This paper is in the following e-collection/theme issue:

Innovations in Mental Health Systems (370) Mental Health Issues in Adolescence (380) e-Mental Health and Cyberpsychology (1387) Web-based and Mobile Health Interventions (3093) Users' and Patients' Needs for Mental Health Services (378) School-based Health Education and Interventions (76)

Published on in Vol 8, No 10 (2021): October

Preprints (earlier versions) of this paper are available at https://preprints.jmir.org/preprint/29989, first published .
Examining the Preliminary Effectiveness and Acceptability of a Web-Based Training Program for Australian Secondary School Teachers: Pilot Study of the BEAM (Building Educators’ Skills in Adolescent Mental Health) Program

Examining the Preliminary Effectiveness and Acceptability of a Web-Based Training Program for Australian Secondary School Teachers: Pilot Study of the BEAM (Building Educators’ Skills in Adolescent Mental Health) Program

Examining the Preliminary Effectiveness and Acceptability of a Web-Based Training Program for Australian Secondary School Teachers: Pilot Study of the BEAM (Building Educators’ Skills in Adolescent Mental Health) Program

Authors of this article:

Belinda L Parker1, 2 Author Orcid Image ;   Melissa Anderson1 Author Orcid Image ;   Philip J Batterham1, 3 Author Orcid Image ;   Aimee Gayed1, 2 Author Orcid Image ;   Mirjana Subotic-Kerry1, 2 Author Orcid Image ;   Melinda R Achilles1 Author Orcid Image ;   Cassandra Chakouch1 Author Orcid Image ;   Aliza Werner-Seidler1, 2 Author Orcid Image ;   Alexis E Whitton1, 2 Author Orcid Image ;   Bridianne O’Dea1, 2 Author Orcid Image
Article Authors Cited by (7) Tweetations (2) Metrics

    Original Paper

    1Black Dog Institute, Randwick, NSW, Australia

    2Faculty of Medicine, University of New South Wales Sydney, Kensington, NSW, Australia

    3Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia

    *all authors contributed equally

    Corresponding Author:

    Bridianne O’Dea, PhD

    Black Dog Institute

    3 Hospital Rd

    Randwick, NSW, 2031

    Australia

    Phone: 61 29382 8509

    Email: b.odea@blackdog.org.au


    Background: Secondary schools are increasingly supporting adolescents’ mental health and well-being, yet many teachers report that they lack the skills and confidence to do so. Building Educators’ skills in Adolescent Mental Health (BEAM) is a web-based training program developed to improve secondary school teachers’ knowledge and confidence in caring for students’ mental health.

    Objective: This pilot study examined the preliminary effectiveness and acceptability of the BEAM program for improving mental health knowledge, attitudes, confidence, helping behaviors, and psychological distress among secondary school teachers.

    Methods: A single-arm pilot trial was conducted from July to December 2019 among secondary school teachers located in New South Wales, Australia, who were employed in leadership positions responsible for managing student well-being (ie, Year Advisors). Participants had access to the BEAM program for 6 weeks. Self-report surveys, delivered at baseline, postintervention (6-weeks post baseline) and 3-month follow-up (19 weeks post baseline) were used to measure changes in training outcomes. Acceptability was assessed by program use, barriers, satisfaction, and participants’ perceptions of program effectiveness.

    Results: A total of 70 secondary school teachers took part (mean age 36.5 years, SD 9.41 years, range 24-60 years). Significant improvements in confidence were reported at postintervention and 3-month follow-up. Significant improvements in helping behaviors were reported at 3-month follow-up only. There was also a significant reduction in psychological distress at postintervention. Participants agreed that the program content was easy to understand and relevant, but program completion was challenged by lack of time, competing priorities, and forgetfulness.

    Conclusions: Findings indicated that a web-based training program may be beneficial for improving secondary school teachers’ abilities to care for students’ mental health; however, program modifications are required to increase training completions.

    Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619000821190, Universal Trial Number U1111-1232-7680; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377529

    JMIR Ment Health 2021;8(10):e29989

    doi:10.2196/29989

    Keywords

    mental health; training; high school teachers; youth; mental health programs; secondary schools 


    Background

    Adolescence is a key period for the development of mental illness, with over half of all mental health problems first emerging before the age of 18 years [1]. Secondary schools are increasingly providing mental health care and support to adolescent students, primarily owing to the accessible nature of educational settings for service provision and the functional impacts of mental illness on social development and academic achievement. There are over 2800 secondary schools in Australia, enrolling over 2 million young people and employing more than 140,000 full-time teachers. One-third (n=830) of these schools are in New South Wales (NSW), where the average school size is 700 students with 58 teachers [2,3]. Population surveys in Australia and the United States [4] have confirmed the use of school services for mental health problems among youth, with service utilization rates similar to those of traditional health care settings [5]. Secondary schools can enable the early identification of mental illness, [6-9] as many Australian teachers are the first to identify emotional problems in students and initiate help-seeking [5]. However, many teachers report a lack of skills and confidence in recognizing and responding to students’ mental health needs [10,11] and few have received specialized training in this domain [8,12]. Many teachers have reported that additional management of student well-being has led to greater workload and stress [8,13,14]. In 2020, specialized mental health training was mandated for all NSW teachers [15], further confirming the need for these skills. Workplace learning and development opportunities may improve teachers’ abilities to care for students’ mental health and reduce the associated stress [16,17]. However, there are limited evidence-based training programs currently available.

