Addressing a Gender Gap in School-Based Mental Health Promotion: Planning an implementation 

study with multiple stakeholders

CIHR Planning Grant

Girls Action Foundation    and PRAM  

Background 

Research studies by the Canadian Council on Learning (2009) and Canadian Institute for Health Information (2009) demonstrate that up to one in five Canadian children and youth experience mental health issues that have a significant impact on their academic, social, and family life (Kutcher & Short 2009; Wilder & Short 2010).  The middle childhood years pose particular challenges for boys and girls as they transition into their adolescence. Children at this age are faced with increasing demands and concerns related to peer and family relationships as well as to such issues as sexuality, body image, eating disorders, depression and substance use and abuse (Watt, Dickey & Grakist, p. 24).   

While boys and girls are equally likely to exhibit adjustment difficulties as infants and toddlers (Freidrich et al. 2010), gender differences in relation to health behaviours and the development of psychopathology become increasingly significant throughout childhood and into adolescence (Freidrich et al. 2010).  Adjustment problems in boys tend to manifest as externalizing behaviours such as conduct disorder, physical aggression and ADHD (attention deficit hyperactivity disorder), while more girls than boys experience internalizing behaviours such as body image dissatisfaction, guilt, self-blame, self-disappointment, feelings of failure, sleep problems, overall fatigue, and health worries (Freidrich et al. 2010; Phares, Steinberg & Thompson 2004).   

Girls report higher rates of depression and headaches than boys (Boyce, 2004) and are twice as likely to be prescribed medication for depression as boys (CAMH Centre for Prevention Science 2005); With the onset of puberty, girls are typically three times as likely as boys to suffer from depression due to low self-esteem, negative body image, feelings of helplessness and hopelessness, and stress (Leischield et al., 2000);  

Girls 10 to 14 years old are 5 times as likely to be hospitalized for attempted suicide as their male counterparts (Public Health Agency of Canada, 2006); 

Girls are more likely to drop out of school, develop eating disorders, experience a lack of self-esteem, and suffer from depression and isolation (The Alliance of Five Research Centres on Violence, 2001). 

Through universal mental health promotion targeting all students, schools are ideal sites to promote mental health through decreasing risk factors, building resilience and strengthening protective factors. School-based mental health (SBMH) programs support early identification and intervention to prevent the onset of problems and respond to children and youth in distress; in fact, schools often provide the sole source of support that children and youth receive for mental health difficulties (Wilder & Short, 2010). SBMH programs build the resilience of all students through social-emotional learning and the development of social, cognitive, emotional and physical competencies.    

Freidrich et al. find “very few empirically validated gender-informed or gender-specific programs currently available for implementation in schools” and thus assert that “an increase in research on gender-specific universal, secondary and tertiary school-based programming is clearly needed,” beginning with gender analyses of current programs that assess whether and how current mental health programs are meeting the needs of girls and boys equally (p. 132).  

Canadian resarchers Smith, Cousins and Stewart (2005) similarly call for further research examining gender differences in how students respond to antibullying programs. 

Social determinants approach: The health of children and youth is shaped by a broad set of determinants including “social, economic, and political factors; psychological, genetic, and biological factors; gender; personal health practices; community resources; and the physical environment (Health Canada, 1994; 1996).  Given the complex ways in which these determinants interact with one another to impact on the health of individuals and communities as well as the positive correlations between health categories (e.g., healthy living and emotional health; parental relationships and social integration), the proposed project emphasizes holistic, cross-disciplinary approaches to mental health programs.  In keeping with the definition of SBMH promotion advanced by the International Alliance for Child and Adolescent Mental Health and Schools (INTERCAMHS), the proposed project emphasizes diversity and inclusiveness, and engages the participation of all stakeholders including teachers and various other school staff, and families throughout the research (Canadian School Health Community 2010).   

Current opportunity & Project goals 

Two of the partners in this project are Girls Action Foundation and the English Montreal School Board. The experience of these stakeholders working in multiple school environments provided the impetus for this project. Their professional experience indicates that 10 to 12 year-old children are facing a range of issues to which the school environment is often not equipped to respond, including physical and emotional violence (often characterized as bullying), gender discrimination and homophobia, stress, anxiety, problematic body image and low self-esteem, isolation, lack of assertiveness or ability to seek adult assistance, and lack of problem-solving ability in interpersonal conflicts. 

Practitioners have identified that these disparate issues are, in fact, often interrelated and require a holistic and whole school intervention approach.  

 This project will convene practitioners, school staff, parents, students, and researchers to explore why, despite the availability of many school-based mental health promotion programs and curriculum tools, teachers and schools are often at a loss as to how to address these mental-health related challenges. The project will draw on the perspectives of each of these stakeholders to identify program implementation gaps.  

The other key aspect of the project is gender, because despite the prevalence of gender as a factor in children’s mental health outcomes, most SBMH programs do not take gender into account. The survey of existing programs will help describe how extensive is this gap, and the needs assessment will identify some promising practices that could be tested in the implementation study to be developed as a result of this Planning Grant. Thus, the Planning Grant will allow for in-depth assessment with stakeholders of the following questions, which will form the basis for a larger research project: 

How can the barriers to implementation of effective school-based mental health (SBMH) programs be reduced and school uptake increased? 

How can the gap in gender-specific SBMH promotion programs best be addressed? 

This project is relevant and timely as increasing numbers of SBMH programs (including anti-bullying, healthy relationship and violence prevention programs) are being developed while teachers and school staff continue to report a lack of resources to address mental health related challenges among students. The project will focus in-depth on one to two schools in Montreal, in order to delve into the research questions from multiple stakeholder perspectives within a limited number of communities. 

Objectives 

The Planning Project objectives are to: 

Build consensus among multiple school community stakeholders and scholars about gaps and needs to improve mental health promotion for students in middle childhood Assess literature on mental health in middle childhood from a gender-based analysis; 

Identify, and assess for gender sensitivity, existing school-based mental health (SBMH) programs available in Canada for children aged 10-12 years, with emphasis on holistic programs that address social and emotional competencies Through a multi-stakeholder deliberation process, including scholars, health providers, curriculum designers, teachers, parents, school adminstration and health promotion organizations in two school communities, 

• Identify barriers to implementation of effective SBMH programs  
• Identify promising practices that could be tested in a future implementation study 
• Assess the need for gender-specific SBMH promotion programs and promising practices to address gender  

With participation from the stakeholders involved in the needs assessment, develop a future project (including feasibility, relevance, partners, and work plan) in order to present a proposal for an implementation study to design and test interventions based on the promising practices identified 

Expected Outcomes:  

A working research partnership among scholars and community stakeholders is established with the aim of developing an implementation study that would advance knowledge and improve interventions to promote pre-adolescent children’s mental health. 

The following outputs are produced:  

• Summary review of literature related to mental health issues and school-based mental health programming for pre-adolescent children in grades five and six. 
• Summary review of SBMH programs available in Quebec and if these programs incorporate gender analysis and address gender differences in relation to childhood mental health.   
• Report on multi-stakeholder consensus reached during the project on the gaps, needs, and future directions for better design and implementation of SBMH programs.
• First phase of research project proposal: Partnership agreement between researchers and community stakeholders and action plan to prepare proposal for  an implementation study of gender-sensitive SBMH programs.