She academy 2021 health promotion: Call for action

0 13 - 15 October University of Minho Braga, Portugal SHE Academy 2021 Health Promotion: Call for Action - SHE Academy 2021 - Organizing Committee Rafaela Rosário; Jesper von Seelen; Cláudia Augusto; Maria José Silva; Silvana Martins; Ana Duarte; Ana Catarina Maia. Acknowledgements We acknowledge the scientific contributions from Peter Paulus and Catriona O´Toole. We would like to thank Simon Murphy, Jeremy Segrott and Sophie Jones. ISBN 978-989-98852-8-8 How to cite Augusto, C., Duarte, A., Silva, M. J., Martins, S., Maia, A., Seelen, J., & Rosário, R. (2021) SHE ACADEMY 2021 Health Promotion: Call for Action. Braga: Escola Superior de Enfermagem. This work was supported by the Schools for Health in Europe Network Foundation and has received funding under an operating grant from the European Union’s Health Programme (2014-2020) 1 Contents Presentation ................................................................................................................ 2 Programme .................................................................................................................. 3 Keynote Speakers ........................................................................................................ 6 #1 Catriona O’Toole ................................................................................................. 6 #2 Pedro Melo ......................................................................................................... 7 #3 Peter Paulus ........................................................................................................ 9 Capacity Building Workshop ...................................................................................... 10 Jeremy Segrott ....................................................................................................... 10 Sophie Jones .......................................................................................................... 10 Projects all over the world ......................................................................................... 11 Alexandra Marinucci .............................................................................................. 12 Anne Torhild Klomsten .......................................................................................... 15 Ana Álvares ............................................................................................................ 18 Ana Lourenço ......................................................................................................... 20 Lynda Lattke .......................................................................................................... 22 Matteo Olivo ......................................................................................................... 25 Moses Amonje ....................................................................................................... 28 Paula Frieiro Padín ................................................................................................. 31 Sanja Prosheva ...................................................................................................... 34 Cláudia Bacatum .................................................................................................... 37 Cecilie Dangmann .................................................................................................. 38 A. Edelmann and L. Eppelmann .............................................................................. 41 Maria Warne & Åsa Svensson ................................................................................ 46 Call for Action ............................................................................................................ 49 2 Presentation The SHE Academy is a unique opportunity to critically discuss research methodologies, analytical perspectives and dilemmas from practice in an international learning environment, with input by leading scholars and experts from the field of school-based health promotion and education. The 2021 SHE Academy was the ninth course organized by the Schools for Health in Europe Network Foundation. This year the focus was Mental Health. The SHE Academy was organized dynamically and flexibly to meet the interests and needs of the participants with wide-ranging experience and fields of interests. The program was structured around plenary lectures, dialogue and group sessions for all participants and parallel workshops for PhD students, researchers and practitioners. The 32 participants in the SHE Academy 2021 represented 19 countries, most of whom were female (85%). They were mainly academics (42.5%), 25% belonged to the national government and/or headteachers, 17.5% were health professionals, and 15% were teachers. All of the participants worked in the field of health-promoting schools. The SHE Academy 2021 was supported by a team of seven organizers. The SHE Academy 2021 was a collaboration between the University of Minho and SHE Network Foundation, in partnership with University College South Denmark. “The vision of SHE is that the health promoting school approach becomes an acknowledged and accepted concept all over Europe and Central Asia, with increased implementation activities on regional and local level within schools. We want to make every school a health promoting school.” 3 Programme Wednesday October 13th 2021 13:30-16:00 (UTC, Portugal time) 13:00 Log in – technical issues 13:30 Welcome (SHE & University of Minho) 13:45 Ice breaker 14:15 Introduction to SHE 14:45 Break 15:00 Keynote #1: School based mental health promotion: key issues and controversies (Catriona O´Toole, Assistant Professor, Maynooth University School of Education, Ireland) 15:45 Q&A and closing day Thursday October 14th 2021 09:00-16:00 (UTC, Portugal time) 8:45 Log-in 9:00 Welcome and todays program 9:10 Keynote #2: Community empowerment approach in promoting mental health in school: a clinical decision-making model (Pedro Melo, Assistant Professor, Institute of Health Sciences, Universidade Católica Portuguesa, Portugal) 10:00 Session 1: Presentation of the projects and discussion groups (Separate rooms) ROOM 1 School-based mental health literacy and action program in Australia Alexandra Marinucci, Christine Grove and Kelly-Ann Allen Mental health and resilience in Syrian refugee youth Cecilie Dangmann ROOM 2 A school-based program to promote healthy eating in children – application of Nola Pender’s Health Promotion Model Claudia Bacatum 4 Assessment of the effects of health promotion in primary schools with focus on mental health in the Republic of North Macedonia Sanja Prosheva ROOM 3 New relational nuances, vertical and horizontal, during the pandemic: students' perspectives Lynda Lattke Right to play in primary education: challenges and opportunities in the pandemic Ana Lourenço School staffs’ attitudes on pupils’ mental health before and after a mental health intervention in the Northern part of Sweden - a study protocol Maria Warne and Åsa Svensson 12:00 Lunch break 13:00 Keynote #3: Work & teachers´ mental health: Where we’re coming from, where we’re now and where we´re going (Peter Paulus, Full Professor, Leuphana University Lüneburg, Germany) 14:00 Session 2: Presentation of the projects and discussion groups (Separate rooms) ROOM 1 Design of a musical program, and of digital musical instruments, for the development of life skills and musical skills of people with cognitive disability Matteo Olivo The promotion of social and emotional skills for student education Ana Álvares ROOM 2 School-based mental health programs in Kenya Amonje Moses Oluchiri Development of a Program Fostering Stress Resiliency and Mental Health Literacy in Secondary Schooling Anika Edelmann and Lena Eppelmann 5 ROOM 3 Student´s own experiences of learning about mental health, thoughts and feelings in school Anne T. Klomsten Eating disorders: prevention programmes in schools Paula Frieiro Padín 15:45 Q&A and closing day Friday October 15th 2021 09:00-12:00 (UTC, Portugal time) Capacity building workshop Involving children and young people in the design and conduct of health promotion research (Jeremy Segrott and Sophie Jones. Centre for Trials Research and the DECIPHer Centre at Cardiff University, Wales, UK) 6 Keynote Speakers #1 Catriona O’Toole Dr Catriona O’Toole is a chartered psychologist and Assistant Professor in Maynooth University Department of Education. Her research focuses on school wellbeing and mental health promotion, mindfulness, compassion and contemplative approaches in education. She has a particular interest in childhood adversity and traumainformed practice. Her work also explores how education can contribute to human flourishing and to the creation of peaceful and equitable societies. Current projects include, ‘Sanctuary Schools’ funded by the Irish Research Council, which aims to build capacity for trauma-informed practice across education sectors in Ireland; and ‘Education for Human Flourishing’ with the UNESCO Mahatma Ghandi Institute for Peace and Sustainable Development. She has recently completed a review of the state-of-the-art in school-based mental health promotion with Emily Darlington, commissioned by the Schools for Health in Europe (SHE) Network Foundation. School based mental health promotion: key issues and controversies Positive mental health and wellbeing is crucial to enable children and young people to lead fulfilling lives, personally, socially and academically. However, mental health problems in this age group are common; globally 10–20% meet the criteria for a mental health condition and this is increasing. Schools are crucial settings for mental health promotion, as it is now well recognised that the holistic development of students (including academic, health and mental health) is central to the goals and purposes of education. Thus, the WHO Health Promoting Schools Framework places mental health promotion within the core educational mandate. A growing body of empirical research demonstrates that well designed and carefully implemented whole school programmes have a strong positive impact on student mental health and wellbeing. Nevertheless, there are some debates in relation to the provision of mental health promotion activities in schools. Amongst these, are issues around how we understand or conceptualise ‘mental health’, the role of schools in addressing social inequalities and other determinants of mental distress, and student participation in the design, planning and implementation (co-creation) of mental health promotion initiatives. This keynote will introduce delegates to state-of-the-art research and practice in school mental health promotion, and provoke debate on key issues in the field. 7 #2 Pedro Melo Pedro Melo is Doctor in Nursing, author of MAIEC (Community Assessment, Intervention and Empowerment Model), Main Researcher in the Centre for Interdisciplinary Research in Health (CIIS) in Universidade Católica Portuguesa and Assistant Professor in the same institution. Has several national and international publications regarding community and public health, such as research manuscripts, books and chronicles in speciality journals. Has also experience as broadcaster in a local radio, producer, and presenter of video programs about health, actor in a theatre company and novel, assays and poetry where puts the communication skills in the service of society regarding health issues. His professional motto is: "the power of words...for you!" Community empowerment approach in promoting mental health in school: a clinical decision-making model Mental health, regarding school context it is a complex issue that must be approached from a community-based level and supported under health planning process to grant the continuity and success of the health gains from present to future (Melo, 2020). The first step to the success in promoting mental health in school is assuring a salutogenic approach anchored in community partnerships (Melo e Alves, 2019) and in community empowerment in Nursing clinical decision-making (Melo, 2020). It is an evidence that community, as a whole, can be a client of nurses (Melo e Fonseca, 2020) and this effectively allows the achievement of health gains related to community management, in this specific case, related to Mental Health. In this matter, MAIEC, Community Assessment, Intervention and Empowerment Model is a theoretical model in Community Health Nursing that explains the concepts that are foundations of community empowerment in nursing, but also the postulates and assumptions that guide the clinical decision-making of nurses, supported by a clinical-decision matrix which includes the ICNP main focus of nursing attention (Community management) and its three diagnostic dimensions (community process, community participation and community leadership). This matrix also includes the diagnoses and the interventions to be prescribed regarding the identified diagnoses (Melo, 2020). 14 Riebschleger, J., Costello, S., Cavanaugh, D. L., & Grové, C. (2019). Mental health literacy of youth that have a family member with a mental illness: Outcomes from a new program and scale. Frontiers in Psychiatry, 10(2). https://doi.org/10.3389/fpsyt.2019.00002 Riebschleger, J., Tableman, B., Rudder, D., Onaga, E., & Whalen, P. (2009). Early outcomes of a pilot psychoeducation group intervention for children of a parent with a psychiatric illness. Psychiatric Rehabilitation Journal, 33(2), 133-141. https://doi.org/10.2975/33.2.2009.133.141 Tully, L. A., Hawes, D. J., Doyle, F. L., Sawyer, M. G., & Dadds, M. R. (2019). A national child mental health literacy initiative is needed to reduce childhood mental health disorders. Australian & New Zealand Journal of Psychiatry, 53(4), 286-290. https://doi.org/10.1177/0004867418821440 Tully, L. A., Hawes, D. J., Doyle, F. L., Sawyer, M. G., & Dadds, M. R. (2020). A call for mental health illiteracy: Response to Samuel. Australian & New Zealand Journal of Psychiatry, 54(8), 845-846. https://doi.org/10.1177/0004867420931158 World Health Organization. (2014). Preventing suicide: A global imperative. World Health Organization. World Health Organization. (2020). Adolescent mental health. WHO. https://www.who.int/news-room/factsheets/detail/adolescent-mental-health 15 Anne Torhild Klomsten (Associate professor, Department of education and lifelong learning, Faculty of educational sciences, NTNU, Trondheim, Norway) Student´s own experiences of learning about mental health, thoughts and feelings in school Keywords: mental health literacy, education, secondary school, students Introduction: There is an emerging global emphasis on more comprehensive mental health promotion and intervention for children and youth in schools (WHO, 2021). This is partly due to the increase in mental health problems in the adolescent population (Bakken, 2018; Collishaw, 2015; O´Reilly, Svirydzenka, Adams & Dogra, 2018). For example, in Norway, 15% - 20 % of adolescents experience mental difficulties such as stress, depression, and anxiety which influence their everyday functioning, coping, and learning (Mykletun, Knudsen, & Mathiesen, 2009). The school setting provides an efficient means of improving young people’s health and wellbeing, in accordance with a Health Promoting School approach (Bada, Darlington, Masson, & Santos, 2019; WHO, 1997, 2021). A whole-school approach is recognized as particularly efficient for mental health promotion in this population (Stewart-Brown, 2006). However, mental health education within schools is also of significant importance (O´Higgins, Galvin, Kennedy, Gabhainn, & Barry, 2013; WHO, 2021). The focus on teaching should be on wellbeing, quality of life, and life skills among other things. Implementing personal skills development in mental health education can help young people acquire and practise life skills that enable them to deal effectively with the psychological demands and challenges of everyday life. This means enhancing their wellbeing, which in the current study is defined as “a positive and sustainable mental state that allows individuals to thrive and flourish” (Clarke et al., 2011; WHO, 2014, 2021). The intent of the present study is to shed light on mental health education. The Irish education system mandates health education for all students; accordingly, Social, Personal and Health Education (SPHE) has been a compulsory subject since 2000. Research has shown that SPHE is valuable in school. All stakeholders agree that SPHE provides students with the opportunity to develop personal and social skills, promotes their self-esteem and wellbeing, contributes to their physical, mental and emotional health, and fosters tolerance and respect for others. Furthermore, 65% of students agreed that the subject appealed to them (O´Higgins et al., 2013). In Norway the National Curriculum for primary and secondary education and training is renewed (The Norwegian Directorate for Education and Training, 2019). The Norwegian government has decided to include the interdisciplinary topic “Health and life skills” 16 (H&LF) in the curriculum for primary and secondary schools from school year 2020/2021. The main aim of this topic is to give the pupils competence to promote health and mastery, and to provide them with better skills for making responsible life choices. Furthermore, the purpose of H&LF is to give the pupils competence which promotes sound physical and mental health were development of positive self-image and confident identity is particularly important (The Norwegian Directorate for Education and Training, 2019). According to the core curriculum, relevant topics for H&LF are: Physical and mental health, lifestyle habits, sexuality, gender, drug, abuse, media use, consumption and personal economy, value choices, meaning of life, ability to draw boundaries and respect others´ boundaries, and the ability to deal with thoughts, feelings and relationships. Although