    Three recent systematic reviews on youth mental health training for secondary school teachers have indicated a lack of evidence-based programs [18-20]. Anderson et al [18] found that only 6 programs had been evaluated, and while all improved the mental health knowledge of the participating teachers, none increased actual helping behavior toward students (eg, referring or recommending a student seek professional help). Four of the reviewed training programs were delivered through didactic instruction (the remaining 2 were a combination of face-to-face and web-based components) and required teachers to be absent from school duties, likely limiting the uptake [18]. Furthermore, only 1 program was evaluated within the Australian context [21,22]. Similarly, Yamaguchi et al [19] noted that while most programs observed an improvement in knowledge, attitudes, confidence, and behavior, the quality of studies was low [19]. These findings were further confirmed by Ohrt et al [20]. Taken together, these reviews suggest that a focus on mental health literacy alone is unlikely to elicit behavior change. There is a clear need for high quality programs that are evidence-based, flexible in delivery, and effective for improving teachers’ confidence and skills in the domain of student mental health. Web-based mental health training has been shown to be effective in workplace settings [23], and may provide a delivery model that is scalable and accessible for school settings.

    The Black Dog Institute has developed a web-based training program that aims to improve secondary school teachers’ knowledge, confidence, and skills in recognizing and supporting students with mental health problems. Delivered over 6 weeks, the Building Educators’ skills in Adolescent Mental Health (BEAM) program combines self-directed content with in-person peer coaching activities and printable resources. The program consists of 5 topics that include educational information, quizzes, blog-style story-sharing, and case studies (Figure 1). Each topic is complemented by a peer coaching component that aims to help teachers contextualize the program, build professional relationships, self-reflect, and learn from those with different expertise and experience [24,25]. Topics are completed in sequential order and are not unlocked until the peer coaching activities are completed. However, topics can be completed at any pace during the 6 weeks with no limit on topics completed per week.

    BEAM was developed in partnership with a lived experience advisory group of 12 teachers [12], and the delivery format was adapted from the evidence-based manager-training program HeadCoach [23,26]. HeadCoach is designed to help managers to better understand and support the mental health needs of their staff [23]. An evaluation of HeadCoach demonstrated positive effects on managers’ confidence and workplace practices for mental health, with significant improvements in responsive and preventative behaviors toward staff [23]. BEAM includes similar persuasive techniques (eg, reminders, feedback, theory, and practical advice) to target engagement [27] and tunneling (eg, program modules are presented in a structured and sequential manner) to guide program completion [28,29]. As such, the BEAM program can be completed at a time and place that is convenient for teachers. However, this web-based training model for student mental health is the first of its kind to be delivered in Australian secondary schools. It is unclear whether teachers are open to this type of training, and whether a self-directed program is effective for improving outcomes and behavior related to student mental health.

    ‎
    Figure 1. Overview of the Building Educators’ skills in Adolescent Mental Health (BEAM) training program.
    View this figure

    Objectives and Hypotheses

    This study examined the preliminary effectiveness and acceptability of the BEAM program for improving mental health knowledge, attitudes, confidence, and helping behaviors among secondary school teachers in NSW, Australia. It was hypothesized that participating teachers would report improvements in knowledge, attitudes, confidence, and helping behaviors at postintervention. This study also examined teachers’ psychological distress to determine whether the training program was associated with positive improvements in the mental health of teachers themselves. Program acceptability was examined by measures of program use, barriers to use, and training satisfaction. Our results provide important information about the feasibility of using a training platform that combines web-based and offline learning to address shortages in teachers’ professional development in student mental health.


    Design

    An uncontrolled, single-arm pilot study was conducted with outcome measures assessed at baseline, postintervention (6 weeks after baseline), and 3-month follow-up (19 weeks after baseline). The study was approved by the University of New South Wales (UNSW) Human Research Ethics Committee (HC190047), the NSW State Education Research Advisory Process (SERAP 2019048), and the Sydney, Parramatta, and Maitland-Newcastle Catholic Dioceses. This trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619000821190) and assigned a Universal Trial Number (U1111-1232-7680).

    Participants

    The current study targeted secondary school teachers from NSW, who were employed in a teaching role with increased responsibility for the mental health of students aged between 12 and 18 years (eg, Year Advisor or equivalent, Student Coordinator, Head of Year). These teachers were identified as requiring significant skills in student mental health as they acted as informal case managers for students by offering support when needed and liaising with others about school performance. Secondary school teachers were eligible to participate in the current study if they were (1) employed full-time for the duration of the study in a teaching role that had responsibility for student well-being, (2) able to obtain support and signed consent from their school principal, and (3) able to participate alongside at least 1 other equivalent colleague from their school to enable completion of the peer coaching.

    Recruitment and Consent

    Recruitment was undertaken between June 17 and July 19, 2019, in NSW. The study was advertised in 9 School-Link newsletters (ie, a state government service that connects schools with local mental health services). The study was also advertised on the Black Dog Institute’s website and Facebook page. Teachers were directed to the study website where they completed the eligibility screening and registered with their name, school, and email address, and downloaded the participant information statement and consent forms (PISCFs). Eligible teachers were advised to consult with their school principal and colleagues and email the completed PISCFs to the research team.

