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​Promoting teen mental wellness

A formal evaluation of a skills-based approach to promote mental wellness, prevent risky behaviours in adolescents is underway

Adolescence is turbulent enough without the risky behaviours teens may be exposed to, such as drug use, bullying and violence, which have also been linked to poor mental health. However, most prevention programs aimed at reducing these public health concerns don’t consider mental wellness.

To help address this gap, experts at CAMH’s Centre for Prevention Science designed the Fourth R Healthy Relationships Plus Program (HRPP), a small-group program focusing on healthy relationships to foster positive youth development.

The research team (left-right): Dr. David Wolfe (principal investigator); Dr. Deinera Exner-Cortens; Debbie Chiodo; Ray Hughes
The program, similar to the classroom-based Fourth R program, works to improve communication, interpersonal and help-seeking skills to promote mental wellness. 

This proactive, skills-based, universal prevention program has been in place for the past five years, undergoing two major revisions in the last three years, but has never been formally evaluated.  Researchers at the CAMH Centre for Prevention Science have now launched a trial to a study how well it works.

"The study has two goals,” says co-investigator Deinera Exner-Cortens, post-doctoral fellow. “The first is to demonstrate the program has a positive impact on mental health and on the reduction of risk behaviours. And the second is to look at who the program is working for and why. Most studies of these kinds of programs look at aggregate date to answer the question ‘does it work?’ But we are actually studying the effectiveness of the program while considering differences among students in their cognitive functioning, personality and life experiences.”

These results will help to improve the program so it suits the unique needs of different student populations.

Half of the participants were randomly assigned to a control group involved in orientation-type activities, while the other half participated in the program, which uses practice, role play, and peer-feedback to reinforce their ability to navigate romantic relationships and friendships. Participants learned skills ranging from how to apologize, to setting boundaries, to breaking up with a boyfriend or girlfriend in a respectful way.

“This is not an intervention-based program, but one that is focused on prevention,” explains Debbie Chiodo, research associate and co-investigator on the study.

Students were assessed directly before and after the two-week session, when students’ attitude change and knowledge retention were assessed.

As one Grade 10 student commented, “The Fourth R has really made me think about how I treat others. I realize now that I don’t treat people very well and I am going to make changes.”

Follow-up interviews will be done three times up to a year after the program, to determine whether the lessons and skills learned in the program lead to lasting behavioural changes in mental wellness, such as an increase in positive mental health, and less psychological distress and risk behaviours.

The students in the study represent a good variety of demographics. “There was also a full participation rate, which did not waver across the study,” says Chiodo. “We hope that translates to success during follow-up.”

For anyone interested in the program, a comprehensive package of resources is available online. The “Fourth R” refers to relationships, which the team believes are an often-neglected aspect of harm reduction in youth.

In addition to the current study, the program is undergoing a national implementation in three provinces Alberta, Saskatchewan, Ontario and the territories of Nunavet and Northwest Territories as part of a Health Canada-funded project, and is also used in BC and Alaska. Through these partnerships, schools and communities across the country receive training and deliver healthy relationships programming that promotes youth wellness across the country. 



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