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ENQUIRE PROJECT DETAILS BY GENERAL PUBLIC |
| Project Details |
| Funding Scheme : | General Research Fund | ||||||||||||||||||||||||
| Project Number : | 14603519 | ||||||||||||||||||||||||
| Project Title(English) : | Teachers’ attitudes toward seeking professional psychological help and their relation to referring students for mental health support | ||||||||||||||||||||||||
| Project Title(Chinese) : | 教師對尋求專業心理幫助的態度及其與轉介學生接受心理健康服務的關係 | ||||||||||||||||||||||||
| Principal Investigator(English) : | Prof CHUI , Tsz Yeung Harold | ||||||||||||||||||||||||
| Principal Investigator(Chinese) : | |||||||||||||||||||||||||
| Department : | Dept of Educational Psychology | ||||||||||||||||||||||||
| Institution : | The Chinese University of Hong Kong | ||||||||||||||||||||||||
| E-mail Address : | haroldchui@cuhk.edu.hk | ||||||||||||||||||||||||
| Tel : | |||||||||||||||||||||||||
| Co - Investigator(s) : |
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| Panel : | Humanities, Social Sciences | ||||||||||||||||||||||||
| Subject Area : | Education | ||||||||||||||||||||||||
| Exercise Year : | 2019 / 20 | ||||||||||||||||||||||||
| Fund Approved : | 607,508 | ||||||||||||||||||||||||
| Project Status : | Completed | ||||||||||||||||||||||||
| Completion Date : | 30-6-2023 | ||||||||||||||||||||||||
| Project Objectives : |
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| Abstract as per original application (English/Chinese): |
The mental wellbeing of teachers and students has attracted much attention from the public and media in Hong Kong recently. Although academic pressure, particularly in secondary schools, has been cited as a key contributor of poor wellbeing, there may be other ways in which teacher and student mental health are related.
One possibility is that compromised wellbeing affects teachers’ ability to notice and care for students in need. Another possibility is teachers’ attitude. Could teachers’ negative attitude toward help seeking be associated with the reluctance to refer students in need for mental health support? In particular, reasons for referral studied thus far often focus on perceived problem severity and teachers’ self-efficacy, but rarely on teachers’ psychological health and personal attitudes about help seeking. Given the extensive interaction that frontline teachers have with students, a comprehensive understanding of factors that affect timely referral of students to mental health services is needed.
This proposal has three parts. First, a new measure on attitude toward referring students for mental health support will be developed and evaluated on 150 secondary school teachers. Second, another 250 secondary school teachers will be recruited to validate this new measure and to complete other questionnaires. In particular, teacher factors, such as gender, teaching experience, and counselling training will be examined in relation to teachers’ attitude about help seeking. Teachers will also be asked to rate how likely they are going to refer students on standardized vignettes for mental health support. The likelihood of referral will be examined in relation to teachers’ wellbeing, self-efficacy, perceived problem severity, attitude about help seeking, and attitude about referral. Structural equation modelling will be used to test a novel theoretical framework on referral decision in education settings. Finally, to uncover unique contextual factors that influence teachers’ referral decisions in Hong Kong, 12 teachers will be invited to participate in a phone or in-person interview. For comparison, six who score high on the referral questions in Study 2 will be selected along with six who score low (match on demographics if possible) to discuss their decisions to refer or not to refer. Data will be analyzed using Consensual Qualitative Research (Hill, 2012). Results from these studies will help identify teacher and system factors so that professional development activities may be developed to improve teachers’ attitudes toward help seeking and referrals, with the goal of enhancing mental health for both teachers and students.
