AICAFMHA:
promoting mental health for young Australians
Australian Infant, Child, Adolescent and Family Mental Health Association Ltd
ABN 87 093 479 022

The Gatehouse Project. Promoting a positive social environment in secondary schools
Dr Jane Burns on behalf of the Gatehouse Project Team, Centre for Adolescent Health, Murdoch Children’s Research Institute

Summary
Introduction
The intervention
Intervention strategies
Evaluation
Results, Conclusion

The Gatehouse Project is a Universal school based intervention designed to promote a positive social environment in secondary schools. The Projects conceptual framework draws on cognitive behavioural and attachment theory. Working across several levels; at the classroom, curriculum, whole school and community/school interface, the program promotes a sense of security and trust, effective communication and positive self-regard. Distinguishing features of the project, developed in partnership with schools, include; the establishment of adolescent health teams; the identification of risk and protective factors in each schools social and learning environment; setting priorities and planning implementation strategies; providing professional development and establishing processes for ongoing review. The project has a strong evaluation framework, measuring both outcome and process in a randomised controlled trial. Early results indicate improvements in school connectedness and participation, some reduction in the severity and frequency of bullying and reductions in poor behavioural outcomes.
Back to top

The Gatehouse Projects strength and one reason for its success is that it has been developed in partnership with both the education and research sectors contributing to its design. The team based at the Centre for Adolescent Health at the Royal Children’s Hospital in Melbourne, Victoria consists of psychiatrists, psychologists, epidemiologists but also importantly educationalists, including individuals with backgrounds in teaching and student welfare.

The "Public Health Approach", popularised by Jeffrey Rose, advocates the importance of understanding risk processes to inform prevention. Research indicates that one health problem raises the risk for subsequent problems; for example, young people who drink are also more likely to smoke. Risk factors cluster in individuals; young people who report poor school connectedness are more likely to report increased conflict with teachers, poorer communication skills and poorer self-concept. Research also supports the idea that common risk and protective factors can be identified for different problems. Poor family cohesion, increased parental conflict, poor social attachments to school or community and individual characteristics such as poor communication or poor coping skills are risk factors for multiple outcomes including alcohol and drug use, antisocial behaviour and depressive symptomatology.

The Institute of Medicine in 1994 introduced and popularised the concept of working across the Mental Health Prevention Spectrum [1]. Prevention efforts have previously focused at the high risk end of the spectrum, targeting young people either with observable signs or symptoms of a disorder or targeting a selected population who are known to be at increased risk for example young people who might be homeless. The Universal approach is a broad strategy targeting whole populations, or all young people in a particular setting such as the school. Broad based prevention strategies aim to shift known risk and protective factors in a favourable direction. Interventions are delivered to all young people so that more young people benefit from the program but also so that less young people fall into the high-risk end of the spectrum. The best example of a public health approach to prevention can be taken from the area of cardio-vascular disease. Treatments have improved but people are now also more aware that if you eat healthy foods, you do not smoke and you exercise regularly you can reduce the risk associated with having a heart attack.

The aim of any prevention program is to shift known risk and protective factors in a favourable direction. The rationale for prevention indicates that effective intervention in one area will lower risk for other problems, Interventions that are effective in reducing one risk factor (or enhancing a protective factor) are likely to affect other risk factors and successful intervention for one risk or protective factor is likely to bring multiple benefits. For example, increased communication skills will reduce conflict with peers, parents and teachers. This will impact on outcomes such as depressive symptomatology, alcohol and drug use.
Back to top

The design of any intervention needs to be informed by current evidence. Earlier research has raised doubts about the capacity of schools to affect student behaviour and academic outcomes given the impact of social class, family and other social conditions. Subsequent work drawing on research from both observational and intervention studies highlights the importance of schools as an important social setting for young people. Young people spend close to half their waking hours in school and inevitably the quality of experiences with teachers and peers in that setting affect emotional well-being. Rutter and colleagues, in an observational study recorded in the seminal work "Fifteen Thousand Hours" showed that differences in academic achievement and behaviour are largely the result of school organisation and climate and not the background/socio-demographic characteristics of students [2]. This work emphasised the importance of social relationships and the school as a social institution. The relationships between teachers and students in classrooms, opportunities for student participation and responsibility, and support structures for teachers consistently emerge as associated with student progress and development.

Intervention studies conducted by Dan Olweus examining the prevention of bullying uses questionnaires and surveillance and multiple levels of interventions [3]. Educational ‘school effectiveness’ and ‘school improvement’ research also highlights the importance of classroom factors and whole school influences [4-6].

Research drawing from work conducted in the United States by Resnick and Blum and Catalano and Hawkins has shown clear associations between social attachment, connectedness and adolescent health [7]. Attachment and social connectedness are protective factors amenable to intervention. Young people who report poor social attachments more commonly experience adverse life events, report poorer interpersonal attachments and lack social support buffers. Young people reporting poor family-school connections are at an increased risk and likelihood of conflict with parents and teachers. They have a poorer self-concept, a stronger affiliation with peers and are influenced more strongly by ‘peer culture’.

Michael Resnick at the International Pacific Rim Adolescent Health Conference in New Zealand asked the question "Who says education and Health should be housed in separate buildings?" The education system, schools and teachers are increasingly being asked to do more; juggling drug and alcohol education on the one hand while trying to teach English and Maths; dealing with parental expectations while being asked to participate in suicide prevention strategies, sunsmart campaigns, sexual education and life skills training. Many teachers struggle with increased demands and find this juggling act incredibly difficult.
Back to top

The theoretical framework informing the Gatehouse Project takes as its basic premise the importance of belonging and a sense of connectedness. Drawing on cognitive behavioural therapy and attachment theory it acknowledges the characteristics of the individual but also highlights the importance of the social and learning environments in which the individual interacts. Targeting three specific areas, security, communication and positive regard the Gatehouse Project intervention aims to promote skills in young people but also provide young people with opportunities to use those skills. It was expected that targeting connectedness at both an individual and environmental level would influence not only emotional well-being but would also impact on learning outcomes [8].

