The authors have declared that no competing interests exist.
There are relatively few research publications of mental health promotion initiatives for primary school aged children that are based in community rather than educational settings.
To describe developmental frameworks and models of mentoring, coaching and mental health promotion and to summarize any evidence for the efficacy of community initiatives.
An umbrella review was undertaken of publications on theories and models, and a synthesis of findings from reviews of outcomes of mentoring, mental health promotion initiatives undertaken outside of school time for children aged 5-11 years.
Developmental mentoring on its own or in combination with outside school activities is potentially more flexible in terms of delivery and targets than school-based programs. Pooled effect sizes (range about 0.2-0.4) suggest modest but significant gains across several key domains (cognition, emotion, physical health, and social connectedness) that equate to about 10 percentile point on the developmental evaluations employed. Mediators of benefits include the level environmental or individual risk of the child and parental involvement. It is noteworthy that poor quality, atheoretical programs can have detrimental effects.
Children aged 5-11 years may be more accepting of, and could make significant gains from, community-based mental health promotion interventions such as developmental mentoring. However, there are some significant gaps in the knowledge-base that need to be addressed through more systematic research.
Recent decades have witnessed the introduction of promotion and prevention initiatives to improve mental health and reduce mental disorders in children, adolescents and young adults. Typical approaches during the pre-school period include community-based health promotion interventions for toddlers such as Head Start and Sure Start
Given the extensive literature now available on pre-school, school-based programmes and/or adolescent programmes, we determined that it is useful to extend the knowledge-base by reviewing what universal, community-based, ‘developmental’ mentoring and/or outside school-time (OST) activity programmes have been offered to children in their early school years and what is known of their effects. Whilst not all primary schools can or wish to offer programmes, it can be argued that opportunities to promote the development of physical, cognitive, psychological-emotional and social competencies in 5-11 year olds could instil a positive sense of self-esteem, mastery, identity, and social connectedness. All of these potential benefits could determine future health and well-being
This paper begins by briefly summarizing key elements of a developmental framework that provides a rationale for health promotion in primary school children, and then discusses pathways by which mentoring, coaching or similar developmental interventions might theoretically promote well-being. It then examines evidence for any social-emotional, academic or physical health benefits associated with participation in these programmes, and any influence on social connectedness, micro- or macro-systems or neighbourhood networks (as advocated by the World Health Organisation). Also, the limited data on potential moderators of outcomes and health economics of such programmes are explored.
O’Connell et al9 identified four key features of normal development that need to be considered when designing promotion and prevention interventions, these are:
related patterns of competence and disorder- it is recognized that the development of specific ompetencies occurs throughout life but that competencies acquired in early childhood (also referred to as developmental assets) establish a foundation for developing other competencies in the future. Failure to develop certain competencies at an early age may affect a broad range of functional domains (e.g. physical, cognitive), and/or behavioural decision making at a later age (e.g. risk taking behaviour). It is suggested that the more competencies developed, the greater the individuals’ ability to tolerate adversity in the future
this refers to expectations regarding an individuals’ behaviour in given social contexts; these may vary with age, gender, culture and across generations or over time (decade by decade). Examples include developing secure attachments, appropriate conduct, etc. The young person and/or other people judge the level of success in completion of these tasks and perceived failures affect subjective or observer views of competence and self-confidence
individual development at different ages occurs in multiple contexts: family/home, school, neighbourhood, community, and culture etc. These micro-, meso- and macro-systems, influence developmental processes and the acquisition of competence requires individuals to adapt to the demands of different contexts and to negotiate transitions between elements of the system (e.g. between family and school, etc.).
Interactions between Biological, Psychological & Social Factors- many complex interactions occur between different factors, (e.g. genes and environment can influence developmental trajectories, offering potential opportunities to understand and/or intervene in selected processes or pathways). Also, it is known that temperament and personality characteristics can influence the events to which a person is exposed and/or how they react to these.