several school-based programs that aim mental health promotion are available (Holte, 2016; O´Reilly et al., 2018; Taylor, Oberle, Durlak & Weissberg, 2017), there is a strong need to explore how pupils experience the interdisciplinary topic “Health and life skills” (H&LF) in the curriculum. We know little about students´ opinions about learning about mental health as part of the curriculum in school, and more specifically how do they reflect upon learning about thoughts, feelings and relationships within a school setting. There is an explicit need for research that investigates how students themselves experience mental health literacy education within a school setting. Thus, the aim of this study is to investigate how secondary school students themselves experience to learn about mental health, thoughts, feelings and relationships within school. Methods: Participants and procedure During the 2017/2018 school year, students in secondary school learned about mental health, relationships, thoughts and feelings within a subject called Education in mental health (EMH), as part of preparing for educational principles that underpin the new Norwegian school curriculum (The Norwegian Directorate for Education and Training, 2018). Measures To gain insights into students´ own reflections about EMH in the curriculum, 16 students was interviewed through semi-structured interviews. The interviews were audiotaped with the permission of participants and parents. Data management The qualitative interviews were transcribed and analyzed according to guidelines for content analysis from Corbin & Strauss (2015). Results: (To be presented at the SHE Academy) The knowledge gained through this study may be a relevant contribution when it comes to designing new courses that support 17 mental health and wellbeing for students in Norway or other European countries. This paper is based upon the article A slow transformation: Students´ experiences of learning about mental health in school which is published in the Nordic Journal of Education and Practice, Vol. 14, 2, 122-139. References: Bada, E., Darlington, E., Masson, J., & Santos, R. M. (2019). Schools for Health in Europe Network Foundation. European Standards & Indicators for Health Promoting Schools. Bakken, A. (2018). Ungdata 2018. Nasjonale resultater. NOVA Rapport 8/18. Oslo: NOVA. Clarke, A., Friede, T., Putz, R., Ashdown, J., Martin, S., Blake A., Yaser, A., Parkinson, J., Flynn, P., Platt, S., & Stewart-Brown, S. (2011). Warwick-Edinburgh mental well-being scale (WEMWBS). Public Health, 11, 487. Downloaded 21.01.2019 from https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-245811-487 Collishaw, S. (2015). Annual research review: Secular trends in child and adolescent mental health. Journal of Child Psychology and Psychiatry, 56, 370 – 392. Corbin, J. & Strauss, A. (2015). Basics of qualitative research. Techniques and procedures for developing grounded theory. USA: SAGE Publications, Inc. Holte, A. (2016). Sats bredt på psykisk helse i barnehagen og skolen! Psykologisk.no. Hentet fra https://psykologisk.no/2016/06/sats-bredt-pa-psykisk-helse-i-barnehage-ogskole/ O´Higgins, M. Galvin, C. Kennedy, Gabhainn, S. N., & Barry. (2013). The implemention of SPHE at post-primary school level: A case study approach. Galway: National University of Ireland. Klomsten, A. T. (2017). Psykisk helse som eget fag i skolen. I M. Uthus (red.), Elevenes psykiske helse i skolen. Utdanning til å mestre egne liv. (s. 255-285). Gyldendal Norske forlag. Mykletun, A., Knudsen, A. K., & Mathisen, K. S. (2009). Psykiske lidelser i Norge: Et folkehelseperspektiv. Oslo: Nasjonalt Folkehelseinstitutt. O´Reilly, M., Svirydzenka, N., Adams, S., & Dogra, N. (2018). Review on mental health promotion interventions in schools. Social Psychiatry and Psychiatric Epidemiology, 53, 7, 647 – 662. Stewart-Brown, S. (2006). What is the evidence on school health promotion in improving health or preventing disease and, specifically, what is the effectiveness of the health promoting schools approach? Copenhagen: WHO Regional Office for Europe. Retrieved 22.01.2019 from http://www.euro.who.int/__data/assets/pdf_file/0007/74653/E88185.pdf Taylor, R. D., Oberle, E., Durlak, J. A., & Weissberg, R. P. (2017). Promoting Positive Youth Development through School-Based Social and Emotional Learning Interventions: A Meta-Analysis of Follow-Up Effects. Child Development, July/August 2017, 88, 4,1156–1171. The Norwegian Directorate for Education and Training. (2018). Fagfornyelsen. Retrieved 22.01.2019 from https://www.udir.no/laring-og-trivsel/lareplanverket/fagfornyelsen/ WHO. (1997). Promoting health through schools. Report of a WHO Expert Committee on Comprehensive School Health Education and Promotion. Switzerland: Geneva. WHO. (2014). Mental health: a state of well-being. Retrieved 21.01.2019 from https://www.who.int/features/factfiles/mental_health/en/ World Health Organization and the United Nations Educational, Scientific and Cultural Organization. (2021). Making every school a health-promoting school: global standards and indicators for health-promoting schools and systems. Geneva: Licence: CC BY-NC-SA 3.0 IGO. 18 Ana Álvares (MA in Educational Sciences – School, Community and Democracy – Health Education Faculty of Psychology and Educational Sciences – University of Porto) The promotion of social and emotional skills for student education Overview: The development of social skills in schools has been presented as one of the interventions with best cost/benefit ratio for mental health promotion. In Portugal, advocacy for the development of social and emotional skills in schools, under this designation, seems to have been initiated in School Health and to be in a process of assimilation by Education. Social and emotional skills promotion started being advocated at a national level in reference documents such as Programa Nacional de Saúde Escolar (2015, updated on 2020), the manual Saúde Mental em Saúde Escolar (2016) and the Referencial de Educação para a Saúde (2017). As for reference documents in Education at a national level, although the development of social and emotional skills in schools is mentioned in Orientações Curriculares para a Educação Pré-Escolar (2016) and in two subdivisions of Estratégia Nacional de Educação para a Cidadania (2017), it was stressed only in 2020 and 2021, in the pandemic context, with the publication of two Editals under the National Programme for the Promotion of School Success (PNPSE) and the Orientações para a recuperação e consolidação das aprendizagens (2020). Of the 1316 measures proposed by more than 600 school clusters under the 2020 Edital, the category of social and emotional skills is the second biggest, representing 23% of the measures approved. This reveals that schools actively seek to promote these skills (PNPSE Bulletin, 2020). In my research, I will try to understand how and why three school clusters sought to promote social and emotional skills under the Edital, and to what extent this is regarded as an educational practice. The aim is to provide useful information for the integration of social and emotional skills promotion as an educational practice and seek to address critical aspects identified by literature. Research question: To what extent did the Edital of August 20201 provide an opportunity for school clusters to include activities for the promotion of social and emotional skills in educational training? Sub-questions: • Which reasons led the participating school clusters (SC) to apply with personal, social and community development plans (PDPSC)? • How do school directors and teachers regard social and emotional skills? 