    Procedure

    Once eligibility was confirmed and consent forms were returned, participants were invited to complete the baseline survey. Participants who did not attempt or complete the baseline survey within 7 days were withdrawn from the study. Upon completion of baseline, participants were given access to the BEAM program for 6 weeks. The BEAM program was accessible on internet-enabled computers only. Modules were completed sequentially, and all activities were mandatory. The program provided automatic feedback on incorrect responses and this content was not reviewed by the researchers. Responses to the peer coaching activities were submitted to the research team through the program and researchers provided feedback via email within 3 days of submission. Participants were sent 4 reminders to use the program. At 6 weeks post baseline, participants were invited to complete the postintervention survey. At 3-month follow up (ie, 19 weeks post baseline), participants were invited to complete the follow-up survey, and those who completed it were reimbursed with an Aus $50 (US $36.26) e-gift voucher, irrespective of whether they completed the BEAM program.

    Measures

    Demographics and Background Characteristics

    At baseline, participants reported their gender and age, teaching experience, duration in current role, and employment at current school (all reported in years). Participants also reported the location of their current school (metropolitan, regional, or rural/remote), the school funder (government or nongovernment), and gender type (single-sex or coeducational). Participants reported their current level of training in student mental health (none, limited, moderate, or extensive). Participants were asked to rate the importance of receiving mental health training and their confidence in web-based programs for satisfying their training needs. Items were answered using a 5-point Likert scale ranging from not at all (1) to extremely (5).

    Mental Health Knowledge

    A 6-item adapted subscale of the Mental Health Knowledge Schedule (MAKS) [30] scale was used to measure mental health knowledge. The first 6-item subscale assessed literacy (eg, “most students with mental health problems want to complete their schooling”) and were answered on a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5). Items were summed to yield a total score ranging from 6 to 30. Higher scores indicated greater mental health literacy. As the MAKS consists of multidimensional items that examine different mental health-related domains, calculating and reporting the subscale Cronbach α has been considered inappropriate [30].

    Mental Health Attitudes

    A modified version of the Depression Stigma Scale–Personal Stigma subscale [31] was used to measure teachers’ attitudes toward students with mental health problems. Participants were asked to rate how much they agreed with 9 statements (eg, “students with a mental illness could snap out of it if they wanted”) using a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5). Items were summed to yield a total score, ranging from 9 to 45. Higher scores indicated greater levels of stigma. In this study, Cronbach α=.82.

    Confidence in Helping Behaviors

    An adapted version of the Confidence in Helping subscale [32] was used to measure participants’ self-confidence in their ability to recognize, refer, and support students with mental health problems. Participants were asked to rate their confidence in dealing with 15 mental health scenarios (eg, “recognizing a student with mental health problems”). Items were answered using a 5-point Likert scale ranging from not at all confident (1) to very confident (5). Items were summed to yield a total score ranging from 15 to 75. Higher scores indicated greater levels of confidence. In this study, Cronbach α=.95.

    Frequency of Helping Behaviors

    A 14-item adapted version of the Help Provided to Students questionnaire [21] was used to measure the frequency of helping behaviors for mental health among teachers. Participants were asked to indicate how often, in the past 2 weeks, they had engaged in 14 helping behaviors (eg, “reached out to a student with mental health problems”). Items were answered using a 4-point scale (never, once, occasionally, or frequently). Items were summed to yield a total score ranging from 14 to 56. Higher scores indicated more frequent helping behaviors. In this study, Cronbach α=.89.

    Psychological Distress

    The self-report 5-item Distress Questionnaire-5 (DQ5) [33] was used to measure teachers’ psychological distress. Items were answered using a 5-point Likert scale ranging from never (1) to always (5). Items were summed to yield a total score ranging from 5 to 25. Higher scores indicated greater psychological distress with a score of 14 indicating the possibility of a mental health condition [33]. Completion of the DQ5 was optional, since it was not a primary outcome of the training program. The DQ5 has high internal consistency and convergent validity [33,34]. In this study, Cronbach α=.84.

    Perceived Effectiveness

    At postintervention, participants were asked to rate (using 4 separate items) the extent to which they believed the BEAM program increased their confidence, skills, and approach to students’ mental health needs, and whether the program met their training needs. Items were answered using a 5-point Likert scale ranging from not at all (1) to entirely (5).

    Program Use and Barriers

    Program use was measured by the number of topics completed. As topics were sequential, participants could not progress through the program without completing the peer coaching. Therefore, topics were deemed completed when a participant submitted the corresponding peer coaching activity. Barriers to program use were assessed at postintervention. Participants were asked to report whether they had experienced any items from a list of 11 barriers to program use (eg, “forgot about the program” and “the program wasn’t a priority,” answered with “yes” or “no”).

    Program Acceptability and Satisfaction

    Acceptability was measured at postintervention using a 13-item questionnaire that was adapted for the BEAM program [35,36]. Participants were asked to rate the extent to which they agreed with 13 statements (eg, “the content was easy to understand” and “the program activities were engaging”). Items were rated on a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5). Satisfaction was measured at postintervention using 3 items. Participants were asked to rate how satisfied they were with the program, the likelihood of future use, and the likelihood of recommending the program to others. Items were rated on a 5-point Likert scale ranging from not at all (1) to entirely (5).