The Gatehouse Project Team acknowledged that, if the theoretical framework informing the intervention was to work in practice the intervention itself needed to sit within existing school structures. The Team, in partnership with individual schools, worked to enhance the social and learning environment of the school by measuring, via self reports from students, three main contextual areas; security and victimisation, communication and positive participation. The social climate profile provided a focus for existing health promotion work. The profile can be motivational, allows schools to formulate local solutions and provides a longer-term view. For example, the majority of schools had existing policies and procedures in place, however when they were able to examine their own school social profile many were surprised by the results and were able to change or modify some of the existing practices. School-based adolescent health teams were established and supported by a critical friend from the Gatehouse Project Team in each school. The identification and support of school based adolescent health teams allowed local coordination and brought together individuals from different school sectors.

Importantly, the conceptual framework for promoting emotional well-being in the schools social and learning environments works across three layers; at the curriculum and classroom level, at a whole school level and at the school community interface level.

The intervention was both individually and environmentally focused and has been delivered over a five-year period, from 1997-2001. The following examples highlight the broad approaches and many of the strategies employed to promote security, communication and positive regard at a curriculum, classroom, whole school and school community interface level.
Back to top

• Supporting the contribution of parents to school activities
• Use of local media to publicise school and student achievements
  Back to top

For an intervention to be deemed effective it is important to measure both outcome, "Did the project work?"and process, "If the project worked why did it work, if it did not work, why not?"

The Gatehouse Project is a cluster based randomised controlled design. Schools were stratified by type (government, catholic or independent) and metropolitan and regional status. Randomisation occurred before the schools were invited to participate. Overall thirty-two schools were sampled; twelve agreed to participate in the intervention while 14 agreed to participate in the project as comparison schools. 3,623 Year 8 students (13-14 years old) were eligible to participate. Overall 2,678 students (74%) completed the survey at baseline (year 8).

Year eight students completed a baseline computer administered questionnaire in term one of 1997. Students were then asked to participate in follow-up surveys at the end of year 8 (wave 2), in year 9 (wave 3), in year 10 (wave 4) and year 11 (wave 5). A pencil and paper survey was conducted in 1999 to measure whole school changes in the successive year eight cohort. A variety of questions covering adolescent health and risk taking behaviours including drug and alcohol use, depression, antisocial behaviours and smoking were asked. Several characteristics of the school social environment were examined including; peer victimisation (type, frequency and emotional impact); attachment, commitment, opportunities for involvement, disincentives, rewards, and social interaction (availability and adequacy of attachments and arguments with others).

The population completing the survey was a relatively representative sample of Young Victorians; 52% were female; 25% were from non-metropolitan Victorian regions; 22% were from non-English speaking backgrounds, and 78% were living with both parents. Preliminary results comparing self-reports from year 8 students in 1999 with self-reports from year 8 students in 1997 show; improvements in school connectedness and positive participation; some reduction in the severity and frequency of some forms of bullying but not the occurrence and reductions in poor behavioural outcomes, including a 25% reduction in smoking rates and reductions in more frequent marijuana use.
Back to top

The Gatehouse Project has several distinguishing features, including;

• The establishment of an adolescent health and welfare team in each school
• The identification of relevant risk and protective factors in each school’s social and learning environment
• The setting of priorities and planning implementation strategies
• The provision of targeted professional development, and the
• Establishment of processes for ongoing monitoring and review

This paper has been presented and written on behalf of the Gatehouse Project Team. The Gatehouse Project is funded by several organizations including The Queens Trust, The Victorian Health Promotion Foundation, The Department of Human Services, The Syndey Myer Fund, The Catholic Education Office and the National Health and Medical Research Council. The team would like to acknowledge the valuable contribution made by the school communities.
Back to top

1. Institute of Medicine. (1994) Reducing the risks for mental disorders: frontiers for preventive intervention research. 1^st Edition. Washington; National Academy Press.

2. Rutter M, Maughan B, Mortimore P, Ouston J, Smith A. Fifteen thousand hours: secondary schools and their effects on children. London: Open Books, 1979.

3. Olweus D. Bullying at School: Basic Facts and Effects of a School Based Intervention Program. J Child Psychol & Psychiatr 1994;7:1171-90.

4. Hargreaves A, Earl L, Ryan J. Schooling for change: reinventing schools for early adolescents. London: Falmer Press, 1996.

5. Ainley J, Batten M, Collins C, Withers G. Schools and the social development of young Australians. Melbourne: ACER, 1998.

6. Scheerens J, Bosker R. The foundations of educational effectiveness. Oxford: Pergamon, 1997.

7. Resnick MD, Bearman PS, Blum RW, Bearinger L, Harris KM, Jones J et al. Protecting adolescents from harm: findings from the National Longitudinal Study on Adolescent Health. JAMA 1997;278:823-32.

8. Patton, G.C., Glover, S., Bond,L., Butler, H., Godfrey, C. DiPietro, G. Bowes, G. The Gatehouse Project: a systematic approach to mental health promotion in secondary schools. Austrlaian New Zealand Journal of Psychiatry 2000; 34:586-593.

Back to top

Back to papers index

Last Modified: 27-11-2002 10:10:24