Supporting student well-being

Children and young people are increasingly experiencing mental health problems, including self-harm and suicidal behaviours. Children with mental health difficulties face increased risk of poorer educational outcomes, higher school absenteeism and early school leaving. Childhood maltreatment may also contribute to poorer outcomes. A better understanding of risk and protective factors associated with educational outcomes is required to improve support and multi-agency response for children experiencing mental health difficulties.  

This research program aims to improve health and education outcomes through the use of a cross-sectoral, linked population-level dataset containing longitudinal information on health, education and communities and justice, for children living in the Illawarra Shoalhaven Local Health District.  

The purpose of the current study is to describe patterns of children accessing health services for mental health problems, self-harm and suicidal behaviours in the Illawarra and Shoalhaven region, and to assess the relationships between childhood adversity and health service use for mental health concerns, and educational outcomes. 

The study has several research questions as follows: 

• What are the backgrounds and demographic and clinical characteristics of children and their families who access health services for mental health, self-harm and/or suicidal-related reasons?
• What are the associations between health service use for mental health, self-harm or suicide-related reasons and childhood adversity and educational outcomes across primary and high school?
• Do children who access health services for mental health, self-harm or suicidal-related reasons spend more time absent from school than other children (accounting for health problems, school disciplinary actions, and child protection/out-of -home care)?
• What is the health service use for mental health, self-harm, suicide-related reasons for children and young people?
• What are the services and pathways used by children who access health services for difficulties with mental health, self-harm or suicidal-related reasons?
• Are children who access health services for mental health, self-harm and/or suicidal-related reasons more likely to have physical health needs, including developmental disabilities?
• To what degree does childhood vulnerability and adversity contribute to risk of health service use for mental health difficulties, self-harm or suicide-related reasons for children and young people?
• What risk factors could inform targeted early intervention strategies?
• What protective factors in childhood reduce the likelihood of children presenting to health services for mental health, self-harm, suicide-related reasons? 

This longitudinal retrospective cohort study links multiple administrative data sets relating to health, ambulance, child protection, and education. The program of research participants are children from one large health district in Australia, the Illawarra Shoalhaven Local Health District (ISLHD), who were born in or moved into the region by school commencement, who are followed until adulthood. The ISLHD services a population of over 400,000 people, across 5,700 square kilometres, including approximately 74,736 people aged 5 to 19. The ISLHD has four ED facilities that together have approximately 160,000 presentations per year. Study factors include age of onset and recency of specific events and factors including childhood adversity and mental health problems, and outcomes include educational engagement and attainment and health service use for physical and mental health reasons. Data analysis will include generalised mixed models, structural equations models and time-to-event models. 

Outputs from this study to guide support and intervention for students with mental health concerns include: 

• Three peer reviewed open access journal articles will be written based on the research findings.
  • Journal article 1 is intended to describe the 12-month prevalence of health service use for mental health, self-harm or suicide-related reasons in school aged children in the regional area.
  • Journal article 2 intends to describe the contribution of childhood adversity to risk of health service use for mental health, self-harm or suicide-related reasons in school age children.
  • Journal article 3 will describe the contribution of health service use for mental health, self-harm or suicide-related reasons, and childhood adversity on attainment of educational outcomes across primary and high school.  
• A public report will be developed from the research outlining the findings and implications for use by policymakers in government departments, school principals, student welfare staff, school-link coordinators, caseworkers and clinicians working with students in school and health settings. 
• An evidence to action note, focusing on enhancing practice for this group of students, will be developed for use by school principals, student welfare staff, school-link coordinators, caseworkers and clinicians working with students in school and health setting. 
• A webinar will be developed for school principals, student welfare staff, school-link coordinators, caseworkers and clinicians working with students in school and health settings to disseminate the research findings and inform clinical applications. This webinar will be recorded and made publicly available via the University of Wollongong’s website.  

• The study protocol was finalised, describing research aims and objectives, data analysis plan and data linkage flowchart. A literature review was conducted and a manuscript outlining the research protocol has been submitted for publication.
• Data custodian approvals have been obtained from all agencies.
• Advisory groups consisting of parents, carers, clinicians and educators have been established and feedback sought on student experiences, research questions, and study design.
• Arrangements for provision of linked data are underway with ISLHD and CHeReL.  

Ethical approval has been obtained from: 

• NSW Population and Health Services HREC 2021/ETH01435 
• The University of Wollongong HREC  
• The Illawarra Shoalhaven Local Health District  

This study will provide new evidence on the relationship between child adversity, mental health problems and educational engagement and outcomes. This evidence will inform the co-development of recommendations with young people, parents, educators, clinicians, policy makers and interagency collaborations to better support students at school and health settings and in the community. The current study aims to enlarge our understanding of when and how public agencies (health, education, child protection) can work together for the welfare of children at risk of mental health difficulties and poor educational attainment.  

Chief Investigator  

• Dr Michelle Townsend, University of Wollongong 

Co-investigators  

• Dr Luise Lago, University of Wollongong 
• Dr David Alcorn, Illawarra Shoalhaven Local Health District 
• Dr Karlen Barr, University of Wollongong 
• Professor Nagesh Pai, Illawarra Shoalhaven Local Health District and University of Wollongong 
• Professor Brin Grenyer, University of Wollongong
• Mr Brendan McAlister, Illawarra Shoalhaven Local Health District 
• Mr Stephen Moules, University of Wollongong  

The current study is funded by the NSW Department of Education Strategic Research Fund. 

For further information or if you would like to be involved, please contact Dr Michelle Townsend, 02 4298 1304 or mtownsen@uow.edu.au