families, outside agencies, and the wider community.

3. Targeted

   1. ○

      Targeted social or emotional support such as individual or small group interventions for areas such as self-esteem, resilience or coping skills for children and young people who need extra support in developing social and emotional skills.

4. Support during periods of student transition

   1. ○

      Support during periods of transition (for example developmental transitions such as puberty, life transitions such as family break-ups or bereavement, and educational transitions such as moving from primary to secondary school).

The student outcomes identified were:

1. Emotional distress

2. Behavioural skills

3. Social and emotional skills

4. Self-esteem

5. Bullying perpetration

The aim of the analysis was to conduct economic modelling and provide costs and benefits to those who are considering implementing an intervention at school to prevent poor wellbeing and improve mental wellbeing, measured in terms of student outcome variables.

As outlined in the final scope, the updated guideline and economic model are for:

1. Teachers, school support staff and others working in schools with – or responsible for – children and young people

2. School leadership teams, including governors and leadership teams of multi-academy trusts

3. Practitioners with a health or social care remit (including public health, mental health, and social workers) working in the NHS or local authorities

4. Commissioners and providers of interventions and services for child social, emotional and mental wellbeing

5. The wider public, private, voluntary and community sectors working with children and young people

The economic model outputs were used to inform the committee’s guidance decisions for questions prioritised in the NICE scope and provide an interactive online calculator to help inform the implementation of mental wellbeing interventions in school. The economic model can be used in addition to tools already available regarding student interventions for mental health and wellbeing. The Education Endowment Foundation’s Early Years Toolkit show the estimated impact and cost of an intervention and the strength of evidence base used to inform this [7]. The economic model outlined in this report also focuses on the cost and impact of student interventions but allows a model user to change inputs to reflect the setting of interest.