1. Front Line Innovation and Trials
Dr Jemma Hawkins, Research Fellow
DECIPHer Cardiff
SHRN as a framework for co-production and identification of innovation
Working with policy and practice partners to develop innovation in SHRN
SHRN allows for integration into policy and practice context
Take a partnership approach with stakeholders in research as well as in other parts of the network

2. Overview Developing and evaluating school-based interventions
Trials research
Examples of front-line innovation
Identifying cases of best practice
Understanding and evaluating to inform wider implementation
Examples of co-production
Developing interventions with key stakeholders
Enhancing capacity
Look at how SHRN offers a framework for developing and evaluating school-based interventions
How we can use research trials to examine effectiveness and impact of interventions on their intended outcomes
Examples of current studies that have been adopted by SHRN
Demonstrate how it can facilitate conducting of trials, coproduction of new interventions and identification of innovation in practice.

3. Medical Research Council Framework
Feasibility/Piloting
1. Testing procedures
2. Estimating recruitment/retention
3. Determining sample size
Development
1. Identifying the evidence base
2. Identifying/developing theory
3. Modelling process and outcomes
Evaluation
1. Assessing effectiveness
2. Understanding change process
3. Assessing cost-effectiveness
Implementation
1. Dissemination
2. Surveillance and monitoring
3. Long term follow-up
Processes involved with developing interventions and evidencing their effectiveness pre-implementation
Examples to illustrate how the network approach facilitates smooth transition between phases and increased likelihood of implementation/sustainability
Work may also take place outside of this cycle, for example in setting the agenda on important topics or areas of need to be focused on in intervention development.
E.g. GW4 study – research team wanted to develop a self-harm prevention intervention but a SEQ supplement found that schools placed more emphasis on mental health prevention and wellbeing promotion more generally, as well as the need to improve treatment services. As a result, an application has been made for some funding to develop an intervention to improve CAMHS provision

4. Example #1 – The WISE study
Feasibility/Piloting
1. Testing procedures
2. Estimating recruitment/retention
3. Determining sample size
Development
1. Identifying the evidence base
2. Identifying/developing theory
3. Modelling process and outcomes
Evaluation
1. Assessing effectiveness
2. Understanding change process
3. Assessing cost-effectiveness
Wellbeing in Secondary Education Project [WISE]
Existing intervention (Mental Health First Aid)
Pilot trial in 6 schools = feasible
Randomised controlled trial in 25 schools
Implementation
1. Dissemination
2. Surveillance and monitoring
3. Long term follow-up
The WISE study -
An example of a research study that is progressing through the stages of the cycle and has benefitted from the SHRN infrastructure
MHFA - train a % of teachers ito support each other and YP experiencing mental distress
Pilot trial in 6 schools, intervention is feasible to implement and was well received
Additional component added = mental health awareness session to staff who have not received the full training
Effectiveness trial in 25 schools in England and Wales to examine the impact of the intervention on staff wellbeing, as well as student wellbeing, attendance and attainment
Welsh arm of the study has benefitted from being part of the SHRN portfolio,
Opportunity offered only to SHRN member schools = fast recruitment
Retention of schools likely to be facilitated by supportive relationship between SHRN and its member schools.
The study started in 2016 and results will be available in 2019
If intervention proceeds to wider implementation in other SHRN schools = assess impact on a longer-term via SHRN questionnaire

5. Example #2 – The WHISP study
Feasibility/Piloting
1. Testing procedures
2. Estimating recruitment/retention
3. Determining sample size
Development
1. Identifying the evidence base
2. Identifying/developing theory
3. Modelling process and outcomes
Wellbeing and Health in Schools Project [WHISP]
Existing delivery = best practice
Theory informed
No evidence of effectiveness
Externally funded research
Understand processes and outcomes
Produce a replicable model for evaluation
Evaluation
1. Assessing effectiveness
2. Understanding change process
3. Assessing cost-effectiveness
Implementation
1. Dissemination
2. Surveillance and monitoring
3. Long term follow-up
The WHISP study - Well-being and Health In Schools Project
An example of a research study that has emerged from the identification of front line innovation
Researchers approached by SHRN school to evaluate their approach to health and well-being
Approach informed by evidence-based restorative approach, but no evidence of effectiveness,
But sustainable (had been implemented for a number of years), and perceived to be acceptable to students/staff
Explore ideas for evaluating impact of approach on student well-being and informing wider implementation
Research team secured external funding
Exploring existing approach with students and staff, understanding processes and intended/possible outcomes
Consult research evidence to identify possible causal mechanisms that may underpin approach
In order to articulate underpinning mechanisms of change, and the influence of contextual factors/implementation practices
Aim to produce model of approach amenable to evaluation – needs to be replicable in other schools in order to do this