19 • What importance do directors and teachers attribute to these skills in student education? • What PDPSC actions focused on social and emotional skills were developed in the SC? • Which factors enabled/hindered the development of activities for the promotion of social and emotional skills, under the PDPSC? Data collection: Document analysis (8 documents) • National Programme for the Promotion of School Success (PNPSE) • Edital of August 2020 (include references to Orientações para a recuperação e consolidação das aprendizagens, to Edital of July 2021 and to Plano 21|23 Escola+) • Actions of the submitted plans for Personal, Social and Community Development under the typology of “Measures to promote social and emotional intelligence and personal development” – 3 plans + 3 SC Educational projects Semi-structured interviews • Interviews to the promoters of the PDPSC: school leader + team responsible for the PDPSC = 9 interviews • Interview to a member of the mission structure of the PNPSE 20 Ana Lourenço (PhD student on Child’s Studies, University of Minho) Right to play in primary education: challenges and opportunities in the pandemic Introduction: Children’s right to play is stated in the Convention on the Rights of the Child (CRC) in article 31: “1. States Parties recognize the right of the child to rest and leisure, to engage in play and recreational activities appropriate to the age of the child and to participate freely in cultural life and the arts.” [1] (p. 9). Furthermore, in 2013 a General Comment on the Right to Play was compiled and several links between play and school context were stated, highlighting the importance of the educational environments as play promotion settings: play is crucial for all children, especially in the early years of school attendance and facilitates children’s learning [2]. Play in schools has been de-creasing due to academic pressure and restrictions in this setting can constrain children’s opportunities for creativity, exploration and social development. Alongside the importance of the right to play in schools, we must highlight its significance to the overall development of children. Play develops children’s social and emotional skills and ability to manage stress, promotes resilience and flexibility to face uncertainty [3]. Evidence has shown that play, health, and well-being are closely connected [2,4,5]. When considering play opportunities in schools, recess comes to mind. Recess is one setting that can improve children’s experience, with studies dispelling the ancient ideas that the impact of recess on children’s lives was insignificant [6]. Studies confirm that recess also influences academic achievements [7,8]. Children’s behaviour, focus, and mood in the classroom improve as a result of recess [9]. Greater levels of attention and productivity are also reported as a result of recess [10]. Another crucial point of play at school is children’s peer interactions: recess can promote healthy relationships amongst children, preventing bullying and social exclusion [7]. Unfortunately, evidence has also shown that the potential of play during recess in schools is often ignored, with schools seldom investing in this [7]. Points to share in SHE ACADEMY: My work for the PhD is in the right to play area, where we developed an intervention project for primary schools in Lisbon to promote the right to play. Links between the right to play, health-related quality of life and playfulness where the main issues we addressed. We would like to share the data we currently have on the project’s impact, namely on children’s satisfaction, children’s interactions, and health-related quality of life (study 1 of our work). Also, since our project was stroke by 21 the pandemic, we needed to change the methodology: the plan was to carry out a quasiexperimental design with pre and post test and our option now was to assume a posttest design and it would be very useful to discuss this matter with the experts and participants. If the pandemic brought for study 1 this constraint in the design, it also brought us a very interesting possibility: we ended up with data on the right to play in primary education pre-pandemic and during the pandemic. In what we believe can be seen as a crosssectional study, we will begin analysing data for study 2 in the next few weeks so we will be able to share some of them also in SHE Academy if you find it relevant. References: 1. UN General Assembly, Convention on the Rights of the Child, 20 November 1989, United Nations, Treaty Series, vol. 1577, p. 3, available at: https://www.refworld.org/docid/3ae6b38f0.html (accessed 27 July 2021) 2. UN Committee on the Rights of the Child (CRC), General comment No. 17 (2013) on the right of the child to rest, leisure, play, recreational activities, cultural life and the arts (art. 31), 17 April 2013, CRC/C/GC/17, available at: https://www.refworld.org/docid/51ef9bcc4.html (accessed 27 July 2021) 3. Hewes, J. Seeking Balance in Motion: The Role of Spontaneous Free Play in Promoting Social and Emotional Health in Early Childhood Care and Education. Children 2014(1), 280-301. 4. Alexander S.A.; Frohlich K.L.; Fusco C. Playing for health? Revisiting health promotion to examine the emerging public health position on children's play. Health Promot. Int. 2014, 9(1), 155–164. doi:10.1093/heapro/das042 5. Alexander S.A; Frohlich K.L.; Fusco C. Problematizing “Play-for-Health” Discourses Through Children’s PhotoElicited Narratives. Qua.l Health Res. 2014, 24(10), 1329-1341. doi:10.1177/1049732314546753 6. Hyndman, B.; Benson, A.C.; Lester, L.; Telford, A. Is there a relationship between primary school children’s enjoyment of recess physical activities and health-related quality of life? A cross-sectional exploratory study. Health Promot. J. Aust. 2017, 28(1), 37–43. 7. McNamara, L. What’s getting in the way of play? An analysis of the contextual factors that hinder recess in elementary schools. Can. J. Action Res. 2013, 14(2), 3-21. 8. McNamara, L.; London, R.; Ramstetter, C.; Baines, E.; Beresin, A.; Claassen, J.; Doyle, W.; Hyndman, B.; Jarrett, O.; Massey, W.; Rhea, D. School re-opening? Make sure children have time for daily recess. Global Recess Alliance 2020. 9. Martin, H.; Farrell, A.; Gray, J.; Clark, T. B. Perceptions of the Effect of Recess on Kindergartners. The Phys. Educator 2020, 75(2), 245–254. 10. Ramstetter C.L.; Murray, R.; Garner, A.S. The crucial role of recess in schools. J. Sch. Health 2010, 80(11), 51726. doi:10.1111/j.1746-1561.2010.00537.x 22 Lynda Lattke (Emanuela Rabaglietti, Aurelia De Lorenzo | SE-CREA research group) New relational nuances, vertical and horizontal, during the pandemic: students' perspectives Background: As a result of the rapid spread of Covid-19, the Italian government decided to close schools in order to contain the spread of the virus (Flaxman et al., 2020). Following this closure, teachers and students had to adapt in a very short amount of time to a new type of teaching which was performed from each person’s home while physically away from school and relying on electronic devices in order to communicate (Cowden, Mitchell & Taylor-Guy, 2020). If we view schools as a place where students also learn how to be with themselves as well as with others, we can begin to imagine how distance learning (DL) had strong consequences not only on the ways of teaching and learning, but also on the meaning of the school context specifically when it comes to social relationships and growth. Furthermore, relationships within the school context are also determined by the physical space in which students and teachers relate to one another, including the verbal and non-verbal communication and which are all necessary for social-emotional development (Sarsini, 2020; Sansone, 2020). School represents a place for the development of adolescents’ identity (Verhoeven, Poorthuis,. & Volman, 2019; Lannegrand-Willems, & Bosma, 2006) contributing to their social-cognitive development (Resnick et al, 1997 in Davis, 2003). During the Covid lockdown, students missed the relational sphere that was part of their daily lives and which is necessary for their growth as individuals and not only as students (Di Palma & Belfiore, 2020). Adolescence is also a period in students’ lives which requires feeling that they are part of a group (Corsano, 2012; Bukowski et al., 2011) and in fact, when this feeling leads to a good perception of class climate, it is associated to positive learning and scholastic achievement (Berkowitz et al., 2017 in Molinari & Grazia, 2021). As reiterated by Mannarini (2016) when a student feels accepted by their classmates and by their teachers, they have a greater possibility of learning. Based on this information and placed within the formal Italian teacher-student relationship determined by a number of factors such as the traditional seating in the classroom and the formal verbal approach towards one another, we decided to explore how the Covid-19 lockdown and the new way of teaching and learning may have affected this dynamic. We also wanted to understand whether there were any differences based on students’ school year given that the first year of middle school sets the foundation for the class group formation specially when taking into account that the group of students remains the same for the following three years of middle school. 