    Data Collection and Analysis

    Program and study data were collected and stored securely using the Black Dog Institute Research Engine hosted on the University of New South Wales servers in Australia. Data was then downloaded into Microsoft Excel and exported into SPSS (version 27.0, SPSS Inc) for analysis. The final sample for analysis consisted of the participants who completed the baseline assessment. At postintervention and 3-month follow-up, participants’ responses were included in the analyses regardless of whether they completed all questionnaires. Basic descriptive statistics, including means and standard deviations were calculated and reported for participant and school characteristics, and acceptability items. To estimate the pre- and postintervention effects of the program on participants’ mental health knowledge, confidence, attitudes, helping behaviors, and psychological distress, mixed models repeated measures analysis of variance were conducted, with time as a main effect. Statistical significance was set at P<.05 (2-tailed). We conducted t tests to compare mean differences in acceptability, satisfaction, and perceived effectiveness scores between program completers (ie, participants who completed the entire program) and noncompleters.


    Participants

    A total of 134 teachers expressed interest in the study. Of these, 81 (60.4%) teachers from 28 schools obtained consent from their principal and were invited to complete the baseline survey (Figure 2). Table 1 presents the participant characteristics for the final sample at baseline (N=70).

    At baseline, 40% (28/70) of the sample reported having had “nil” or “limited” prior training in student mental health and 60% (42/70) reported having had “moderate” or “extensive” prior training. All participants believed that mental health training was “moderately” (5/70, 7%) or “extremely” (65/70, 93%) important. The majority (51/70, 73%) felt “moderately” or “extremely confident” that a web-based program could meet their mental health training needs: 19% (13/70) were “neutral” and 9% (6/70) were “somewhat confident.”

    ‎
    Figure 2. CONSORT (Consolidated Standards of Reporting Trials) diagram of study recruitment and flow. BEAM: Building Educators’ skills in Adolescent Mental Health.
    View this figure
    Table 1. Sample characteristics at baseline (N=70).
    CharacteristicsValues
    Females, n (%)49 (70)
    School funder: government, n (%)68 (97)
    School type: coeducational, n (%)63 (90)
    School location, n (%)

    		Metropolitan21 (30)

    		Regional29 (41)

    		Rural/remote20 (29)
    Age (years), mean (SD); range36.47 (9.41); 24-60
    Experience in current role (ie, Year Advisor) (years), mean (SD); range3.33 (2.97); 0-15
    Experience as a secondary school teacher (years), mean (SD); range9.62 (6.82); 2-36
    Duration of employment at current school (years), mean (SD); range6.23 (4.40); 1-23

    Preliminary Effectiveness

    There were no significant changes in mental health knowledge or attitudes at postintervention or 3-month follow-up (Tables 2 and 3). Significant increases in confidence were found at postintervention (Cohen d=0.60) and 3-month follow-up (Cohen d=0.53). There was also a significant increase in the frequency of helping behaviors at 3-month follow-up and a significant reduction in participants’ psychological distress at postintervention (Cohen d=0.33). Multimedia Appendix 1 provides further information regarding each measure.

    When asked about their perceptions of training effectiveness at postintervention, the mean scores indicated that on average, participants rated the training program as “somewhat” (ie, score of 3) effective for improving their confidence, skills, and approach to student mental health (Table 4).

    Table 2. Outcome measures at each time point.
    MeasuresaBaseline score, mean (SD)Postintervention score, mean (SD)3-month follow-up score, mean (SD)
    Mental health knowledge23.14 (2.27)23.50 (2.24)24.48 (2.71)
    Mental health attitudes13.67 (4.01)13.71 (3.75)14.86 (7.43)
    Confidence in helping behavior52.04 (10.68)58.44 (9.23)63.32 (6.37)
    Frequency of helping behavior35.37 (7.37)36.46 (7.77)41.68 (7.42)
    Psychological distress11.25 (3.78)10.00 (3.39)10.71 (3.23)

    aOwing to attrition, the number of participants at postintervention varied: mental health knowledge, n=28; mental health attitudes n=28; confidence in helping behavior, n=27; frequency of helping behaviors, n=26; and psychological distress, n=21. Similarly, at follow-up: mental health knowledge, n=23; mental health attitudes, n=22; confidence in helping behavior, n=22; frequency of helping behaviors, n=22; and psychological distress, n=21.

    Table 3. Estimates of change in outcomes at postintervention and 3-month follow-up based on mixed model repeated measures analysis of variance.
    OutcomesPostintervention vs baseline3-month follow-up vs baseline

    		Estimate (SE)t test (df)P valueCohen daEstimate (SE)t test (df)P valueCohen da
    Mental health knowledge0.41 (0.29)1.45 (38.03).160.20.59 (0.38)1.58 (31.04).130.4
    Mental health attitudes0.14 (0.61)0.23 (23.35).820.011.25 (1.37)0.91 (23.99).370.3
    Confidence in helping behavior6.83 (1.54)4.44 (30.24)<.001b0.69.79 (1.29)7.54 (33.22)<.001b0.5
    Frequency of helping behavior1.09 (1.00)1.09 (28.62).280.24.98 (1.34)3.73 (23.90).001b0.7
    Psychological distress–1.09 (0.41)–2.66 (21.66).01b0.30.08 (0.45)0.17 (19.97).870.1

    aCohen d effect sizes were calculated as the difference between observed means at postintervention (or follow-up) and baseline, divided by the SD at baseline.

    bSignificant at P<.05.

