Forest school INterventions for Children’s Health (FINCH): a feasibility cluster randomised controlled trial

Background: Child and adolescent mental health is a public health priority and prevention, early intervention, and treatment in this group is a national strategic mental health priority. Children and young people (CYP) in the UK are experiencing poorer mental health outcomes than ever and demand for services is the highest on record. Understanding the effectiveness of school-based interventions in promoting and developing emotional wellbeing is a core research priority.

A school based intervention which is inclusive and has the potential for widespread delivery is ‘Forest School’. Forest School provides children with immersive experiences in nature which are non-classroom based and have a core focus on child-led activity and exploration. Despite widespread implementation, evidence about optimal delivery methods of Forest School and the impact on mental health and emotional wellbeing is scarce.

This study will generate new knowledge about the feasibility of running a definitive Forest School trial with Key Stage 2 (KS2) children aged between 7-11, inclusive of children with Special Educational Needs and Disability (SEND). Research Questions Is Forest School an acceptable and feasible intervention to improve the mental health of KS2 children?

Is it feasible to run a cluster Randomised Controlled Trial (RCT) of Forest School for children in KS2? Aims

1. Assess whether it is feasible to conduct a full-scale definitive trial of the acceptability, effectiveness, and cost-effectiveness of a school-based Forest School intervention on mental health among KS2 children (Work package 1) 2. Conduct a mixed methods process evaluation to evaluate implementation and fidelity (Work package 2)

3. Collect feasibility data to support an economic evaluation in a full trial (Work package 3) 4. Refine the current logic model and optimise the intervention (Work package 4)

Methods: In WP1 we will carry out a feasibility cluster RCT of a Forest School intervention with 200 children in eight schools across Hull, East Yorkshire and North Yorkshire. We will test acceptability and feasibility of delivery, assess feasibility of trial processes, and establish key parameters for effectiveness. In WP2 we will evaluate the quality and fidelity of intervention delivery through a process analysis including observations and qualitative interviews.

WP3 will focus on preliminary collection of health economic data. WP4 will use focus groups to refine the logic model and optimisation of the intervention. We will seek to produce a manualised toolkit informed by the interconnected work packages to inform further research and implementation

Patient and Public Involvement: This proposal has been developed with the active involvement of parents/guardians, children and schools alongside key stakeholders from the local authority, education and the community sector. We have two PPI co-applicants on the bid who will remain involved throughout the duration of the study. We have developed a PPI plan which is embedded within our study GANTT chart.

Dissemination: We will develop accessible presentations, an online workshop with interactive elements and a newsletter. Producing a set of easy read infographics and creative outputs (video/social media) alongside our children’s PPI group will be a key output. We anticipate two publications in open access peer-reviewed journals to share the quantitative and qualitative findings from the study.