Mindfulness interventions in schools: Integrity and feasibility of implementation

Research on mindfulness-based interventions (MBIs) has proliferated in recent years and the integration of mindfulness-based programs in school settings has been at the forefront of implementation research. Recent reviews of studies evaluating the efficacy of school-based mindfulness programs have produced mixed findings, which may in part be due to methodological differences across studies to date, as well as adaptations of MBIs in order to implement them within school settings. For example, there are vast differences across studies in the content, delivery, and training requirements of school-based MBIs, which may influence both fidelity and efficacy. This systematic review aimed to synthesize the literature on the implementation of school-based MBIs and determine the degree to which the interventions align to standards for MBIs. A systematic search identified studies evaluating the effects of a school-based MBI on mental health outcomes in schools, utilizing quantitative and qualitative designs. The results draw comparison across the identified MBIs in relation to intervention integrity, and teacher training and competence according to existing standards. The findings indicate a poor alignment to all standards; for example, intervention integrity was indicated in 45% of studies that included core mindfulness practices, and standards of teacher training were met in 26% of studies. In addition, the feasibility design of studies is critiqued against recommended standards. Despite claims from many studies, feasibility has not yet been established for school settings. Feasibility studies have failed to adequately assess organizational factors that influence implementation. The lack of detail and consistency in reporting across studies is a particular limitation of the field of research, which may have disadvantaged the assessment of studies against stringent guidelines. The ongoing challenges to developing an evidence base for school-based MBIs as well as to implementation are discussed. Recommendations for future directions in implementation science of mindfulness interventions within a school context are provided.

Intervention Integrity

In order for interventions to produce the desired outcome, it is necessary that they be implemented as researched and designed. School-based practitioners, however, should not assume that interventions will always be implemented as intended by teachers and other school personnel. The chapter begins by defining intervention integrity, or the degree to which an intervention is implemented as designed. Next, the chapter provides an overview of methods for the assessment of intervention integrity. Critical steps discussed include operationalization of intervention steps, determining relevant dimensions of integrity, selecting an assessment method, and developing a rating scheme. Methods for collection and evaluation of integrity data are discussed, as well as strategies for promoting intervention integrity.

Intervention Integrity in Mindfulness-Based Research: strengthening a key aspect of methodological rigor

To ensure methodological rigor, research on Mindfulness-Based Programs (MBPs) should include systems forassessing and reporting the integrity of the intervention. The critical variable of the quality of the teaching and thedegree of adherence to the curriculum are likely to influence research outcomes and their interpretation. Currently, three tools for assessing intervention integrity in the MBP field have been developed, but they need further research and development. Research going forward needs to include systematic methods for demonstrating and verifying the integrity of the MBP, both to ensure the rigor of individual studies and to enable different studies of the same MBP to be fairly and validly compared with each other.

The Mindfulness-Based Interventions: Teaching Assessment Criteria (MBI:TAC): reflections on implementation and development

The Mindfulness-Based Interventions: Teaching Assessment Criteria (MBI:TAC) is a useful tool for supporting good practice in teaching, training supervision and research contexts. It has been taken up in practice in teacher training organizations worldwide. The MBI:TAC sits within the wider consideration for research contexts of building methodological rigour by developing robust systems for ensuring intervention integrity. Research on the tool itself is at an early stage and needs development. The process of implementation needs careful attention to ensure reliability and good practice. Resources for assessors are needed to enable evaluation of their reliability level in using the tool. Development is needed to enable it to be of use for other program models, and in diverse contexts and cultures.

HeadPoST

ObjectiveTo critique the Head Positioning in Stroke Trial (HeadPoST) study methods in relation to preceding research findings in an aim to clarify the potential efficacy of positioning interventions and direction for future research.MethodsHead positioning research prior to the conduct of HeadPoST was reviewed by a team of international stroke experts, and methods and findings were compared to HeadPoST.ResultsMethods used to select HeadPoST patients differ substantially from those used in original head positioning studies, in particular enrollment of all types of stroke. HeadPoST enrolled primarily minor strokes (median NIH Stroke Scale 4, interquartile range [IQR] 2–8) without vascular imaging confirmation of subtype; elapsed time from stroke symptom onset to the initiation of intervention was late (median 14 hours, IQR 5–35), and time from hospital admission to enrollment was delayed (median 7 hours, IQR 2–26). Intervention integrity was not reported, including ability to achieve/maintain 30° head elevation in beds lacking head elevation capabilities. Deterioration or improvement associated with the intervention is unknown as serial assessments were not completed, and the trial's 3-month outcome was powered using unrelated study data.ConclusionsThe design of HeadPoST was suboptimal to measure differences produced by the intervention. Future head positioning trials in discrete patient cohorts (in particular, large vessel occlusion) with endpoints supported by pilot work are required to understand the efficacy of this simple yet potentially important intervention.