AICAFMHA:
promoting mental health for young Australians
Australian Infant, Child, Adolescent and Family Mental Health Association Ltd
ABN 87 093 479 022
The Helping Friends Program
Mr. John Dillon, Queensland Health
Abstract
Introduction
Aim and content
Method
Evaluation
Acknowledgements and references
Helping Friends is a training and peer support program for young people in high schools. It is based on the premise that young people initially seek out their peers for help and support, and that every school has many informal helping networks. The program identifies "helpers" and offers them training in specific skills for helping and supporting their peers. An anonymous opinion survey determines the most important issues for young people in the targeted year level.
The Helping Friends Program is not a peer counselling program. Helping Friends are trained in aspects of helping relationships, communication skills, problem solving and decision making, referral/resource networks, and self care. They are encouraged to support friends who approach them for assistance and encourage them to seek professional help when required. Training for the nominated natural helpers is voluntary and can be completed in a range of flexible delivery options.
The aim of Helping Friends is to build on the existing peer helping networks in schools to:
- improve the support provided to young people
- increase young people’s knowledge of, and access to services (in and out of school)
- assist in the development of a safe and supportive school environment
Appropriate staff members facilitate any ongoing follow-up within the school and mentor the Helping Friends if necessary. Approximately one month after the completion of the training, the students provide feedback on the Helping Friends program, including:
- Topics that they have helped their friends with
- Risk assessment of problems (i.e. problems, crises, emergencies)
- Degree of comfort in role as "Helping Friend"
- Further skills and knowledge required
Thorough empirical research into the effectiveness of peer support programs with young
people is scarce. However, peer-based programs do report success in accessing young
people and providing them with information, skills, and support – a task that
professional services and institutions have generally found to be a challenge. Current
methods of data collection have been designed to assess the program's effectiveness in
achieving it's stated objectives.
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Young people experience a range of problems that effect their health and well being. These problems include alcohol and other drug issues, sexual health behaviours, suicidal and self-harming behaviours, accidents and injuries, mental illness, and other social/ relationship difficulties. The Helping Friends Program was developed to address these issues.
The Helping Friends Program is a peer support program to be delivered to high schools in North Queensland. Helping Friends is based on the foundation that young people frequently seek out their peers for help and support, and that every school has many informal helping networks. These "natural" helpers are identified through an anonymous survey, and they are offered training in specific skills for helping and supporting their peers.
RATIONALE
The Helping Friends Program operates on the basis of three central themes that are overlapping and inter-related.
- To address the health and well being of young people by focusing on their underlying problems and needs.
- In times of need, young people mainly seek out their peers for help and support.
Overall, the body of research on the health of young people indicates that although they are generally physically healthy, they have some consistent and difficult issues to cope with that may effect their physical and psychological wellbeing.
Fuller (1998) reviewed several relevant studies and reported that the suicide rate among Australians aged 15-24 has more than trebled in the past 20 years. He also identified high rates of alcohol and other drug use in Australia – 30 per cent of 15 year old students binge drink each week, 30 per cent of 15-16 year olds use tobacco daily, and 12 per cent of this age group use marijuana. Additionally, sixty per cent of young Australian women engage in unhealthy weight loss practices, and both young men and women are at high risk of drug use, depression, sexual abuse, bullying, suicide attempts, and expulsion from school.
Blum and Rinehart (1997,) explain that "during a developmental stage of great physical health, we know that many youth are facing a constellation of problems that have negative health outcomes". The problems that young people are facing include: the use/abuse of alcohol and other drugs, sexual health and early pregnancy, suicide and self-harm, accidents and injuries, eating disorders, violence, criminal behaviour, depression and mental illness, and poor interpersonal and familial relationships.
Through training young people to be better friends, or better helpers, to one another,
the Helping Friends Program will develop a more supportive environment in schools, provide
an interface between young people and professional services, improve early identification
of problems, and promote empowerment and resilience by giving young people the skills and
encouragement to work together on their difficulties.
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From a variety of studies conducted across Canada and the United States, Carr (1987) found that very few students go to counsellors and this has been confirmed by more recent and relevant research in Australia (Donald, et al, 2000). Carr (1987) explains that youth prevention programs therefore need to be directed at peers, and "have a two level thrust: the need to strengthen (or immunize) students against harmful influences (by providing skills in resolving problems more effectively) and at the same time reduce the incidence of psychologically destructive factors within the environment (eliminate an uncaring environment, for example)".