教師和學生的心理健康一直廣受關注。雖然學業壓力被認為是導致心理失衡的主因，但教師個人因素與學生的心理健康可能有着緊密的關係。 其中一種可能的關係是，教師的心理失衡會影響教師在留意和照顧有需要的學生的能力。另一種可能性是教師的態度; 教師若對自身求助持有負面態度，這會否阻礙他們轉介有需要心理健康服務的學生？ 到目前為止，研究教師轉介的原因大多集中在學生問題的嚴重程度和教師的自我效能上，但甚少關注教師的心理健康和個人對求助態度與轉介學生的影響。有見於前線教師與學生之間的頻繁互動，我們更需要全面了解有關影響教師及時轉介學生接受心理健康服務的因素。 此研究建議書有三部分。首先，為了探討影響香港教師轉介決定的獨特背景因素，我們將邀請教師參與電話訪問或面談，討論他們如何作出轉介與否的決定。討論內容將使用Consensual Qualitative Research（Hill，2012）作分析。 其次，從第一部分獲得的質性研究結果會被用來制定一個新量表去評估教師對轉介學生接受心理健康服務的態度。 最後，本研究將招募教師來驗證這新量表，並完成其他問卷調查，包括性別，教學經驗，輔導培訓和對個人求助的態度。除了制定新量表之外，本研究亦透過模擬學生情況的情境題，收集教師如何評估他們轉介學生接受心理健康服務的可能性。結構方程分析將用於測試教師心理健康、自我效能、學生問題嚴重程度、個人求助態度以及轉介態度之間的關係並以驗證新理論框架。 研究的結果將有助於掌握教師和環境制度因素，開發專業發展活動，以改善教師對求助和轉介的態度及增強教師和學生的心理健康。 |
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| Realisation of objectives: | The five objectives were achieved in two studies, as described below. Objective 4 In Study 1, 12 secondary school teachers in Hong Kong were interviewed about their experiences referring students in need of support to mental health professionals (MHPs). This study addresses Objective 4 by revealing the context specific factors, such as student factors, parent/guardian factors, and MHP factors that influence teachers’ referral decisions. The findings were organized and presented as a comprehensive model of factors influencing teachers’ referral decisions in a paper published in one of the top journals in educational psychology. Objective 2 Based on the findings in Study 1 and the adaptation of items in related scales, we developed an initial pool of 47 items of the Thoughts About Referral Scale (TARS) as part of Study 2. These items were then evaluated by 22 in-service teachers and 12 pre-service teachers. Two items were eliminated because they either lacked clarity or overlapped with other items. A sample of 292 teachers from 24 secondary schools in Hong Kong were then recruited to complete the resultant 45-item TARS. Standard item reduction procedure using exploratory factor analysis led to the final 26-item, 4-factor TARS, which can be used to examine the relationship between teachers’ attitude toward referring students and its correlates. The development of TARS achieves Objective 2. Objectives 1 and 3 Besides completing the TARS, the 292 teachers completed measures of wellbeing and attitude toward seeking professional psychological help, and provided information about their teaching experience, experience providing support to students, and experience receiving counseling themselves. In addition, to determine teachers’ self-efficacy in handling student concerns and their inclination to refer students, eight vignettes depicting students with varying degree of mental illness were created. The development of vignettes is crucial in this project as it allows us to assess teachers’ self-efficacy and inclination to refer students based on the same set of student scenarios, rather than relying on their real-life school environment (such as the number of referrals made in the previous year), which can differ significantly across school settings. To evaluate the context validity of the vignettes, ten experienced teachers were recruited to provide comments on whether the vignettes reflect students’ presentations seen in Hong Kong classrooms. Furthermore, nine mental health professionals, including two educational psychologists, a clinical psychologist, a psychiatrist, a social worker, and four educational psychology trainees were recruited to evaluate whether the vignettes depict adolescents in need of referral and mental health support. Comments from teachers and mental health professionals were incorporated to produce the final version of the vignettes. Structural equation modeling was conducted on the scores on completed measures to look at factors that are associated with teachers’ attitude toward seeking professional psychological help (Objective 1) and the relationships between teachers’ attitude toward help-seeking, attitude toward referring students, and their tendency to refer students as depicted in standardized scenarios (Objective 3). Objective 5 Using the findings and materials from Study 1 and 2, we developed the booklet <<中學生精神健康與教師轉介研習小册子>> for teacher training. In this booklet, readers are introduced to the model of factors influencing teachers' referral decisions from Study 1. The eight vignettes from Study 2 are also included in the booklet to raise awareness of the common mental health issues that students face in Hong Kong schools. In addition, readers learn about the local mental health resources available, as well as possible ways to address students' and parents' concerns about referrals (examples derived from the qualitative interviews in Study 1). In terms of dissemination, we have conducted a public seminar (other impact #1) to discuss project findings and how to use the booklet for teacher training. The seminar was attended by 100 participants from the education sector, and each participant received two hard copies of the booklet and a soft copy sent via email. The booklet has also been introduced and distributed in classes and workshops designed for mental health professionals and trainees, such as educational psychologists, SENCO, and counsellors. (other impact #4) | ||||||||||||||||||||||||
| Summary of objectives addressed: |
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| Research Outcome | |||||||||||||||||||||||||
