London School of Hygiene & Tropical Medicine

Restorative practice - bringing together pupils involved in bullying, conflict or misbehaviour to appreciate the harms caused and improve relationships - could help tackle bullying, improve mental health and lower rates of regular smoking and drinking alcohol in secondary school, according to new research published in The Lancet.

Led by the London School of Hygiene & Tropical Medicine and UCL, a randomised controlled trial tested a new approach called the ‘Learning Together’ programme, which involved teachers being trained to use restorative practice, as well as students working with teachers to try to make their schools more engaging and supportive places.

When compared to schools that didn’t introduce ‘Learning Together’, the programme was found to have small but significant benefits for student-reported indicators of being bullied (lower scores) and mental wellbeing (higher scores).

‘Learning Together’ was also shown to lower rates of regular smoking (16% compared with 23%), drinking alcohol (38% compared with 44%), drinking in the last week (7% compared with 11%) and trying illicit drugs (7% compared with 11%). The study found ‘Learning Together’ had no effect on aggression.

The researchers say this type of programme could be one of the most feasible and efficient ways of addressing multiple health outcomes in children and young people.

Bullying, aggression, and violence among children and young people are common in the UK and can result in multiple physical and mental health harms in childhood and in adult life, as well as lower educational attainment.

Prevention of bullying and violence is therefore a major priority for public health and education systems internationally, with schools a key focus of initiatives to improve young people’s mental health and wellbeing. A key challenge is to address these inter-related behaviours using single coherent programmes rather than overburdening busy schools with multiple interventions.

In this trial, funded by the National Institute for Health Research (NIHR) and the Education Endowment Foundation, 20 schools in South-East England were randomly picked to implement ‘Learning Together’ over three years, with 20 ‘control’ schools continuing with their normal practices and receiving no additional input. Students filled in questionnaires aged 11-12 years at the start, and then again when aged 14-15 years.

All school staff in the intervention group were trained in restorative practices, such as using respectful language to promote good behaviour. Schools were also provided with a manual and external facilitator to guide ‘action group’ meetings in which staff and students looked at data on how students feel to decide local actions to make the school more engaging and supportive places.

The programme had a greater impact for boys (higher quality of life and mental wellbeing; fewer psychological problems, less regular smoking, less drinking and bullying others), and students with a history of bullying victimisation at the start (reduced bullying and psychological problems; higher quality of life and wellbeing).

Dr Chris Bonell, Professor of Public Health Sociology at the London School of Hygiene & Tropical Medicine and first author of the study, said: “Our research has shown that a single programme can improve health across different areas of health - this might be more practical than schools needing a separate programme for issues such as mental health and smoking. This study suggests that restorative practice is an effective way to reduce bullying. It also suggests that the Government could save the NHS money by helping ensure schools are inclusive and supportive places. We now aim to refine the intervention so that it can be made available to schools to implement.”

Professor Russell Viner, UCL Great Ormond Street Institute of Child Health and co-director of the trial, added: “These findings show that if we can help change the way schools engage with students, not only will we see less bullying, but also an improvement in pupils’ wellbeing, quality of life and even a reduction in smoking and drunkenness. A single programme costing only £58 per pupil can achieve significant impacts across a whole range of health issues.”

Interviews with perpetrators and victims suggest the programme’s potential to transform understanding and relationships:

I just felt so sorry...the boy was just crying. When he was speaking, he could barely speak and it just reminded me why did I do that? You shouldn't have done that. It just...made me realise… And when we came in, it's just like...at first I was laughing.. But then when I just saw him there sitting down at this table and his eyes were all red from the tears...I just don't...it just came to me and just shocked me. (Male student, perpetrator).

The researchers acknowledge limitations of the study including it being restricted to south east England and that it may have under-estimated benefits because some control schools were also using restorative practices.

Publication

Chris Bonell, Elizabeth Allen, Emily Warren, Jennifer McGowan, Leonardo Bevilacqua, Farah Jamal, Rosa Legood, Meg Wiggins, Charles Opondo, Anne Mathiot, Jo Sturgess, Adam Fletcher, Zia Sadique, Diana Elbourne, Deborah Christie, Lyndal Bond, Stephen Scott, Russell M Viner. Effects of the Learning Together intervention on bullying and aggression in English secondary schools (INCLUSIVE): a cluster randomised controlled trial. The Lancet. DOI:10.1016/S0140-6736(18)31782-3