    Table 4. Participants’ perceived effectiveness of the training program for increasing confidence, skills, approach, and meeting training needs at postintervention (n=25).
    MeasuresValues, mean (SD)
    The extent to which the program increased your confidence to support students’ mental health3.24 (0.88)
    The extent to which the program increased your skills to support students’ mental health3.32 (0.90)
    The extent to which the program improved your approach to supporting students’ mental health3.28 (0.90)
    The extent to which the program met your mental health training needs3.28 (0.84)

    Program Use and Barriers

    A total of 94% (66/70) of the baseline sample accessed the first topic and 50% (35/70) completed it. There was a steady decrease in topic completions over time: 16 (23.9%) participants completed half the program (ie, ≥3 topics) and 11 (16%) completed the entire program (Figure 3). Lack of time, competing priorities, and forgetfulness were reported as the common barriers to program completion. Lack of engagement with content, disruptions to working relationships, and taking leave were the least common barriers to program use (Table 5).

    ‎
    Figure 3. Program use: Sequential topic completion among participants (N=70). Note: Topics were sequential and locked. New topics could not be started unless the peer coaching activity was submitted to the program.
    View this figure
    Table 5. Barriers to program use (n=26).
    BarriersYes, n (%)
    I didn’t have enough time to complete the program22 (85)
    The program wasn’t a priority15 (58)
    I forgot about the program14 (54)
    I had problems with my Internet connection or device access4 (15)
    I didn’t have another colleague to complete peer coaching activities3 (12)
    I had problems with accessing the program2 (8)
    I had concerns about the privacy and security of my data2 (8)
    Other reasons not listed2 (8)
    I went on leave from school/role1 (4)
    Program was disruptive to my working relationships1 (4)
    Program wasn’t engaging1 (4)

    Program Acceptability and Satisfaction

    Most participants rated the program content as easy to understand, relevant, practical, realistic, and helpful (Table 6). Participants gave lower ratings to the peer coaching and feedback components. Overall, participants were “somewhat” to “moderately” satisfied with the training program. t tests indicated no significant differences in the mean scores of acceptability, satisfaction, and perceived effectiveness between participants who completed the entire program (n=9) and those who did not (n=17) (P=.08-.98).

    Table 6. Measures of program acceptability and satisfaction (n=26).
    MeasuresScore, mean (SD)
    Program acceptability

    		The content was easy to understand4.35 (0.56)

    		The content was relevant to my current role4.27 (0.45)

    		The program content matched the learning objectives4.23 (0.51)

    		The learning objectives were clear and realistic4.19 (0.40)

    		The program structure was logical4.15 (0.46)

    		The examples and suggestions were practical and realistic4.12 (0.52)

    		The content was helpful for my current role4.08 (0.56)

    		I had opportunities in the program to practice the skills learned4.04 (0.72)

    		The program activities were engaging3.65 (0.69)

    		The feedback I received throughout the program was constructive3.62 (0.80)

    		The peer coaching activities were helpful3.58 (0.76)

    		I enjoyed the opportunity to complete the Share my Story activity3.08 (0.94)

    		The content was confronting or distressing2.12 (1.07)
    Satisfaction (n=25)

    		Overall, how satisfied were you with the program?3.60 (1.00)

    		How likely are you to use the program again in the future?3.56 (1.00)

    		How likely are you to recommend the program to others?3.84 (1.03)

    Principal Findings

    This study examined the preliminary effectiveness and acceptability of a web-based training program for improving mental health knowledge, attitudes, confidence, and helping behaviors among secondary school teachers in NSW. Our findings indicate that the BEAM program may be beneficial for improving teachers’ confidence in, and the frequency of, helping behaviors toward their adolescent students with mental health problems, when measured with self-report scales. The BEAM program did not appear to be associated with improvements in mental health knowledge or attitudes, although this may be owing to the high baseline levels of experience and training within this cohort. The BEAM program may also be associated with a reduction in teachers’ psychological distress, although this would need to be replicated within a randomized controlled trial. Given that past evaluations of teacher training programs for mental health have not observed improvements in helping behavior or teachers’ well-being [18,19], these initial findings are promising. However, study attrition was high and program completion rates were low. Modifications to the training program and associated study design are needed for future trials.

    Program Acceptability

    Program acceptability was high among the teachers who remained in the study at postintervention. These teachers viewed the training content as relevant, helpful, and engaging but were less favorable toward the peer coaching activities. Only half of all participants continued beyond the first topic, suggesting that the compulsory completion of the peer coaching activity may have halted progress for many participants. While there was no evidence to suggest that program completion was associated with greater acceptability and satisfaction, it is difficult to examine overall levels owing to the high study attrition rate. Future trials may benefit from removing the mandatory completion of the peer coaching activities to encourage more training completions. This would allow participants to complete the program at their own pace and lead to greater exposure to training content. While it is not yet clear which persuasive techniques are associated with better outcomes for web-based programs [37], engagement with the BEAM program may also be enhanced by greater tailoring of content (eg, message personalization and topic recommendations based on experience and interest), thus improving the quality and relevance of the feedback, increasing interactivity, and removing the sequential format. These changes may improve completion rates, perceived effectiveness, and overall acceptability [38].

