Optimising the potential of mindfulness programs in schools: Learning from implementation science

There is a growing need for the provision of mental health services for young people in schools. A number of evidence-based practices (EBPs) now exist for schools to choose from to address their pupils’ mental health needs. However, when such EBPs are introduced into schools, their effectiveness can be lacking and weakened. Implementation science suggests that without effective implementation strategies, the success of EBPs in schools may be limited. The transfer of knowledge into practice is a difficult and challenging process, often referred to as the ‘science to service gap’. To support the mental health of young people, there is a need not just for EBPs but also for evidence-based implementation.
Mindfulness training (MT) is a promising intervention for young people that is currently being introduced to a number of schools across the UK, and internationally. The primary aim of this doctoral work was to understand and examine MT implementation experiences in order to identify the determinants of, and potential ways to promote, the early implementation stages of MT in schools. The first study in this doctoral work examined how far a knowledge broker, sharing implementation related knowledge, could impact the implementation decisions made by a steering group (SG) responsible for implementing a mindfulness program across schools in Cumbria, UK. SG meetings were attended for 14 months and meeting minutes, notes and audio recordings were recorded and analysed for “key moments” and “key outcomes”. A second related analysis of this SG activity explored, via interviews and thematic analysis, the perceived opportunities and barriers for the SG to act as an implementation team. Study 3 aimed to identify the determinants of MT early implementation success in five secondary schools by using the Consolidated Framework for Implementation Research (CFIR). Interviews were conducted with school staff responsible for implementing MT at two time points across 6 months. The schools’ implementation progress was recorded, and the CFIR was used to code the data for 38 implementation constructs. Usefulness of the CFIR was assessed. Finally, in Study 4 the findings of the previous studies were synthesised with the implementation science literature to inform the development of a preliminary implementation framework to promotes the successful implementation of MT in (secondary) schools in order to improve their usefulness in such complex settings.
Findings from Study 1 and 2 suggested that SGs responsible for implementing school public health programs can learn about implementation and then apply this new knowledge to their program. Sharing knowledge with stakeholders responsible for implementing public health programs may be a viable and effective implementation promotion strategy. Having a strong engagement strategy and good relationships with schools can facilitate this process. SGs influence over general school capacity and external funding may be limited and hinder their ability to impact overall implementation. More work is needed to understand how SGs may be empowered to influence general capacity, funding, and have better linkages to other stakeholders involved in their program’s overall provision.
Findings from Study 3 indicated that there are a number of implementation related constructs which seem to distinguish between schools which implement MT well and schools which do not. The CFIR was a useful tool for identifying the barriers and facilitator to EBPs in schools and which barriers and facilitators seem to distinguish implementation success between schools the most. School leadership plays a pivotal role in ensuring implementation success. Who should be solely responsible for the successful implementation of EBPs in schools is less clear but it may be that a concerted effort on the part of program designers, program funders and school leadership might be required to ensure programs are implemented well. Study 4 indicated that implementation frameworks designed specifically for school leaders are likely to be useful but what motivates school leaders to use them is less clear. Further research into ways of promoting the use of implementation guidance by school leaders is needed.