23 Objectives: 1) Explore how the vertical student-teacher relationship may have changed during the lockdown period 2) Explore how relationships may have changed based on students’ school year. Method: A total of 285 secondary school students participated in the study, 56.5% of whom were female, with an average age of 13 years (±1). Each of them was asked to complete an online questionnaire consisting of closed and open-ended questions. The latter were ad hoc questions which investigated the areas related to difficulties, positive aspects and negative aspects found in DL. The answers to the questions were analyzed by three inter-coders using an inductive/conventional approach, relying on the content analysis method identifying key words and categories (Erlingsson & Brysiewicz, 2017). Using the SPSS version 26 program, we performed descriptive and inferential analysis (frequencies and Chi-square tests respectively). Results: The category Relationship emerges as an important category for all 3 areas (difficulties, positive and negative aspects). The results show forms of student-teacher relationships with more horizontal nuances. These relationships also take on different characteristics with respect to the ages of the students. In particular for the youngest in the first and second years of middle school, the relationship is confirmed as difficult [X2(2) =14.24; p< 0.001] between students/teachers and students/classmates and also as a class group [X2(6) =15.85; p=0.015]. This may be due to a number of reasons amongst which the use of an electronic device which was not always available nor reliable. It may also be due to the fact that these students had less time to form a class group, a process which needs time and in their case due to DL, this time was cut short. For third year students instead the relationship with teachers and the class overall seems to take on more positive overtones [X2(2) =4.73; p= 0.90]. One way to explain this may be that by the time schools were closed, these students had spent more time with their classmates and teachers when compared to the younger students. Furthermore, we could assume students in this year were more comfortable with the use of electronic devices rendering communication and technological problem-solving easier. We also believe that students this age have established networks with friends who are outside the classroom context which makes them be less dependent on the class dynamics and therefore be more relaxed within the class context. Conclusions: In the context of DL during the pandemic period, teachers and students were more vulnerable to risky conditions and new challenges. The verticality of the student-teacher relationship took on a more horizontal approach in spite of the difficulties of DL, teachers became available and accessible to their students which led to a more horizontal relationship. Although this research so far presents only the students’ 30 learners who work together to create an environment that is productive, positive and supportive. Step 2: Assessment of school and community environment Basic information regarding regional demographics, health risks and resources should be available for the team to consider. This mainly includes identifying needs to be addressed. Step 3: Development and implementation of a plan Once the needs and potentials for school mental health programs are identified and captured, the next task is to develop a specific plan of action including clearly stated objectives, assignment of responsibilities, a time-line and a coordinating mechanism for sectorial linkages. Step 4: Monitoring and Evaluation After implementation, monitoring and evaluation is conducted to determine whether or not the program is effective and to improve already effective program and retain support Step 5: Coordination and modification of programs Developing a school-based mental health program is a continuous process that requires attention, evaluation and adaptation. This School-Based Mental Health program will take into account the following • The relationship between the school and community environment and any unique cultural values • Involves family and community members in the entire process • Utilizing the school staff and community mental health care providers • Intervention at multiple levels • Teacher training and parent training • Socio-economic and political conditions and processes likely to influence the implementation of the plan • Effective coordinating mechanism 31 Paula Frieiro Padín (University of Vigo, Spain) Eating disorders: prevention programmes in schools This work is going to focus on the realization of a synthesis of the main methodologies and prevention programs that aim to prevent eating disorders at school. It is important to contextualize that the initial development of eating disorders begins during puberty or early adolescence, a period in which they are in compulsory education. For this reason, it is essential that educational institutions take this into consideration, through this work we are going to group and reflect on prevention activities and good practices to be followed by schools and secondary schools (Dakanalis et al., 2019). Nowadays some of the main eating disorder prevention activities focus on Cognitive Behavior Therapy interventions, media literacy interventions, one-shot interventions, cognitive dissonance interventions, healthy weight intervention, Psychoeducation interventions, Mindfulness based interventions, multicomponent interventions (Le et al., 2016). For their part, Watson et al. (2016) states that Cognitivebehavior therapy, a healthy weight program, media literacy, and psychoeducation are effective for selective prevention and effects are maintained at follow-up. By way of synthesis and example, table 1 describes some programs and activities that have been carried out in recent years. Table 1. Synthesis of types of activities and programs about eating disorders that are being developed in schools Program or activity Description Country Mindfulness-based prevention for eating disorders (Atkinson& Wade, 2015). Under optimal facilitation, mindfulness students demonstrated reductions in weight and shape preoccupation, dietary restriction, ideal internalization of weight loss, eating disorder symptoms, and psychosocial impairment after a 6-month intervention. Australia Web-based training for teachers and public health practitioners (McVey et al., 2008) Development of the Student Body program, which was intended to improve knowledge about diet among participating teachers and increase effectiveness in combating weight bias among public health participants. After participating in the intervention, participants reported greater knowledge about how weight bias can be present in their teaching practices and how this can trigger concerns about body image among their students. Canada The attuned representation model for the primary prevention of eating The school psychologist is essential in supporting parenting strategies and communication techniques, providing adolescents with individual support and simultaneous relaxation training. These interventions, as USA 32 disorders (Cook‐Cottone, 2006) prevention strategies, can serve to divert a potential path towards family out of tune and the possibility of developing eating disorders. POPS-program (POtsdam Prevention at Schools), a universal school-based eating disorder prevention program for adolescents (Warschburger & Zitzmann, 2018). The program was designed to be implemented in a school setting to address adolescents aged 12–16 years. The program was delivered through nine consecutive weekly sessions of 45 min duration, with also home-based activities. Information on healthy nutrition and exercising was provided and pupils were guided to reflect media and peers pressure on beauty ideals; they acquired problem-solving strategies to cope with general and appearance-related stress and were supported to base their self-esteem not only on their physical appearance but on several pillars like friendships; family; competence at school; personality. Germany Yoga-based prevention program targeting eating disorder risk factors (CookCottone et al., 2017) The program was designed to decrease eating disorder risk factors and bolster self-care for 14 weeks. Results indicated that participation in the program decreases drive for thinness and body dissatisfaction while significantly increasing self-care when compared to a control group. USA The contribution that teachers and other educators (including health educators, school nurses, school counsellors, school psychologists or sports coaches) have to offer in the prevention of eating disorders is essential. It is possible that many school professionals are unknowledgeable about nutrition, prevention science, and appropriate methods of prevention for eating disorders and obesity. Furthermore, their professional role and experience may not necessarily protect them against having significant levels of anti-fat bias (Yager & Dea, 2005). For everything mentioned evidence of the efficacy of prevention interventions is necessary for health and education institutions to finance and implement them (Le et al., 2016). On the other hand, it is important to note that activities or programs that talk about or describe eating disorders can become a double-edged sword, and can lead adolescents into eating disorders. For this reason, knowing the advantages and disadvantages of each type of intervention is essential. References: Atkinson, M. J., & Wade, T. D. (2015). Mindfulness‐based prevention for eating disorders: A school‐based cluster randomized controlled study. International Journal of Eating Disorders, 48(7), 1024-1037. Cook‐Cottone, C. (2006). The attuned representation model for the primary prevention of eating disorders: An overview for school psychologists. Psychology in the Schools, 43(2), 223-230. Cook-Cottone, C., Talebkhah, K., Guyker, W., & Keddie, E. (2017). A controlled trial of a yoga-based prevention program targeting eating disorder risk factors among middle school females. Eating disorders, 25(5), 392405. Dakanalis, A., Clerici, M., & Stice, E. (2019). Prevention of eating disorders: current evidence-base for dissonancebased programmes and future directions. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 24(4), 597-603. Le, L. K. D., Barendregt, J. J., Hay, P., & Mihalopoulos, C. (2017). Prevention of eating disorders: a systematic review and meta-analysis. Clinical Psychology Review, 53, 46-58. McVey, G., Gusella, J., Tweed, S., & Ferrari, M. (2008). A controlled evaluation of web-based training for teachers and public health practitioners on the prevention of eating disorders. Eating Disorders, 17(1), 1-26. 33 Warschburger, P., & Zitzmann, J. (2018). The efficacy of a universal school-based prevention program for eating disorders among German adolescents: Results from a randomized-controlled trial. Journal of youth and adolescence, 47(6), 1317-1331. Watson, H. J., Joyce, T., French, E., Willan, V., Kane, R. T., Tanner‐Smith, E. E., ... & Egan, S. J. (2016). Prevention of eating disorders: A systematic review of randomized, controlled trials. International Journal of Eating Disorders, 49(9), 833-862. Yager, Z., & O'; Dea, J. A. (2005). The role of teachers and other educators in the prevention of eating disorders and child obesity: what are the issues? Eating disorders, 13(3), 261-278. 34 Sanja Prosheva (Institute of Public Health of the Republic of North Macedonia) Assessment of the effects of health promotion in primary schools with focus on mental health in the Republic of North Macedonia Introduction: School-age children are a special population group characterized by intense physical, psychological and social changes. Schools can contribute to improving the health and well-being of children and young people. Education and health affect each other, both individually and globally. The approach of health-promoting schools is a key strategy for intervention in strengthening health resources and promoting a healthy lifestyle, all in order to reduce risk factors for non-communicable diseases with special attention to mental health starting from the earliest school age. The purpose of the research is to assess the effects of health promotion in primary schools with focus on mental health in the Republic of North Macedonia (RSM) by considering student health indicators as important factors for proper mental development of students, as well as student and school staff satisfaction from the school environment. Material and methods: The research is a prospective study that was conducted as a cross-sectional study that covered 320 primary schools in RNM and was conducted throughout the country in urban and rural areas, during the academic year 2019 / 2020. The questionnaire was fulfilled by the management of the school (Principal, pedagogist, psychologist). The required data were collected through the use of the Rapid Assessment Tool prepared by the Schools for Health in Europe Network (SHE), through thematic units processed from two aspects a) current school situation - with a three-point Likert-type scales of possible answers (not exist, exists partially and fully) and b) priority school work - with a Likert-type scales of possible answers (low/no priority; medium priority; and high priority). The data obtained during the research were statistically processed using SPSS software package, version 22.0 for Windows. A significance level of p <0.05 was used to determine the statistical significance. Results: Few indicators that were analyzed had a focus on students, teachers and nonteaching staff’s mental health. From the current situation in the schools we can see that 35 the indicators connected with the overview of the current situation regarding students, teachers and non-teaching staff’s health, including mental health, have the highest average score i.e. the best current situation for that two indicators. Lowest average score for current situation has the indicator: Our school has undertaken an assessment of the needs and wishes of students, teaching and non-teaching staff concerning health and well-being (e.g. survey, wish boxes). This indicator has the lowest average score for the priority, meaning that this indicator is not priority for the managers of the schools. It is encouraging that more than half of the schools know who is responsible for health topics in the school including mental health promotion. About 45% of the schools fully implement programs that are focused on individual skills and knowledge of health topics including mental health promotion and this indicator is high priority for 67% of the schools. All of the indicators have bigger priority in correlation with the current situation. Indicators Current (in place) Priority Not Partly Fully  ± SD Low Mediu m High  ± SD Our school has an overview of the current situation regarding students’ health (including physical, mental and social health) and well-being. 2 (0,62%) 121 (37,81 %) 197 (61,56 %) 2,61±0,5 0 17 (5,31%) 60 (18,75 %) 243 (75,94 %) 2,71±0,56 Our school has an overview of the current situation regarding teaching/non-teaching staffs’ health (including physical, mental and social health) and well-being. 7 (2,19%) 118 (37,87 %) 195 (60,94 %) 2,59±0,5 4 18 (5,62%) 77 (24,06 %) 225 (70,31 %) 2,65±0,58 Our school has undertaken an assessment of the needs and wishes of students, teaching and non-teaching staff concerning health and wellbeing (e.g. survey, wish boxes). 135 (42,19 %) 132 (41,25 %) 53 (16,56 %) 1,74±0,7 2 27 (8,44%) 138 (43,12 %) 155 (48,44 %) 2,40±0,64 It is known to the whole school community who is responsible for health topics in the school including mental health promotion. 16 (5,00%) 128 (40,00 %) 176 (55,00 %) 2,50±0,5 9 20 (6,25%) 95 (29,69 %) 205 (64,06 %) 2,58±0,61 36 Our school implements programmes that are focused on individual skills and knowledge of health topics including mental health promotion. 23 (7,19%) 152 (47,50 %) 145 (45,31 %) 2,38±0,6 2 13 (4,06%) 90 (28,12 %) 217 (67,81 %) 2,64±0,56 Our school promotes a balance between work and private life, a reasonable workload and provides an open environment to discuss work problems and stress. 49 (15,31 %) 1445 (45,31 %) 126 (39,37 %) 2,24±0,7 0 28 (8,75%) 97 (30,31 %) 195 (60.94 %) 2,52±0,65 Conclusion: Each school is a dynamic organization in itself and flexibility is needed in the approach to health promotion and mental health to ensure that schools can adapt to changing conditions. It is important to raise awareness of the importance of the impact of mental health in schools, by strengthening the existing capacities and striving for better conditions for learning and work in all schools. It is important to listen to the opinions of students, that each school has a complete overview of the current situation regarding students and teaching / non-teaching staffs ’health (including physical, mental and social health) and well-being. It is important to implement programs that will help develop skills for better mental promotion and emphasize the balance between work and private life, a reasonable workload and provides an open environment to discuss work problems and stress and also it is very important to have student and school staff satisfaction from the school environment. It is necessary to prepare a National Strategy for schools that promote health, to introduce European standards and norms for schools, as well as to apply the Concept for health promotion through the introduction of the Rapid Assessment Tool in all primary schools across the country. 37 Cláudia Bacatum (Nursing School of Lisbon (ESEL), Portugal – Community Nursing Departament) A school-based program to promote healthy eating in children – application of Nola Pender’s Health Promotion Model Background: Promote healthy eating in school setting is an opportunity and a possibility to improve the quality of life and well-being of the children and prevent childhood obesity. Educational nursing interventions empower children to self-care, decisionmaking and action control and adopt healthy behaviors as healthy food habits. The healthy eating promotion in and school setting is an e opportunity to contribute to decrease overweight and obesity in childhood. Educational and behavioral multidisciplinary interventions are described as an effective approach to prevent overweight and obesity in childhood. Nurses have a privileged role to coordinate schoolbased programs to empower children and families regarding healthy eating behaviors. Nola Pender’s Health promotion model allows nurses to understand the major determinants of health behaviors through nursing interventions to promote healthy lifestyles. Objectives: To enable school children for healthy eating Methodology: Application of Nola Pender's Health Promotion Model Conclusions: Nola Pender's Health Promotion Model (Pender, N. 2015) allows to improve children and families quality of life to prevent health problems before they occur considering individual characteristics and experiences, behavior-specific cognitions and affect, and behavioral outcomehealth promoting behavior. Thus, in the application of health promotion model, Nursing is a collaborative process that enables children and families to develop favorable conditions for health and well-being; Nursing Cares are, interventions that support, educate, guide and supervise through strategies to promote healthy eating; and school is the Environment in which it is possible to develop favorable conditions to promote children healthy food habits. 