    A key aim of this project was to create a mental health training program for secondary school teachers, which was highly accessible, easily disseminated, and scalable but also engaging and effective. The use of a web-based platform enabled these goals; however, this study shows that 1 in 4 teachers were not confident that this type of program could meet their training needs. Some teachers may have felt that the skills needed to care for students’ mental health could not be taught (or learnt) via a self-directed web-based program. Given that other web-based workplace mental health training programs have been shown to be effective [23], some teachers may require additional messaging to address these attitudes prior to commencing the training. Embedding acceptance facilitation techniques (eg, video explainers, provision of research findings, and feedback on the changes in participants’ outcomes) may help increase confidence and uptake of this training format [39,40]. Additional feedback from peers, students, and parents about improvements in participants’ helping behavior may also help strengthen perceptions of training effectiveness. The results may also indicate some discordance between participants’ improvements on the self-report outcome scales and their ratings of perceived training effectiveness. This may suggest that teachers did not perceive the training to be immediately beneficial and instead require more time to transition their new skills into practice and reflect on these changes. This would suggest that future study designs should carefully examine the outcomes measures used and ensure that suitable follow-up periods are used.

    Limitations

    The study was impacted by high attrition, for both survey completion and program use, thus limiting firm conclusions about program effectiveness and acceptability. It remains unclear whether participants’ attitudes towards the program or other external factors influenced dropout. A larger sample size, with a control group, would allow for these analyses. Of the 11 participants who completed the program, 9 (82%) also completed the postintervention. This may suggest that improvements in program completions may also improve study retention. Future studies would likely benefit from using incentives for all study assessments, thus increasing the study duration to give participants more time to access and complete the program, and modifying the program in accordance with the user feedback to sustain engagement [41]. The high number of teachers expressing interest demonstrates the need the for this type of training program; however, the requirement of signed principal consent and a coparticipating colleague likely hindered recruitment. Future trials may benefit from revising the consent process, eligibility criteria, and study dissemination process to enable greater participation. Different results may also be found when the program is evaluated among teachers who have not received prior mental health training or are not currently in self-selected roles delegated to caring for student well-being.

    Conclusions

    This study indicates that the BEAM program may improve teachers’ confidence in caring for students’ mental health and increase the frequency of helping behaviors. The training program may also reduce teachers’ psychological distress. The program content was easy to understand and relevant, although barriers related to time, competing priorities, and forgetfulness inhibited program use. The results have indicated that some program modifications are necessary to increase completion. Taken together, the findings demonstrate the potential of a web-based training program for improving helping behavior and related outcomes among Australian secondary school teachers. A randomized controlled trial of the BEAM program will help determine genuine effects.

    Acknowledgments

    BOD and MA conceived and designed the study. BOD and MA prepared the protocol, and MA initiated the trial. MA and BP coordinated the trial. PB contributed to the statistical analyses. All authors contributed to the refinement of the protocol, and all authors read and approved the final manuscript.

    Conflicts of Interest

    BOD is a Section Editor for JMIR Mental Health. No other authors have a conflict of interest.

    ‎
    Multimedia Appendix 1

    Mean (SD) values for all outcome measure items.

