Learning together to promote mental health and well-being in English secondary schools: LTMH study refinement and feasibility evaluation, a comprehensive synopsis.

The Learning Together for Mental Health feasibility study met all pre-defined criteria for progression to a Phase III randomised controlled trial.

• All pre-defined progression criteria relating to the intervention and trial methods were met.
• The study included four state, mixed-sex secondary schools in southern England (one dropped out after baseline and was replaced).
• The study spanned one academic school year.
• The study was funded by the NIHR Public Health Research programme (award number NIHR131594).

All-staff and in-depth restorative practice training were implemented with fidelity across all schools.

• All four schools had at least two staff trained in-depth in restorative practice.
• All-staff restorative practice training was implemented with fidelity in all schools.
• Curriculum training was delivered with fidelity in three of four schools.
• Progression required at least two schools to have delivered the curriculum with at least 50% fidelity, which was achieved.
• One of the two schools which delivered the curriculum reported over 80% fidelity and the other reported over 75% fidelity.

Student and staff surveys showed high levels of acceptability for the Learning Together for Mental Health intervention.

• All students and staff across all four schools who completed the action group survey reported that Learning Together for Mental Health was a good way to promote student mental health.
• 93% of senior leadership team members who completed the senior leadership team survey reported that Learning Together for Mental Health was a good way to promote student mental health.
• Qualitative research included 20 staff, 27 year-8 students, and 22 year-10 students, as well as two trainers and one external facilitator.

The baseline survey response rate across participating schools met feasibility targets.

• The response rate to the baseline (needs) survey across the three participating schools was 79%.
• 640 year-7 (age 11-12) students were recruited at baseline survey.
• 566 year-10 (age 14-15) students completed the 12-month follow-up survey.
• Baseline and follow-up participants were different groups, as the focus was assessing feasibility for the age groups to be surveyed at baseline and follow-up in a Phase III randomised controlled trial.

Potential mechanisms of action for Learning Together for Mental Health involve promoting student sense of school belonging and practical reasoning and skills.

• Mechanisms were identified through process evaluation conducted as part of the feasibility study.
• Qualitative research with students and staff contributed to understanding potential mechanisms.
• No harms were reported during the study.

Trial measures and procedures were found to be feasible and acceptable to implement.

• Economic-evaluation feasibility-testing was conducted alongside baseline and follow-up surveys and process evaluation.
• The study included both quantitative surveys and qualitative components.
• The authors recommend intervention and trial refinement prior to a Phase III trial, including making the curriculum optional and improving materials.

The Learning Together for Mental Health intervention was successfully adapted from the previous Learning Together intervention using public involvement.

• One school participated in the intervention adaptation process.
• The adaptation increased focus on mental health relative to the original Learning Together intervention.
• The adapted intervention included a 'menu' of evidence-based actions for action groups to choose from to address student mental health needs and an improved social and emotional learning curriculum.
• The original Learning Together intervention had been found effective in reducing bullying and promoting mental health.