In summary, mental health promotion attempts to establish specific competencies, increase the completion of developmentally-appropriate tasks, enhance the chances of positive development, and strengthen an individuals’ adaptability and tolerance of adversity
The terms developmental mentoring and coaching are used in diverse ways, but in this review, they are used to describe a stable, supportive, created relationship with an ‘attuned’ unrelated adult
Developmental mentoring and coaching can be delivered as a single intervention or as part of a multi-component ‘youth development’ strategy
As summarized in
Mentoring is- |
Mentoring processes are influenced by mediating variables that are external to the mentoring relationship such as:interpersonal history (e.g. traumatic experiences)social competencies (e.g. communication skills) developmental stage (e.g. pre-school, primary school age, adolescent) demographics (e.g. culture, socio-economic status) ecology (e.g. neighbourhood, community) Mentoring outcomes may be mediated by parental and peer relationships. |
*Companionship is defined as a supportive relationship in which fun activities provide both recreation and respite
Dolan and Brady
In summary, all these approaches assume that addressing basic developmental needs across multiple contexts through personal relationships and constructive activities can promote healthy outcomes and protect against engagement in risky behaviours. Having noted the theoretical models and rationale, we then examined the evidence for community-based mentoring or coaching for children aged 5-11 years. In addition, we highlight any reports that examine some of the proposed mediators or moderators of benefit.
Evidence-Mapping: Is developmental mentoring or coaching effective in children?
For the purposes of the evidence mapping exercise, we used a published definition of mentoring or coaching
Whilst there are an enormous number of individual studies and large-scale reviews of mentoring, very few reviews directly address OST programmes for 5-11 year olds, or report on any differences in effectiveness due to the age of mentees and/or the context/structure or primary goals of the programme. Furthermore, many studies that address some of these issues are published as book chapters rather than peer reviewed papers, whilst other publications are not of the quality required for inclusion in a systematic review. Interpretation of the data is also hampered by the wide range and varying reliability and validity of the subjective or observer rated measures employed, and many studies do not used objective data (such as physical health measures, national school records, etc.). We therefore undertook an umbrella review (or a ‘review of reviews’) to synthesize the ‘state of the art’. The review aimed to documented contextual information on how mentoring for young children has been organised, implemented and delivered. We used an ‘umbrella review’ methodology as this has increasingly been shown to be useful in public health and has been found to provide important insights into the social determinants of health and medical illnesses. The approach uses a typical systematic review methodology but focuses on locating, evaluating and synthesizing published ‘review-level’ evidence (narrative reviews, systematic reviews and meta-analyses) and then extracts information on specific studies that may be pertinent to answering the key questions being addressed.
This approach enabled us to build an evidence-map of the findings from previously published, peer reviewed meta-analyses of outcome data in which some or all of the eligible studies included-
(a) primary school age children engaged in developmental mentoring programmes delivered in the community/OST,
(b) mentoring interventions that were undertaken on a one-to-one basis or as one component of a youth (child and adolescent) development programme,
(c) similar interventions (not necessarily referred to as mentoring) that were explicitly based on the developmental framework and conceptual model outlined (i.e. social learning; positive youth development PYD; self-esteem/self-concept; physical health promotion),
(d) outcome data for more than one domain associated with mentoring processes was reported (i.e. social-emotional, cognitive, identity, developmental competencies, etc.), or an intervention that addressed one domain was assessed by outcomes in another domain (e.g. the influence of exercise on self-esteem or self-concept).
