Appendix C: The evidence

This appendix lists evidence statements from the review of effectiveness provided by the public health collaborating centre (see appendix A) and links them to the relevant recommendations. The evidence statements are presented here without references – these can be found in the full review (see appendix E for details). In addition, this appendix lists additional evidence used to inform the recommendations. (See appendix B for the key to quality assessments.) It also sets out a brief summary of findings from the economic analysis

Evidence statement number 1a indicates that the linked statement is numbered 1a in the review 'Systematic review of the effectiveness of universal interventions which aim to promote emotional and social wellbeing in secondary schools'. AE indicates that additional evidence was used to inform the recommendation (see 'additional evidence' section following the evidence statements).

The review is available online. Where a recommendation is not directly taken from the evidence statements, but is inferred from the evidence, this is indicated by IDE (inference derived from the evidence) below.

Recommendation 1: evidence statements 1a, 1b; IDE

Recommendation 2: AE; IDE

Recommendation 3: evidence statements 1a, 1b, 5

Recommendation 4: evidence statements 1b, 5; AE

Recommendation 5: evidence statements 1a, 3a, 3b; IDE

Recommendation 6: evidence statements 1a, 1b; AE

Evidence statement 1a

We identified strong evidence from 3 good quality papers (2 [+] randomised controlled trials [RCT] and 1 [+] controlled before-and-after [CBA] study) of effective interventions to support curriculum approaches to whole-school interventions, which aim to promote pro-social behaviours and skills. The 3 interventions included here were conducted in the USA and Canada in populations with some similarity to the UK, and therefore can be considered to be potentially applicable in English schools.

This evidence suggests that conflict resolution training is successful in promoting pro-social behaviours in the short term and that the use of peer mediators may be effective for longer-term outcomes.

Evidence statement 1b

We identified mixed evidence from a total of 7 RCT studies regarding curriculum approaches to whole-school interventions which aim to prevent bullying and disruptive behaviours.

Five good quality (+) RCT papers discussed interventions which were effective, particularly in association with a community-based project. The majority of these studies were conducted in the USA; 3 in populations similar to the UK (majority white). These studies, along with a fourth conducted in Italy are potentially applicable in the UK. A further 2 papers were conducted in the USA in populations which were predominantly African-American so they may be less applicable in a typical English school.

However, there were also 2 good quality papers (+) that showed that curriculum-based interventions were not effective in preventing bullying and disruptive behaviours (again with some community element to the intervention). These studies were conducted in the USA and The Netherlands respectively and therefore may have limited applicability in the UK context.

This evidence therefore is mixed and it is unclear whether curriculum-based interventions for tackling bullying and disruptive behaviour are effective. However, on balance the evidence suggests that certain interventions can be effective. It is possible that including community elements in these types of interventions may be beneficial.

Evidence statement 3a

We identified 3 papers of varying quality and study design to support the role of young people as peer educators/mediators in interventions to promote pro-social behaviours and skills (1 [+] RCT; 1 [+] CBA and 1 [-] interrupted time series [ITS]. The first 2 of these studies were conducted in the USA, the third in Australia, they may therefore have some applicability in English schools.

This evidence suggests that peer mediation is an effective way of promoting pro-social and behavioural skills in the long term.

Evidence statement 3b

We identified mixed evidence, of varying quality, regarding the role of young people as peer educators/mediators in interventions to prevent bullying and disruptive behaviours.

Four studies (2 RCTs – 1 [+], 1 [-]; 1 [-] ITS; 1 [-] qualitative case study) supported the role of peer mediators in preventing bullying and disruptive behaviour. The case study was conducted in the UK, so will be applicable in English schools (although the study quality was poor). The other studies conducted in the USA, Italy and Finland may have some applicability in this context.

However, a further 2 studies described peer mediation interventions which were not effective in reducing bullying and disruptive behaviours (1 [+] RCT; 1 [+] ITS). These studies were conducted in the USA and Australia respectively although the USA study had a high majority of African-Americans which may limit its applicability.

This evidence shows that although peer mediation can be effective in reducing bullying and disruptive behaviour it is not always successful. There are no clear patterns to define interventions which were effective or those which were not.

Evidence statement 5

We identified strong evidence of good quality, the majority of which (2 [+] RCTs; 1 [+] ITS) supports parent training/education in the implementation of interventions to reduce bullying and disruptive behaviours. Again, the high proportion of African-Americans included in the studies in the USA may limit their applicability in English schools.

One additional (+) RCT study did not support parent training/education in the implementation of interventions to reduce bullying and disruptive behaviours and was also conducted in the USA.

From this evidence it is difficult to judge the effectiveness of parental involvement, as none of these studies placed any emphasis on adult-related outcomes or perceptions of the programme. However some positive outcomes for the children were seen, suggesting that parental involvement can be beneficial.

Additional evidence

PHIAC drew on other sources for a general understanding of the wider public health issues.

Smith P, O'Donnell L, Easton C et al. (2007) Secondary social, emotional and behavioural skills (SEBS) pilot evaluation. London: Department for Children, Schools and Families.

Ofsted (2007) Developing social, emotional and behavioural skills in secondary schools. London: Ofsted.

Cost-effectiveness evidence

Due to the limited evidence available (and its relevance to the UK), the cost-effectiveness model focused on interventions to prevent bullying.

Sensitivity analyses were undertaken to assess the effects of varying 2 key variables: initial prevalence of victimisation and effectiveness of the intervention.

The primary perspective used was the QALY. However it should be noted that this has limited currency in sectors outside the NHS, such as education and criminal justice, which will also incur costs and benefits from the interventions.

Fieldwork findings

Fieldwork aimed to test the relevance, usefulness and the feasibility of putting the recommendations into practice. PHIAC considered the findings when developing the final recommendations. For details, go to the fieldwork section in appendix B and online.

Study of practitioners

Overall, the recommendations were positively received by practitioners who felt they reflected much of current practice and policy. The emphasis on multiagency working was welcomed and endorsed.

They also expressed the wish for:

  • a more explicit link between social and emotional wellbeing and educational attainment – and its role in preparing young people for adult life

  • the guidance to be promoted as part of the Ofsted inspection process

  • a more explicit link to existing guidance and policies, particularly the Social and Emotional Aspects of Learning – SEAL and the National Healthy Schools Programmes

  • more emphasis on the role of young people, parents and carers in promoting social and emotional wellbeing

  • the social and emotional wellbeing of school staff to be promoted

  • training (including initial teacher training) and continuing professional development which provides the necessary knowledge and skills on social and emotional wellbeing

  • practical examples of whole-school approaches to social and emotional wellbeing.

Consultation with young people

Young people wanted to strengthen their role in all activities to promote social and emotional wellbeing (development, delivery and evaluation). In particular, participants stressed the importance of having a robust system in place to ensure they are properly involved in the decision-making process.

Participants also highlighted the need to have 1 clear point of contact when seeking help with personal issues at school.

  • National Institute for Health and Care Excellence (NICE)