Coggan, Patterson, & Fill (1997) also identified that problems with youth attending professional services may be assisted by increasing their knowledge about the services that are available. Moreover, the United States National Longitudinal Study of Adolescent Health (Blum & Rinehart, 1997) reported that a feeling of connectedness to the school was the only aspect of the school environment to be found consistently associated with better health and avoiding risky behaviours among the students.
Glover et al (1998), in their discussion of a school-based study exploring the need for prevention programs in early adolescence confirmed this link between school connections and youth health. Additionally, more than 40 per cent of the young people surveyed in this study stated that they did not have anyone who knows them very well, and nearly a quarter had no-one to talk to if they were upset, no-one they could trust, and no-one to depend on (Glover, et al, 1998).
Keys Young (1997) found that 43 per cent of respondents sought help when needed from a friend the same age. This course of action was the second most frequently mentioned after talking to a family member or partner. "The main perceived advantages of talking about such a problem either to family members or to friends of one’s own age were that they were likely to be sympathetic and that they were likely to be able to relate to the situation".
Improving the helping skills of some students will assist in increasing the level of social support available for young people generally. Social support has been found in numerous studies to be a predictor of better health and wellbeing. Frydenberg (1997), reported that social support offers benefits in three ways:
- A source of acceptance and intimacy
- Useful information and guidance
- Instrumental support in the form of services and resource assistance
The research outlined above consistently reports that peers in the school environment are the most likely source of help for young people in crisis, and that having supportive friends is a strong protection against health and other problems. It also indicates that the issues that underlie the health and wellbeing of young people are the areas that need addressing, these include – forming connections with others, developing problem solving skills, assisting friends to access professional services, and identifying risk warning signs. The Helping Friends Program is firmly based on these principles.
- Schools are in a unique position to address the needs of young people.
While all young people are not accessible through the school system, the majority of adolescents do attend school. The school system also provides one of the most influential environments in a young person’s life, outside of their family, and is therefore an appropriate setting for addressing the concerns of young people.
Schools have also been identified as the most appropriate setting for providing
information on mental health issues (Keys Young, 1997) and contain the necessary
logistical and support considerations needed to ensure the program is effective.
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THE AIM OF HELPING FRIENDS
To build on the school’s existing peer helping network by:
- Improving the helping support provided to young people
- Increasing young people’s knowledge of, and access to, professional services
- Assisting in the development of a safe and supportive school environment
WORKSHOP CONTENT
Unit1 Getting to Know Each Other
Unit 2 Supportive Relationships
Unit 3 Communication Skills
Unit 4 Decision Making
Unit 5 Understanding Your Boundaries
Unit 6 Wrapping It Up
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METHOD OF PRESENTATION
The Helping Friends Program is held outside of school commitments and is designed to be run in a different format to the school curriculum. The basis of the Program’s facilitation is following two fundamental learning principles:
- A Safe and Supportive Learning Environment
- Experiential Learning
A learning environment must provide an opportunity for students to express their opinions and feelings without fear of judgement. Students need to feel that they can challenge themselves and take risks with new behaviours while continuing to feel valued and accepted by the group. There needs to be a feeling of co-operation, informality, care for one another, group cohesiveness, and a sense of being a part of the learning process. "The atmosphere here is such that it encourages the student to try, and there is no punishment if he should not totally succeed in the attempt" (Wittmer & Myrick,1974, p.11).
As the Helping Friends Program trains young people in aspects of personal growth as well as skills in helping others, a safe and supportive learning environment is essential to the effectiveness of the training. The Program is designed to encourage students to express themselves and their experiences and to take risks with the development of their new skills while they continue to feel supported, accepted, and at some level, understood.
Experiential learning is widely accepted as a requirement in education, training, and personal development. Johnson and Johnson (1991, p.19) listed the principles of experiential learning, which can be summarised as:
- Learning must affect the attitudes, values, and cognitive structures of the learner, as well as their behaviour patterns, otherwise the learning will only be temporary.
- Learning needs to be an active, experimental, and discovery-oriented process. Simply telling people to change their behaviours does not mean that they will change.