    DOCX File , 24 KB
    1. Kessler RC, Amminger GP, Aguilar-Gaxiola S, Alonso J, Lee S, Ustün TB. Age of onset of mental disorders: a review of recent literature. Curr Opin Psychiatry 2007 Jul;20(4):359-364 [FREE Full text] [CrossRef] [Medline]
    2. National School Profile Data 2019. Australian Bureau of Statistics. 2020.   URL: https://www.abs.gov.au/statistics/people/education/schools/2019 [accessed 2021-04-28]
    3. National Report on Schooling Data Portal. Australian Curriculum, Assessment and Reporting Authority. 2020.   URL: https:/​/www.​acara.edu.au/​reporting/​national-report-on-schooling-in-australia/​national-report-on-schooling-in-australia-data-portal [accessed 2021-04-28]
    4. Duong MT, Bruns EJ, Lee K, Cox S, Coifman J, Mayworm A, et al. Rates of mental health service utilization by children and adolescents in schools and other common service settings: A systematic review and meta-analysis. Adm Policy Ment Health 2021 May;48(3):420-439. [CrossRef] [Medline]
    5. Lawrence D, Johnson S, Hafekost J, de Haan KB, Sawyer M, Ainley J, et al. The Mental Health of Children and Adolescents: Report on the Second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Australian Government. 2015.   URL: https:/​/www.​health.gov.au/​sites/​default/​files/​documents/​2020/​11/​the-mental-health-of-children-and-adolescents_0.​pdf [accessed 2021-04-28]
    6. Franklin C, Kim JS, Ryan T, Kelly M, Montgomery K. Teacher involvement in school mental health interventions: a systematic review. Children and Youth Services Review 2012 May;34(5):973-982. [CrossRef]
    7. Whitley J, Smith J, Vaillancourt T, Neufeld J. Promoting mental health literacy among educators: a critical aspect of school-based prevention and intervention. In: Handbook of School-Based Mental Health Promotion. Cham: Springer; 2018:143-165.
    8. Mazzer KR, Rickwood DJ. Teachers' role breadth and perceived efficacy in supporting student mental health. Adv Sch Ment Health Promot 2014 Nov 06;8(1):29-41. [CrossRef]
    9. O'Reilly M, Adams S, Whiteman N, Hughes J, Reilly P, Dogra N. Whose responsibility is adolescent's mental health in the UK? Perspectives of key stakeholders. School Ment Health 2018;10(4):450-461 [FREE Full text] [CrossRef] [Medline]
    10. Reinke WM, Stormont M, Herman KC, Puri R, Goel N. Supporting children's mental health in schools: teacher perceptions of needs, roles, and barriers. School Psychology Quarterly 2011 Mar;26(1):1-13. [CrossRef]
    11. Whitley J, Smith JD, Vaillancourt T. Promoting mental health literacy among educators. Can J Sch Psychol 2013 Jan 04;28(1):56-70. [CrossRef]
    12. O'Dea B, Anderson M, Subotic-Kerry M, Parker B. Secondary school Year Advisors' perspectives on their role, responsibilities and training needs for student mental health: insights from a co-design workshop. Research Square 2021 Mar 04 [FREE Full text] [CrossRef]
    13. Bower JM, Carroll A. Capturing real-time emotional states and triggers for teachers through the teacher wellbeing web-based application t*: a pilot study. Teach Teach Educ 2017 Jul;65:183-191. [CrossRef]
    14. Lever N, Mathis E, Mayworm A. School mental health is not just for students: why teacher and school staff wellness matters. Rep Emot Behav Disord Youth 2017;17(1):6-12 [FREE Full text] [Medline]
    15. Overhaul of Teacher Training. NSW Education Standards Authority. 2020 Nov 29.   URL: https:/​/educationstandards.​nsw.edu.au/​wps/​portal/​nesa/​about/​news/​media-releases/​media-release-detail/​overhaul-of-teacher-training [accessed 2021-04-28]
    16. Panari C, Guglielmi D, Simbula S, Depolo M. Can an opportunity to learn at work reduce stress? J Workplace Learn 2010 Apr 06;22(3):166-179. [CrossRef]
    17. Gustavsson M, Lundqvist D. Learning conditions supporting the management of stressful work. JWL 2021 Jan 28;33(2):81-94. [CrossRef]
    18. Anderson M, Werner-Seidler A, King C, Gayed A, Harvey SB, O’Dea B. Mental health training programs for secondary school teachers: a systematic review. School Mental Health 2018 Oct 3;11(3):489-508. [CrossRef]
    19. Yamaguchi S, Foo JC, Nishida A, Ogawa S, Togo F, Sasaki T. Mental health literacy programs for school teachers: a systematic review and narrative synthesis. Early Interv Psychiatry 2020 Feb;14(1):14-25. [CrossRef] [Medline]
    20. Ohrt JH, Deaton JD, Linich K, Guest JD, Wymer B, Sandonato B. Teacher training in K–12 student mental health: A systematic review. Psychol Schs 2020 May;57(5):833-846. [CrossRef]
    21. Jorm AF, Kitchener BA, Sawyer MG, Scales H, Cvetkovski S. Mental health first aid training for high school teachers: a cluster randomized trial. BMC Psychiatry 2010 Jun 24;10:51 [FREE Full text] [CrossRef] [Medline]
    22. Kidger J, Stone T, Tilling K, Brockman R, Campbell R, Ford T, et al. A pilot cluster randomised controlled trial of a support and training intervention to improve the mental health of secondary school teachers and students - the WISE (Wellbeing in Secondary Education) study. BMC Public Health 2016 Oct 06;16(1):1060 [FREE Full text] [CrossRef] [Medline]
    23. Gayed A, Bryan BT, LaMontagne AD, Milner A, Deady M, Calvo RA, et al. A cluster randomized controlled trial to evaluate HeadCoach: an online mental health training program for workplace managers. J Occup Environ Med 2019 Jul;61(7):545-551. [CrossRef] [Medline]
    24. Webb WR, Nickerson H, Bush JB. A comparative analysis of online and face-to-face professional development models for CS Education. In: SIGCSE '17: Proceedings of the 2017 ACM SIGCSE Technical Symposium on Computer Science Education. 1999 Presented at: SIGCSE '17: The 48th ACM Technical Symposium on Computer Science Education; March 8-11, 2017; Seattle, WA p. 621-626. [CrossRef]
