Implementation dosage as a modifier of treatment effects of universal mindfulness and relaxation interventions on emotional difficulties in primary and secondary schools: complier average causal effect estimation in the INSPIRE cluster randomised trial

Education for Wellbeing was a large-scale research programme, funded by the Department for Education, involving two randomised control trials. Through Education for Wellbeing, we evaluated a range of mental health and wellbeing interventions being delivered in primary and secondary schools. Our aim was to examine the impact of these approaches on children and young people’s mental health. The programme ran between 2018 and 2024. Across England, 32,655 pupils across 513 schools participated in Education for Wellbeing. The Anna Freud Schools Division delivered the interventions within the programme and the Evidence-Based Practice Unit evaluated the approaches, examining their impact on pupils’ mental health and wellbeing.  There were two trials that are part of Education for Wellbeing: AWARE and INSPIRE.  As part of AWARE, schools were randomly allocated to one of the following approaches:  - A set of five lessons that use role play designed to improve pupils’ understanding of mental health and reduce suicide rates. Developed in Sweden and America, Youth Aware Mental Health (YAM) encourages pupils to share their own ideas about how to maintain good mental health and how to help each other to find ways to resolve everyday dilemmas. - A teacher training programme developed in Canada called The Guide. Adapted for England for the study, it develops teachers’ understanding of mental health, trains them on how to teach their pupils about it and addresses stigma. - Usual practice. Schools that are allocated to usual practice continue as usual and receive free mental health and wellbeing training at the end of the trial. As part of INSPIRE, schools are randomly allocated to: - A series of eight lessons designed to increase young people’s skills around personal safety and managing their mental health, as well as helping them to identify their support networks. - Training pupils in relaxation techniques embedded into the school day, every day for five minutes. Training pupils in mindfulness-based exercises embedded into the school day, every day for five minutes.  - Usual practice. Schools that are allocated to usual practice continue as usual and receive free mental health and wellbeing training at the end of the trial. The results from the programme highlight three interventions that show promise for use in schools: Strategies for Safety and Wellbeing, for both primary and secondary schools Relaxation Techniques, for primary schools only Mindfulness-Based Exercises, for secondary schools only. Findings also provide recommendations around implementation, selecting evidence-based approaches and monitoring outcomes in the longer term when new interventions are embedded in schools. For more information see: https://www.gov.uk/government/publications/education-for-wellbeing-programme-findings https://www.annafreud.org/research/current-research-projects/education-for-wellbeing/