Thirty-three systematic reviews were screened, of which nine were meta-analyses that met criteria for inclusion in the evidence map. As shown in
y | Comments | Effect Sizes (ES) for Differences in Pre- and Post-Intervention Ratings on Outcome Measures | ||||||||||
Global Outcome | Attitudes | Social Competence/Relationships/Connectedness | Emotional/Psychological | Self-Esteem/Self-Confidence | Cognitive/Academic | Pro-social/ Positive Behaviours | Problem Behaviours/Conduct | Physical Health | Follow-up | |||
|
||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Review of 55 studies (1970 -98) of mentoring interventions for individuals aged<18 ys. Includes analysis of predictors of outcome. | .14 | .15 | .10 | .11 | .21 | .10 | ||||||
Review of 73 studies (1999-2010) of mentoring interventions for individuals aged<18 ys. Detailed examination of potential mediators & moderators. | .21 | .19 | .17 | .15 | .21 | .06# | .17 | |||||
|
||||||||||||
Evaluation of 69 OST adult-supervised programmes that promoted personal & social skills in children & adolescents; 46% studies= elementary school-age children | .22 | School bonding: .14 | .34 | .1# to .17 | .19 | .19 | .19 | |||||
Summarizes three previous reviews of 317 studies of which 55 were OST social-emotional learning programmes; 56% studies = elementary school age children | .22 | .22 | .91 | .08 | .22 | .17 | ||||||
|
||||||||||||
49 studies of training in social competence for 3-15 years (5 studies= individual training; 5= individual plus group); 8-12 studies provided separate data for 6-8 ys, & 19-34 studies for 9-11 ys). Multimodal programmes were more effective for age >9 ys. | 6-8 ys: .339-11 ys: .35(ES, all age groups: .47) | Social Interactions/ Adjustment6-8 ys: .29/ .199-11 ys: .28/ .17 | Self-Related Cognitions/ Affect6-8 ys: .089-11 ys: -.06# | Social-Cognitive Skills6-8 ys: .559-11 ys: .35 | ES, All Age Groups: ~.15(-.17 to +.34) | |||||||
Review of 177 mental health prevention programmes for those aged < 18 ys (mean age ~9 ys); 64 studies classed as health promotion. Examined sub-sets of studies (school v person-centred v parent training). Person-centred approaches are reported separately for 2-7 & 7-11 ys. | Mean ES, all studies: .35(Person-Centred: .39; School-Based: .35;Parents: .16#) | Person-Centred=Inter-personal problem solving:2-7 ys: .937-11 ys: .36 | Person-Centred = ‘Affective education’2-7 ys: .707-11 ys: .24 | |||||||||
Reviewed 23 studies of the use of exercise (used alone or as part of a comprehensive programme) to improve self-esteem in individuals aged 3-20 ys. | All studies: .49; Comprehensive Packages: .51 | Healthy v At Risk Children:.53# v .49 | ||||||||||
116 studies of interventions to improve self-esteem in individuals aged <18 ys. Programmes driven by underlying theory were significantly more effective than those with no clear model. Clinical & non-clinical studies were included. | All studies: .27(Theory driven: .71;No theoretical model: .11) | Healthy Children: .24 to .25 | Self-Esteem as only target: .47Multi-Focus Package: .57 | Healthy Children: .17 to .29 | Healthy Children: .15 to .49 | .35 to .38 |
ES are statistically significant unless accompanied by # (indicating non-significant 95% confidence intervals);
The evidence is reported from three perspectives:
Do the interventions work?
As the studies included in each meta-analysis used many different pre-post intervention measures, outcome data were grouped into broad categories. These included: academic competence, self-esteem/self-confidence, connectedness/relationships, or global outcome (which represents a composite measure that the researchers derived from all the assessments), etc.
What is the magnitude of any effect (reported as effect sizes: ES)?
The ES are reported for as many post-intervention outcome categories as feasible as well as ES for the limited number of follow-up evaluations (see
What factors influence the effectiveness of mentoring?
Analyses of moderators of mentoring effects were identified and ES or correlations were noted.
As shown in
Dubois et al
Dubois et al
The moderator analyses in the later publication were more circumscribed
Several of the findings from the reviews by Dubois’ group were confirmed in other meta-analyses. For example, it was shown that the theoretical underpinnings and infrastructure of the programme are important moderators of mentoring outcome
All eight meta-analyses demonstrate that the benefits of interventions are not just ‘domain specific’ and, for example, non-cognitive social interventions may promote improvements in cognitive skills and academic performance. Also, Ekeland et al
Only one publication to date that synthesizes data on the effects of ‘developmental’ programmes on school, family and community systems
What are the costs of developmental interventions?