38 Cecilie Dangmann (PhD student. Mentors: Per Normann Andersen – Professor INN; Øivind Fjeld-Solberg - Associate professor Röda Korsets Högskola; Anne Kjersti Myhrene – Associate professor INN; Sevald Høye – Professor INN/Nord University) Mental health and resilience in Syrian refugee youth Background: Monitoring key indicators of health in children and youth is an important aspect of public health surveillance. As an example, studies such as “Ungdata” and “Health and Behaviour in School age Children” (HBSC), indicate current trends and areas of concern that need to be addressed through policy or intervention. However, some groups of children and youth are less visible in these surveys, one example being those who recently moved to Norway. Practical challenges in recruitment and language skills means we have less knowledge of the health and wellbeing in groups such as refugees. Historically, both surveillance programs and studies on refugees, have focussed more on quantities of ill health and years lost, rather than the quality of health and life. Nevertheless, efforts to combine both in a more holistic assessment of population health are increasing, including the assessment of quality of life, and of both risk and protective factors. Syrians are one of the largest groups of refugees recently resettled in Norway, of which half are children and youth. A majority of them arrived with their families and are granted permanent residence in Norway, which includes the right to attend school up to 24 years of age. Local municipal services such as kindergartens, schools, primary healthcare and introductory programs for migrants are therefore in close contact with the children and their parents in early settlement periods, with a common purpose of supporting positive development and integration. Increasing our knowledge of their health and quality of life could inform policy and interventions aimed at uncovering, treating and preventing illhealth as well as promoting their quality of life. Previous literature suggest that most Syrian children and youth have experienced several dramatic events during war and flight and have spent time in camps or asylum centres. In addition, stressors related to settling in a new country, such as language problems, cultural differences, discrimination and loneliness are common. These factors are associated with an increased risk of mental distress in both the children and their parents, 39 sometimes lingering for many years after resettlement. Yet, how these factors are interrelated and how they relate to quality of life, is less explored. Notably, most refugee children and youth do not report mental distress. Therefore, protective or resilience resources, such as individual coping mechanisms, social support and access to services are important to explore. It is suggested that these resources buffer the effects of trauma and stress on mental distress and quality of life, but the concept of resilience and its mechanisms are still unclear. Purpose: This PhD project explores Health-Related Quality of Life (HRQoL) in young Syrian refugees, recently resettled in Norway. More specifically, the levels and dimensions of HRQoL related to sociodemographic factors, and the interrelation between preand postmigration stressors, mental distress and resilience. Methods: Cross-sectional survey in a sample of 160 recently resettled Syrian youth (1324 years). The survey was carried out in introductory classes for recent migrants in 23 secondary or upper secondary schools. The questionnaires were offered in Norwegian, Arabic and English, with a simplified version for those who had language problems. Main variables were Health-related quality of life (KIDSCREEN-27), Potentially Traumatic Events (The Refugee Trauma History Checklist), Post-migration Stressors (The Postmigratory Refugee Stress Scale), general mental distress (HSCL10), Post-traumatic Stress Disorder (CRIES-8) and Resilience (Child and youth resilience measure CYRM28). Analyses were descriptive statistics, hierarchical regression, serial and conditional mediation models (PROCESS macro by Hayes). Results (so far): Article 1: “Health-related quality of life in young Syrian refugees recently resettled in Norway” (accepted august 2020) (C. R. Dangmann et al., 2020). This article explores the levels of HRQoL and its different dimensions related to measurements in a norm population. In addition, it explores potential influences of sociodemographic factors, such as age, gender and living conditions on HRQoL. Findings suggest that HRQoL was moderately good, but slightly lower than norms. Dimensions contributing the most to positive HRQoL were School satisfaction and Relationship with parents/Autonomy. Lowest scores were found in physical and mental wellbeing, with the latter showing the greatest difference from norms. Gender had little impact on levels, but age differences showed lower HRQoL in the older age groups. Controlling for these differences and amounts of adverse experiences from war, living conditions (living with parents or not), did not affect the overall HRQoL. 46 Maria Warne & Åsa Svensson (Department of Health Sciences, Mid Sweden University, Sweden) School staffs’ attitudes on pupils’ mental health before and after a mental health intervention in the Northern part of Sweden - a study protocol Background: Nordic countries have a higher level of young people with mental health problems compared to other European countries and among the Nordic countries Sweden has the highest level (Ottova-Jordan et al. 2015). Girls reports a higher level than boys and trend reports show that the problem is increasing. There is no indication that these results would be an over-reporting, rather, studies show that problems can be greater than what appears from surveys, that young people under-report (Bor et al. 2014; Calling et al. 2017). More and more children and young people are also being cared for depression and anxiety (ref). This is a paradox because Sweden is a welfare state and scores high on FN’s HDI and has a leading position when it comes to health promoting policies (UNDP, 2016). The increasing trend of mental health problems has become a public health issue and is an important goal in Swedish public health policies in line with the Sustainable Development Goal 3.4 (https://sdgs.un.org/goals). The school is an arena that can affect adolescent mental health. Meta-analysis show that school-based initiatives with a purpose to teach students about mental health and how it is managed can reduce both depression and anxiety, but the effect decreases over time and after 12 months, it is very small (Werner & Seidler et al. 2017). The effect applies from preschool class to high school. Research is lacking whether a refill can contribute to longer duration of the effects or not. A review by Salerno (2016) showed that many universal programs that aimed at raising young people's awareness of mental health and preventing mental illness focused on increasing knowledge about mental (ill) health, attitudes to mental illness and seeking help. One example is Youth Aware of Mental Health (YAM) (Wasserman et al., 20xx). Common to several of these programs is that they are led by adults and are based on how adults define mental illness. Several of the methods proved to be effective, but there were also problems, for example that the teachers who were supposed to implement the programs were not trained for this (Salerno, 2016). Another study of Shelemy, Harvey and Waite (2019) shows that many teachers wanted advice on how to identify mental 47 health problems in their students and how to prevent a situation from worsening, rather than training in how to provide long-term support for students. School staffs’ views on student mental health is of interest when planning and evaluating mental health promotion in school. The aim for this project is to evaluate if an implementation of YAM intervention affects school staffs’ competence to act and help students with mental illness and if the school staff experience that YAM has increased the students' skills to meet life's difficulties and knowledge about mental illness. Method: The context for this study is a small municipality in a rural area in the northern part of Sweden. The main industries are within winter and summer tourism. The administration for the