    25. Nabhani M, Bahous R, Hamdan Z. School-based professional development in one Lebanese school: how much is too much? Professional Development in Education 2012 Jul;38(3):435-451. [CrossRef]
    26. Gayed A, LaMontagne AD, Milner A, Deady M, Calvo RA, Christensen H, et al. A new online mental health training program for workplace managers: pre-post pilot study assessing feasibility, usability, and possible effectiveness. JMIR Ment Health 2018 Jul 03;5(3):e10517 [FREE Full text] [CrossRef] [Medline]
    27. Asbjørnsen RA, Smedsrød ML, Solberg Nes L, Wentzel J, Varsi C, Hjelmesæth J, et al. Persuasive system design principles and behavior change techniques to stimulate motivation and adherence in electronic health interventions to support weight loss maintenance: scoping review. J Med Internet Res 2019 Jun 21;21(6):e14265 [FREE Full text] [CrossRef] [Medline]
    28. Kelders SM, Kok RN, Ossebaard HC, Van Gemert-Pijnen JEWC. Persuasive system design does matter: a systematic review of adherence to web-based interventions. J Med Internet Res 2012 Nov 14;14(6):e152 [FREE Full text] [CrossRef] [Medline]
    29. Oinas-Kukkonen H, Harjumaa M. Persuasive systems design: key issues, process model, and system features. CAIS 2009;24. [CrossRef]
    30. Evans-Lacko S, Little K, Meltzer H, Rose D, Rhydderch D, Henderson C, et al. Development and psychometric properties of the Mental Health Knowledge Schedule. Can J Psychiatry 2010 Jul;55(7):440-448. [CrossRef] [Medline]
    31. Griffiths KM, Christensen H, Jorm AF, Evans K, Groves C. Effect of web-based depression literacy and cognitive-behavioural therapy interventions on stigmatising attitudes to depression: randomised controlled trial. Br J Psychiatry 2004 Oct;185:342-349. [CrossRef] [Medline]
    32. Sebbens J, Hassmén P, Crisp D, Wensley K. Mental Health in Sport (MHS): Improving the early intervention knowledge and confidence of elite sport staff. Front Psychol 2016;7:911 [FREE Full text] [CrossRef] [Medline]
    33. Batterham PJ, Sunderland M, Carragher N, Calear AL, Mackinnon AJ, Slade T. The Distress Questionnaire-5: population screener for psychological distress was more accurate than the K6/K10. J Clin Epidemiol 2016 Mar;71:35-42. [CrossRef] [Medline]
    34. Batterham PJ, Sunderland M, Slade T, Calear AL, Carragher N. Assessing distress in the community: psychometric properties and crosswalk comparison of eight measures of psychological distress. Psychol Med 2018 Jun;48(8):1316-1324. [CrossRef] [Medline]
    35. O'Dea B, King C, Subotic-Kerry M, Anderson M, Achilles MR, Parker B, et al. Evaluating a web-based mental health service for secondary school students in Australia: protocol for a cluster randomized controlled trial. JMIR Res Protoc 2019 May 17;8(5):e12892 [FREE Full text] [CrossRef] [Medline]
    36. O'Dea B, King C, Subotic-Kerry M, Achilles MR, Cockayne N, Christensen H. Smooth Sailing: a pilot study of an online, school-based, mental health service for depression and anxiety. Front Psychiatry 2019;10:574. [CrossRef] [Medline]
    37. Pugatch J, Grenen E, Surla S, Schwarz M, Cole-Lewis H. Information architecture of web-based interventions to improve health outcomes: systematic review. J Med Internet Res 2018 Mar 21;20(3):e97 [FREE Full text] [CrossRef] [Medline]
    38. Muench F, Baumel A. More than a text message: Dismantling digital triggers to curate behavior change in patient-centered health interventions. J Med Internet Res 2017 May 26;19(5):e147 [FREE Full text] [CrossRef] [Medline]
    39. Baumeister H, Terhorst Y, Grässle C, Freudenstein M, Nübling R, Ebert DD. Impact of an acceptance facilitating intervention on psychotherapists' acceptance of blended therapy. PLoS One 2020;15(8):e0236995 [FREE Full text] [CrossRef] [Medline]
    40. Batterham PJ, Calear AL, Sunderland M, Kay-Lambkin F, Farrer LM, Gulliver A. A brief intervention to increase uptake and adherence of an online program for depression and anxiety: protocol for the Enhancing Engagement with Psychosocial Interventions (EEPI) randomized controlled trial. Contemp Clin Trials 2019 Mar;78:107-115. [CrossRef] [Medline]
    41. Sauermann H, Roach M. Increasing web survey response rates in innovation research: an experimental study of static and dynamic contact design features. Research Policy 2013 Feb;42(1):273-286. [CrossRef]

    ‎
    BEAM: Building Educators’ skills in Adolescent Mental Health
    DQ5: 5-item Distress Questionnaire
    MAKS: Mental Health Knowledge Schedule
    NSW: New South Wales
    PISCF: Participant Information Sheet and Consent Form
    UNSW: University of New South Wales

    Edited by J Torous; submitted 29.04.21; peer-reviewed by C Eichenberg, D Wang; comments to author 19.06.21; revised version received 14.07.21; accepted 14.07.21; published 22.10.21

    Copyright

    ©Belinda L Parker, Melissa Anderson, Philip J Batterham, Aimee Gayed, Mirjana Subotic-Kerry, Melinda R Achilles, Cassandra Chakouch, Aliza Werner-Seidler, Alexis E Whitton, Bridianne O’Dea. Originally published in JMIR Mental Health (https://mental.jmir.org), 22.10.2021.

    This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Mental Health, is properly cited. The complete bibliographic information, a link to the original publication on https://mental.jmir.org/, as well as this copyright and license information must be included.