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MasterMind: Empower Yourself With Mental Health. A program for adolescents.

In many schools, mental health issues are not ad. dressed until they result in classroom disruption and then are handled on a case-by-case basis. Nondisruptive issues remain unrecognized, sometimes with dire consequences. Furthermore, timely recognition is increasingly difficult when class sizes increase for budgetary or other reasons. A classroom-based program that teaches mental health skills could reach virtually all students and could expose and address issues in a community-oriented manner. However, our review of the literature and our discussions with school personnel identified a paucity of mental health education materials that are both suitable for different school-aged groups and packaged for easy use. (1,2) The need and opportunity to foster mental health in adolescents led to development of our program, MasterMind: Empower Yourself With Mental Health.

Recent surveys of public middle school students in Seattle, WA, indicated that approximately 22% of these students stated they needed help for depression. Yet, 41% of students surveyed reported discomfort approaching someone at school for help. Up to 30% did not feel optimistic about the future. Alarmingly, 23% seriously contemplated suicide, and of this 23%, almost 43% attempted suicide. (3)

The pilot implementation of MasterMind: Empower Yourself With Mental Health was at a public middle school where 9% of sixth-grade students were identified through depression screenings as needing referrals for help. (4) Furthermore, previous worrisome incidents at this middle school included alleged rape, (5) accidental discharge of a gun, (6) and intentional shooting with a pellet gun. (7) These incidents exemplify behavioral and safety issues found throughout the United States and indicate underlying mental health concerns. (8,9) This article describes development of curriculum and educational materials for an effective, easily implemented, adaptable, low-cost program to foster adolescent mental health. It also describes the pilot implementation of this program and discusses broader implications.

PROGRAM DEVELOPMENT

Project Objectives

The project had 2 major objectives: (1) development of an educational curriculum and materials fostering mental health for middle school students that would effectively create a "toolbox for mental health" and (2) pilot implementation of the program in a classroom.

The Curriculum and Educational Materials. Topics for MasterMind: Empower Yourself With Mental Health were developed to address well-documented emotional health challenges and to promote mental health priorities of young adolescents. (8,9) The methods used in the curriculum draw from the evidence supporting peer-to-peer education and seek to engage students with different learning styles, (10-16) In addition, curricular content and format were informed by discussions with teachers who have extensive experience working with high-risk adolescents in the district. The curriculum was implemented as a pilot project.

The curriculum has 3 goals: (1) create a safe environment where students can discuss mental health, including emotionally charged topics, (2) increase student awareness about mental health issues, and (3) provide students with "tools" to develop and maintain mental health.

The MasterMind curriculum covers a variety of topics: self-esteem, media literacy, school resources, developing and strengthening relationships, emotions (particularly sadness), depression and suicide, the effects of stress and ways to de-stress, and future goals. In addition to addressing national priorities for adolescent mental health, these topics were selected through needs assessment that included discussions with administrators, school counselors, and teachers within the Seattle Public School System; they were finalized in first session with the participating students. To optimally engage students with different learning styles, the curriculum combines instruction and written exercises with "peer-teaching-peer" group activities, individual assignments, and open discussion. (14,15) For example, in our pilot program, the students worked in small groups to develop improved communication skills to foster good relations. In another session, each student completed an individual assignment, which critically evaluated the media and how it influences his or her mental wellness. Students also participated in large group discussions of challenging topics, such as processing a recent event in which a fellow student had attempted suicide. The curriculum seeks to create a low-pressure environment for the exploration of relatively sensitive topics. There were no formal grades.

The curriculum also incorporates 2 ongoing activities: "Anonymous Questions" and "You've Been Caught!" For Anonymous Questions, students submit questions in a designated box in the classroom. Questions are retrieved weekly and discussed. Responses are posted on a bulletin board so students can refer to them later. For You've Been Caught, students submit positive comments about one another, focusing on "catching" each other doing admirable acts. The comments were read aloud and posted on the bulletin board to remind students of their power to support one another.

The educational materials have the following goals: to be (1) effective, (2) easily implemented by instructors at minimal cost, and (3) adaptable for students at various developmental levels, diverse ethnic and socioeconomic groups, and different settings. Personalized student folders contain activity worksheets, homework assignments, entry and exit surveys, a workshop evaluation, and a letter to parents explaining the program's purpose and suggestions for enhancing their child's experience. The instructor's handbook includes suggested schedules, activity instructions, and worksheet master copies.