6. Example #3 - The GMI_ALC study
Feasibility/Piloting
1. Testing procedures
2. Estimating recruitment/retention
3. Determining sample size
Development
1. Identifying the evidence base
2. Identifying/developing theory
3. Modelling process and outcomes
Evaluation
1. Assessing effectiveness
2. Understanding change process
3. Assessing cost-effectiveness
Implementation
1. Dissemination
2. Surveillance and monitoring
3. Long term follow-up
The GMI_ALC study – Group Motivational Interviewing intervention to prevent alcohol misuse in secondary schools
An example of a research study that has co-produced an intervention in collaboration with students and teachers and is now looking to progress to the pilot trial stage
More detail of co-production process

7. The GMI_ALC study Developing a GMI intervention
Feasibility/Piloting
1. Testing procedures
2. Estimating recruitment/retention
3. Determining sample size
Developing a GMI intervention
Identifying the evidence base:
Lack of evidence for impact of curriculum approach to health promotion
Competency-focused pedagogy emphasises processes internal to the learner
Group Motivational Interviewing [GMI] facilitates active participation and exploration of personal goals
Emerging evidence for use of GMI with young people
Development
1. Identifying the evidence base
2. Identifying/developing theory
3. Modelling process and outcomes
Evaluation
1. Assessing effectiveness
2. Understanding change process
3. Assessing cost-effectiveness
Implementation
1. Dissemination
2. Surveillance and monitoring
3. Long term follow-up
Curriculum approaches (e.g. PSE/PSHE) associated with changes in health-related knowledge
Limited evidence for impact on behaviour, possibly due to delivery method
Didactic approaches have low levels of student acceptability
Competency-focused pedagogy emphasises development of cognitive, affective and motivational competencies
GMI has number of commonalities with competency-focused pedagogy
Offers alternative to didactic approaches through facilitation of active participation and exploration of personal goals
Facilitator uses conversational style central to Motivational Interviewing.
Emerging evidence for use with young people
D’Amico et al (2013) GMI for young offenders = Reduced alcohol and drug use and recidivism (3 and 12 mths)

8. The GMI_ALC study Developing a GMI intervention
Feasibility/Piloting
1. Testing procedures
2. Estimating recruitment/retention
3. Determining sample size
Developing a GMI intervention
Identifying/developing theory:
Identify key components of a GMI approach to PSE lessons
Identify key components of a teacher training package
Modelling process and outcomes:
Small scale testing of GMI intervention delivery
Small scale testing of teacher training delivery
Development
1. Identifying the evidence base
2. Identifying/developing theory
3. Modelling process and outcomes
Evaluation
1. Assessing effectiveness
2. Understanding change process
3. Assessing cost-effectiveness
Implementation
1. Dissemination
2. Surveillance and monitoring
3. Long term follow-up
Worked with students and teachers to coproduce a GMI-based lesson for PSE
Identified key issues with existing delivery (didactic messages met with resistance)
Identified suggestions for content and format of a GMI-based approach (autonomy/responsibility)
Developed a prototype of a GMI intervention lesson plan for PSE
Tested delivery with two Y8 classes, lesson was found to be acceptable to students
But delivered by very experienced MI facilitators which is not sustainable long-term
THEN worked with students, teachers and HSCs to coproduce a training package to equip teachers with a responsibility for delivering PSE
Recruited schools from SHRN, advertising the opportunity via SHRN regional events and the newsletter
Tested delivery of training with 13 teachers
11 of the teachers went on to deliver the lesson to a class of Year 8 students
Explored teacher experiences of delivery and student experiences of receiving the session

9. Moving forward to a pilot trial
Feasibility/Piloting
1. Testing procedures
2. Estimating recruitment/retention
3. Determining sample size
Development
1. Identifying the evidence base
2. Identifying/developing theory
3. Modelling process and outcomes
Evaluation
1. Assessing effectiveness
2. Understanding change process
3. Assessing cost-effectiveness
Consultation with stakeholders
Consider results of testing and discuss key queries
Refine training and lesson plan
Identify resources needed to scale-up
Finalise measurement tools
Implementation
1. Dissemination
2. Surveillance and monitoring
3. Long term follow-up
Findings suggest that it is feasible to train teachers to deliver a structured GMI educational intervention
And delivery by a teacher is acceptable to students
Teachers felt the GMI skills could be applied to other lessons within the PSE curriculum
In order to move forward to a pilot trial of the intervention we have been consulting with key stakeholders (PH, WG, teachers)
Refine training package and lesson plan based on the results of the development and testing work
Identifying important topics that stakeholders would want the lesson to focus on
Also finalising measurement tools that we would pilot in the trial.
If funded, the pilot trial would recruit SHRN member schools, and would look to make use of SHRN data to monitor the impact of the intervention on health and wellbeing outcomes targeted by the intervention.