It was not feasible to identify the cost of developmental mentoring programmes for children separately from youth. Furthermore, the nature and quality of individual studies of developmental mentoring (or other similar interventions) make a systematic evaluation of cost-effectiveness impossible. Indeed, the only detailed health economics review of programmes (undertaken in the USA)
Most importantly, Asos and colleagues
The current best estimate of the cost of delivering a community-based mentoring intervention with OST activities is about $1500. Although this appears to be higher than the average cost reported a school-based programmes (range ~$500-1000 depending on the structure and goals of the programme), it is notable that mentees spend twice as much time per month with their mentor in community-based programmes (up to 12 hours) `compared to school-based interventions
This review suggests that effective ‘developmental interventions’ that use evidence-based practices and provide a long-term, high quality relationship between an adult and child can produce small but positive gains on a range of academic, psychosocial and health behaviour outcomes. The immediate gains equate to an advantage for mentored over non-mentored children of about 10 percentile points on the developmental measures employed in the evaluation studies
These modest but positive findings need to be balanced by a recognition that the methods of evaluation of mentoring or PYD are rarely as rigorous as those undertaken in traditional clinical settings. Also, the estimated pooled ES are < .3 for the intervention compared to the control groups across most outcome domains. Cavell and Smith
The available evidence indicates that for an intervention programme to be effective it is necessary to follow best practices in recruiting, training, and critically in providing ongoing support and supervision to mentors
Other evidence suggests that context is important and that site-based programmes which are mainly located in schools may fail to engage some children (who are ambivalent about school attendance). Furthermore, site-based programmes may be less beneficial than field-based community projects that utilize a range of OST activities. However, these findings must be considered in context. School-based programmes may not only vary considerably in their design, duration, and goals, but also may be entirely dependent on the commitment of a school and its governance structures to deliver the intervention. There are often sound reasons why the development of mentoring scheme cannot proceed as planned, is no longer be a priority, or cannot be allocated adequate resources. Having noted these barriers, it is equally true that organizations that instigate community-based developmental programmes may discover that the introduction of a programme is not practical or feasible within neighbourhoods where there is the greatest need. Also, Jones
This umbrella review identifies that a small number of research groups have undertaken the core reviews, mediator/moderator and economic analyses; also, the available publications indicate a failure to evaluate or at least to publish findings regarding the outcomes of any initiatives. The synthesis of findings leaves an impression that enthusiasm for introducing programmes has exceeded attention to detail regarding which programmes are most effective. Many instigators have failed to adhere to the core components of best practice and many new programmes have been pursed without any supporting evidence from reliable or valid process or outcome evaluations
Our review suggests that there appear to be plausible reasons why 5-11 year olds may make very good candidates for individual OST programmes that incorporate mentoring and structured activities and that are based on a developmental framework that promotes health and well-being. Also, the timing of any interventions (during primary school years) offers a valuable opportunity for the promotion of developmental competencies. These can enhance well-being and build a level of resilience that may help protect this age group from the onset of mental disorders during adolescence. The use of OST interventions can also supplement other programmes that are incorporated within a school curriculum.
AM was previously employed as a research psychology at The University of Sydney and was funded by a philanthropic grant from UnitingCare Australia, a national charity in Australia.
IH is a Commissioner in Australia’s National Mental Health Commission; a Member of the Medical Advisory Panel for Medibank; a Board Member of Psychosis Australia Trust. He has received honoraria for presentations of his own work at educational seminars supported by a number of non-government organisations and by the pharmaceutical industry (including Servier, Pfizer, AstraZeneca, and Eli Lilly) and funding from Servier for a study of major depression and sleep disturbance in primary care settings. Other relevant funding for IH is in relation to this study includes ‘Testing and delivering early interventions for young people with depression’ (APP ID: 1046899).
JS is a visiting professor at the Brain & Mind Centre at The University of Sydney. JS has received UK grant funding from the Medical Research Council (including for projects on actigraphy and bipolar disorders) and from the Research for Patient Benefit programme (PB-PG-0609-16166: Early identification and intervention in young people at risk of mood disorders). SN has received grant funding from the National Health and Medical Research Council including for research on sleep and actigraphy.