School-based interventions

School-based interventions to promote good mental health

A systematic review of school-based interventions found that (Clarke et al., 2021):

  • There is strong evidence that universal social and emotional learning interventions enhance young people’s social and emotional skills, and lead to short-term reductions in depression and anxiety.
  • Universal and targeted cognitive behavioural therapy (CBT) can reduce symptoms of depression and anxiety in the short- and medium-term.
  • There is a range of evidence supporting the reduction of risk factors in schools:
    • Bullying prevention interventions can lead to long-term reductions in bullying frequency.
    • Some evidence suggests that programmes targeted at young people at risk of experiencing sexual violence can reduce sexual violence and harassment.
    • Some evidence shows that violence prevention interventions can lead to small and short-term reductions of aggressive behaviour.
  • High-quality programme implementation (in terms of delivery quality, the number of sessions and student engagement) are vital for programmes to be successful, with some studies finding that there were only positive impacts when programmes were well implemented.
  • Some interventions, including depression and anxiety prevention programmes, are more effective when targeted at young people showing symptoms of these conditions.

This review highlighted that schools should be supported to use well-evidenced programmes to improve young people’s wellbeing (Clarke et al., 2021). It recommended that programmes are more likely to be successful when introduced as part of a whole-school approach to improving mental health and wellbeing, which consider mental health and wellbeing within the curriculum, behavioural policies, pastoral support, engagement with the broader school community and staff wellbeing. Teachers need to be supported to respond to young people’s mental health needs; and there should be external mental health professionals to support the most vulnerable pupils (Clarke et al., 2021).

The Mental Health Foundation has identified facilitators and barriers to the implementation of effective mental health support in schools (Abdinasir, 2019):

Table 15: Facilitators and barriers to the implementation of effective mental health support in schools. Adapted from: (Abdinasir, 2019)

What is the evidence around school absenteeism?

A search of the science direct database was carried out by Johannes Jaenicke for articles from 2018-2023 with the keywords: School, Anxiety, Measure, Intervention, Attendance. This yielded 3666 results with n = 734 review articles, n = 2919 research articles, n = 4 mini reviews, n = 13 practice guidelines. Several different attendance intervention strategies were identified which prevent address school absenteeism:

School based anxiety intervention programs

School-based anxiety intervention programs general report success in reducing school related anxiety and depression. These programs can be offered (i) to all students, (ii) on a targeted basis for at risk students, (iii) on an indicated basis for students with more severe symptoms, or (iv) self-referral basis. Employed interventions include mindfulness-based interventions (García-Rubio et al., 2023), cognitive behavior therapy (Brown et al., 2019) and acceptance and commitment therapy (Petersen et al., 2023). Whilst showing good efficacy at reducing school-based anxiety, the evidence on school absenteeism is limited.

Incentive and reward-based interventions.

  • School-based recognition and reward programs are seen as an effective means of increasing school attendance. These programs reward students for regular attendance and make parents aware of attendance policy and unexcused absences.
  • Interventions include sending parents a notice letter by the teacher of an unauthorized absence and recognising students that having perfect attendance. Importantly, when schools texted parents about attendance, the biggest improvements were seen when messages contained specific tools and tips to parents to improve attendance (Institute of Education Sciences, 2022).
  • A reward-based intervention, ‘Perfect Pals Program’, rewarded students with perfect attendance with monthly free school meals, small treats and having their pictures on the school bulletin boards. This saw a steady increase in the number of students attending the ‘Perfect Pals’ luncheons and 93% of surveyed teachers agreed that the incentive was a good idea (Peek, 2009)

Approaches targeting illness related absenteeism

Several studies were found which evaluated the role of strategies to promote hand hygiene and asthma management to reduce illness-related absenteeism (Hammond et al., 2000; Rodriguez et al., 2013). It was found that mean absenteeism due to illness decreased when full-time nurses were added and that the overall reduction in absenteeism due to infection was 19.8% for schools that used alcohol gel hand sanitizer compared with control schools. However, many factors affect why students go to school, and schools cannot address attendance alone.

School and community-based interventions

  • The University of Minnesota currently runs a ‘Check and Connect’ intervention which has been implemented across the United States in 48 states. The Check component assigns a mentor that regularly assesses student performance and progress while the Connect component involves program staff giving individualized attention to students in partnership with school staff, family members and community service organizations. This found a 25%-30% improvement in students staying in and progressing in school (US Department of Education, 2015).
  • In Check and Connect, basic interventions involve regular structured discussions between the mentor and student about school progress, time management and conflict resolution strategies. Intensive interventions are tailored to specific student and family variables. There is a focus on problem solving, academic support, and recreational and community service activities. The program also focuses on family outreach, with mentors expected to have frequent contact with family members.

Multi-modal approaches

These approaches aim to create partnerships between schools, families, social workers, and outside organizations in the community including the police.

  • The ACT Now Program is an institutionalized response to absenteeism in Arizona, USA, which focused on three key elements, (i) the enforcement of a mandatory school attendance law by holding parents accountable, (ii) a program that offers services to youth and their parents to address the root causes of absenteeism, (iii) sanctions for parents and youth for continued absenteeism or for those who fail to successfully complete the program. It was found to be effective in breaking the cycle of absenteeism before it lead to school dropout (Baker et al., 2001).
  • A study which compared student attendance in elementary schools and developed school-wide programs of school, family, and community partnerships showed that in schools working to implement these partnerships, student attendance improved an average of 0.5%, whereas in comparison schools, rates of student attendance declined slightly from 1 year to the next. Further analysis suggested that school outreach to families was the driving mechanism that caused this effect (Sheldon, 2007).
  • Chang and Romero set out a comprehensive repose to absenteeism in their 2008 Present, Engaged, and Accounted For report (Chang & Romero, 2008). This calls for effective absence monitoring and programs which (i) prepare children for entry into school, (ii) ensure access to preventative health care, (iii) offer a high quality education that response to diverse learning styles, (iv) engage families of all backgrounds in their children’s education, (v) educate parents about the importance of attendance, (vi) encourage families to help each other attend schools, (vii) offers incentives for attendance to all children, (viii) conducts early outreach to families with poor attendance and (ix) coordinates with public agencies.

Additional resources 


Full list of references is included at the end of this chapter.