Co-Principal Investigators: Fefer, Sarah; Ferron, John; Kiefer, Sarah

Purpose: Adolescents with the best academic, social, and physical health outcomes have both low psychopathology andelevated subjective well-being (SWB). Psychological research and practice have focused on pathology. There are few interventions available to improve SWB. This project will evaluate the efficacy, fidelity, feasibility, acceptability of implementation and training, and cost-effectiveness of the Well-Being Promotion Program. This program is an innovative Tier-2 intervention for use by school mental health teams that is integrated within a multi-tiered system of support for student mental health to increase student SWB. Researchers expect students who take part in this positive psychology intervention will experience lasting gains in SWB in addition to the prevention/reduction of psychopathology and greater academic success.

Project Activities: Researchers will examine the efficacy, feasibility, acceptability, and cost of the Well-Being Promotion Program in a partially clustered randomized control trial.

Products: Findings from this study will be reported via conference presentations and peer-reviewed publications.

Structured Abstract

Setting: Thirteen public middle schools in urban and suburban communities in two states (Florida, Massachusetts) with socioeconomically and ethnically diverse students will participate.

Sample: Approximately 1170 students in grades 6, 7, and 8 and their teachers and parents will participate. About 50 school mental health (SMH) providers will participate by implementing the intervention after initial training and supported by ongoing coaching by study staff.

Intervention: The Well-Being Promotion Program is a fully developed positive psychology intervention that is commercially available through Guilford Press. The program includes 10 core sessions for students that are divided into 3 phases focused on past, present, and future aspects of emotional well-being. These core sessions include group activities and homework assignments designed to increase students' gratitude, acts of kindness, use of signature character strengths, savoring of positive experiences, optimism, and hopeful/goal-directed thinking. The intervention manual contains protocols that outline planned activities, student handouts, fidelity checklists, and 1-page parent handouts for each session.

Research Design and Methods: Researchers will implement the intervention and examine its efficacy, feasibility, acceptability, and cost in a partially clustered randomized control trial. After schoolwide screenings of SWB, students in the bottom quartile (with consent/assent) will be randomly assigned to intervention or business-as-usual (BAU). The 10 weekly sessions will be held in the fall, with monthly follow-up sessions in the spring. Students will be served in groups of 6 to 8 youth, with a total of 84 small groups. To evaluate immediate and long-term effects, student outcomes will be examined at baseline, post-intervention, and at a 6-month and 1-year follow-up. Teachers and parents will take part by rating student outcomes. Parents will receive information about intervention goals and content and weekly guidance on how to apply the positive activities at home. Parents and SMH providers will report perceptions of intervention acceptability, feasibility, and usability.

Key Measures: Student participants will self-report on mental health, engagement, and internal and relational assets. Teachers and parents will rate students' mental health. Teachers will also rate students' class engagement. Academic outcomes include course grades and performance on statewide exams.

Data Analytic Strategy: Multilevel models for partially clustered designs will be used to evaluate the intervention's impact on each student outcome after intervention and at a 6-month and 1-year follow-up. The multilevel models will be extended to explore the extent that the treatment effect changes over time and is moderated by features of the individuals (such as baseline mental health, SES, dosage) and features of treatment group cluster (such as fidelity of implementation).

Cost Analysis: An ingredients (bottom-up) methodology will be used to verify program inputs and assign prices to inputs to obtain cost estimates. Incremental cost-effectiveness ratios will be calculated where the adjusted differences in life satisfaction and student engagement across treated and BAU groups will be divided by the corresponding differences in average cost.