The Pilot Program Implementation. MasterMind was presented to 30 eighth-grade students for 80 minutes weekly over 6 weeks. One of the program's developers led the sessions, allowing her to assess strengths and weaknesses of the program from the instructor's perspective. To test the curriculum and materials, we specifically assessed: (1) content and process of the program related to the grade level, (2) adequacy of time available for the workshop, and (3) student and teacher acceptance of the program.

PROGRAM OUTCOMES

Pilot Program Evaluation

Evaluations of our pilot program included identical entry and exit surveys that consisted of process measures with 23 questions, some with quantitative scales and all with space for qualitative comments. These surveys were designed to ascertain changes in student knowledge of adolescent mental health issues. Specifically, they assessed knowledge about handling life's problems (eg, identifying strong emotions, signs of depression, and recognition of suicidal ideation in self and others), knowledge of available resources and support systems, knowledge about attaining personal goals, and their outlook for the future.

The program increased student knowledge of mental health issues, as shown by more accurate and complete responses on the exit survey. At entry, the students were able to identify many common mental health issues for their age group. However, the program increased the students' depth of knowledge about those issues. The differences between the entry and the exit surveys did not achieve statistical significance, and paired testing could not be performed because the authors were not able to retain linked identifiers. The following changes were seen overall:

* 13.3% increase in identifying coping mechanisms for strong emotions such as anger and sadness

* 20% increase in identifying supportive resources in their families and in the school

* 23.3% increase in ability to identify the signs of depression

* 16.7% increase in the ability to identify an appropriate action if they thought someone was at risk of suicide.

Additionally, the students were given a 12-question form to evaluate the program, and the classroom teacher completed a weekly, 5-question assessment. The weekly teacher assessment and weekly discussions with students provided immediate feedback to help establish relevance and feasibility of the overall project.

Student responses on both the student exit surveys and the program evaluations confirmed the student interest in the topics that was indicated by lively classroom discussions. This survey finding reinforced the program leader's perception that students felt that the curriculum provided a safe environment for exploring mental health topics. In the discussions, the students shared perspectives on topics important to them and were able to have their questions answered. They ranked 6 of the 8 topics greater than 4 on a 5-point interest scale (Figure 1). The relevance of the topics was also supported by the classroom teacher's observations of the high quality of the students' questions and discussions.

The responses to Anonymous Questions and You've Been Caught activities were noteworthy. During 6 weeks, 30 questions and more than 100 compliments were submitted. The number of compliment submissions increased weekly from 5 in the second week to over 20 in the last session, and students competed to read the submissions aloud, to post the submissions on the bulletin board, and even simply to hold the bulletin board during the reading and posting. These activities were so popular that the teacher continued You've Been Caught! and Anonymous Questions after the MasterMind program was completed.

Students actively participated during the workshops and they gave responses on the exit surveys and workshop evaluations that identified the components they found useful. The student feedback surveys of the program showed that 2 tools were especially popular: the list of local and national resources for teens and a de-stressing meditation technique.

The classroom teacher evaluated the program noting that the materials were appropriate for the developmental level and the ethnic diversity of the students. The teacher noted that since students rarely ran out of comments or interest in the topics, 80 minutes was an appropriate class length.

[FIGURE 1 OMITTED]

The educational materials were easily implemented at low cost. The instructor for the pilot program implementation, also a developer of this program, found the materials to be effective and easy to use. Implementation of the program by instructors not involved in its development will be useful in assessing ease of presentation. The cost for the pilot program implementation for 30 students was $99.50. Economies of scale would reduce costs.

Broader Applications

MasterMind is designed to be adapted to a variety of settings. The curriculum and materials are flexible and can be modified in topic choice, depth of exploration, or length of sessions. This flexibility supports use of MasterMind at various grade levels in school settings and outside the schoolroom, such as in community-based programs. Likewise, the program's low cost and easily produced materials encourage its broad use.

MasterMind combines structured content with a peer-educating-peer format, an approach with documented success in reaching adolescents. (10-13) In addition, as a classroom- or group-based program engaging different learning styles, MasterMind helps eliminate disparities in access to health education since all students in the class participate in the workshop. (14-16) Furthermore, although MasterMind is not designed as an intervention for those with identified mental health problems, it may enable the school staff, group leaders, and even adolescents themselves to identify individuals with mental health needs that might otherwise be overlooked. A larger sample size of participants would be necessary to determine whether the changes between the entry and the exit surveys are statistically significant. Future implementations of the project will benefit from more rigorous, formal evaluation techniques and longitudinal evaluations of long-term outcomes.