municipality has identified that about 15 percent of the population has a reduced mental health. Young people and the elderly population are more affected. Based on these findings, a project funded by the European Union was started to reach the entire municipality's population by educating more than 1300 people in the method MHFA (Mental Health First Aid) for the adult population in the municipality, business, civil society and the general public and YAM for all students 14-16 years in high school. The intention was to increase the general level of competence among the population and professionals to understand and manage mental illness. YAM has been found to be effective in a study among more than 11,000 school students in ten EU countries (Wasserman et al. 2015). The program is expected to promote the development of problem-solving ability and emotional intelligence, such as how to deal with one's own and others' feelings, relationships and empathy. A basic idea is that young people should be made aware that certain mental states are part of a normal life. Another to be able to identify when they themselves or someone close to them needs help with their mental state Wasserman et al. (2015). YAM has been was adapted by Dr Hadlaczky, (National Centre for Suicide Research and Prevention of Mental lll-Health) NASP, Karolinska Institute, Stockholm, to Swedish conditions. The study is carried out during 2019 to 2022. The municipality arranged for four instructors to be trained in YAM. At the end of the intervention the instructors will have educated all pupils in grade 8 based on the method at all the three schools in the municipality. The intervention includes three occasions for each group of students. The study design is a qualitative interview study with a base line and a follow up. Until now we have conducted the baseline interviews; three focus group with school staff one on each school and a also a group with student health team. The interviews has been 48 audio recorded, transcribed verbatim and preliminary analyzed with thematic content analysis. In March 2020 the pandemic started and the project met difficulties because of restrictions and high level of sick leave. The project needed to be postponed. Next data collection, the follow up, is preliminary planned to the winter season 2021-2022. Preliminary results from the first data collection The analysis resulted in three themes: 1. To discover and interpret poor mental health. The school staff discussed distribution, signs, and difficulties for school staff and students to detect and handle poor mental health. 2. The surrounding community. School staff reflected on the impact of students’ contexts, including school, home, leisure activities, and social media, in the rural setting. 3. What the school and students can do. School staff elaborated on conditions and possibilities to prevent and manage poor mental health in the local context. References Bor, W., Dean, A. J., Najman, J., & Hayatbakhsh, R. (2014). Are child and adolescent mental health problems increasing in the 21st century? A systematic review. Australian & New Zealand journal of psychiatry, 48(7), 606-616. Calling, S., Midlöv, P., Johansson, S. E., Sundquist, K., & Sundquist, J. (2017). Longitudinal trends in self-reported anxiety. Effects of age and birth cohort during 25 years. BMC psychiatry, 17(1), 1-11. Ottova-Jordan, V., Smith, O. R., Gobina, I., Mazur, J., Augustine, L., Cavallo, F., ... & Positive Health Focus Group. (2015). Trends in multiple recurrent health complaints in 15-year-olds in 35 countries in Europe, North America and Israel from 1994 to 2010. The European Journal of Public Health, 25(suppl_2), 24-27 Shelemy, L., Harvey, K., & Waite, P. (2019). Supporting students’ mental health in schools: what do teachers want and need?. Emotional and behavioural difficulties, 24(1), 100-116. DOI: 10.1080/13632752.2019.1582742 UNDP (2016) The human Development Report 2016: Human Development for Everyone. Annual Report on Evaluation 2016, Independent Evaluation Office of UNDP, New York, June 2017. Wasserman, D., Hoven, C. W., Wasserman, C., Wall, M., Eisenberg, R., Hadlaczky, G., ... & Carli, V. (2015). Schoolbased suicide prevention programmes: the SEYLE cluster-randomised, controlled trial. The Lancet, 385(9977), 1536-1544. Werner-Seidler, A., Perry, Y., Calear, A. L., Newby, J. M., & Christensen, H. (2017). School-based depression and anxiety prevention programs for young people: A systematic review and meta-analysis. Clinical psychology review, 51, 30-47. 49 Call for Action 50 The SHE Academy 2021 virtual discussions (sprint sessions) occurred on 14th October 2021, resulting in a research and practice agenda. This was followed by asynchronous email communication, an adapted web-based Delphi technic, from 20th to 31st October 2021, during which participants and experts opinions reviewed the criteria based on their relevance. The Academy was developed amid the pandemic of COVID-19 and following school closures. Acknowledging that: i) the children, parents and teachers are experiencing constraints in well-being. Note that the pillars and values of health-promoting schools can tackle and prevent these constraints and needs; ii) the school faces an increase in the children and families' inequalities following the COVID-19 lockdown, the social determinants of health (e.g., SES) are not sufficiently considered, and teachers and children do not use, efficiently, the health services; iii) there is a gap between evidence, policies and practice; and, iv) the opportunities for teachers' professional/personal are limited. We hereby call on schools (e.g., children, families, teachers and staff), key stakeholders, researchers and the global community to commit to undertaking the following actions concerning health promotion in schools: Strive inclusion, supporting teachers (and the school) in addressing children's background and their determinants of health, fostering inclusion and equity. 51 Support empowerment, allowing education and training opportunities for teachers and school staff's (initial and lifelong) in (mental) health, family training/support (lifelong) concerning mental health and lifestyles. Support a whole school approach and engage with schools and communities to produce, verify, and disseminate holistic health promotion strategies that lead to healthy behaviours and health. Consider children as true actors in the co-development of health promotion strategies that are grounded in the specific school's setting, with its problems, culture and resources. 3 Support school quality, mainly the opportunities for developing teachers' pedagogical approach and competencies, along with learning promotion, citizenship education, children's participation and teachers' well-being. Consider promoting socio-emotional development and well-being among the teachers, pupils and school staff. Recognize that health, education and (sustainable) development are interconnected. 52 Strive to make evidence and science more available, transparent, and understandable for schools, promoting evidence-informed policies and integrating health content in the school curricula. 5 5 Support the engagement with the wider community (schools and communities), recognizing that the codevelopment of interventions (bottom-up) and the decisions concerning health are made with the families and the community. Support the empowerment of the school community to address the school's challenges. Emphasize that everyone has a role in addressing health promotion in schools. Emphasize research into schools, supporting joint research projects (e.g., multidisciplinary, different countries and regions) and action research to reflect and adapt to change. Support the development of reliable and validated measurements and tools, especially for pupils, reliable over time. Commit to innovation, finding (new) solutions and tools for health promotion, consistent with democratic values. Support the empowerment of children, families, teachers and staff in reaching health goals. 7 53 The SHE Academy is an important part of the Schools for Health in Europe Network Foundation. Every year teachers, Ph.D. students, policy makers and researchers meet, share, discuss and listen in a dialogue that creates a shared understanding of the most important issues in working with health promoting schools. The issues and format have changed over the years, but the goal remains the same: to share knowledge and to support the development of health promoting schools. This year the SHE Academy was focused on mental health in school health promotion. A growing challenge that has become even more challenging in the time of Covid related restrictions. On behalf of SHE I would like to thank the University of Minho, the organizing team and especially Professor Rafaela Rosário for their great work organizing the event. It has been a pleasure to share this task with you. Regards Dr. Jesper von Seelen, SHE Secretariate and University College South Denmark