Primary school mentalisation-based art therapy (Primary-smART): a Person-Based Approach optimisation study

ABSTRACT

Background

The children’s mental health crisis in the UK continues to worsen and more and more schools are employing art therapists (ATs) to provide services for children experiencing social, emotional, and mental health (SEMH) difficulties. Although some studies have found indications of positive SEMH outcomes following art therapy, the evidence-base is still emerging. The initial development of a formalised art therapy intervention called Primary-smART included children, teachers, parents/carers, and art therapists. Indications from exploratory research showed this intervention could be helpful for children experiencing SEMH difficulties.

Aims

This study aimed to optimise a Primary-smART toolkit to ensure it is acceptable, engaging and persuasive for ATs in preparation for a future evaluation study in primary schools with children.

Methods

The Person-Based Approach (PBA) to intervention development was used to develop Primary-smART. In this study, feedback gained through online interviews with ATs was used to refine and optimise the toolkit.

Results

The 18 ATs who participated in this study perceived Primary-smART as acceptable overall. However, ATs during Rounds 1, 2, and 3 had important concerns which may have resulted in barriers to using Primary-smART. Seven out of eight main sections were modified and no new significant barriers were fed back by Round 4.

Conclusions

This study was successful in refining and optimising the Primary-smART toolkit. Results show that PBA methods enabled the research team to meet the study's aims.

Implications for practice/policy/future research

Future evaluation studies are now needed to test the clinical, carbon and cost effectiveness of Primary-smART.

Plain-language summary

The children’s mental health crisis in the UK has continued to worsen, especially since the COVID-19 pandemic. More and more schools are employing art therapists to provide services for children experiencing social, emotional, and mental health difficulties.

Although some research studies suggest art therapy can be helpful for some children, it is still not clear exactly how it may help or if it can be helpful for many children experiencing social, emotional or mental health difficulties. To test art therapy in this way, we need to develop standardised approaches that lots of art therapists can use with many children in different schools and compare their results and experiences.

This study focused on completing a step-by-step toolkit designed to enable primary-school-based art therapists to use a specific approach, which we are calling Primary-smART. This approach combines artmaking with other activities to help children understand and manage their thoughts and feelings. In this research, we asked art therapists to help us improve the toolkit. Now that the toolkit is complete, Primary-smART can be used in future studies to test if art therapy is helpful for many children in different schools and find out what is and is not helpful about the approach.

KEYWORDS:

• Art therapy
• children
• schools
• mentalisation-based
• intervention development
• Person-Based Approach

Acknowledgments

In line with PBA recommendations, we would like to thank the art therapists who have participated in the development of Primary-smART for generously giving their time, sharing their clinical perspectives, and contributing their creative thinking including, but not limited to, Amanda Dudley, Amber Bartlett, Bobby Lloyd, Carol Arnold, Charlotte Rollo-Walker, Elizabeth King, Francesca La Nave, Hannah Cridford, Jayne McConkey, Jenny Kavanagh, Jo Frost, Julie Barton, Magda Floreck, Melody Weightman, Michael Cousins, Neil Springham, Rachael Donhou, Sally Mungall, Sarah Bartholomew, Sophie Blackett, Stephanie Harkin, and Violeta Camarero.

Huge thanks also to the children, parents/carers, teachers and art therapists who contributed invaluable PPI consultation and our partners, the British Association of Art Therapists and Newcastle University for supporting this study and the development of Primary-smART.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The qualitative data used to support the findings of this study are included within the article and within the supplementary information files.

Additional information

Funding

This study was conducted independently without funding.

Notes on contributors

Alex McDonald

Alex McDonald, SRA’sT (Art), MRes (Clinical Research), has a clinical background as an art therapist working with children, young people, and families. She is currently Guest Researcher at Newcastle University, Professional Development and Communications Manager at the British Association of Art Therapists, and formerly Editor-in-Chief of the International Journal of Art Therapy.

Sarah Kavermann

Sarah Kavermann works in New Zealand as an art therapist within an education setting. While studying for her Masters in art therapy at the University of Hertfordshire she worked as a Research Assistant with the Department of Psychiatry at Oxford University and has continued to pursue an interest in research.

Sue Holttum

Sue Holttum, PhD, C.Psychol., AFBPsS, Reader in Applied Psychology, supervises clinical psychology doctorate research and practitioner PhDs, and is part-time Research Officer for the British Association of Art Therapists. Her research interests include mental health recovery, psychotherapy mechanisms, and healing through arts engagement and expression throughout the lifespan.

Bobby Lloyd

Bobby Lloyd is a visual artist, art therapist and CEO of Art Refuge, with extensive background in NHS, education and community settings, and internationally in contexts of conflict and upheaval. Her particular focus is on socially engaged art and art therapy vis-a-vis displacement, crisis support, co-production, community and social justice.

Ania Zubala

Ania Zubala, PhD, is a psychologist and psychotherapist by training whose research practice focuses on establishing evidence base, designing and evaluating arts psychotherapies interventions. Her most recent research highlights opportunities and considerations for introducing novel technologies to art therapy practice, in rural and remote communities of Scotland and beyond.

Jane Bourne

Jane Bourne is a clinical researcher at Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust and visiting researcher at Newcastle University. Her clinical modality is dramatherapy and she works within in-patient services with children and young people. Her Ph.D. is by Published Works from the University of Derby. Jane has an interest in interventional research.

Simon S. Hackett

Simon S. Hackett, PhD, is a Consultant Art Psychotherapist at Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust and Senior Clinical Lecturer in Applied Mental Health Research. Simon’s research has recently focused on developing and testing a number of Arts Psychotherapy interventions in different populations.