| Major findings and research outcome: | Based on the interviews with teachers in Study 1, several factors were found to affect teachers’ decision to refer students to mental health professionals (MHPs). These include student factors (e.g., problem severity and persistence, willingness to be referred, familiarity with professional support), parent/guardian factors (e.g., beliefs about the usefulness of referral, trust and collaboration with teachers), MHP factors (e.g., perceived effectiveness, frequency in meeting students, quality of interaction with teachers), and teacher factors (e.g., self-efficacy in handling student issue). Although these factors have been investigated previously in separate studies, our work offers a comprehensive framework to understand the interconnection among different factors. The findings from this qualitative study had been published in one of the top journals in educational psychology, Journal of School Psychology (SSCI Q1; 5-year IF: 6.4; see publication #1). They were also presented in a panel in Denver, Colorado, USA, in June 2022 (conference #1). Using the qualitative findings from Chui et al. (2023) and adaptation of items from related measures, we developed the Thoughts About Referral Scale (TARS) in Study 2. This scale contains 26 items and assesses teachers’ attitude toward referring students for professional psychological help. Using exploratory factor analysis, the TARS was found to have four dimensions: Projected Stigma of Help-Seeking (PS), Valuing Independent Problem-Solving (VI), Dedicated Action to Facilitate Referral (DA), and Perceived Helpfulness of MHPs (PH). When the TARS was administered along with other teacher self-report measures, it was found that teachers who reported higher self-stigma of seeking help also reported higher PS and VI, but lower DA and PH. In addition, DA fully mediated the relationship between teachers’ help-seeking stigma and referral of students, suggesting that those with favorable attitude toward seeking help themselves are more likely to dedicate efforts to facilitate student referrals, which predicts a higher tendency to refer students. Moreover, compared to teachers who had not sought counselling, those who had been to counselling perceived greater helpfulness among MHPs, have lower self-stigma toward help-seeking, valued independent problem-solving to a lesser extent, and are more likely to refer students. The development of the TARS in Study 2 has thus offered a valuable tool that can be used to investigate the correlates of teachers’ attitude toward referring students. Study 2 had been presented in Dublin, Ireland, in June 2023 (conference #2), and the manuscript is currently under preparation. | ||||||||||||||||||||||||
| Potential for further development of the research and the proposed course of action: |
The results from Study 1 highlighted that the quality of interactions between teachers and MHPs may affect teachers’ decisions to refer students for help. It is therefore important that the discussion around referral does not only involve teachers but also MHPs. When MHPs are more intentional about working collaboratively with teachers, teachers will become more familiar and confident with MHPs and refer more students. To this end, we have disseminated project findings to MHPs by publishing in an international journal read by psychotherapists (other impact #2) and giving a keynote on this topic at a professional meeting for counseling psychologists in Taiwan (other impact # 3). We also have plans to extend outreach to other stakeholders at school (e.g., special education needs coordinators). Based on the findings of Study 2, we proposed in the GRF 2024/25 exercise to use an experimental design to investigate the effect of incorporating personal counseling in teacher continuing education on teachers’ self-stigma toward help-seeking, thoughts about referring students for professional psychological help, intention to refer and actual referrals made, and self-efficacy in managing student problems. The GRF proposal (Ref No. 14602424) is under review at the time of the submission of this report. | ||||||||||||||||||||||||
| Layman's Summary of Completion Report: | Mental health challenges often emerge during adolescence. Frequent interaction between secondary school teachers and their students enables teachers to notice students’ difficulties and refer students to MHPs to receive support. In Hong Kong, where academic pressure is high and teachers have significant involvement in guidance and counselling, teachers’ ability make timely referrals is crucial. This project aimed to identify factors affecting teachers’ referral decisions to facilitate the development of targeted training to improve student referrals and enhance mental health outcomes. Based on Study 1’s findings, we developed a model of factors influencing teachers’ referral decisions. One such factor is the quality of interaction with MHPs. This motivated us to expand outreach beyond schools to MHPs and emphasize the importance of collaboration with teachers. In Study 2, we developed a measure to assess teachers’ attitude towards referrals. Results showed that teachers with prior counseling experience had lower stigma toward seeking help, took more proactive actions when facilitating referrals, and were more inclined to refer students. This demonstrates the need to complement knowledge and skill training of teachers with experiential learning and attitude change. New approaches to teacher training are thus proposed for further investigation. | ||||||||||||||||||||||||
| Research Output | |||||||||||||||||||||||||
| Peer-reviewed journal publication(s) arising directly from this research project : (* denotes the corresponding author) |
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| Recognized international conference(s) in which paper(s) related to this research project was/were delivered : |
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| Other impact (e.g. award of patents or prizes, collaboration with other research institutions, technology transfer, etc.): |
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| SCREEN ID: SCRRM00542 |