In sum, this classroom- and group-based approach fosters open, respectful discussions, peers teaching peers, and a low-pressure environment with no formal grading. This flexibility supports use of MasterMind at various grade levels and in various settings, including school classes and community-based programs.

CONCLUSIONS

The paucity of mental health education resources readily available to the adolescent population creates a great need for programs to develop and support mental health. An effective, easily implemented, adaptable, and low-cost program to foster mental health in adolescents is MasterMind: Empower Yourself With Mental Health. In particular, the curriculum included not only content on key topics but also longitudinal activities (peer-to-peer teaching, Anonymous Questions, and You've Been Caught!) that reinforce healthy concepts and behaviors. The pilot program implementation demonstrated this program's ability to provide adolescents with their own toolbox to optimize mental health.

REFERENCES

(1.) Lauria-Horner BA, Kutcher S, Brooks SJ. The feasibility of a mental health curriculum in elementary school. Can J Psychiatry. 2004;49(3):208-211.

(2.) Ringwalt CL, Ennett S, Vincus A, Thorne J, Rohrbach LA, Simons-Rudolph A. The prevalence of effective substance abuse prevention curricula in U.S. middle schools. Prey Sci. 2002;3(4): 257-265.

(3.) Harachi T, Hillard P, Peterfreund N. Seattle Public School Teen Health Survey. Seattle, Wash: Seattle Public Schools Health Education Office; 1999.

(4.) Vander Stoep A, McCauley K, Thompson KA, et al. Universal screening for emotional distress during the middle school transition. J Emotional and Behav Disord. 2005; 13(4):213-223.

(5.) Angelos C, Ramirez M. Alleged rape investigated. The Seattle Times. February 8, 1994. Available at: http://archives.seattletimes.com. Accessed October 9, 2003.

(6.) Editorials & Opinions. A police matter--expulsion is not enough to curb guns at school. The Seattle Times. January 18, 1992. Available at: http://archives.seattletimes.com. Accessed October 9, 2003.

(7.) Seven R. Youth charged in pellet gun shooting. The Seattle Times. January 15, 1992. Available at: http://archives.seattletimes.com. Accessed October 7, 2003.

(8.) US Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion. Healthy Youth!, Health Topics, Mental Health. 2006. Available at: http://www.cdc.gov/ HealthyYouth/AdolescentHealth. Accessed August 18, 2006.

(9.) National Mental Health Association. Children's Mental Health Statistics. 2006. Available at: http://www.nmha.orglchildren/ prevent/stats.cfm. Accessed August 18, 2006.

(10.) Sloane B, Zimmer C. The power of peer health education. J Am Coll Health. 1993;41:241-245.

(11.) Ochieng BMN. Adolescent health promotion: the value of being a peer leader in a health education. Health Educ J. 2003;62(1):61-72.

(12.) Mellanby AR, Rees JB, Tripp JH. Peer-led and adult-led school health education: a critical review of available comparative research. Health Educ Res. 2000; 15(5):533-545.

(13.) Ward J, Hunter G, Power R. Peer education as a means of drug prevention and education among young people: an evaluation. Health Educ J. 1997;56(3):251-263.

(14.) Reid JM.ThelearningstylepreferencesofESLstudents. TESOL Q. 1987;21 (1):87-111.

(15.) Eiszler CF. Perceptual preferences as an aspect of adolescent learning styles. Educ. 1983;103:231-242.

(16.) Wakefield AP. Learning styles and learning dispositions in public schools: some implications of preference. Educ. 1993;113:402-406.

KATHERINE A. TACKER, MD (a)

SHARON DOBIE, MD (b)

(a) Resident Physician, (tackerk@ohsu.edu), Department of Psychiatry, Oregon Health and Science University, Multnomah Pavilion, UHN-80, 3181 SW Sam Jackson Park Rd., Portland, OR 97239-3098.

(b) Associate Professor, (dob@u.washington.edu), Department of Family Medicine, University of Washington School of Medicine, Seattle, WA 098125.

Address correspondence to: Katherine A. Tacker, Resident Physician, (tackerk@ohsu.edu), Oregon Health and Science University, Department of Psychiatry, Multnomah Pavilion, UHN-80, 3181 SW Sam Jackson Park Rd., Portland, OR 97239-3095.
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Title Annotation:Health Services Application
Author:Tacker, Katherine A.; Dobie, Sharon
Publication:Journal of School Health
Article Type:Report
Geographic Code:4EUUK
Date:Jan 1, 2008
Words:2368
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