- An environment that fosters challenging yourself and valuing each other’s input is necessary for learning to take place.
Carr (1987) recommends the use of experiential learning in peer support programs. The
training model used in the Peer Counselling programs run by Carr in Canada has a
student-determined structure and focuses on the importance of the process of learning as
opposed to the learning material. The skills, knowledge, and experience gained in the
Helping Friends Program is based on these principles of experiential learning. The Program
is designed to assist students to incorporate the learning into their daily lives by
providing opportunities to discuss, to experience, and to develop meaning for the
learning. Addressing these principles ensures that students will return to their daily
lives and use the new skills and knowledge gained in the Helping Friends training.
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The program has been quite difficult to evaluate as the Helping Friends program seeks to strengthen the relatively informal peer support networks that young people access in and out of school. Nevertheless if peer-based initiatives are considered valid interventions for a range of social and health related there is a genuine need to demonstrate their effectiveness to ensure ongoing resourcing and commitment to such approaches. Consequently a comprehensive evaluation protocol has been implemented to assess the impact of the program on the participants as well as their peers.
- Pre & post workshop content questionnaire - an attitudinal survey of pre-existing and acquired knowledge of workshop topics
- Workshop evaluation (participant & facilitator)
- Helping Friend activity review - estimated number of friends helped, issues discussed and severity of situations addressed
- Helping Friend focus groups - qualitative assessment of the program and its usefulness
- Anecdotal information from interviews with key support staff in schools
- Social Provision Scale (Cutrona & Russell, 1987) - administered to the cohort of Year 11s pre-workshop and 6 months following the workshop to detect changes in the extent and type of social support being provided across the Year level
Information collected using the protocol is not sufficient to draw any meaningful conclusions at this point in time. However there does appear to be positive participant and school reactions to the program with a high rate of skill application by the Helping Friends. Results from the Social Provision Scale have shown increased levels of social support but further data needs to be collected to confirm the effectiveness of the Helping Friends peer support program. Development of the program will continue over the next few years and expansion into a number of adaptations across population groups and settings is currently being planned.
This program could not have taken place without then enthusiastic and committed support
of students, staff, school nurses, health promotion officers and other community agencies
in North Queensland. Partnerships are critical to the implementation and maintenance of
the Helping Friends program and their contribution to its development is highly valued and
appreciated.
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Blum, R. & Rinehart, P. M. (1997) Reducing the risk: Connections that make a difference in the lives of youth. Youth Studies Australia 16 (4) 37-50.
Carr, R. A. (1987) The theory and practice of peer counselling. Peer Resources: Victoria, Canada.
Coggan, C., Patterson, P., & Fill, J. (1997) Suicide: Qualitative data from focus group interviews with youth. Social Science Medicine (45) 10 1563-1570.
Cutrona, C. & Russell, D.(1987) The provisions of social relationships and adaptation to stress. Advances in Personal Relationships,(1), 37-67.
Donald, M., Dower, J., Lucke, J. & Raphael, B. (2000) The Queensland Young People's Mental Health Survey. University of Queensland.
Frydenberg, E. (1997) Adolescent coping: Theoretical and research perspectives. Routledge: USA.
Fuller, A. (1998) From surviving to thriving: Promoting mental health in young people. ACER: Victoria.
Glover, S. Burns, J., Butler, H. & Patton, G. (1998) Social environments and the emotional wellbeing of young people. Family Matters, Australian Institute of Family Studies, (49) 11-16.
Johnson, D. W. & Johnson, F. P. (1991) Joining together: Group theory and group skills. Prentice-Hall: USA.
Keys Young (1997) Research and consultation among young people on mental health issues: Final report. Dept of Health and Family Services: Canberra.
Lewis, M.W. & Lewis A.C. (1996) Peer Helping Programs:helper Role, Supervisor Training and Suicidal Behaviour. Journal of Counseling and Development (74) 307- 313
Taylor, B. & Howard J. (1998) Educating for life: Guidelines for effective suicide prevention programs in secondary schools. Department of Health and Family Services (in press).
Wittmer, J. & Myrick, R. D. (1974) Facilitative teaching: Theory and practice. Goodyear Publishing Co.: California USA.
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